Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
April 23, 2004

Participants: Caryl Knudsen, Tim Kral, Kristin Ahrens (facilitator), Arlene Jones, Nancy Hazelette, Cindy Helvington, Pam Ring, Tom Giles, Kathryn Weit, Mike Maley, Cynthia Owens, Judy Cunio, Mary Lee Faye, Dan Peccia, Jessica Leitner, JoAnn Fuhrman,

Agenda: Previous Meeting Next Meeting

Introductions

Monitoring/Updates

* Budget

· Waiver update

· Protective service

· QA grant

· Waitlist Group

· Fairview Housing Trust

· Dual Waiver

· VR/DD workgroup

· DD Housing Taskforce

· Training Activities

Strategic Planning

· Slot/Individual Budget/Provider Rates

· Waiver review process

· Base Plus

Quality Assurance

· Quality Framework presentation

· Data

· Discovery

Review Parking Lot Items

· workers compensation insurance

· long term housing and support options for brokerage clients leaving family homes

Set Agenda for June 25

Stakeholder groups:

Families ask that we provide handouts in advance of the meeting so that they can be better prepared. They also reported that a special meeting would happen in May to see if the Regional Training Steering Committees can help with increasing trainings for families on a variety of topics including how to be an employer. There is a concern that the size of the brokerages, particularly in the metro area, are getting larger then originally intended. The State clarified that this will become an issue in the next biennium but is not currently. The maximum number a brokerage can serve is 700 persons but projections on the waitlist indicate we will exceed capacity in the future. Families would like to keep this on the agenda and be involved in planning for the solution to this problem. Families also want to be sure that families involved in services know that they can report their concerns to the brokerage. This is considered an obligation on the part of families as a way to help us.

Counties updated on the dual waiver transfer. It has been difficult to put the over 20K plans together because the staff have little training on goals survey and person centered planning. There may be some lessons learned in this process and in the voc transfer that would help us in planning for the SILP transition.

Provider update. ORA reported that they are hearing that offsets for the comprehensive waiver may be changing. The State clarified that it won't change for people in residential services but will change for people in-home. Molly reported last meeting on the strategy at our last meeting. Kathryn asked for some information about how much is collected through offsets. Mary Lee will get this information and report back. It is approximately 4 million each biennium. Information will come out soon about this change.

State Update: Mary Lee reported that there would be some changes with the Brokerage waiver. Originally SPD would be asked to report on offsets quarterly. SPD will now change some of the documentation required of PA's so that they can demonstrate some of the resources customers are using already to support their plans as a way to document and demonstrate contribution to the cost of care. Mary Lee also reminded us that this affects a small number of people.

Brokerage Update: Dan reported that the brokerages are also dealing with the dual waiver transfer and acknowledges that larger brokerages may not be a friendly as smaller brokerages. Dan reports that fiscal intermediary costs are off from the projections in the budget. What is allowed in the budget doesn't cover the costs especially in the rural areas where there are fewer providers and the customer relies mostly on family members for care. A group is convening in May to look at paperwork - requirements and inconsistencies in use. This group will also look at the relationship between the paperwork and what is required in rule. The brokerages ask that SIG members attend the skill builders (formerly called the halflies). Brokerages welcome our participation. There is also an issue with worker's compensation insurance. A couple of families have bought services but it can't be covered by the plan and it is cost prohibitive. Tim has had conversations with a self-insured agency but the numbers are too low. Some homeowners insurance covers domestic employees but many are now dropping it. Mike reported that some State's are tackling this issue (such as MS) and we may be able to check with them on how they did it.

Monitoring/Updates:

* Budget: Mary Lee reported that the Essential Budget Level (formerly known as the continuing service level) would include the roll up for next biennium for Staley. The other things included are diversion, Kids turning 18, Kids turning 21, case management ratios associated with the kids aging in. There is a separate policy package that includes Local Admin for Counties (average currently is about 1.5%) and a COLA (but it is minimal). The package would include coverage for all services provided and be added to service expansion. In the past the LAO1 came with special projects such as CIP but does not come when a new home opens through diversion for example. There are some large concerns with the projection for reductions at SPD in the coming budget. Oregon Project Independence, Retired Senior Volunteer Program and other such programs could be cut. The total reduction needed could be as high as 20 million in general fund. Cynthia reported that Senator Smith is working on special legislation to bail out Oregon and 4 other States.

* Waiver update: The support services waiver was approved for another 5 years. SPD is providing Region 10 with additional information and education about the services and how they are delivered. Mary Lee also reported that last week Oregon and Baltimore met with Region 10 to talk about how State's are maximizing Federal Match. For examples many Counties send GF to the State to be matched by the Feds to augment their budgets. The new regulations require State's to provide this information upfront.

* Protective service: Mike reported that the main workgroup has completed its work on best practices and is now converting that information into a training to be provided statewide. This may intersect with the QA grant that ORA and OTAC got. Tim asked for this information.

· QA grant: ORA, OTAC and HSRI were awarded a grant to look at health and safety issues, how to plan, monitor and respond to issues in people's homes across the divisions of SPD. Through the grant, an oversight group will be formed and may be a place to work through some of the policy issues related to individual choice and how to balance that against the requirements and regulations.

* Waitlist Group: A date has not been set for this group to meet. Staley staff will meet shortly to get a head start.

* Fairview Housing Trust: 124 requests have been received already. Gerry will pull together information about the types of requests made. This clearly represents an unmet need in the community. For the requests that exceeded the amount allowed, Gerry will be asking for information about how the remaining funds will be raised or costs covered.

* Dual Waiver: This was covered during stakeholder's updates.

* VR/DD workgroup: The focus has shifted from developing a manual for PA's and VR Counselors to developing a booklet for families and consumers as well. The workgroup will continue for a few more sessions. This group has come a long way to clarifying expectations between agencies.

* DD Housing Taskforce: This legislative task force had its final meeting and made recommendations. This hope is that we can address the issue of individuals who are ready to leave family homes with some support (less the 24 hour). It was not a "bricks and mortar" work group because the issue is really about support. The hope is that we can think creatively and come up with new solutions for this problem. Families want to know what will happen with their children after they are gone. Kathryn reiterated that this group of people are not "comprehensive" people.

Strategic Planning

* Slot/Individual Budget/Provider Rates: Tim shared the outcome from the group that met to review rates for vocational providers. There were representatives from all stakeholder groups. One provider has eliminated brokerage slots completely and many are saying they plan to because the rates do not cover the costs. This group is making a strong recommendation for the cap to be increased for supported employment, crew and enclave work, and for community inclusion, assessment or skill training. Without this increase many major providers will not be able to offer the service. The group acknowledged that many people would not want to pay high rates for this service because it would eat up the plan dollars, however, if you are building up a plan you may be willing to. There is not a perfect solution since many of the organizations operate differently. In some ways those providers who start at ground zero to develop a job because they bill more for a longer timer vs. the providers who do continuous development and may have a job ready to plug a new person into and now cannot recoup your cost. The group also talked about vacancies. The new caps would allow for a vacancy recovery. The group also feels there needs to be education for providers, consumers etc. on the whole issue. There was also a feeling that the contracts with consumers need modification. Apparently there is already work being done on this with the brokerages. The group shared individual stories of how people would be affected both positively and negatively by this change. Examples were shared of situations where providers lose money because they are committed to maintaining the employment site itself or don't have the less expensive personnel available to take over supports after the person has been placed. Mike suggested that the rate be tied to outcome. For example, agencies that provide individual placements at above minimum wage may command a higher rate then those that provide enclaves. Judy shared her experiences from when she was in supported employment. The group wanted to have discussion time before making a recommendation to the State. There are concerns about possible price fixing especially in areas of the State where there are a limited number of providers. The group had extensive discussion about how changing the caps would impact plans. There is a possibility that providers would increase rates across the board instead of charging an individual rate for each person factoring in absenteeism etc. At this time most of our information is anecdotal. The biggest issues are 1) lost money due to absenteeism 2) ongoing cost of supported employment and the possibility to tie the reimbursement to outcomes 3) community inclusion costs could be handled through the rate exception process. Caryl suggested we gather more data on attendance to help us understand the issue more. A motion was made to refer the recommendations to the State for further discussion and analysis in the following order; first recommendation of increasing the cap for ongoing supported employment to $50 per hour, second the issue of absenteeism, third the rate paid for community inclusion. However, once the State does it's analysis, who should the data go back to? The group members had consensus that they were not the expert on this issue and suggested it be referred back to the workgroup both as the experts and because it is representative of all major stakeholders. The SIG's role would be to ask additional questions to help clarify the issue AND to understand the potential impact on families. This process needs to be timely however given the urgency of this issue. There may be strategies available that would be alternatives to raising the cap which work group members may not have been aware were options (such as billing in different increments). Some questions or clarification brought up by the SIG group included

o To prioritize and identify issue more thoroughly

o Develop suggestions for training (see notes from ORA quarterly)

o Implications of outcome based strategies

o Safeguarding persons service whose situations do not fall into the above defined issue e.g. cost going up for someone who attends 5 days as a result of other not attending regularly

o Look at what is billable and challenge assumptions that certain things are not

o Can a rate exception be granted for absenteeism?

o Consider the needs of those that would be negatively impacted by this change which appears to be mostly in response to the 700 voc slots that transferred

This SIG group ended the discussion noting how concerned everyone is about this issue and the need to respond quickly. This was a good discussion and everyone understood the importance of the outcome on this issue both in terms of the impact to our provider community and to our families.

* Waiver review process - tabled until a later date.

* Base Plus - no report at this time

Quality Assurance

* Quality Framework presentation: Kathryn and Mary Lee gave a slide show presentation put together by Jean Tuller on HCBS waivers. There are a number of changes both in Oregon and in CMS as a whole that will impact the future of waiver services. As the SIG begins to morph into it's new role of quality assurance oversight group, it will be important for members to understand the framework developed by CMS. A handout of the slides was distributed. An electronic copy will be attached to these minutes.

* Data: Mike shared additional information on the waiver review process. Essentially CMS asked us to answer a series of questions in lieu of a site visit. Copies of the State's response were distributed. Mike also shared a number of data points that have begun to emerge. The group was asked if there were specific data points that we would like tracked in the future. It was suggested that we continue to track what we have and look at it at fixed intervals. The information will become more meaningful as we are able to look at longer periods of time.

* Discovery: Mike distributed a list of areas where SPD would like to gather information. This list was generated internally but was not intended to be final - these are just suggestions. Mike asked the group to suggest priorities for SPD to look at. The group recommended that SPD prioritize customer satisfaction and health and safety data. It was also suggested that we focus on the follow up plans of correction to the certification reviews.

Our next meeting will be on June 25 from 9:30 to 2:30 location TBA.

Families and Advocates pre meeting will start at 8:30 AM

* base/base plus

* continued discussion on provider recommendations

* workers compensation insurance

* long term housing and support options for brokerage clients leaving family homes

Future meetings will be on August 18 also from 9:30 to 2:30 location TBA.

Jessica R. Leitner, MSW

Senior Program Manager

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