The Basics About
Self Directed Support Services for Adults
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Participants: Bill Lynch (facilitator), Mike Maley, Mary Lee Fay, Bev Herrin, Tom Giles, Arlene Jones, Dayna Davis, Jo (Dayna's aide), Kathryn Weit, Jim Wrigley, Marci Ingledue, JoAnn Fuhrman, Lynn Greenwood, Jean Tuller, Cynthia Owens, Molly Holsapple, Tim Kral, Caryl Knudsen, Dan Peccia, Jessica Leitner, Diana Buel, Vickie Storie
Monitoring/Updates
· Report from stakeholders
Brokerage Report: Bev reported that brokerages would present to Dalton, Gordley and a handful of others on the Joint Human Resources legislative interim committee Sept 14th. Dalton was the Chair of a committee on housing options for people with developmental disabilities. Brokerages will be showcased.
Family and Consumers reported that they are looking for additional family/consumer representatives, specifically people who are receiving brokerage services in Eastern Oregon and Metro region. County representatives will follow up on this along with brokerage directors. Kathryn will also contact brokerages in those areas directly. Families had recently put out questions on the list serve to get feedback on how services are being delivered. Families do not have a way to gather this information currently and encourage brokerages to gather email addresses so that they have a way to build two-way communication between them and their constituents. Brokerage directors will take this back to their meeting. Families are also requesting copies of the customer satisfaction survey brokerages are sending out to customers. This discussion was deferred until later in the agenda. Families appreciate the responses they have been receiving from everyone when they make requests.
Providers: Tim reported that providers are waiting for the implementation of the new rate guidelines that were approved by SPD and supported by this group. Tim brought information about SILP and would like to begin discussion on the transition plans for this group. Tim has preliminary information about enrollments statewide. Mary Lee shared that after the November E-board SPD will begin work on transition planning (this fall) for a 07 implementation. Caryl gave a brief history on Semi Independent Living Services (SILP), which was designed to meet the needs of people who do not need 24-hour services but need a little support to maintain independence in the community. Molly indicated a work group would be formed to examine the impact of the transfer on both providers and consumers. Molly also shared that approximately one third of those individuals with SILP slots also have VOC slots. Many are also not Medicaid eligible. Dayna asked about the difference between assisted living and semi-independent living. Assisted living is a complex or building where several people live and there are staff and supports available. SILP services are 4-6 hours per week of a staff person coming to an individual's private home or apartment to help with grocery shopping or cleaning or budgeting for example.
Counties: Lynn reported that her region is recruiting for a new crisis coordinator. Please encourage those interested in driving and crisis to contact her! Lynn also shared that she helped to raise money for Full Access Brokerage by riding her bike 25 miles!
· Mike’s Data Report
Enrollment Data: Mike handed out (and copies were emailed out in advance of the meeting) data summarizing the enrollments of support services. Some brokerages are closer to capacity then others but on a statewide basis we are about 66% full. There have been about 270 terminations since the start of the brokerage. Most have been the result of moves to comprehensive services. Jim asked about "refusal of service" which in this context is the result of an enrollment and then a subsequent disenrollment after referral to the brokerage. Counties shared that there are additional individuals who refuse services before they are even referred to the brokerage. These numbers would not be captured in the current report. There was discussion about the relationship between crisis diversion referrals and the brokerage. Overall the number of people who moved to comp seems small when you consider the number of people whose crisis may have been resolved by enrollment in the brokerage.
· Update on prioritized activities
Prioritized Activities Update: Rate restructuring, waiver reconstruction, and QA were identified as the areas of activity the SIG prioritized for most critical activity. Mike distributed a DHS transmittal that went out on August 10, 2004 regarding a change in the reimbursement rates for providers under the Support Service OARs. The SIG made prior recommendations that were implemented by SPD. The impact of this change will be studied by SPD and reported back to this group. Molly went over the handout and reviewed the changes. There was a question and answer session. Specifically SIG members were interested in whether or not providers would be allowed to bill for set up and "pre-placement" activities when the customer is not present. The answer is Yes. It is important to be sure that families understand this when they select a provider and be clear about what their plan is being charged for. Several SIG members had previously volunteered to work on a group that reviews the impact of this change. Lynn shared concerns that providers are being asked to use separate systems for tracking and billing the same services depending on if the individual is enrolled in Comp or Support Services. Should this change impact the services under the comprehensive waiver Counties are concerned that there would not be enough resources to meet the needs.
· Comp 300 status report
Comp 300-status report: There was not much to report on. There is a meeting scheduled with some of the committee members to begin thinking about how to move forward in to next biennium to fulfill obligations under Staley. SPD did not have data to report on the number of people who have been enrolled but will present that at the next meeting.
· Dual Waiver transfers
Dual Waiver transfers: The majority of individuals who transferred went in to the brokerage with a few who remained in comp services. There are a small number of individuals who have appealed their services. All transfers are complete however there are additional individuals who have been identified as DD eligible but are not actually considered as Dual Waiver individuals since they do not currently have services under the DD Waiver. Mary Lee acknowledged the hard work that has been done by the local field offices and DD programs to assure that individual's are identified and correctly supported in the community.
· Report to E board
Report to E board: SPD will report in November on the budget that was set aside to support Staley. There will be changes suggested to some of the funding levels (such as a interim base plus level) before the November report. SPD is gearing up to work on this at this time. A draft report has to be done by the 2nd week of October. It may be helpful to have a small number of people from this group available to review information if needed. Tim, Kathryn and Jim volunteered. A draft of the report could be shared at the next SIG meeting.
· 05-07 Budget Assumptions
05-07 Budget Assumptions: Since there was no cost of living increase (COLA) this year, SPD does not know yet how it will implement this at the Brokerage next biennium. We may need a small workgroup to deal with this. It has the potential to impact families and small providers since rolling out a small increase results in plan changes, contract changes etc. and could end up being a tremendous amount of work.
New brokerage: Last meeting the SIG recommended that SPD set aside start up funds for a new brokerage. Mary Lee reported that this not currently in the budget but that does not necessarily exclude the possibility that a new brokerage would open.
Backfill: The budget for this biennium assumes that there is some turnover at the brokerage. This is why Counties have not been allowed to backfill slots when individuals exit the brokerage. Mary Lee does not believe this problem will exist in 05-07.
Other budget assumptions: SPD expects we will be on target to meet the requirements under the Staley agreement in terms of number of enrollments targeted for each biennium.
· Criminal background checks
Criminal background checks: Tim reported that there was a meeting last week but that ultimately there is no way to speed up the process. If providers are willing to become an authorized designee it will speed up the process somewhat. SPD is working on decentralizing the LEDs check that will also help with the bottleneck. Computers with the ability to complete these checks will be located in each of the local AAA's. SPD is considering mandating DD providers and Counties to become authorized designees. The hope is that the decentralization will be completed by November
Strategic Planning
· Waitlist
Waitlist: Jessica summarized the discussion among DD programs last month about how Counties are tracking enrollments and the waitlist. Counties agreed to try and achieve some consistency in determining when people can be enrolled and what information is provided to families who call to say "when will I be served?" 7 Counties have reported back so far and there is actually consistency among those reporting. Most have a spreadsheet or database in which they are tracking individuals based on the enrollment categories. They use this to project when people will be enrolled. Advocates shared that they continue to be concerned about the fact that the general waitlist numbers are not accurate and do not reflect the ongoing support needs of the people who may eventually want services. There was a suggestion that we do trend analysis of those who have needed comprehensive services in the past. The total caseload could be analyzed and projections could be made using that information/demographics. Data is also needed on the needs of people already in the brokerage. Kristine Duffy and Jon Cooper are organizing a work group to plan what the next steps will be.
· Base Plus
Base Plus: A draft revised tool was sent out to brokerages to field test. This includes revisions requested by this group and by brokerages in regards to the difficulty in making people eligible for the increased benefit amount. Brokerages have expressed concern that there are individuals who need extra support that have not been found eligible. A review of the tool determined that the application and interpretation of the questions and scoring was not consistent across brokerages. Changes have been made to the tool to correct for that. The tool also takes in to account the perspective of the support needs of the individual, rather then the family. There is also an effort to create a mid range benefit between base and base plus. This category of funding is included in next years budget. This new category would serve about 250 people. Diana Buel is working with the brokerages on the field test and will be making revisions based on the feedback provided. Only one or two people in each brokerage are trained to do the base plus review. This helps to assure reliability.
Mike explained the variables that are measured that allow us to project or forecast our costs. The variables include planned expenditures vs. actual expenditures, enrollments, waiver participation etc. The data that has been collected so far has allowed us to carve out this mid level benefit. It may also allow us to add additional enrollments next biennium.
Anecdotal information from advocates reflects a concern about the lack of system savvy on the part of PA's and CM's helping families and individuals think and plan for services. over the basic benefits. There was concern that the excess resources are taken out of the Staley budget or that there might be belief that those resources are not needed, when in fact they are.
· Voc rehab and employment
Vocational Rehabilitation and Employment: Molly reported on the VR workgroup that is about to wrap up its work. She distributed data about the use of VR services by brokerage customers since July 03. On Sept 9 there will be a meeting between brokerage directors and VR branch managers to communicate common values and practices as well as outlining the process for working together to assure that customers get access to VR in a collective and collaborative process. The work group will also present outcomes expected for individuals who access VR services that both brokerages and VR counselors should work to achieve. This information is a baseline that we will track over the next year to see if the data changes after the new guidelines that the workgroup developed have been implemented.
Tom shared a story about a client he worked with who was 26 and had a job shredding and recycling. He became involved in SDS and they bought hearing aid batteries and eventually transferred to the brokerage. The brokerage was able to increase respite and added a membership to the gym locally. The client got back in shape and was doing very well. After the brokerage voc transfer, there was no longer any funding for transportation, to and from the job site, the gym membership, hearing aides, and respite etc. While there may be good stories out there of the other transfers, this is an illustration of what can happen as a result of these policy changes.
Members of the group shared their reactions to the story. It has been difficult for the brokerage to respond to complaints and concerns of families who feel they have lost services as a result of transferring to the brokerage. Mike reported that approximately half of the brokerage total enrollees statewide came with pre-existing rates (SDS, Voc or Dual Waiver). Only about a third of those with rates actually experienced a reduction in funds.
Members of the group are interested in tracking data about the experience of people who feel they lost services. We have the information about actual plan reductions but we don't have the kind of anecdotal or experiential data points from the perspective of families and consumers. The issue really is about what to do with individuals and families who have lost services, as opposed to understanding from a data perspective what the identified problem is.
Our stated value is around employment but in our actual implementation we seemingly have not valued this. Molly shared that a great percentage of the projected referrals to the brokerage in the coming years are high school transition age. This means employment will be an even bigger focus in the coming years.
· Quality Assurance
Quality Assurance: Mike reported that 3 brokerage field reviews have been completed and overall went well. Mike shared a story about a progress note that was found during the chart review in which a PA indicated they had called a consumer because it was the person's birthday. The field team felt that this progress note embodied the spirit of what this whole project was about.
Vickie Storie presented on Quality Assurance. She has spent the last year working on CMS assurance pieces and developing emerging strategies for implementing local, provider and brokerage QA practices. Vickie reviewed the handouts starting with the overview of what CMS expects from States who provide waiver services. Some of the acronyms were clarified. POC stands for Plan of Care. LOC stands for Level of Care.
Vickie also shared some of the strategies that are being used to gather information about the quality of services currently provided. For example SPD is in the middle of a chart audit. A question was asked about eligibility and the relationship between the file reviews and the increase in the number of people who have recently been found "not eligible" for services. Many situations have been uncovered and are now being corrected. CMS may be visiting less frequently but part of the plan includes regular ongoing dialogue with States about QA activities. Jean pointed out that there is a down side. If CMS does not do field reviews then they start to lose touch with services and how they are being delivered in the field.
Vickie shared the model for QA oversight and the composition of groups that will be advising SPD on these activities. The Staley group will be working with the SPD-DD internal group that is responsible for managing the HCBS waiver program oversight. She also shared that Counties are now required to have QA oversight committees as well.
SPD intends to revise the SERT process that was built largely for the comprehensive service waiver. This has started already and will incorporate the work of the PSI's in family home workgroup.
Group members clarified the role of the SIG in the QA process. The Staley team is still adjunct to the formal QA process but could play a role in setting goals for the whole state. This group was not charged with oversight of the whole DD service system however Lynn observed that oversight is needed in all areas, not just support services. Kathryn described the role of the SIG as being woven in to the larger QA efforts. The agenda for the meeting already has items on it that fit naturally within the QA framework. Bill pointed out for example that we already look at customer satisfaction survey results. That was one of the items on the plan.
The group reviewed the QA document and identified the following items that fit within our scope:
Section I 2.1 4.1
Section II 1.1 2.2 3.1 4.1
Section III 1.1 2.1
Section IV None
Section V 2.2 2.3
Section VI 1.1 1.2 1.3 1.4 1.5 1.6
Bill asked if the reporting timelines indicated were firm. Mike indicated they are not. Suggestions for additions or revisions will go to Vickie. Cynthia asked that future revisions of the document be sent out as they are made so members of the group can review and consider before future meetings.
Set Agenda for October 15, 2004
Our next meetings will be on October 15, 2004 and on January 28, 2005 from 9:30 to 3:30 PM at OTAC.
Families and Advocates pre meeting will start at 8:30 AM
Agenda will include:
· Data on number of comp 300 enrollments
· Review draft report for November E board
· Update from Counties on planning for waitlist enrollments
· Update from Kristine Duffy on SPD waitlist workgroup planning
· Review updated QA plan
· Report on VR meeting with Brokerage Directors
· Feedback on the midrange Base Plus implementation
· Report from families on feedback received of services not available under the waiver
· PA/case manager relationships
January Agenda
· report from SPD waitlist work group
Bill thanked many group members for work they do in between meetings. Many people made special contributions and their work is appreciated.
Notes provided by Jessica Leitner, Senior Program Manager, Clackamas County
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