Staley Implementation Group Meeting Previous Meeting  Next Meeting
Official Minutes
December 12, 2000
Summary
Representatives: Kristin Ahrens, Tom Giles, Cindy Helvington, Kathryn Weit, Pam Ring, Cynthia Owens, Diane Duerschiedt, Judy Cunio, Tim Kral, JoAnn Furhman, Beth McHugh, Dave White, Jessica Leitner, Kent Layden (facilitator), Jack Morgan, Alternates and Observers: Charlie Hammett, Tara Asai, Charlotte Duncan, Howard Klink, Jean Olsen, James Toews, Bill Lynch, Mike Maley, Marsha Clark, Amber Pedia, Dana Davis, Nancy Hazelett, Roger Stanton
Agenda:
· Logistics
· Week in review
· Matrix group report/SDS report
· Regional planning groups (structure, composition, process)
· Children's needs and services
· Service package
· Next steps
Logistics: This morning the first hour (from 9-10) was for small group meetings. This format was effective and will continue. Meetings will begin at 10:00 AM. In case of poor weather in the future, please check your e-mail before leaving for Salem or check it the night before the meeting for notification of cancellation. Folks can also contact Margaret at OTAC 503 364 9943 Ext. 17 in the morning to see if the meeting has been cancelled.
Matrix Workgroup Update: This group meets Dec. 21 from 9-4 at OTAC. Brokers across the State will send representatives to the meeting on the 21st and will flush out more description of their role and functions to provide that group.
SDS Quarterly Report: Diane shared the outcome of the discussion from the SDS quarterly meeting in Eugene. There were significant issues raised about communication. It was clear that there were different levels of understanding about the lawsuit settlement, what entitlement was, and what individuals would now be entitled too. Although the brokers are receiving our minutes, there was still misunderstanding based on the content of those minutes. This led to different interpretations by brokers and SDS staff across the State about the planning process itself. .
Some of the feedback boards provided was that many of them do not like the proposed regions because of the process in determining them and the size. Overall, the brokers had a sense that they "do not know" what is happening at the Statewide level and that they want to be part of the planning process. The Brokers feel strongly that the planning process needs to be local or have
a local emphasis. With regards to regions, boards feel that the broker needs to live in the community they support. This will affect their success and ability to develop natural supports. A concern was that the regional structure added a layer that would remove services from the local community.
The message brokers, families and SDS boards asked to have sent back to this group was that they want power and access at the local level. They want to have input to the QA process, policy-making, and the definition of what a brokerage is as well as the brokering functions. They also want input into the resource development. Folks were also encouraged by the possibility that private non profits can lobby outside sources for additional revenue to support families who are not eligible and for those who are but need or want things not funded by the program. This group also felt strongly that there needed to be funding included to support families who participate on boards and planning processes.
Part of what may have led to communication difficulty between programs and brokers and then to families is that information flow may be slow in traveling to them from representatives of this group. The group agreed that we need to label our minutes as the "official" minutes in case other versionsare floating around. It was also suggested that contact information for constituent groups be included in the summary notes.
Regional planning groups (structure, composition, process): Families, self-advocates, and advocate participants expressed serious concerns about the regional configuration that mirrored much of what had been expressed by the SDS groups in Eugene. They felt that some of the proposed configurations were too large, including too many counties and as a result would effectively discourage meaningful self-advocate and family participation in planning and decision-making. It was their understanding that some of the proposed Regional configurations were being proposed without input from all stakeholders. In addition, concern was expressed that the eadership that has been nurtured at the local level would be disenfranchised by large Regional structures.
The Division shared some of the history behind the regional strategies.Beginning with crisis response, the Division originally started funding positions and projects along regional lines to slow admissions to Fairview and strengthen the base of providers (funding and planning for people with difficult needs). Regions evolved because crisis management County by County did not afford them enough money within their budgets to manage crises effectively. Particularly in smaller Counties, one expensive or high needs case could exhaust the budget and leave the County beholden to the Division for approval of further expenditures. Training dollars soon followed. When SB 919 planning began, regional allocations made sense given the track record of the existing crisis and training regions. It also made good financial sense in that in this entitlement system, there must be a way to maximize the available dollars across multiple diverse geographic areas. The regional structures made good sense in terms of pushing local planning out to already established multi-county partnerships and in maintaining a large enough budget across those Counties to support a variety of needs within that region without putting the entire budget at risk. The advantages of the regional structure includes more local control of the available dollars it brings Counties together to look at different situations and get creative.In the existing regions there are different models. Some regions have a lead County that manages the money and reports to the division. Other regions have the allocation shared across the participating Counties. Some have a separate entity that manages the contract as a subcontractor of a lead County or of several Counties.
Counties shared that in Human Services, most of the services available (MH, A&D, Housing, etc) are organized by different regions. This means that within any County there may be a variety of resources or services available depending on what region the County is part of for that service. It is important to Counties that partnerships with different regions be maintained. Others in the group continued to maintain that any Regional configuration must make sense to the goals of the developmental disabilities system and involve all stakeholders in the decision.There are also implications with regards to the DHS reorganization. There may be little impact that this group can make on the regional configuration. What the group can impact is the decision to budget by region or to budget by individual County knowing that this presents problems in obtaining a large enough "N".
The group diagrammed several models to illustrate possible structures for delivering supports and services.
There are three key functions necessary for Universal Access:1.budget management, 2.service delivery, and 3. quality assurance. These can be provided by a regional entity or on the local level. The group agreed that service delivery and quality assurance should be and can be delivered locally. What we continue to struggle with is the configuration of the budget management piece.
Budget management:
· Must be streamlined and efficient
· Able to accommodate local needs
· State can direct dollars to:
Local governments
Regional entities
Brokerages
Quality Assurance and Service Delivery
· Provided at the local level
Building on that, we could clarify which decisions will be made at the local or the regional level and turn the planning process over to the local SDS groups. Regional decisions would be turned over to regional groups. This idea still does not resolve the consumer and advocates desire to have rational reasons that determine regional configurations including such issues as history of collaborations, geography, proximity, transportation etc. This ill continue to be an issue. It is important that regional planning groups draw representation from local SDS boards.
Additional questions were raised with regards to the inverse relationship between the region and the brokerage. If the brokerage has control of budget management and QA, why would it care which Counties were in that region? The statewide RFP will recruit potential qualified vendors. The local or regional entities would review those RFP's. A brokerage, depending on size and strength could service multiple regions.
For January 4th Meeting:
ODDS will provide:
· Budget Guidelines
· Basic Functions/roles
· Ideas for regional configurations (including majority representation of
self-advocates and families)
·
The group asked that counties provide them with ideas or plans about discussions that they have had about regional configuration. It is important that regional configuration address issues of geography, resources, population, and distribution of resources rather than just for administrative convenience.
The State shared some of their ideas and expectations of the planning process. This will include the expectation that the majority representation be self-advocates and families. The State will propose the composition of these anning groups as well. They will try and get this to us before the
meeting January 4, 2001.
Children's needs and services:
The budget supports services to children who meet up to 200% of the federal poverty level. There is no commitment to serve the next child if the money runs out, as children are not entitled to this service.
The group reviewed questions generated at the SDS quarterly (see handout).
For clarification, it is important to note that the case management and broker ratios do not distinguish between adults and kids. Therefore all eligible individuals will have a County CM and a broker. What is limited or restricted for children is access to the available pot of Medicaid money under Universal Access.
There was a suggestion that part of the local planning process could include identification of local resources to serve children outside of Medicaid eligibility. It is important that we keep children's issues on the table as part of our long range planning and advocacy.
Kids will have access to a broker and person centered planning. Kids will still have access to diversion service resulting in foster care, residential placement or crisis stabilization to prevent out of home care. What other financial assistance are they eligible for? We are not planning to disenroll children from SDS on July 1, 2001. Plans that are in process will be continued until the plan ends.
The State will communicate this information to families who are currently receiving those services. However we need to address the long range needs of children currently receiving SDS. Some issues we need to address include:· What should we do with kids in SR Day Care?· What should we do with kids in the old Family Support program?· Individual Counties will receive an SDS allocation on July1, 2001. It will likely be the annual amount that was previously budgeted. Business should continue as it had been for all plans that are current.· We need to identify the long range vision or plan for the service delivery model and deal with the outliers or special deals after that· We need to address the issue of universal access to children and families for services when they are not Medicaid eligible. We need to develop a plan to advocate for additional funding
In order to implement Universal Access, need:
· Budget approval by legislature
· Write Medicaid Waiver
· Hire staff
Budget is currently $18 to $19 million. When fully funded - 2005-2007 biennium, the budget will be about $60 million general fund for adults and $20 million for children. It is clear we don't want a "pared down" Medicaid program for children. We want to create flexibility in use of Medicaid dollars. It may be that less money will be needed for services to adults and there may be some flexibility in the funding amounts between adults and children. There will be more flexibility in the budget in the beginning, less later on in the transition to full implementation to Universal Access.
Accomplishments of this meeting (dittos from group on all points):
· Feedback from SDS boards
· We will have local planning guidelines
· We won't forget kids
· Some kids will receive services
· We can't resolve all the issues
· State will send letter to SDS regarding SDS plans continuing past July 1st
· All kids will have access to person-centered planning and case management
· State's willingness to participate and hear us out
· Evolution of this group
· Idea to switch places in the room next time
· We may not always agree, but have been able to "compromise" and see other
people's point of view - work things out
· Liked the visual presentation of various regional models
· Disneyland analogy - Walt Disney was a visionary and we are acting as
visionaries also - we're almost in "tomorrowland"
· Confirmation that the SDS Boards do still have a role and will continue
· Regions are not "in cement"
· Recognizing our barriers
· Encouraged that we will make good decisions
Parking Lot:
· The words we use to describe things such as "universal access" and "self directed supports." It is clear that our words have meaning for different people around the state. We need to have agreement about which words we use and how we use them. (example: Is Universal Access a new program or is it universal access for adults to SDS?)
· Glossary of terms
· How are we going to ensure true control by self-advocates and families
(QA)?
· SDS brokers et al want power and access to remain local
· How should we handle the LTD folks in DD49? Will they convert to the
brokerage or be considered part of comprehensive services?
Next Agenda: We are meeting on January 4th from 10-4. 9-10 is for small group
discussion. Agenda includes:
1. Feedback and summary of Robin Coopers work so far
2. Guidelines for local planning
3. Feedback from matrix workgroup (meeting 12/21)
4. Feedback from Support Services Package (support plus) workgroup
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Summary of Notes Top of Page
December 12, 2000
Representatives: Kristin Ahrens, Tom Giles, Cindy Helvington, Kathryn Weit, Pam Ring, Cynthia Owens, Diane Duerschiedt, Judy Cunio, Tim Kral, JoAnn Furhman, Beth McHugh, Dave White, Jessica Leitner, Kent Layden (facilitator),Jack Morgan,
Alternates and Observers: Charlie Hammett, Tara Asai, Charlotte Duncan, Howard Klink, Jean Olsen, James Toews, Bill Lynch, Mike Maley, Marsha Clark, Amber Pedia, Dana Davis, Nancy Hazelett, Roger Stanton
Agenda:
· Logistics
· Week in review
· Report from SDS Quarterly
· Regional planning groups (structure, composition, process)
· Children's needs and services
· Service package
· Next steps
Logistics: This morning the first hour (from 9-10) was for small group meetings. This format was effective and will continue. Meetings will begin at 10:00 AM.
Matrix Workgroup Update: This group meets Dec. 21 from 9-4 at OTAC.
SDS Quarterly Report:
· There were significant issues raised about communication and getting information to stakeholders that is both timely and accurate. The group agreed to label minutes as the "official" minutes in case other versions are floating around. It was also suggested that contact information for constituent groups be included in the summary notes.· Many SDS Boards are concerned about the proposed regions because of the process in determining them and the size.
· Overall, the brokers had a sense that they "do not know" what is happening at the Statewide level and that they want to be part of the planning process. · The message brokers, families and SDS boards asked to have sent back to planning group was that they want power and access at the local level. They want to have input to the QA process, policy-making, and the definition of what a brokerage is as well as the brokering functions. They also want input into the resource development.· They expressed concern about the ongoing status of SDS and services to
non-Medicaid eligible children.
Regional planning groups (structure, composition, process): · Families, self-advocates, and advocate participants expressed serious concerns that regional configurations would effectively discourage meaningful self-advocate and family participation in planning and decision-making. · The Division shared some of the history behind the regional strategies.- regional allocations made sense given the track record of the existing crisis and training regions.- It also made good financial sense in that in this entitlement system, there must be a way to maximize the available dollars across multiple diverse geographic areas. - It would bring counties together to look at different situations and get creative.
· Counties shared that most Human Services ( MH, A&D, Housing, etc) are organized in different regions. This means that Counties must deal with many different regions. This is difficult for administration and clients.· The Department of Human Services is reorganizing all the regions and those decisions may determine what we do. · The group diagrammed several models to illustrate possible structures for delivering supports and services.
There are three key functions necessary for implementation of Universal Access:
1.budget management
2.service delivery
3. quality assurance.
· These functions can be provided by a regional entity or on the local level. · The group agreed that service delivery and quality assurance should be and can be delivered locally. · What we continue to struggle with is the configuration of the budget management piece. udget management:
· Must be streamlined and efficient
· Able to accommodate local needs
· State can direct dollars to:
Local governments
Regional entities
Brokerages
· It is important that regional planning groups draw representation from local SDS boards.
· The statewide RFP will recruit potential qualified vendors for brokerages. The local or regional entities would review those RFP's. A brokerage, depending on size and strength could service multiple regions.
For January 4th Meeting:
ODDS will provide:
· Budget Guidelines
· Basic Functions/roles
· Ideas for regional configurations (including majority representation of
self-advocates and families)
· The counties will provide the group with ideas or plans about discussions
that they have had about regional configuration. · It is important that any regional configuration address issues of geography, resources, population, and distribution of resources in addition to administrative convenience. · The State shared some of their ideas and expectations of the planning process. This will include the expectation that the majority representation be self-advocates and families. · The State will propose the composition of these planning groups as well. They will try and get this to us before the meeting January 4, 2001.
Children's needs and services:
· Children are not entitled to universal access to services under the Settlement Agreement.
· Dollars to serve children were included in the Settlement Agreement. · What is limited or restricted for children is access to the available pot of Medicaid money under Universal Access. · It is important that we keep children's issues on the table as part of our long range planning and advocacy.· We are not planning to disenroll children from SDS on July 1, 2001. Plans that are in process will be continued until the plan ends. · The State will communicate this information to families who are currently receiving those services · Kids will have access to a broker and person centered planning.· What children will have access to support dollars is yet to be decided. · Individual Counties will receive an SDS allocation on July1, 2001. It will likely be the annual amount that was previously budgeted. Business should continue as it had been for all plans that are current.· We need to identify the long range vision or plan for the service delivery model. · We need to address the issue of access to children and families for services when they are not Medicaid eligible. · We need to develop a plan to advocate for additional fundingIn order to implement Universal Access to services for adults, need:
· Budget approval by legislature
· Write Medicaid Waiver
· Hire staff
· When fully funded - 2005-2007 biennium, the budget will be about $60 million general fund for adults and $20 million for children.· We want flexibility in use of Medicaid dollars. · There will be more flexibility in the budget in the beginning, less later on in the transition to full implementation to Universal Access.
Accomplishments of this meeting (dittos from group on all points):
· Feedback from SDS boards
· We will have local planning guidelines
· We won't forget kids
· Some kids will receive services
· We can't resolve all the issues
· State will send letter to SDS regarding SDS plans continuing past July 1st
· All kids will have access to person-centered planning and case management
· State's willingness to participate and hear us out
· Evolution of this group
· Idea to switch places in the room next time
· We may not always agree, but have been able to "compromise" and see other
people's point of view - work things out
· Liked the visual presentation of various regional models
· Disneyland analogy - Walt Disney was a visionary and we are acting as
visionaries also - we're almost in "tomorrowland"
· Confirmation that the SDS Boards do still have a role and will continue
· Regions are not "in cement"
· Recognizing our barriers
· Encouraged that we will make good decisions
Parking Lot:
· The words we use to describe things such as "universal access" and "self directed supports." It is clear that our words have meaning for different people around the state. We need to have agreement about which words we use and how we use them. (example: Is Universal Access a new program or is it universal access for adults to SDS?)
· Glossary of terms
· How are we going to ensure true control by self-advocates and families
(QA)?
· SDS brokers et al want power and access to remain local
· How should we handle the LTD folks in DD49? Will they convert to the
brokerage or be considered part of comprehensive services?
Next Agenda: We are meeting on January 4th from 10-4. 9-10 is for small group
discussion. Agenda includes:
1. Feedback and summary of Robin Coopers work so far
2. Guidelines for local planning
3. Feedback from matrix workgroup (meeting 12/21)
4. Feedback from Support Services Package (support plus) workgroup
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