Staley Implementation Group Meeting Previous Meeting  Next Meeting
Official Minutes
December 3, 2003
Participants: Rod Branyan, Don Fries, Molly Holsapple, Randy Fulghum, Bev Herrin, Ron Snook, Pam Ring, Tom Giles, Marla Henry, Dayna Davis, Christine Merrit, Judy Cunio, Mable, Deb Lindsay, Diane Drummond, Cynthia Owens, Arlene Jones, Nancy Hazelett, Marla Henry, Mary Lee Fay, Tim Kral, Kathryn Weit, James Toews, Jessica Leitner, Bill Lynch (facilitator), Mike Maley, Tara Asai,
Agenda:
Introductions
Updates on Enrollments
QA State Perspectives
Community Comments
Visit from James
Tax Measures
County Contacts
Support Waiver Discussion
Base/Base Plus
Criminal Record Checks
Offsets
VR
Next Steps
Introductions: Agenda was reviewed and changes made. Update on Enrollments: 2850 people are enrolled in the brokerage as of October. This includes the 700 plus people enrolled as a result of the voc only transition. Waitlist enrollments are continuing as scheduled. Dual waiver transition will impact future enrollments (130 new people) but no firm date has been given yet by SPD.
Jessica shared, and Rod confirmed, that Counties are still catching up from the freeze and will not get to general waitlist people until next spring. The order of enrollments requires that kids turning 18 from family support be enrolled first.
Mike handed out a copy of the Q&A document that went out related to the modified settlement agreement. This information went out to Counties, ARC, the DD Council etc. as a way to give information out to the people most likely to get calls from people and families with questions about the settlement agreement itself.
The original plan was for a summary letter written in people first language was to go out with the official notification to the class. There was a problem with this since the attorneys for both sides did not want it going out. As a result it was good that this Q&A document was developed so that people receiving calls from people were able to answer questions accurately and consistently. Judy offered to put some of this information in to the People First magazine and information did already go out in the Clarion Bulletin.
The deadline to give comments to the court is coming soon (Jan 14). Kathryn asked about what people are hearing from families in their communities. Counties are not hearing objections to the modifications on the settlement agreement. Most families that are calling have younger children in family support and are not impacted by the delay or increased length of wait.
Tax Measure: James shared that the tax measure will be going for a vote in February as activists collected enough signatures to certify it for a referendum on Feb 3. Polling shows the tax increase going down but this may change when we get closer to the election. State government will begin preparing contingency plans shortly. For SPD this means $18 million dollars plus federal match. The impact will seem even greater as a result of the lateness in this fiscal year. This means you have less time to make up the total losses. Cuts would be scheduled for May 04.
What would be cut is not necessarily those items that were added back to the Ways and Means budget. The loss is so great that it would be deeper then even just the basic Medicaid population. The whole department will be overshadowed by changes in the health plan. SPD could have to make find as much as $40-50 million and will have fewer places to make this up. For example, the federal government will not allow SPD to cut deeper into the waiver services because of the risk to people who would lose services. James does not know when or how the information on planning will be released. He was also not clear on how this information will be used in the campaign.
Even if the tax passes and the economy grows, we are still going in to next biennium (05-07) with a billion dollar deficit. Tim asked about additional cuts the governor may require across the board. SPD is about one third of the State budget so if we hear this will happen we can estimate that SPD will need to absorb approximately 30% of the total amount requested.
Persons interested in working on contingency planning should contact Kathryn with the DD Coalition.
County Contracts: Kathryn distributed a copy of information about transferring contracts for the brokerages to the County. The Support Services Committee oversees the Staley implementation and is concerned that discussions not happen outside the Staley Implementation Group arena. James clarified that there were many versions of discussions about contracting, including an original plan for regional RFP committees that involved local government. Then local government wanted to respond to the RFP and there were discussions about right of first refusal. As a result, the RFP process had to be changed to a statewide process that resulted in direct contracts. The state wanted to be able to manage the first years of implementation and has continued in this role. With the budget crisis it has made sense for SPD to continue to direct contract.
In general, SPD contracts through Chapter 430, does business through local government. There is no intent to immediately transfer contracts to Counties. This discussion will continue as the end of the agreement comes near but would be inclusive of the Staley Implementation Group. James has told Counties that when problems between Counties or brokerages within regions, SPD will intervene and doesn't believe that the County has to hold the contract in order to resolve issues. Advocates ask that these issues be brought to the Staley Implementation Group which has not heard much from the field about what is actually happening. This group wants to be informed so it can focus its efforts in the right place. Rod explained that the issue the Counties have is the role change that resulted from implementing Staley. There is not comprehensive management of the system and a significant change in the role of case manager, which the County uses to manage the system in the community. It assures quality management and assures community cohesion.
There was discussion about regionalization and the potential impact. Discussions actually started over a year ago but were dropped because of the budget crisis and special sessions. It is being started again as Counties begin to think about planning for the future. This issue is really bigger then contracting, it is about application and implementation of the system. James suggested we get real examples of how counties and brokerages are working together and examples of people getting hurt as a result of split e.g. families confused, people not getting the services they want. Consumers shared they don't feel they have a relationship with their case managers and don't want to have them more involved. The breakdown in communication started with the quarterly and half yearly meetings went away. Consumers would like to see that training money restored.
There was a best practices discussion a while back that will be revisited. Jessica agreed to distribute the document in advance of our next meeting. Kathryn asked if the brokerages and Counties meet regularly. They are meeting locally and are meeting prior to DD managers when there is an agenda. It was suggested that whenever possible we drill down to specific issues so we can address them in policy if needed.
BASE/BASE PLUS
Mike reminded us that the revisions worked on by Diana Buehl were to clarify the language and assure consistent application of the tool across brokerages.
Mary Lee shared the history on the decision to keep base plus limited to those who need more then the base level. The total funds available only allow about 10% of the total enrollees to access the higher fund level. This decision was made because we wanted to make sure that the maximum number of people have access to the maximum benefit.
Without new funds, any changes to the base plus policy would have to be done within available resources. The choices were made with no information available, and now, we have information about expenditures and needs in the community. SPD is planning to hire a data analyst who will work with brokerages to get the data on what Each month SPD is collecting the plan costs, averages, distribution by levels from the brokerages using a special form because they are not reporting in CPMS. Later SPD will ask for comparison numbers from the information collected by the brokerage against the larger budget.
There was a recommendation that we set some time aside to look at possible changes to policy before March even if there are limitations on the resources. We could start these discussions based on the data available.
The current tool was not designed to be a needs assessment but that may be what we need. Our current tool is a combination of needs and circumstances. The current tool needs to be as fair as possible. We could reconvene the work group discuss the assessment tool for base plus and make revisions as needed.
Volunteers would be needed for a new work group on this. Several people indicated a willingness to work on this issue. Volunteers should work with Mike Maley who will coordinate this work. The group will convene in January.
Support Services Waiver: Mike introduced Don Fries, waiver specialist, and distributed information about suggested changes to the Support Services Waiver. Region 10 was in Oregon recently and provided input to the renewal of this waiver which is due June 04. Region 10 said there is not going to be extensions on the waiver but rather increase timeliness to questions and in the approval process. There will not likely be major revisions to our waiver this round because SPD wants to assure that the resubmission is considered a renewal, not a new waiver. Therefore, larger issues that are identified in the waiver may be filed later as an amendment. In the revision, private pay clients will be addressed. The revision will allow them to have support services but restrict what they can buy to not duplicate what is already covered in the private pay contract.
Don shared information about the process used to renew a waiver. We do have flexibility to write definitions, but don't want to make too many revisions at this time.
Suggestions were discussed such as including ability to use PASS plan consultants to increase benefits available to individuals that want to work. Other ideas were allowing the cost of staff attending activities (such as the cost of the movie ticket). Training for families is allowed but not for paid caregivers. This is also true for people with specific or uncommon disabilities. This will go on the suggestion list. "No Shows" is also an issue - which currently is not covered. Definitions of service categories were discussed.
Speed for making purchases of needed equipment and ability to use non-Medicaid vendors was also discussed. Part of the PA's role is to do resource analysis. This slows the process down but also helps us determine what might be covered elsewhere. A question was posed if a non-licensed contractor can install and complete minor adaptations to home (e.g. automatic door opener). Also the need to look at specialized medical equipment outside of what is covered via OMAP.
Bridge funding while waiting for VR or other agencies to determine eligibility or during appeals is needed. Any additional suggestions people have need to be in to Mike Maley by the end of next week. Kathryn pointed out that the lack of feedback may be because we do have a good set of broad definitions that are generally meeting many of our needs. Mike suggested that we do more regular review of expenditure guidelines and administrative rules so that we are clarifying on a more regular basis.
Criminal Record Checks: Mike reported that the rule committee continues to edit the draft that will be submitted for filing mid December. This rule impacts all DHS - not just DD or SPD. The rule will allow employers the ability to designate someone in their organization do their own final fitness determination but it is no longer required. There is also a designated contact person who would be able to determine if someone can work with supervision while waiting for a final fitness determination.
Family members will still have to get background checks. So will coworkers who are being paid to provide support. One good outcome is the ability to have your criminal check move from department to department without resubmitting fingerprints. There are rule changes that we will need to make such as mandatory disclosure of new crimes or rechecks. This is not included at this time.
Offsets: Mary Lee shared that this issue has been on the agenda but SPD has been working with CMS on other issues. There is a Medicaid rule that requires individuals whose income is over 300% of federal poverty level make a contribution to their care. We have not actually collected the difference and are asking CMS if it is acceptable to demonstrate in the resource analysis that they are contributing to their cost of care.
There are questions about who would monitor this contribution and how it would be tracked. There are also questions about what the impact would be of changing the criteria in the waiver. There are strong feelings about the disincentive this creates for employment.
VR: A planning meeting is happening in Dec to continue work on transition and communication issues. The new VR rule is about to come out. Contact Molly for information.
The next meeting will be February 27, 2004 also at 9:30 at OTAC.
Hold April 23, 2004 also at 9:30 at OTAC
Agenda for Next Meeting
Criteria for Comp 300
Report from Base Plus work group
County oversight and contracting with the brokerage
Best practices discussion between Counties and Brokerages
Private pay policy issues and the support service waiver
Translation between waiver language and what is in admin rule (specifically cooking example for people with disabilities)
Feedback on the Satisfaction Survey
Changes to Medicare (Tina)
Report on perceived loss of services to voc only people dropping to GF
Report on dual waiver transfer
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