Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
December 6, 2000
Summary

Representatives: Cynthia Owens, Beth McHugh, Tom Giles, Kathryn Weit, Cindy
Helvington, Kristin Ahrens, Judy Cunio, Fred Renter, Nancy Hazelett, Mike
Maley, Jack Morgan, Mary Lee Fay, Jessica Leitner, Marsha Clark
Kent Layden (facilitator), Bill Lynch and Delores Martin (flip chart
recorders)
Alternates and Observers: Sue van deer Naald, Tina Kitchen, Al Soehneker,
Vickie Storie, Dan Peccia, Diane Duerscheidt, Laurie Lindberg, Pam Ring, Dave
White, Bill Lynch, Tara Asai, Nancy Adcock, Paul Partridge, Charlotte Duncan,
Joanne Furhman, Roger Stanton, Sandy Stewart, Howard Klink

The week in Review: Representatives shared what occurred over the last week,
meetings and activities that relate to further development on Universal Access
Implementation. In addition the group raised some questions:
•       Concerns about timeline and rush
•       Need to send more info out on assumptions
•       DD case managers fear of losing jobs, "what’s in it for me"
•       Role of SDS groups
•       Send out specific questions to the constituents?
•       Make up of regions
•       Keeping all stakeholders involved and up to date

Broker / Case manager Discussion
Mary Lee drew a circle marked with key discussion topics. She shared thinking
about where we are going and where we have been. We have been discussing the
role and functions of CM and Brokers under UA. This leads naturally into the
discussion about the service package. We have also discussed the model for a
brokerage. All of the above must be clarified before we can start talking to
the Regions, which are yet to be defined. Many of the Counties are unclear as
to how to align given that the above information is still unsettled. Because
we are not moving through a linear process, it may feel at times that we keep
coming back to the same issues and decisions again and again. We need to
expect this and understand that it is a result of the process we are in which
is more circular and the decision points must be seen as interdependent.

Why the rush? We are pushing for a July 2001 implementation.

There was group consensus that whenever possible we need to leave decisions
to the local planning groups so that people in the community have a chance to
participate and to insure that the resulting plans reflect the local
community. This will need to be balanced with those items that must be
standardized across the State.

Review Case Manager and Broker Roles (matrix): Mary Lee updated the matrix to
include information she received from our group and the smaller group that
has been meeting with the Division on this issue. There were several
recommendations that came out of this work.
1   We need to identify on the matrix those specific functions that cannot be
delegated away from the County (per HCFA expectations). This would allow
flexibility at the local level so that tasks that can be delegated and may
work better in some communities if performed by the broker or visa versa.
2   We also need to do some broader vision of the matrix to articulate those
functions that a case manager/county does regardless of whether or not
someone is in comprehensive or support services such as protective services.
3   We are planning to draft up some case scenarios to illustrate how the two
positions might interact in the real applications of these functions.

There was a question from the DD mangers last week regarding HCFA’s
willingness to accept separate definitions of case manger in two different
waiver applications.  If HCFA would not accept two definitions then there
might be less flexibility on recommendation # 1 with regards to what can be
shifted to a broker.

CM’s shared questions that were generated in Multnomah County regarding the
matrix.

Jessica shared the description of case management functions completed by DD
managers last week. The intent of the document is to flush out the items in
the matrix that do not articulate the work of the county case manager. DD
managers generated this document as a draft list of functions performed for
all eligible individuals across the State.

Ratios are not on the table at this time. We are still defining the necessary
functions. The result of this work may bring the ratio question back to the
table. The State continues to run several budget scenarios that include
adjustments to the proposed ratios.

The UA group asked brokers to generate a description of their functions
similar to the work done by the DD Managers. This could then be given to the
matrix workgroup to further define the matrix. The workgroup will meet
December 21 from 9-4 at OTAC in the main conference room (not the annex).
Participants will include but are not limited to: Cynthia Owens, Diann
Drummond, Tara Asai, Sue van der Naald, Sandy Stewart, Diane Duerscheidt,
Randy Fulgham, Tim Kral or Roger Stanton, Dennis Dahlen or Chris Johnson ,
Dan Peccia

The Family and Self-advocates will bring information on functions needed to
support families and individuals at the next meeting.(Cindy, Judy, Kathryn)

Group agreed that we are not here to represent special interest groups but to
work toward our common vision.

Supports Package: Mary Lee distributed information from Robin Cooper
regarding the benefit packages in other States. The information reflects work
in States that are NOT entitled. Other States are looking to us as many of
them have lawsuits pending.

Tina Kitchen shared three models for assessing care needs. One is a checklist
for care required based on activities of daily living. The second is an
example of the checklist used by MFCU to assess level of nursing tasks. The
third is a behavioral assessment that assesses level of intervention needed
based on behavior support needed. It is currently used by the CIIS program.
Tina shared that the documents being used by CIIS are reproducible,
explainable and fair. That is one its strengths. Its weakness is that there
may be lower interrater reliability and that it does not recognize family
circumstances as a piece of the assessment.

The group discussed the components of the basic package. It is important to
note that any group of individuals receiving above the average drives the
total pool of money available down for those below the average. It is assumed
that everyone in support services will go through a person centered planning
process to identify their needs. We still must be able to identify how much
money will be available to each individual/ family.

The exercise for today is about process. How does an individual or family
move from the basic package to the extended package (base+) We are trying not
to get bogged down in the content of services available in the waiver.
Charlotte suggested that we concentrate on selecting an approach to
developing services. Other states used functional skill sets to establish
needs. Montana offered a specific package that had an average cost.  This
idea was supported by members of the group who had experience with managed
care models in which specific services are available and receipt of services
outside that basic package require some sort of authorization process. Small
groups broke out to identify 3-4 criteria that they feel are critical to be
included in a base package. Guiding principles (entire list from flip charts):
•       Start with person and needs
•       Respond to all needs—use all resources
•       Flexibility and timeliness
•       Clarity about what the Division will pay for
•       Revisit, prioritize, and negotiate Person-Centered Plans
•       Revisit each plan and make changes when needed
•       Discussion should start with needs, not dollars
•       Explain advantages of using different funds or resources
•       Construct plan without discussion of cap
•       Clear and strong criteria for accessing funds above base
•       Start with person
•       Provide training to brokers regarding the value of self-reliance,
independence, cost-effectiveness, utilizing all options in the community,
communication, and constructing a quality plan
•       Up to $600 as base for employment and other services
•       "Minimal day service"
•       Encourage value of employment
•       Incentives for independence, ie.employment
•       Menu of services
•       What are the incentives in the overall system?
•       Utilize community services and help develop them (e.g., respite in
rural communities)
•       Clear criteria applied when they need to be applied
•       Criteria applied by persons in role A or B
•       Apply criteria when the plan requires additional funding
•       Incentives to use other resources
•       Brokers have to know how to communicate
•       Education to consumers about options
•       One place, statewide, to call for access to person-centered
planning—knowledgeable and competent
•       Process that defines needs
•       Access all community resources
•       Broad plan which includes all options (distinguish public funds from
other resources)
•       Negotiate priorities
•       Objective priorities
•       Cost variations
•       Concern about "menu" versus person-centered plan
•       Natural supports—trade off costs within plan?
•       Flexibility in use of $600—could start lower then go up, based on need
•       Access to day program
•       Pay family directly
•       Place base higher with more rigid criteria for increase
•       Uphold value of true Person-Centered Planning
•       Large menu
•       Write all possible options into Medicaid Waiver
•       People could choose what they want, not necessarily base services on
"need"
•       Broker autonomy in purchase of services
•       Equitable criteria


There was group consensus that the "menu" of services really means the list
of Medicaid reimbursable services as defined in broad categories of services
and should not imply that the choices individuals make is limited to that
list. The PC Plan should reflect wants and needs that can be met by a variety
of resources available in the community. Some of those may be funded by
Universal Access funds.

There was also group consensus that some of the values and guiding principles
identified by the small groups are shared. They are:
•       The process/discussion needs to start with the person and their needs
not $
•       Respond to all needs - use all resources
•       Flexibility and timeliness
•       Revisit, renegotiate and prioritize Person Centered Plans
•       Revisit PC plans and make changes as needed
•       Clarity about what the Division will pay for
•       Clear criteria and strong criteria for accessing funds above base
•       Provide training to brokers regarding the value of self-reliance,
independence, cost effectiveness, utilizing all options in the community,
communication, and construction a quality plan.
•       Education of consumers about options
•       Brokers are autonomous in purchase of services
•       Criteria for determining amount of $ available needs to be equitable

SDS Boards and Role:

What happens to folks in SDS July 1? Some individuals in many counties still
have plans that extend beyond the fiscal year. In these cases we will
continue to support and fund those plans until the end of the plan cycle.
Issues of Medicaid eligibility and reimbursable services should not drive
these continuing plans. Because there are services continuing and work that
still needs to be done, SDS Boards will to some degree continue in their
current role.

Two questions emerged: 1. What is the role of the local SDS Boards in the
regional planning process and 2. What is the long-term ongoing role of the
local SDS Boards in universal access.

One proposal for the continuing role of the SDS Boards would be if some of
the long range plan dollars (Fairview closure)could continue to be available
to support both the local consumer driven policy boards and the continued
need to do capacity development.
(Looking at the broader community needs)
Some additional roles for the current Boards could include: Capacity
development, guiding plan development / planning, regional liaisons, needs
assessment, monitor consumer satisfaction.

SDS board members whenever possible need to be part of the regional planning
process.

One aspect of the regional planning process could be the identification of
the long term, ongoing role of the SDS board at the local level.

Because there is an SDS quarterly meeting this week, we anticipate questions
about this issue. What is the message, beyond what James already communicated
in his letter, that we want to send to board members? The group consensus was
to communicate to the boards that they are vital to the developing UA system,
that we expect to be addressing the issue of the regional planning process
next week and therefore will be able to communicate more definitively after
that, and that the regional planning groups may draw heavily from the local
SDS boards for representation. We have a continuing commitment to 50%
representation from each group of families and self advocates but we may need
to import additional expertise. Finally, the UA planning group, this group,
is made up largely of individuals who are also serving on local SDS boards.

Next Meeting:
Groups that want to opportunity to orient and discuss issues will meet before
the group convenes from 8:00 to 10:00. Lunchtime will also be used for small
group discussion. This will allow for more small group discussion time around
critical issues both before, during and after the large group meeting.
Whenever possible, groups should try and distribute handouts before the
meeting so that people have time to absorb them.
Agenda:
•       Begin defining the composition of regional planning groups, regional
planning process, composition, and group membership
•       Form a group to develop the criteria for the service package
•       Discussion of children’s needs/services

Parking Lot:
1. Target dollars for capacity development
2. Define "quality plan"
3. Define the categories of services included in "menu" and address cost
variations as well as the issue of paying families for care (relative foster
care)
4. One stop shopping – information and referral – single point of entry or
access
5. Day program – should this be a basic benefit to all eligible individuals
6. Incentives – what values does the system promote? Employment? Independence?
7. When should the criteria for jumping to a higher funding level be applied?
At the beginning? Or as needed?

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Summary of Notes                                                            Top of Page

Representatives: Cynthia Owens, Beth McHugh, Tom Giles, Kathryn Weit, Cindy
Helvington, Kristin Ahrens, Judy Cunio, Fred Renter, Nancy Hazelett, Mike
Maley, Jack Morgan, Mary Lee Fay, Jessica Leitner, Marsha Clark
Kent Layden (facilitator), Bill Lynch and Delores Martin (flip chart
recorders)
Alternates and Observers: Sue van deer Naald, Tina Kitchen, Al Soehneker,
Vickie Storie, Dan Peccia, Diane Duerscheidt, Laurie Lindberg, Pam Ring, Dave
White, Bill Lynch, Tara Asai, Nancy Adcock, Paul Partridge, Charlotte Duncan,
Joanne Furhman, Roger Stanton, Sandy Stewart, Howard Klink

The week in Review: Representatives shared what occurred over the last week,
meetings and activities that relate to further development on Universal
Access Implementation.

Broker / Case manager Discussion
Mary Lee drew a circle marked with key discussion topics. She shared thinking
about where we are going and where we have been. Because we are not moving
through a linear process, it may feel at times that we keep coming back to
the same issues and decisions again and again. We need to expect this and
understand that it is a result of the process we are in which is more
circular and the decision points must be seen as interdependent.

Why the rush? We are pushing for a July 2001 implementation.

There was group consensus that whenever possible we need to leave decisions
to the local planning groups so that people in the community have a chance to
participate and to insure that the resulting plans reflect the local
community. This will need to be balanced with those items that must be
standardized across the State.

Review Case Manager and Broker Roles (matrix): Mary Lee updated the matrix to
include information she received from our group and the smaller group that
has been meeting with the Division on this issue.
•       We still need to identify on the matrix those specific functions that
cannot be delegated away from the County (per HCFA expectations).
•       Need to articulate those functions that a case manager/county does
regardless of whether or not someone is in comprehensive or support services
such as protective services.
•       We are planning to draft up some case scenarios to illustrate how the
two positions might interact in the real applications of these functions.
•       CM shared several documents related to CM current responsibilities.
•       Ratios are not on the table at this time. We are still defining the
necessary functions. The result of this work may bring the ratio question
back to the table. The State continues to run several budget scenarios that
include adjustments to the proposed ratios.
•       Brokers will generate a description of their functions similar to the
work done by the DD Managers. Self-advocates and families will identify key
functions.
•       The Matrix workgroup will meet December 21 from 9-4 at OTAC in the
main conference room (not the annex). There is a desire to keep the workgroup
small with representation from the stakeholders. Participants will include
but are not limited to: Cynthia Owens, Diann Drummond, Tara Asai, Sue van der
Naald, Sandy Stewart, Diane Duerscheidt, Randy Fulgham, Tim Kral or Roger
Stanton, Dennis Dahlen or Chris Johnson , Dan Peccia

Supports Package: Mary Lee distributed information from Robin Cooper
regarding the benefit packages in other States.
•       The information reflects work in States that are NOT entitled. Other
States are looking to us as many of them have lawsuits pending.
•       MaryLee was asked to provide models of assessment tools for ideas on
how we establish criteria for movement from the base level of supports to
base plus
•       Tina Kitchen shared three models for assessing care needs used in the
Children's Intensive In-home Supports Program. Tina shared that the documents
being used by CIIS are reproducible, explainable and fair. Those are the
strengths. Its weakness is that there may be lower inter-rater reliability
and that it does not recognize family circumstances as a piece of the
assessment.

The group discussed the components of the basic package.
•       It is important to note that any group of individuals receiving above
the average drives the total pool of money available down for those below the
average.
•       It is assumed that everyone in support services will go through a
person centered planning process to identify their needs.
•       We still must be able to identify how much money will be available to
each individual/ family.

The groups broke out to identify 3-4 criteria that they feel are critical to
be included in a base package. There was group consensus that some of the
values and guiding principles identified by the small groups are shared. They
are:
•       The process/discussion needs to start with the person and their needs
not $
•       Respond to all needs - use all resources
•       Flexibility and timeliness
•       Revisit, renegotiate and prioritize Person Centered Plans
•       Revisit PC plans and make changes as needed
•       Clarity about what the Division will pay for
•       Clear criteria and strong criteria for accessing funds above base
•       Provide training to brokers regarding the value of self-reliance,
independence, cost effectiveness, utilizing all options in the community,
communication, and construction a quality plan.
•       Education of consumers about options
•       Brokers are autonomous in purchase of services
•       Criteria for determining amount of $ available needs to be equitable
There was group consensus that the "menu" of services really means the list
of Medicaid reimbursable services as defined in broad categories of services
and should not imply that the choices individuals make is limited to that
list. The PC Plan should reflect wants and needs that can be met by a variety
of resources available in the community. Some of those may be funded by
Universal Access funds.

SDS Boards and Role:
What happens to folks in SDS July 1?
•       Some individuals in many counties still have plans that extend beyond
the fiscal year. In these cases we will continue to support and fund those
plans until the end of the plan cycle.
•       Issues of Medicaid eligibility and reimbursable services should not
drive these continuing plans.
•       Because there are services continuing and work that still needs to be
done, SDS Boards will to some degree continue in their current role.

Two questions emerged: 1. What is the role of the local SDS Boards in the
regional planning process and 2. What is the long-term ongoing role of the
local SDS Boards in universal access?

What is the message that we want to send to SDS Board members?
•       The group consensus was to communicate to the boards that they are
vital to the developing UA system.
•       We expect to be addressing the issue of the regional planning process
next week.
•       Regional planning groups may draw heavily from the local SDS boards
for representation.
•       There is a continuing commitment to 50% representation from families
and self advocates but we may need to import additional expertise.
•       The UA planning group is made up largely of individuals who are also
serving on local SDS boards or involved in SDS programs.

Next Meeting- December 12, 2000:
•       Groups that want an opportunity to orient and discuss issues will
meet from 8:00 to 10:00.
•       Lunchtime will also be used for small group discussion. This will
allow for more small group discussion time around critical issues both
before, during and after the large group meeting.
•       Whenever possible, groups should try and distribute handouts before
the meeting so that people have time to absorb them.

Agenda:
•       Begin defining the composition of regional planning groups and
regional planning process.
•       Create a workgroup to develop the criteria for the service package
•       Begin discussion of children’s needs/services

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