Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
February 7, 2001


Representatives: JoAnn Furhman, Jean Olsen, Cynthia Owens, Kristin Ahrens, Kathryn Weit, Mary Lee Faye, Tom Giles, Judy Cunio, Dana Davis, Marsha Clark, Dianne Deurchiedt, Diane Drummond, Beth McHugh, Jessica Leitner, Kent Layden (facilitator)

Alternates and Observers: Nancy Hazelett, Sue vanderNaald, Mary Cook, Cindy S, Dave White, DeAnna Hartwig, Molly Hollsapple, Paul Partridge, Dan Peccia, James Toewes, Joann Sowers, Randy Fulghum, Lori Powers, Tara Asai, Charlie Hemmett, Cathy Holmes, Joe Carroll, Pam Ring, Bev Herrin, Tina Kitchen, Lorriane Linder, Laurie Lindberg, Patrice Botsford, Howard Klink, Roger Stanton, Sandy Stewart, Cindy Helvington

Agenda:

Status of the Waiver
Employment Recommendations under UA Workgroup
50 Families Workgroup Report
Base/Base + Workgroup Report
Self Directed Supports
System Chart/Design
Allocation Plan
RFP Update
Next Meeting Dates
Parking Lot

Status of the Waiver Application: The renewal of the current Home and Community Based Waiver has been submitted. This waiver currently covers comprehensive services (group homes, supported living, foster care). The State expects to hear by mid February. The State is still working on the model waivers (CIIS). DeAnna expects to begin work on this in the next week
or so. The estimated time to submit the new waiver applications for support services and an amended waiver for comprehensive services would be no later than April 1, 2001. Our hope would be to have it approved by July 1, 2001.Much of what will go into the waiver applications will be cut and pasted fromthe materials prepared by Robin Cooper. A draft will come to the UA planning group for review at our February 28, 2001 meeting.

Services in excess of $20,000 annually will be covered under the comprehensive services waiver. Some adjustments will need to be made to explain how people will move back and forth between the support and comprehensive waivers. All services under the comprehensive services waiver
have minimum provider qualifications. We do not anticipate this changing. Currently, under the comprehensive waiver, to deliver in home supports in the home, you must be 18 years old, pass a criminal history check and have a federal ID number. The group wanted to know if the qualifications might be as flexible as the ISP Team selects you to deliver the service. We hope to
secure choice for individuals under the comprehensive waiver like what we are anticipating under the Support Waiver.

Employment and Universal Access Recommendations: The subcommittee gave a report on their meeting. See Handout. The group shared their assumptions regarding access to VR and VR funded services. It was the group’s recommendation that we clarify language in our waiver application to ensure that we are not funding the same service at the same time, and/or that we
consider documentation of availability of VR funding or documentation that services were denied. We would also need to define what constitutes an appropriate referral to VR. The group also recommends that we include the VR Counselors in the Person Centered Planning process. We need to be sure that employment is a goal of the consumer before moving forward with referrals to VR.  There would also need to be training for VR Counselors on working with
persons with developmental disabilities.

Providers shared some concern that if a significant number of individuals began requesting services from VR it might force and order of selection. We will need to do some meetings with representatives of VR to discuss this issue and negotiate a solution.

This committee meets again on March 2, 2001 at OTAC from 9-11 AM.

"50 Families" Workgroup (access to non-crisis comprehensive services):  The settlement agreement identifies 300 people or 50 individuals per year whowould gain access to comprehensive service on a non-crisis basis. See Handout. The workgroup made the following recommendations:
• Access to services will be prioritized by the age of the caregiver first. Eligible individuals who are living with a primary caregiver age 70 and older.
• The ISP Team has agreed that support services will be inadequate to meet the needs of the family or individual within the next two years. (This language is in the Settlement Agreement)
• Local vacancies would be offered individuals who meet the criteria if there was a match and if the vacancy was not used by an individual through Crisis/Diversion.
• Beyond the "50 families / individuals" it was suggested that an available vacancy would be offered persons on the old waitlist if none of the "50" are interested. 

There is still no decision on "who goes first." This will need to be decided by an implementation group.

ODDS will run numbers to determine the number of families who might be eligible at age 70. At age 75, ODDS estimates 353 families Statewide. (This is based on age of individuals living with family in the community. There is actually no data on age of caregiver.) There are several ways an individual can access comprehensive services. If families access those services through a way other than being one of the "50", they will not count against the total obligation the State has to
develop services for 300 individuals over the implementation of the settlement agreement.

Next steps include an implementation discussion by the workgroup and a review of the waiver language after ODDS has developed a first draft. This workgroup does not have a next scheduled meeting. 

Base/Base Plus : Tina presented a draft of a tool that will be used to determine movement from base (or the basic $ amount all eligible adults received in support services) to base + (an amount above the basic $ value). The budget was based on an average ($800), which means that every individual who received more than the average results in someone else receiving less than the average. The workgroup recommended that the base $ amount be set as high as possible to assure meaningful benefit, maintain flexibility and autonomy by the broker and the family before having to seek approval.

Robin’s suggestion during her visit was to be very flexible at your base level and set strict, objective criteria to determine access to more funding. It is very important to be able to defend denial of service.

See Handout. The draft tool is designed to examine the individuals needs - primarily medical and behavioral needs and the ability of the caregiver to respond to those needs. The tool does not identify what the dollar value will be resulting from the score on the tool. That will be the next step after we agree on the criteria in the tool. Scores are designed to move individuals to
a range of dollars that is above the base rate. There may in fact be two ranges – from $800 to $1200 and from $1200 to $1600. 

Tina requested that we look at this tool and provide comments to her by next Friday February 16th. Tina also asks that case managers/brokers test the tool on individuals and caregivers they work with who are receiving SDS. Compare the tool against how much the family is receiving per month. This tool does not apply to individual who receive more than $1666 per month or $20,000 per year. This will also not address individuals in crisis. Please provide this
feedback to Tina by the 16th of February. Tina also asks that we not distribute this broadly because in order to understand and use the tool you need the background and history. Fax #: (503)3737274 or e mail: Tina.C.Kitchen@state.or.us

One assumption made in the tool is that individual who live alone are not likely to qualify for base plus. The assumption is that those individualsprobably do not require supports beyond what can be provided through base funding. People need to remember that universal access supports are in addition to other supports or resources (SSI) the individual may receive.

Providers want to caution that results of feedback on use of the tool not directly set rates. There are rate inequities in the comprehensive system and we do not want to replicate these issues in the new service system. Many local SDS groups went through a similar exercise when they developed local plans. This first tool relied heavily on prioritization. work done by those
groups.

This group meets again on February 21st from 1-3 in the Library at the Division office.

Self-Directed Supports: In the next few weeks ODDS will be collecting and analyzing additional information from the local SDS groups. This information will be used to calculate allocations for kids and adults. It will also tell us important information about who is being served (adults/kids).

ODDS will also be sending out info to SDS groups confirming that we will be continuing services as they are now after July 1, 2001. SDS as it is now will be our existing infrastructure while we wait for the approval of our new waiver. What we don’t know yet is what those continuing services will look like. Is it continuing already approved plans? Or are we going to be allowed to open new folks?

Services to kids is a complex issues. At some time ODDS will have to break out the dollars designated to kids. This could be done July 1 or could be continued under SDS and phased out as originally planned. ODDS is requesting the formation of a separate group to work on kid’s issues. It is important that these issues get addressed concurrently to UA implementation but the
volume and commitment of time is beyond the expectation of this original planning group. Members of this group who are interested in participating are encouraged to express interest. 

ODDS expects that they will contract for at least one year if not longer at approximately the same amount annually as SDS groups received in FY2001. This will present problems for Counties who planned to receive the increased allocation in the third year of plan implementation based on the original long range plan documentation. This was intended to capture the "roll up" of ongoing services projected over a full biennium.

A second discussion we need to have is that even if everything is approved July 1 we have to decide on a roll-out schedule. We could opt to roll-out geographically or we could roll out everywhere at once but not serve everyone at the onset. For example we could bring up voc only first – or last depending on how we want to prioritize access to new services under UA.

There were several questions asked regarding SDS groups. SDS groups are continuing as is but they will be change once UA is fully implemented and operational. SDS groups are discouraged from changing their priorities or "ramping up" to serve more individuals or families in the next 6 months because allocations are going to be based on historic practice and expenditure trends. Counties could potentially experience cost overruns if they project significant utilization in the last 6 months of the year.

System Chart/Design: ODDS distributed a revised chart/system design. See handout. This reflects the compromise reached during the January 11th UA meeting. Under this design both targeted case management and title XIX administration are used as funding sources for staff and service activity at the County. Brokers and support services activity are funded under the waiver.

County provides:
• Eligibility Determination
• Referral
• CM for Comprehensive Services
• Family Support for Kids
• Regional Crisis/Diversion
• Title XIX Administration – plan approval and waiver applications
• Protective Services
• Comprehensive Services (Group Homes, Foster care, SPL, )

Brokerages Provide: (Counties can also provide this if there are no interested providers)
• Support Services/Personal Agent Services
• Fiscal Intermediary Services


Kids case management is funded under targeted case management is only for kids who are Medicaid eligible. Kids who are not Medicaid eligible will have case management funded with General Fund dollars.

Much more discussion needs to occur on how an individual can exercise choice in the selection of the "provider" of supports. Also how an individual can move from one structure to another.

Allocation Plan: A draft allocation plan was handed out. On the caseload page (pgs. 6 and 7) the Family Support numbers are based on the State’s caseload which equal the total kids allocation divided by $400 (dollars per child per month) and then distributed based on a per capita distribution by County.
This number is not intended to reflect the number of kids in case management. Kids are defined as everyone 18 years old and younger.

QA positions were funded at the County. This should not be interpreted as intead of a QA role that current SDS groups might assume. Local SDS groups could be doing QA activities. The County QA positions will look at all community based services as required by HCFA. The focus will be on Medicaid compliance as opposed to customer Satisfaction. James acknowledged the imbalance since funding was not offered to the local groups or brokerages for QA activities.

Allocations do not reflect GF contributions made by Counties to their individual budgets. Allocations also do not reflect FTE doing activities that support case management activities other than clerical and supervision.

THE HANDOUT REFLECTS PROJECTED REVENUE AND RATIOS AFTER FULL IMPLEMENTATION OF UNIVERSAL ACCESS. IT IS NOT INTENDED TO REFLECT CURRENT FUNDING LEVELS AT THE COUNTY OR HOW RESOURCES ARE DEPLOYED AT THE LOCAL LEVEL.

There was a group consensus that 30% utilization of fiscal intermediary services was too low. Brokers currently in the system believe it will be much higher, especially because the tax threshold for families is so low and there will be more funding available under universal access.

Previously, the group recommended that the case ratios for personal agents/brokers not be beyond 1:35 or 1:40. There was concern that the proposed ratios are beyond what families and self-advocates feel is manageable. ODDS explained that there are unique issues related to both the support service group and the comprehensive group. This is a difficult balance because of the relationship in the budget between those positions. There was significant discussion in the group about the needs of individuals in both service systems. Mike reminded us that this is an allocation METHOD which means what the actual resulting ratios are will vary depending on cost of positions at the local level and where RFP respondents might decide to cut costs to provide with relief. There are significant burdens placed on brokers because individuals are spread out and may have many aspects of their plan that require monitoring. Kristen explained that she could be developing and monitoring 3 or 4 separate contracts for an individual. Jack shared that the equivalent of this on the comprehensive side is protective services,
monitoring foster care and monitoring licensed 24-hour homes that are not doing well.

There continues to be strong disagreement on the proposed ratios. This allocation plan is designed to explain and show rationale for how money was distributed.  It is not intended to dictate the model by which services will be delivered.

We need to be mindful that the transition will be bumpy. It will be some time before the ratios identified on paper will reflect our practice. The administration of brokerage activities and services are not funded out of available service dollars. This is a change from the practice under SDS. There is a firewall between administrative and service dollars at the brokerages so that client service money will not be jeopardized. It also means that an individual's ability to choose administrative structures will be more difficult because the money for their service coordination will be tied to a structure.

In review of our November minutes, this group had asked ODDS to keep brokerage ratios at 1:40 and comprehensive ratios at 1:55. Jack was asked to run these numbers for the group.

Mary Lee explained the hydraulics of the budget. If you look at the total administrative dollars available there are places where the budget has more flexibility. We need to be careful that we don’t get stuck in the presentation of the dollars as being reflective of the actual cost of
delivering services.

There was a clarification that ratios are based on an expected number of individuals worked with annually. Some may have significant needs every month. Others may have one-time only or infrequent needs that are less intense. We agreed to continue this discussion at the next meeting.

RFP Process: See handout. Mike presented a concept outline regarding the RFP.
The three questions we need to address are:
1   Does the RFP clearly outline expectations of person receiving the contract?
2   Does the group responding have enough information to respond or self eliminate based on ability?
3   Will the response have enough information for reviewers to make a reasonable decision about who should be awarded the contract?
Mike walked us through the draft outline. This group did not review the completed outline with the specific questions because some of the members of the group could be potential respondents.

There will be specific questions to address the issue of local governance and local capacity as it pertains to a catchment area. For example, in Eastern Oregon, the catchment area IS the minimum number in the model brokerage. If some agencies are only interested in developing parts of the system i.e.: fiscal intermediary services, there will still need to be a responsible party
(respondent) who agrees to take responsibility contractually for the total catchment area.

Jack will be attending the MH Directors meeting to discuss County procurement issues – specifically requesting that Counties accept the results of the Statewide RFP in lieu of their local contracting process. This was done under CIP V.

Local SDS group representatives expressed concerns that the outline does not specify a requirement for respondents to work with local SDS groups even though it does ask a question about the relationship between those two entities. It is important to clarify that we are not saying local SDS groups need to continue in their CURRENT role or function, but rather respondents
should connect with and benefit from the work of local groups and indicate how they intend to include that in the delivery of services.

Our projected timelines are (see handout) that interest letters will go out February 15th. Letters of interest are due by March 7. RFP will be mailed on April 13. There will be a bidders conference on April 24. Review panels will then be selected and responses will be scored during June. Review panels will be made up of a core group of conflict free individuals who were trained to review these RFP along with local representatives who would augment the core
group when reviewing local plans. Awards will be made July 6. During March and early April ODDS hopes to facilitate discussion among respondents to develop partnerships, encourage development in some areas, encourage collaboration etc. ODDS is thinking about offering technical assistance dollars and start up money to encourage these discussions locally.

The RFP will fulfill two purposes. It will identify those entities who are qualified/certified to deliver the service and it will award a contract to some or all of those organizations. If an individual consumer requests a certified entity as a provider of their services, while the entity may not hold a contract, it is still technically eligible to provide services if
requested.

Our next meeting is on February 28th from 10:00 to 4:00 at OTAC. Small group discussions will be from 8:30 to 10:00 AM.

Future meeting dates are Tuesday March 6 from 12-3 – parking lot discussion

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