Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
February 27, 2004

Participants: Mary Lee Faye, Pat Allen, Caryl Knudsen, Mike Maley, Tom Giles, Cindy Helvington, Pam Ring Dayna Davis, Nancy Hazelette, Judi Cunio, Tim Kral, Kathryn Weit, James Toews, Molly Holsapple, Arlene Jones, Cynthia Owens, Kristin Ahrens, Pam Ring, Bev Herrin, Dan Peccia, Jessica Leitner, Bill Lynch (facilitator)

Alternates: JoAnn Furhman, Janet Straw, Tara Asai, Howard Klink, Danna McFerrin (Dayna's PA)

Agenda: Introductions and Updates

• DHS/SPD Budget
• Base/Base Plus Updates
• Dual Waiver Updates

• Staley progress report
• Stakeholder perspective
• Support waiver
• PSI in family home
• VR/DD workgroup
• PA/Support Specialist Training
• Resource/Benefits Analysis

• Perceived loss of services/voc only?
• Day services transportation

• Priorities
• QA oversight by SIG
• CMSW QA grant
• CMS waiver monitoring
• Brokerage site reviews
• Consumer satisfaction survey feedback

• paperwork general - too much, too little, what is essential?
• Base plus
• Rates for vocational providers.
• Revisions via amendment to the waiver

• Staley progress report:
  Mike distributed the update to the group. It was also sent our in advance of the meeting over email. Questions should be directed to Mike. He also distributed information about annual plan amount. The average cost is between $6000 and $9600 per year or $670 per month. This includes base plus recipients. This number is fluid because people are constantly revising their plans. The percentage of brokerage clients on the waiver is 84%. That means about 16% are GF only. The data is best used for looking back at what has happened, and not very useful for projecting further expenditures. The next report will be issued in September 2004.
• Stakeholder perspective:
  Brokerages distributed recommendations they have developed about caseload size and paperwork requirements. This is affecting the availability of person centered planning time. Only about 25% are getting a full futures plan. No one who requests one is not getting one. Some of this is due the availability of time but the forms themselves are very complicated and even small changes to individual plans require multiple forms. There continues to be confusion over the roll of the PA and the voc provider in the transfer of individuals between those programs. Some of this will be resolved through the rule process. Families shared that they also have a ton of paperwork they have to read and sign. This can be overwhelming at first. Some families have exited the brokerage because it just wasn't worth it to them. One of the large impacts on PA's time is the individual contracting piece. This has to be changed every time there is a change. Providers shared that paperwork is an issue for them as well. The problem is not unique to anyone in the system. Everyone is feeling like they are not able to put their efforts into areas that matter, such as working with individuals and their families.
  
  Counties reported that they are still wanting training on the in home over 20K families. This is scheduled to take place around the state in Feb, March and April. Counties also reported that they would like to increase enrollment to the brokerages since they are behind on the waitlist roll out due to the freeze.
  
  Families shared that they will be collecting information from those people who participated in the voc only transfer. They want to know how the transfer impacted lives. They plan to share this information next month. Molly shared that the rate setting group for the voc transfer also developed survey questions to ask those that had to reduce services. The survey has not been distributed because those affected won't experience the reduction until after June since they were allowed to maintain the full benefit for 365 days.
  
  The group reviewed ORA's findings for the impact of the voc transfer. Overall there is a loss of funds for vocational providers that will weaken the stability of the provider system overall. In some cases the providers are giving the same service to the same clients as before but for as much as 30% less. Some rate adjustments have been made since this data was collected. That may help some. Providers want to provide the service that is requested of them. But they are staffing to cover the work with no reimbursement for vacant days.
• Support waiver:
  SPD reported that the support services waiver was submitted with very few changes and all of them were technical. A summary of the requested changes was distributed. The reason the requested changes are not being made is that we can make changes to it using the amendment process once it is approved but major changes before submission could have triggered a full review.
• PSI in family home:
  A workgroup is meeting to revise the material distributed to investigators as well as organizing training for PA's etc. The group is also looking at SERT and I/Rs. The group will be meeting for a while and minutes are available. There are a number of complex issues related to this including how we inform families of their responsibilities when accepting services and the expansion of the family home as a service setting.
• VR/DD workgroup:
  Representatives reported that the workgroup is making progress. There are several small subgroups that are working separately and brining their work back to the group. The outcome will be a set a policy recommendations and guidelines to go out to VRD and Brokerages for how to work together in the future. The material will need to be reviewed by the larger community before implementation. There is no self-advocate on this committee at this time.
• PA/Support Specialist Training:
  SPD distributed a handout of the outline for the joint training with County CM's and PA's. The goal of this training is to connect the two entities and provide general instruction. There will an opportunity to generate a list of things to be covered or clarified later. One session was completed earlier this week in Marion County. There was good feedback from participants. Families asked if there would be something similar offered for families, at this time there is no plan for this.
• Resource/Benefits Analysis:
  No new information is available on this topic. Mary Lee reminded everyone that Medicaid eligibility is dependent on financial status (SSI or percentage of SSI eligibility). In Oregon it is 300% of SSI eligibility. For anyone who has between 100% and 300% they have to first use their resources before Medicaid will pick up the cost of any services. We commonly refer to this as offsets. In Support Services, we still have to meet this expectation and have proposed a different process then having the individual make a payment direction to SPD of the difference. Rather, SPD is proposing some resource analysis and needs to set up some examples to send to CMS to see if they would approve the practice. The process would include getting the offset amount from the local DSO (completes financial eligibility) and giving that information to the Brokerage. The PA's would then have that amount written on to the support services plan and demonstrate the use of these funds to contributing to the cost of one's care. CMS has raised a few questions. They are worried about accountability and how we will be able to prove the resources are being used as intended. The group discussed an example of how this would affect individuals at the brokerage. Although they would be required to contribute to the cost of their own care, they would not experience a reduction in the total benefit available. Oregon has some control of selecting the percentage of eligibility and the room and board amount but it impacts all waivers, not just DD. Therefore it is not an option to not collect the offsets. We need to develop capacity to develop PASS plans or IRWE expertise so that we can make sure we don't create a disincentive people from working.

• QA oversight by SIG: CMS says that QA activities need to be happening on all waivers. We are at different places in comprehensive services then we are in support services. SPD does not want the system so bifurcated that there is no continuity for what is happening in the State but rather wants to have information funned into a group that has total oversight. Mike shared a diagram that describes the SIG as a broad stakeholder group that gets information from an internal SPD QA committee which comes from support services data collected. This could include I/R's, SERTs, Provider Qualifications, Plan information as it relates to health and safety and consumer satisfaction. The SIG would review and comment, look for trends etc. and make recommendations for actions, priorities or other.
  
  Members of the group asked if this was a change in role for current group. It is to the extent that if formalizes a role of this group in an area that it has not been there before. There were a number of questions generated about what this change would mean. There is momentum gathering statewide with the implementation of QA systems at all levels.
  
  Any future agenda will need to include a placeholder for quality assurance. It would include some comprehensive information to the extent that it covers Comp 300 and those with support plans over 20K but the focus would need to be support services.
• CMS QA grant: Last fall SPD was awarded a grant through the Federal Real Choice Systems Change Grant. Mike passed out the abstract of the grant which was submitted. An RFP will be distributed next week for a contractor to implement the grant.
• CMS waiver monitoring: CMS was criticized last year for not having monitored wavered programs on site. Last summer CMS committed to reviewing every waiver that was up for renewal by June 04 and then realized that it could not be done. Oregon has three waivers up for renewal. CMS sent SPD a letter in Feb asking them to answer a self-assessment in order to determine if they will come out for an onsite review. One of the things they are looking at is how we are using the QA process to know what is going on. Many of the things happening already are part of that QA process. There will not likely be time for SPD to give that information to the SIG for review before it is submitted to CMS but they will give it to us at the next meeting.
• Brokerage site review: Site reviews were completed earlier this year and at the end of last. All brokerages had improved and all had certificates renewed. Mike passed out a summary what is going well and not well as evidenced by the review. Overall the reviews are very positive. The efforts that still need work are similar to those issues discussed today by the group. The brokerage talked about the reviews from their perspective. The review was not deep enough to capture some of the level of detail that would be needed to know what is really happening, both positive and negative.
• Consumer satisfaction survey feedback: Mike distributed the summary of the results of the satisfaction survey. There was a 43% response rate. Overall the summary results were very positive. There is evidence of relationship building happening between the brokerage and the individuals served. There were a number of surveys that were answered by someone other then the individual. Pam shared some feedback about the survey which was given to Mike. Any changes to the survey will come through the SIG before being implemented.

• paperwork general - too much, too little, what is essential? 1
• Base plus tool 7
• Rates/issues (vacancies) for vocational providers 9
• Transportation 2
• Revisions via amendment to the waiver 8
• Resource analysis 3
• VR/Dept of Ed 1
• Family Support 5
• Dual Waiver 1
• Data Systems (SERT, payment, CPMS) 0
• Quality Assurance 9
• Waitlist 0
• CMS Grants 0
• · Crisis 0

The next meetings will be on:
April 23, 2004 also at 9:30 at OTAC
June 25, 2004 also at 9:30 at OTAC

Jessica R. Leitner, MSW
Senior Program Manager

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