Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
February 28, 2001

Representatives: Marsha Clark, Tom Giles, Cynthia Owens, Kathryn Weit , Nancy Hazelett, Pam Ring, Judy Cunio, Beth McHugh, Cindy Helvington, Kristin Ahrens, Dianne Deurscheidt, James Toewes, Jeanne Olsen, Tim Kral, JoAnn Furhman, Joe Carroll, Mary Lee Faye, Jessica Leitner, Kent Layden (facilitator)
Alternates and Observers: Anne Coffey, Bev Herrin, Roger Stanton, Mike Maley, Tara Asai, Charles Hemmett, Randy Fulghum, Lori Powers, Sandy Stewart, Laurie Lindberg, Fred Renter, Diane Drummond, DeAnna Hartwig, Howard Klink, Paul Partridge, Vickie Storie

Where are we? Status Issues? Timelines?
Mike Maley and Kent Layden are working on going through our minutes and preparing a summary to capture our progress. We will have further discussion at the next meeting and after the meeting of the Parking Lot committee.

There was a group consensus that all decisions we make within this group need to be checked against the principles of self-determination. These four principles should be our filter through which we consider everything before us: freedom, authority, support, and responsibility.

March  2001
Finish Waiver and submit by April 1, 2001
HCFA Protocol
ODDS tour around the state to discuss RFP
Identify persons to score RFP responses who do not have conflict of interest
April/May 2001
Rule Writing
Legislative Budget Process
RFP Underway April 12
Roll Out Dates
Kids work group initiated
June 2001
Adopt Rules
Continuing operations and budget finalization
Score and announce RFP results
Initiate Roll Out

Universal Access Activity: Pairs of two played out a scenario in which you had $100 to spend and 20 people to serve at different rates. Almost every group broke their budgets. This was to help people understand the difficulty in managing the limited resources across areas where there is a variety of needs.

Base/Base +: There were 8 recommendations that came from the subcommittee. The UA group reviewed these recommendations and commented. Some key recommendations that were different from what the UA group had previously discussed:
• Suggestion that only 2 levels rather than 3 levels of support.
• The scoring tool would be completed only if the results of the person centered plan indicates that the individual/family is requesting or needing more than the base level of funding.
• The subcommittee also recommended that someone other than the broker/case manager complete the scoring tool. This would make the results more objective since the individual would be more neutral.

The point was made that these recommendations do not sound very consumer/family friendly and that it is important that all information that is ultimately used and shared needs to use language and set a tone that is positive and respectful.

It’s a reality of having limited funding and a waiver/Medicaid system. We are in the position of having to find ways to justify saying "no" and limiting access to higher funding while at the same time finding ways to advocate for individuals/families to get what they need.  Advocates felt we need to insure there was a good appeals process so that individuals/families could have an
avenue to disagree with the results of the scoring tool.

There was significant discussion and brainstormed suggestions over the idea of having a neutral person conduct the assessment using the scoring criteria.

DECISION: It was agreed that if we have a neutral person conducting the assessment an advocate/broker/case manager will be present at the discretion of the family.

The issue in a nutshell: What circumstances need to exist for somebody to access above the base level of funding other than the fact that the base budget doesn’t meet your needs. Is it health and safety? Is it some other criteria? And how can it be uniformly decided upon and implemented? The answer to this question needs to be narrowly defined.

The tool was designed to answer this question. The needs of the individual, the needs of the caregiver and the individual/family circumstances are what is included in the scoring tool/assessment.
Summary of Base/Base + discussion:
•We want to make the Base portion of the budget as large as possible and very flexible in order to provide as many supports to as many people as possible.  The hydraulics of the budget are such that more people need to be funded at less than the average and a very few to be funded at above the average.
• We need advocates present during the assessment process.
• The language used on the recommendations sheet (and all materials) needs to be more consumer/family friendly.
• As we move into implementation we need to make sure we include local involvement.
• The "who" of who will be doing the assessment needs to be addressed as an implementation issue.

Medicaid Waiver: DeAnna distributed a DRAFT version of the service descriptions that would be included in our waiver. DeAnna has used language that the feds like and will accept. Most of the descriptions are standard descriptions of Medicaid approved services. She has also borrowed heavily from other State’s waivers. After review the group did a Q and A session. DeAnna agreed to check with HCFA on many of the issues presented. Small groups met and reported their feedback. The group will meet to review DeAnna's draft on March 8, 2001. She then plans to do a dry run of the waiver with our regional contact at HCFA. That way we can remove or reword items that will slow down the approval process. Whenever possible, she will
reference other State’s where similar language has been approved before.

The Role of SDS Groups:
Mike shared that in most situations a single brokerage will cover multiple counties. There are currently SDS programs going on and operations will continue, as we know them today for some time after July 1. But at some point in time, to be determined, the responsibility for children will transfer back to county programs in the places it is outside the county. There will be a
transition period but for all but 8 counties this will be transparent since those counties manage their SDS in house. AT that point the SDS program would continue but only serving adults. How long is a decision point that has to be determined. How we roll out universal access to adults will help to determine this timeline as well as what kind of response we get from the RFP.
Eventually, again at a date to be determined, services to adults will transition to the brokerage and Universal Access will be born! 

It is important that we minimize the number of transitions we expect families to make and that we don’t try and transition kids in the summer which is a particularly chaotic time for families. We also need to pay attention to the relationships that families have developed with their broker/case manager through SDS so that they can be maintained during and after the transition.

It is critical that we remember in implementation that regardless of who delivers the service that the service is the same and that they are flexible (evenings and weekends) and timely. The practice must match and reflect the values this group put forth.

Chicken and Egg Questions: Can’t decide when to roll out and where to roll out until you know who is available to deliver the service. Which means that the uncertainty will continue for a while. In the mean time STAY THE COURSE. Plan to deliver services or continue to deliver service through July 1. By then we will have a plan and ODDS can go around and talk to individual groups about the transition.

Mike will re do the handout to show what timelines and budget information we have for distribution at the SDS Quarterly Meeting in March. We need to continue to get accurate information out to folks, as more and more misinformation seems to be filtering down to consumers and family members. It is important that local SDS groups understand that when asking the question "where do I fit in in this process" there is no standard answer. How SDS
services look in each County is very different. Therefore how the transition will occur will look different in each County. What will be the same across the State is the outcome.

The RFP will require respondents to clearly identify how they link to all their community groups. This will include local SDS groups. The State will not prescribe how they do this. Respondents will have a requirement that respondents demonstrate the 51% representation by families and self
advocates.

Between the 7th of March and the 13th of April ODDS staff will meet with Letter of Interest Respondents to make sure that all the services can be provided and that all areas of the State are covered. Small pots of money are available to purchase facilitators if someone wants to take the lead in gathering multiple respondents together from a geographic area. This
information went out with the Letter of Interest and will go out again with the official list of respondents.

Next Meetings:

Tuesday March 6 10-3 for Providers Big Conference Room
Tuesday March 6 12-3 for Parking Lot Issues Room 6
Thursday March 8 10-12 for Waiver Discussion Room 6
Wednesday March 21 from 9-4 UA Full Group Big Conference Room
Wednesday April 11 from 9-4 UA Full Group Big Conference Room

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