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Summary of Official Minutes
January 4, 2001
Representatives: Kristin Ahrens, Fred Renter, Tim Kral, Kathryn Weit, Charlotte Duncan, Cynthia Owens, Judy Cunio, Dianne Duerschiedt, Dana Davis, Tom Giles, Amber Pedia, Diane Drummond, Marsha Clark, Jessica Leitner, Jack Morgan, James Toewes, Kent Layden (facilitator)
Alternates and Observers: Nancy Hazelett, Roger Stanton, Vickie Storie, Donn Nelson, Mike Maley, Joe Carroll, Pam Ring, David Winters, David Bing, Paul Partridge, Roger Stanton, Laurie Lindberg, Howard Klink, Tara Asai, Cindy Applegate, Randy Fulhgum Beth McHugh, Cindy Helvington
Week In Review: Representatives presented their activities since the last meeting. Providers shared that there has been movement around the state regarding the definition of brokerages and the resulting impact to providers and the system. Consumers continue to advocate that representation at all levels by families and self-advocates must be maintained. The DHS reorganization is a major factor in the continued discussion of implementation of universal access.
Review Goals/Vision:
The group reviewed the key elements to support services
Freedom from conflict of interest
Flexible individual budgeting
Personally directed and controlled planning
Individual support brokerage
Autonomous fiscal intermediary
Meaningful activities/meaningful lives
System structure and function that supports self-determination.
Four principles of self determination
freedom
authority
support
responsibility
Existing Agreements: Handout reflects our discussions and agreements to date
(Separate e-mail)
Group Reports:
Matrix Group:
There were 22 core categories which are now being sorted into:
A. those activities that must be done by the Single State Medicaid Agency according to HCFA.
B those activities that CAN be done by the state Medicaid agency but don't have to be.
The information from the group will be given to our waiver specialists to integrate into a future waiver application.
The Base /Base + group did not meet.
Terms: Members of the group discussed the need to clarify terms. We are all using words that may have different meanings to us. See the attached glossary of terms the group has defined.(Separate e-mail)
Medicaid 101: Group reviewed information about the Federal Medicaid program, its origin and its purpose in preparation for Medicaid discussion next week.
Staley lawsuit was based on eligible individuals access to Medicaid funded services. States decide the service description and limitations. This is often based on available funding. To participate in the Federal Medicaid program, States have to contribute money to draw matching money from the Federal government. Waiver services are additional Medicaid services that State's can provide for individuals with long-term care needs. What we have historically funded is the result of decisions along the way, the State's values, available revenue etc. Robin Cooper (Medicaid expert) was contracted to research the broadest range of services available by combing through other State's waiver applications. We will be able to compare our current waiver definitions against other state's definition to seek the most expansive and inclusive definition possible. It was suggested that SDS consultants be polled to find out the top 5 individual or family requests that are NOT covered by Medicaid. We can discuss this list with Robin and figure out how to get these item included either by expanding the definitions or figuring out where they may fit in through interpretation.
Questions for Robin:
Offsets for residential services
How does our waiver interact with other waiver programs like the Employed Persons with Disabilities program? What are the other barriers that prevent us from being part of those programs? Robin will need to assist us with separating state DD program issues from Home and Community Based Waiver (HCBW) issues. For example, offsets are a State policy. If you have this policy you must apply it to the Medicaid program as well. You can't apply policies to your State general fund budget only.
DHS Reorganization:
The entire Department of Human Services is being reorganized. Four of the DHS departments (VR, Health, SDSD, Children) currently operate their own field structures with state employees. DD and MH have local county relationships. The expectation is that we will move to a single field structure with offices that are multi-service. Each field office will be under a single manager. Like functions such as intake and eligibility will be streamlined and share a common planning base.
Regions:
James reiterated that it is important to have large enough budget scenarios with a large enough geographic area to create a stable budget. This was the thinking behind establishing DD regions.
The Division heard from SDS boards and families about their concern over size of regions and ability to impact local decision making. The impending DHS reorganization will most likely result in a pairing between DD services and SDSD services in a new regional configuration. As a result, ODDS is considering that in the first 2 years of UA implementation, they might contract the settlement dollars County by County. Later in the implementation they could renegotiate regional allocations after the DHS reorganization is solidified. This does not prevent Counties and SDS groups who want to partner from doing so. James clarified that the Counties do have the legal authority to regionalize. If a County decides not to provide services the state has some options. They can bring in a private entity or they can operate it themselves, for example. Several questions were raised about the County's participation in decision-making around interested providers and regionalization. James reiterated the three ways the State could contract funds:
1. State sends money to Counties and Counties contracts with provider(s)
2. State sends money to a single county who contracts with a provider(s) serving several counties
3. State contracts directly with provider (State does not want to do this because of inflexibility in contract language, inability to make retroactive service payments etc.)
RFP Development
Local Planning groups will have complete participation in the Request For Proposals (RFP) process. This group (UA planning group) will help to draft the RFP. The responses will be evaluated to create a pool of qualified providers that can be given to local planning groups for consideration. The local groups will make the "selection" from the pool of qualified providers. These local groups need to have family and self advocate representation. The final part of the process is plan approval. Dianne pointed out that local groups need to be free to identify what they need in their area be it a brokerage, fiscal intermediary, or administrative oversight. At that point then the local groups would want to RFP for services that would meet that local need. Jack explained that the statewide RFP would demonstrate which agencies have interest and ability to provide any number of services up to and including full service brokerage.
Local Planning
The configuration of the local planning groups has not yet been determined. This will be included in the yet to be developed local planning guidelines.
Kids:
The State has had internal discussion and is not recommending a full-blown Medicaid program for kids. There will continue to be personal care services for Medicaid eligible kids. There will also continue to be diversion services and kids residential services. SDS plans written by June 30th will be honored for up to 12 months even if it extends beyond July 1. The State is recommending to the Universal Access Planning Group that there be a separate general fund pot of money for family support for all families. This would not be an entitlement. This would not limit services to just Medicaid eligible kids. It would allow us to be more flexible about supports
but with less money because we would not have the Medicaid match. A decision has not been reached to support this recommendation.
Slot conversion
Slot conversions will be treated as comprehensive services and are expected to continue as long as the needs of the individual are met.
Future Meeting Dates:
January 10, 2000
January 11, 2000
January 17, 2000
We also set the following meeting times.
February 7, 2001
February 28, 2001
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