Staley Implementation Group Meeting Previous Meeting  Next Meeting
Official Minutes
January 11, 2001
Summary
Representatives: Marsha Clark, Cynthia Owens, Dianne Duersheidt, Howard Klink, Joanne Fuhrman, Beth McHugh, Diann Drummond, Judy Cunio, Tim Kral, Tara Asai, Cindy Helvington, Kathryn Weit, Mary Lee Fay, Joe Carroll, James Toews, Charlie Hammett, Kent Layden (Facilitator)
Observers/Alternates: Sarah Jane Owens, Paul Partridge, Mike Maley, Charlotte Duncan, Dayna Davis, Jack Morgan, Laurie Lindberg, Bev Herron, Nancy Hazelett, Tom Giles
Agenda:
1. Introductions
2 Announcements
3. Meet by interest groups:
Debrief yesterday:
What did you hear?
o Broker/case manager
o Self direction specialist
o Medicaid
Burning Questions
Recommendations from group
1. Announcements:
· Bobby Mink has been appointed interim director of DHS· Request from OTAC - To help with the maintenance of our meeting room, please pick up trash, put soda cans in the recycle box, and pick up or clean up spills. Thanks.
· Pictures of the group will be taken for Clarion.
· The group is concerned about the information we received that those reviewing our waiver probably will not understand Oregon or where we are coming from nor will they care much about the principles and values behind the waiver. So how do we (or can we) impact their decision making process?
· It was suggested that the DD Coalition form a group to talk with Senators Smith and Wyden in preparation for our waiver application. This is in response to what we heard yesterday on the way waivers are approved in Baltimore.
· Kathryn passed out information on the current waiver that included a summary of the HCB and definitions of services that are in our current waiver. She suggested that the group review the current definitions as a starting place to understand what needs to be broadened or changed for new waiver.
3. Debriefing Yesterday: Interest Groups met to debrief yesterday's discussion using the above questions. Each group identified critical issues that we want to be sure are considered in the waiver and state policy.
Discussion:
· Request to get information on how state systems work. A feeling that we may not have all the information about how the state works to enable us to make good decisions.
· Some felt it was important to debrief what was heard and what we felt at the same time. A feeling among some that yesterday's meeting was not as open and that the information had an impact on the group. There is general feeling in the group that we may not have finished the discussion of yesterday.
· Report from Interest Groups (listed as discussed but not necessarily agreed to by the group):
Self-Advocates / Families / Advocates Group:
What did you hear?
- Best to do broad array of services with dollar cap.
- There is a potential conflict with HCFA with the direction we have been going trying to separate duties between CM and Broker.
- If someone becomes a qualified provider then the individual can choose.
- The State has some concern about accountability with large number of qualified providers.
- Choice is an important part of a Medicaid program
- State is willing to push with waiver application even if it may get rejected as written
- There is something called Community Standards. May want to have a local board to review some expenditures.
- TCM, Administrative, Waiver - billing for CM/Broker can't duplicated.
- Current system of comprehensive services is not being addressed re: brokers, choice, etc.
Burning Questions
- We would like to see a summary of pro & con of each model
a. from the perspective of consumers
b. state
c. county
d. choice / values
e. role of consumers in each model
- What happens to individuals who are not Medicaid eligible because of income?
- Where does consumer input/ oversight come in?
- How do we resolve county, state, consumer conflicts?
- How do we assure private sector participation?
- Who makers final decision about the system change?
- Is there money for private entity startup?
Recommendations:
- Q A must be a special meeting /topic - need a subgroup with representation from consumers and families
- Comprehensive (over $20,000) waiver needs to reflect some choice options
- Important to use the broadest array of service definitions as possible
- Residential offsets issues need to be resolved (VR, too)
- Grievance process - consumers need to know that it is there and how to use it
- Need to have options in system other than current system
- Stay the course with the vision and values!! (message to state)
- Self Direction = values all consumer choice and participation at every level
- Responsive, responsible, and accountable to consumer
- Oversight boards 51% consumers
- There should be allocation for each community for capacity building
- Need to assure that we have technology to support individual budgets/vision
Other Group:
What did you hear?
- People couldn't be as open as in the past meetings.
- We need to understand the political background.
Burning Questions:
- Want to see an actual cost estimate for using county CM and private SD specialist.
- Want more clarification on RFP/RFQ issue revolving around SD specialist/broker role.
Recommendations:
- Need to form group to resolve DD/VRD waiver issue - DeAnna, Milly, JoAnne S.Debra M, Kathryn, Cynthia
- Need to form group of DDS staff and a few select knowledgeable UA members to write waiver - explore definitions for waiver
- Use electronic solution for accounting to eliminate double billing problem rather than solve it through defining different roles.
County Directors/Managers:
What we think we heard:
- There has to be a clearly defined distinction between TCM and waivered services
- Oregon has historic and current problems with waiver approval. This complicates our task.
- Both plans A & B support consumer choice in different ways.
- We should write it the way we want it based on our values and reality.
- We agreed to a broad based service definition maximizing choice and flexibility with caps on expenditures.
Burning Questions:
- How do we define the functions to make the system work?
- How do we develop and operate community standards?
- How do we ensure/maximize consumer choice, ease of understanding the system, quality of service, access, fairness/equity/ consistency?
Recommendations:
- The matrix needs more work (3 weeks to go….)
- Recognize and use Robyn's information and recommendations, but…
- Write the waiver the way we want it - based on our values and reality.
Case Managers :
Recommendations/ Burning Questions / What we heard
1. Ability to directly pay parents/relative foster care
2. Clarify issues re: VR
3. Maintain and/or increase voice/power of local planning committees. If more responsibility remains at county how can local communities increase voice in government operations?
4. If we need to rework matrix, roles need to be identified and understood by everyone. Clear delineation of responsibilities
5. How do we address equity with individuals who are starting with nothing?
Providers - Burning Questions:
Address the following questions:
1. Offsets - any relation to waiver? What to do to fix?
2. $7/month room and board - how to increase
3. CM/Broker/Self Directed Specialist:
Who decides public or private?
Why decision to stop with "A"?
What happens if A fails?
How does A avoid problems of B?
4. DHS Reorganization - Regions LTC - keeping DD whole
5. Broker/Provider vs. separate entity (cost etc.)
6. Impact on comprehensive system
Funding streams - flex
Slot conversion
7. Rate restructuring (comprehensive)
8. VR and DD
9. Local/Regional input/control
10. Employment focus
New Proposal:
James and ODDS staff met with Robyn this morning and further developed Scenario A and think that it may have more possibility to satisfy HCFA.
Scenario -"Beyond A" or A+
Administration:
- Intake
- Eligibility
- Referral
- QA
County: Targeted Case Management
- Case Management for Comprehensive Services
- Kids and Family Support
- Long Term Diversion
- CM for people not in service
- Protective services
County / Private - Title IXX Administration
- Plan Review
- Plan Approval
- QA
- Support Services-personal agent
· Need to assure Medicaid that there is freedom of choice and fair and equitable decision-making process.
· No requirement in Medicaid that you have to fund an unlimited pool of providers. The state would still need to contract based on capacity. An entity can be "qualified" but not have a contract. Choice does not always translate immediately into more options. Capacity will be a big issue - choice means little if there is no place to go.
· State does lose some match capability under this new plan on the support services side - Title 19 Administration billing vs. the TCM billing.
· Recommendation from Robyn: Get the word "broker" out of our vocabulary for HCFA. It is hard for them to understand. By changing to another term such as "personal service agent" (or something else we can agree to) it will be clearer to HCFA based on what they understand.
· Kids - Kathryn wants to have a larger discussion on the "choice issues" for kid's case management. Medicaid and non-Medicaid - should they all be case managed by the counties? Why not use the current SDS model - moving the "Kids - Family Support" to the support side. Family Support pool of dollars could be moved to the Support Services organization. (i.e. a support org. managing the waiver services for adults and a pool of state general fund for kids flexible services.) Personal care would have to remain with the counties.
· RFP - There is an assumption that there will be local or regional groups reviewing RFP's for their areas.
A general comment: Thanks to the state for this process and for being flexible and able to respond to our concerns and comments in a productive, collaborative way.
Group Agreement: The group agrees that Scenario - Beyond A seems to be the best at this point.
RFP Discussion:
· The group will give Mike Maley input and feedback today to assist him in writing the guidelines for the RFP.
· Mike: 3 perspectives we want to convey
1. What are we wanting to convey to responders and what are we expecting
2. Enough information for entity to assess if they can do it
3. Ability from response to assess if they can do it.
· Large Group discussion on RFP
Assumptions:
o Certain functions must be performed by government
o Lawsuit encourages increased private sector participation
o Choice is required by Medicaid
o Self-determination principles and values must guide all decisions and these must be clearly reflected in the RFP.
o Local groups do not have the option to limit the choice of the individual in selection of provider if that provider is qualified (fee-for-service)
o Local planning group may recommend to the Medicaid agency which applicants
should receive a contract for capacity in their region from a list of
pre-qualified providers
o Provider qualifications must be spelled out in the waiver (so changes to qualifications would require a waiver change.).
o Self-advocates and families must be involved in all aspects of the process
o Qualifications should limit the field by not discourage the field
o Regions are not driving the process
o We will not exclude new and emerging organizations
o We have a minimum and maximum size of organization
o All services requested will be defined in the RFP
o Must reflect the 4 Principles of Self-Determination and the 7 Key Elements to Support Services
o Agencies can partner to provide full-service brokerage services but one agency must be the lead agency
What are we RFPing for?
o Full-service brokerage services - 7 Key Elements to Support Services
o Will provide services to all eligible consumers
Who:
o Entities (public/private) only (must have governing body)
o Qualified entities only
Process
o Who will write? - Mike will draft RFP with input from UA Committee
o Who will review?
o Who will select qualified providers?
What should the qualifications of the provider be?
o Overall program is overseen by an overall governing or policy group that is, at a minimum, 51% consumers and families
o Require meaningful participation in the governance of the program and give extra points to those who demonstrate the 51% governance.
o Agencies are committed to moving in a direction to demonstrate full participation of consumers and families
· Question: What are we looking for when we write an RFP? (See Mike's questions) Where does increasing capacity fit in? Who can apply?
Assumption: At this point we need to make an assumption that we don't know all the answers. What we recommend from this group could be applied to either a single county, regional, or statewide RFP. Regions are not driving the process.
Mike: If the proposal represents 100% DD services, then the expectation is that 51% of the governing board must be consumers and families. If the organization is a blend of service delivery to many populations, then it would be required that there be a guidance group that has decision-making authority that meets the 51% requirement.
· Mike: Will take information from group and add to his brainstorm of things that should be included in RFP. Including:
Organizational governance and oversight
"System" organization/oversight/planning
Geographic catchment area
Ultimate size and scope of activities
How this relates to CMHP or multi-county affiliation
How relate to local SDS program/groups
How relate values of SDS/self-determination
Use of "community" partners, if any
What functions and how it's implemented
How "regulated" (Licensing, etc.)
Contracts held where?
Data Collection, information systems
QA
"Local" brokering
General structure
Cash flow management
Fiscal status and stability and how relates to what
Organization history and how it relates
"Firewall" - "independent" and "autonomous"
Who are key staff and their qualifications?
Key relationships with others
Administrative/fiscal capacity
Ability to handle multiple contracts
Self-determination values
Cultural competency
How to weight the qualifications (points system)
How to deal with grievances and appeals
Will support people who have been deemed eligible for services (can't say no)
Meets applicable OARs
How to handle training and technical assistance
Budget - start-up / operations
Understanding of roles
Understanding of philosophy
Size and scope of services
Implementation schedule
Home Health Care Organizations
Rules are being developed to review and regulate organizations that provide "in-home" caregivers. Originally was targeted to temporary agencies but there are efforts to make the rules broader and they may have some effect on some of the groups that serve people with developmental disabilities. This will be effective July 1, 2001. At the same time DD will come up with rules that will cover our in-home staff. DD office will have a rule advisory committee to help write our guidelines or we will be regulated under the rules of the state commission.
Desired Sub-Groups:
· Base/Base+: Kathryn, Cynthia, Joanne, Howard, Kristin, Dave White, Beth, Jessica or Sue from Clackamas Cnty, Tara, (Tina will convene) (Get info from Matrix Group), Deb McClain
· VR/DD Group: Tim will nominate from ORA
Cynthia, Debra, Molly, Kathryn, Debra M, JoAnne S.
(Cynthia will coordinate) Report at next meeting
· Matrix Review Group: Report at our next meeting - this group has completed its work at this time.
· 50 Families Group: DeAnna Hartwig, Mary Lee (convener), Beth, Cynthia, Katherine, Dianne
Parking Lot: Guidelines for Local Planning Groups
The group, as a whole, found the process of these two days helpful and feel that the plan is beginning to take shape. There is general agreement that the group is really beginning to work together as a team.
Suggestions: Change name of Scenario - "Beyond A" to "A +"
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Summary of Notes Top of Page
January 11, 2001
Representatives: Marsha Clark, Cynthia Owens, Dianne Duersheidt, Howard Klink, Joanne Fuhrman, Beth McHugh, Diann Drummond, Judy Cunio, Tim Kral, Tara Asai, Cindy Helvington, Kathryn Weit, Mary Lee Fay, Joe Carroll, James Toews, Charlie Hammett, Kent Layden (Facilitator)
Observers/Alternates: Sarah Jane Owens, Paul Partridge, Mike Maley, Charlotte Duncan, Dayna Davis, Jack Morgan, Laurie Lindberg, Bev Herron, Nancy Hazelett, Tom Giles
1. Announcements:
· The group is concerned about the information we received that those reviewing our waiver probably will not understand Oregon or where we are coming from nor will they care much about the principles and values behind the waiver. So how do we (or can we) impact their decision making process?
· It was suggested that the DD Coalition form a group to talk with Senators Smith and Wyden in preparation for our waiver application. This is in response to what we heard yesterday on the way waivers are approved in Baltimore.
2. Debriefing Yesterday: Interest Groups met to debrief yesterday's discussion.
· Report from Interest Groups (listed as discussed but not necessarily agreed to by the group):
Self-Advocates / Families / Advocates Group:
Burning Questions
- We would like to see a summary of pro & con of each model
a. from the perspective of consumers
b. state
c. county
d. choice / values
e. role of consumers in each model
- What happens to individuals who are not Medicaid eligible because of income?
- Where does consumer input/ oversight come in?
- How do we resolve county, state, consumer conflicts?
- How do we assure private sector participation?
- Who maker final decision about the system change?
- Is there money for private entity startup?
Recommendations:
- Q A must be a special meeting /topic - need a subgroup with representation from consumers and families
- Comprehensive (over $20,000) waiver needs to reflect some choice options
- Important to use the broadest array of service definitions as possible
- Residential offsets issues need to be resolved (VR, too)
- Grievance process - consumers need to know that it is there and how to use it
- Need to have options in system other than current system
- Stay the course with the vision and values!! (message to state)
- Self Direction = values all consumer choice and participation at every level
- Responsive, responsible, and accountable to consumer
- Oversight boards 51% consumers
- There should be allocation for each community for capacity building
- Need to assure that we have technology to support individual budgets/vision
Other Group:
Burning Questions:
- Want to see an actual cost estimate for using county CM and private SD specialist.
- Want more clarification on RFP/RFQ issue revolving around SD specialist/broker role.
Recommendations:
- Need to form group to resolve DD/VRD waiver issue - DeAnna, Milly, JoAnne S., Debra M, Kathryn, Cynthia
- Need to form group of DDS staff and a few select knowledgeable UA members to write waiver - explore definitions for waiver
- Use electronic solution for accounting to eliminate double billing problem rather than solve it through defining different roles.
County Directors/Managers:
Burning Questions:
- How do we define the functions to make the system work?
- How do we develop and operate community standards?
- How do we ensure/maximize consumer choice, ease of understanding the system, quality of service, access, fairness/equity/ consistency?
Recommendations:
- The matrix needs more work (3 weeks to go….)
- Recognize and use Robyn's information and recommendations, but…
- Write the waiver the way we want it - based on our values and reality.
Case Managers :
Recommendations/ Burning Questions
1. Ability to directly pay parents/relative foster care
2. Clarify issues re: VR
3. Maintain and/or increase voice/power of local planning committees. If more responsibility remains at county how can local communities increase voice in government operations?
4. If we need to rework matrix, roles need to be identified and understood by everyone. Clear delineation of responsibilities
5. How do we address equity with individuals who are starting with nothing?
Providers - Burning Questions:
Address the following questions:
1. Offsets - any relation to waiver? What to do to fix?
2. $7/month room and board - how to increase
3. CM/Broker/Self Directed Specialist:
Who decides public or private?
Why decision to stop with "A"?
What happens if A fails?
How does A avoid problems of B?
4. DHS Reorganization - Regions LTC - keeping DD whole
5. Broker/Provider vs. separate entity (cost etc.)
6. Impact on comprehensive system
Funding streams - flex
Slot conversion
7. Rate restructuring (comprehensive)
8. VR and DD
9. Local/Regional input/control
10. Employment focus
New Proposal:
James and ODDS staff met with Robyn this morning and further developed Scenario A and think that it may have more possibility to satisfy HCFA.
Scenario -"Beyond A" or A+
Administration:
- Intake
- Eligibility
- Referral
- QA
County: Targeted Case Management
- Case Management for Comprehensive Services
- Kids and Family Support
- Long Term Diversion
- CM for people not in service
- Protective services
County / Private
- Title IXX Administration
- Plan Review
- Plan Approval
- QA
Support Services
· Need to assure Medicaid that there is freedom of choice and fair and equitable decision-making process.
· No requirement in Medicaid that you have to fund an unlimited pool of providers. The state would still need to contract based on capacity. An entity can be "qualified" but not have a contract. Choice does not always translate immediately into more options. Capacity will be a big issue - choice means little if there is no place to go.
· State does lose some match capability under this new plan on the support services side - Title19 Administration billing vs. the TCM billing.
· Recommendation from Robyn: Get the word "broker" out of our vocabulary for HCFA.. By changing to another term such as "personal service agent" (or something else we can agree to) it will be clearer to HCFA based on what they understand.
· Kids - Concern about the "choice issues" for kid's case management. Medicaid and non-Medicaid - should they all be case managed by the counties? Why not use the current SDS model - moving the "Kids - Family Support" to the
support side. Family Support pool of dollars could be moved to the Support Services organization. (i.e. a support org. managing the waiver services for adults and a pool of state general fund for kids flexible services.) Personal care would have to remain with the counties.
· RFP - There is an assumption that there will be local or regional groups reviewing RFP's for their areas.
A general comment: Thanks to the state for this process and for being flexible and able to respond to our concerns and comments in a productive, collaborative way.Group Agreement: The group agrees that Scenario - Beyond A seems to be the best at this point.
RFP Discussion:
· Mike: 3 perspectives we want to convey
1. What are we wanting to convey to responders and what are we expecting
2. Enough information for entity to assess if they can do it
3. Ability from response to assess if they can do it.
· Large Group discussion on RFP
Assumptions:
o Certain functions must be performed by government
o Lawsuit encourages increased private sector participation
o Choice is required by Medicaid
o Self-determination principles and values must guide all decisions and these must be clearly reflected in the RFP.
o Local groups do not have the option to limit the choice of the individual in selection of provider if that provider is qualified (fee-for-service)
o Local planning group may recommend to the Medicaid agency which applicants should receive a contract for capacity in their region from a list of pre-qualified providers
o Provider qualifications must be spelled out in the waiver (so changes to qualifications would require a waiver change.).
o Self-advocates and families must be involved in all aspects of the process
o Qualifications should limit the field by not discourage the field
o Regions are not driving the process
o We will not exclude new and emerging organizations
o We have a minimum and maximum size of organization
o All services requested will be defined in the RFP
o Must reflect the 4 Principles of Self-Determination and the 7 Key Elements to Support Services
o Agencies can partner to provide full-service brokerage services but one agency must be the lead agency
What are we RFPing for?
o Full-service brokerage services - 7 Key Elements to Support Services
o Will provide services to all eligible consumers
Who:
o Entities (public/private) only (must have governing body)
o Qualified entities only
Process
o Who will write? - Mike will draft RFP with input from UA Committee
o Who will review?
o Who will select qualified providers?
What should the qualifications of the provider be?
o Overall program is overseen by an overall governing or policy group that
is, at a minimum, 51% consumers and families
o Require meaningful participation in the governance of the program and give extra points to those who demonstrate the 51% governance.
o Agencies are committed to moving in a direction to demonstrate full participation of consumers and families
· Question: What are we looking for when we write an RFP? (See Mike's questions) Where does increasing capacity fit in? Who can apply?
Assumption: At this point we need to make an assumption that we don't know all the answers. What we recommend from this group could be applied to either a single county, regional, or statewide RFP. Regions are not driving the process.
Mike: If the proposal represents 100% DD services, then the expectation is that 51% of the governing board must be consumers and families. If the organization is a blend of service delivery to many populations, then it would be required that there be a guidance group that has decision-making authority that meets the 51% requirement.
· Mike: Will take information from group and add to his brainstorm of things that should be included in RFP. Including:
Organizational governance and oversight
"System" organization/oversight/planning
Geographic catchment area
Ultimate size and scope of activities
How this relates to CMHP or multi-county affiliation
How relate to local SDS program/groups
How relate values of SDS/self-determination
Use of "community" partners, if any
What functions and how it's implemented
How "regulated" (Licensing, etc.)
Contracts held where?
Data Collection, information systems
QA
"Local" brokering
General structure
Cash flow management
Fiscal status and stability and how relates to what
Organization history and how it relates
"Firewall" - "independent" and "autonomous"
Who are key staff and their qualifications?
Key relationships with others
Administrative/fiscal capacity
Ability to handle multiple contracts
Self-determination values
Cultural competency
How to weight the qualifications (points system)
How to deal with grievances and appeals
Will support people who have been deemed eligible for services (can't say no)
Meets applicable OARs
How to handle training and technical assistance
Budget - start-up / operations
Understanding of roles
Understanding of philosophy
Size and scope of services
Implementation schedule
Home Health Care Organizations
Rules are being developed to review and regulate organizations that provide "in-home" caregivers. Originally was targeted to temporary agencies but there are efforts to make the rules broader and they may have some effect on some of the groups that serve people with developmental disabilities. This will be effective July 1, 2001. At the same time DD will come up with rules that will cover our in-home staff. DD office will have a rule advisory committee
to help write our guidelines or we will be regulated under the rules of the state commission.
Desired Sub-Groups:
· Base/Base+: Kathryn, Cynthia, Joanne, Howard, Kristin, Dave White, Beth, Jessica or Sue from Clackamas Cnty, Tara, (Tina will convene) (Get info from Matrix Group), Deb McClain
· VR/DD Group: Tim will nominate from ORA
Cynthia, Debra, Molly, Kathryn, Debra M, JoAnne S.
(Cynthia will coordinate) Report at next meeting
· Matrix Review Group: Report at our next meeting - this group has completed its work at this time.
· 50 Families Group: DeAnna Hartwig, Mary Lee (convener), Beth, Cynthia, Katherine, Dianne
Parking Lot: Guidelines for Local Planning Groups
The group, as a whole, found the process of these two days helpful and feel that the plan is beginning to take shape. There is general agreement that the group is really beginning to work together as a team.
Suggestions: Change name of Scenario - "Beyond A" to "A +"
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