Participants:  Bill Lynch (facilitator), Tara Asai, Judi Cunio, Christine (Judi's PA), Dan Peccia, Kathryn Weit, Cynthia Owens, Arlene Jones, Tim Kral, Caryl Knudsen, LaDonna Whitney, JoAnn Furhman, Mike Maley, Jessica Leitner, Bev Herrin, Scott Pelham, Susanna Vasquez. Mary Lee Fay, Molly Holsapple, Rod Branyan, Howard Klink

Agenda:

Introductions

Monitoring/Updates

*        Brokerage Directors

*        Report from Families

*        Enrollment Data

*        State Update on Budget and Policy

*        Issues - OAC

*        Base/Base Plus

*        Training

*        Waitlist

Strategic Planning

*        Workers Compensation

*        Waiver review process

*        Capacity

·        Group Living

·        Criminal Record Checks

·        Provider Rates

Quality Assurance

·        Update on Grant

·        CMS Materials

·        Field Audit

·        Schedule of QA data to present to group

Review Parking Lot Items

·         Set Agenda for August 18, 2004

Brokerage Report: Dan reported that there was nothing new regarding the issue with paperwork discussed at last meeting. The brokerages have been exchanging information and strategies to cut down on inefficiencies (Tom Raccioppo has been helping). There are legislative issues around control of the brokerage contracts. Brokerages have not decided how they will respond to this. They have been invited to present at the join Human Services Committee this September. Concerns continue around rates and the base plus tool. These issues will be discussed later in the meeting.

Family and Consumers reported that they are looking for additional family/consumer representatives, specifically people whoa re receiving brokerage services. There are questions about the issue of siblings caring for disabled siblings. An example was shared of a 66-year-old man who is caring for a 73 year old, older sister. Families asked Counties to report on how and when they communicate to families about how long they can expect to wait for services. Counties report and State agreed that there is no real way to accurately predict this since the number of enrollments allowed and the situations change.  Bev asked about the ability to backfill through attrition. This attrition was included in the budgeted and enrollment numbers. Families suggested that there be a script or uniformity between Counties on how information is shared. A recommendation was made that Counties develop written materials to distribute to families that would describe the general enrollment schedule and answer some basic questions about when they can expect to be served and the best method for continuing to check in with case managers. Brokerages also asked this information include what families can expect once referred. Counties will work on this with SPD. Families will be sending out specific questions approximately 2 weeks in advance to solicit input from a broader group. Families will report on the answer to this question at future SIG meetings. Families also request that materials for the meeting be sent out in advance of the meeting. If it is DRAFT or NOT FOR DISTRIBUTION it should be marked as such.

Enrollment Data:  Mike distributed enrollment data for the whole state. This information is presented by enrollment categories. He also presented the termination data. 258 people have left the brokerage since we started. There was discussion about the numbers of people moving in to comprehensive. The number is actually small on a statewide basis and does include the comp 300 families. This number likely reflects similar numbers to those people without services who go into crisis and access comprehensive services.

The revised agreement requires that 1000 people be "enrolled" in the 03-05 biennium. That means that people can enroll and then disenroll and still be counted. Mike presented data that shows the % of enrollments against planned enrollments distributed across Counties statewide. Overall, we are in line with equal distribution and access to brokerage services statewide based on the percentage of population served.

Jessica shared that the data reminded her that high school transition may be part of the inconsistency in communication with families since kids turning 21 will be in school until June, how and when a County determines to refer them to the brokerage may vary (e.g. some counties start in March or April before the child graduates (June) while others may begin planning at the start of the school year). Additionally, Counties cannot refer anyone turning 21 that have already graduated.

Mike presented information on average plan costs. They continue to hover around $600-$700 per month and the lead category continues to be Community Inclusion. This category includes workshop and all voc activities that is not Supported Employment. Because of the way the waiver is written there is no clear way to separate this for reporting purposes although strategies may need to be considered. A factor in the numbers may also be the working relationship with local VR. If VR were expending more dollars towards plans then the number of expenditures against the brokerage plan for employment services would be reduced. Molly agreed to share information with this group in Sept about expenditures through VR on brokerage clients.

Mike shared that he will continue to produce these reports for the SIG so that we can establish a baseline of information that will help us establish trends over time. For example, some categories like OT/PT are low but may go up once changes in the Oregon Health Plan take affect. The data may also be flat as a result of other factors we can't yet identify.

Budget Update:  Staley was selected for a Department of Human Services internal audit. The auditors met with brokerage directors last week. The audit will start this fall. The audit will focus on eligibility, plans, plan costs etc. A report will be generated following that audit.

Molly shared that the initial 200 clients identified for the dual waiver transfer have been transferred (May 1). 120 went to the brokerage, 80 went to comprehensive services. 11 went to formal appeal. 15 people were late in the process and so will not transfer until August. Since this process started, additional people have been identified and more yet may come up. SPD has directed local DSO/AAA to review caseload again for one last pass at clients who are DD waiver eligible. There was discussion about the complexity of the issues involved around eligibility and different in the waiver delivery of services. There will be policy discussions between local SPD managers and Counties over the next few months to resolve and discuss the policy issues.

Molly reported on the VR workgroup. The work has lasted longer then planned but has been productive. The workgroup has developed a manual for workers and for families that everyone could use to guide them through the VR process. A meeting is scheduled between the VR manager and brokerage directors on Sept 9. The workgroup will resent to this group and offer the option to develop a local plan. The long-term plan is to expand this group to include all persons with DD (comprehensive). Judy reported that VR was present at last week's consumer policy group meeting. The person there from VR answered questions about the services VR could provide. Families expressed concern that the group not lose a focus on transitional age kids and VR's work with schools.

OAC Issues: OAC has received calls from clients involved in dual waiver transitions. Because it is so complex. OAC is feeling that they need more information in order to be able to respond to these questions and issues. Specifically, people are concerned about loss of funding and the change in the way services are delivered (RFC to In Home Support) for example. SPD will be available to talk/meet with OAC intake staff and train them on the process and on information. Information is currently available on the SPD website if anyone is interested.

Base/Base Plus: There is no report because the meeting has been rescheduled. Mike stated that SPD understood the workgroup wanted them to look at the possibilities of an interim level of funding - between $800 and $1666 where the criteria would be less then it is currently. Mike shared that the analysis indicates the budget will support this and we are now ready to go back and work on the tool. The tool would be adjusted to get at people who have significant needs but the way the scoring is currently cannot qualify. The new rate category would be less then 20,000 annually but more then 9600. The tool will not be available until the group can convene to review it. It is scheduled for July 20.

Training: A group met to discuss training needs for families. The goal would be for families to understand the system better (domestic employee rules, basis services, protective services). It would be important to get this information out on a statewide basis and in a consistent format such as a manual on line. It will be important to share success stories or examples of things working well.

Waitlist: SPD is supposed to convene a group to develop the policy and procedure for waitlist practices. There was an internal meeting and a staff member was assigned to follow up with Counties and gather information about current practices. Jessica suggested that we conduct a training on the current waitlist list so that the SIG would have common understanding of how we collect data currently. Counties are required to update this information annually. Brokerage are required to ask enrollees about desire for comprehensive services, but no one is certain how this information is being exchanged currently between SPD, Counties and Brokerages.

Strategic Planning: Several issues were on the parking lot. Workers Compensation insurance was one of these topics. There continues to be concern about liability should a domestic employee be injured on the job. SPD had agreed to consider this in policy. No outcome was determined.

The SIG group had asked that there be a process to continue to review the waiver and determine if changes were needed. The last round of updates did not include some of the major changes since we were hoping to get the renewal with little problems. Mary Lee suggested that we start by prioritizing the changes we want so that we can think through how to best go about obtaining them. The recommendation was that we have a smaller group start the work and report back to the larger group. SPD has a starting list that was collected earlier when we first started working on the renewal. The SIG will review this list at a future meeting.

Mike presented capacity data statewide. Since one brokerage was not funded at the start of this process, and the Multnomah County brokerage has since closed, there is a deficit in capacity across the system to meet the needs of persons statewide. This is apparent mostly in tri-county and mid valley. SPD increased capacity with DSI and Inclusion to meet this need. The bottom line however is that we will be at full capacity by the end of 05-07 and there will be a need to discuss either opening a new brokerage or increasing capacity to existing brokerages if they are willing. SPD will be coming up with some recommendations and will discuss with SIG. The group talked about the value of quality vs. quantity and at what point do you become so large that you can no longer manage the workload effectively or consistently. SDRI representatives talked about their experience growing and then shrinking again and they felt it was very important to their mission and vision to remain small. They felt this assured the highest quality of service to the individual consumer and family. Mike shared that if SIG wanted to recommend as a strategy that we include start up funds for a potential new brokerage in the either metro or mid valley we would need to include that in the budget package that is submitted by then end of this month. If we decide to open another brokerage it may result in the need to completely redraw the regional boundaries or some other strategy to equitably distribute access and choice on a statewide basis. The recommendation of the SIG to SPD is to include start up funding for a potential new brokerage in the 05-07 budget package due at the end of this month.

Jean Tuller announced that OTAC is hiring for a policy analyst.

Group Living: There continue to be examples statewide where individuals with DD want to live in congregate settings. There was an affordable housing workshop and many groups are accessing HUD grants to create these shared living situations. Because supports are such an integral part of success when people move out for the first time, it may be important for this group to address this down the road. Judy said that there is a group called "families united" that is working on an 8-bedroom apartment complex where families will be doing shifts. This could constitute a comprehensive environment. The rules currently say that shared living situations are okay as long as the plans are independent and loss of funding to one doesn't jeopardize the other. A small group has formed to discuss the interpretation of statutes and how to address the multiple projects that have started statewide. Interested persons should contact Kathryn. Providers commented that many of the examples shared are similar to SILP and Supported Living services are provided. Molly reported that SILP services are scheduled to roll in to the brokerage next biennium but Supported Living services are not.

Criminal Record Checks: Tim reported that ORA is gathering information and preparing examples of problems that providers are having with the process. Meetings have taken place with the head of the unit but really the problem is a combination of resources, timing and backlog. There is not one clear-cut solution. The rule was written to go across all agencies but in fact does not really apply across all agencies. Some major changes include families no longer being able to complete the paperwork and the delay in submitting fingerprints until after the first check has come back requesting them. Mary Lee shared that, as with other new rules or programs, these are the bumps that come with starting up a new process. Tim is planning to facilitate continued meetings on this topic. SPD will also continue to communicate within DHS on this topic.

Provider Rates: Molly presented a report on provider rates for vocational services as identified at the last meeting. The report outlines follow up that SPD was asked to do by the SIG in relationship to this issue. Clarification was sought regarding the issue of absenteeism and the fact that the report focuses on the provider organizations (as opposed to independent contractors or persons). Molly indicated that she treated the issue of rate and absenteeism separately and that she did include all types of providers in the proposed increase of rates. There has historically been a difference in rates for independent contractors and provider organizations since the contractors don't typically have infrastructure and administrative costs. Any increase in one type of provider rates would need to reflected system wide. SPD needs to continue to track the impact of these rate changes on individuals and their plans given that many may no longer be able to afford the services.

Tara asked if the rates would cover contacts with employers, development and training (non face to face hours) to maintain the placement. The answer was YES. It always has but was not as clear in the previous expenditure guidelines.

ORA has requested data from providers about absenteeism. This will help to shape the discussion further. Early feedback is that the vacancy rates were always high (roughly 10%) but providers did not notice because they were paid for that time. There are noticeable spikes in December, July and August. Mike shared that the internal work that SPD did, as requested by the SIG showed that there is no real clear solution to the problem and that the best interim strategy is to do what we can and start researching what has been done nationally.

Once the new rates are rolled out, SPD will need to track the data on the impact to the individual consumer and family. We will also need to know how many providers raise their rates, how many individuals are capped out on their plans and are adversely affected by this changes etc. Families are concerned that they really can't compete with provider agencies for quality staff since they don't offer benefits and paid vacation hours etc.

A recommendation was made to accept the rate increased proposed by SPD. Brokerage directors have also agreed to this increase. The recommendation was accepted with the caveat that there be long term study of impact on consumers of this change AND that the group consider long term strategies (such as grants) to identify new and creative strategies for delivering the services along with sharing information among the providers for addressing these issues in a cost effective way that does not push the cost off on to the

Consumer. It should be noted that there was not consensus among the group on this recommendation but that majority was obtained.  A group was formed to track this issue Tim, Kathryn, Cynthia, Susanna, Caryl, Dan (liaison). Tim will convene the group.

Quality Assurance: Mike distributed the handouts related to QA. LaDonna was at the meeting yesterday on the CMS grant and shared that the meeting was a general overview (get up and running) meeting. They will meet again soon. A family member receiving in home supports should be added to the group. As should OAC representation. The SIG requested regular updates on the grant and progress.

Since there was not time to go over all the QA materials, Mike re-orientated everyone to the handouts on the extension of the waiver and the new QA committee. SIG members are asked to review them and be prepared to discuss at the August meeting. 

***************NOTE TIME CHANGE*************

Our next meeting will be on August 18 from 9:30 to 3:30 location TBA.

Families and Advocates pre meeting will start at 8:30 AM

Agenda will include:

*        Molly to present data on VR expenditures statewide on clients enrolled in the brokerage

*        Counties will present draft materials for communicating with families about where they are on the waitlist

*        Base Plus work group will present on new tool

*        Waitlist training - how/what data is currently collected

*        Review list of changes people wanted to the support services waiver and form waiver committee/review priorities and where this fits in with other assignments.

·        Focused discussions about group living options using support service dollars

·        Quality Assurance Discussion

Future meetings will be on October 16 also from 9:30 to 3:30 location TBA.

Jessica R. Leitner, MSW

Senior Program Manager

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