Staley Implementation Group Meeting Previous Meeting  Next Meeting
Official Minutes
March 21, 2001
Representatives: Fred Renter, Tom Giles, Dianne Deurschiedt, Cindy Helvington, Don Meyers, Pam Ring, Janna Starr, Kathryn Weit, Tim Kral, Judy Cunio, Cynthia Owens, Randy Fulghum, Mary Lee Fay, Bev Herrin, Beth McHugh, Diane Drummond, Joe Carroll, Jessica Leitner, James Toews, Kent Layden (facilitator)
Alternates and Observers: Kristin Ahrens, DeAnna Hartwig, Sue van der Naald, Tara Asai, Charlie Hemmett, Anne Coffey, Sara Jane Owens, Mike Maley, JoAnn Furhman, Laurie Lindberg, Amber Pedia, Zoelle Allen, Lauri Powers
Technology Update: Cynthia announced the switch to e-group from listbot. This should get the information out better to the larger groups who are receiving our summaries. If you have problems please e-mail Cynthia directly, not the e-group, and she will try and fix it.
SDS Quarterly Issues and Information:
There was a huge turnout of self-advocates. Initial feedback from the event was positive. Some felt there was not enough networking time for brokers.
Others felt that brokers needed an opportunity to get more technical information. It was suggested that maybe the day before the Quarterly could be just for brokers and others who needed the technical information.
Currently: Once each year the a national speaker is brought in for the Quarterly. These trainings are delivered regionally to insure maximum participation. The other three Quarterly trainings are more generic and occur in one location.
There will likely be additional trainings/Quarterlies held between now and December. The focus will likely remain on SDS brokers and council members through December. We need to incorporate the best parts of the Quarterly model as we consider training and technical assistance related to UA. It is hoped that in the future we can include other interested people like providers, case managers, and families.
It was also suggested that case managers and brokers would need cross training since under the new system many of the traditional case management activities will now be done by brokers and current case managers will need to understand the broker role.
Division Updates and Discussion:
There were 56 responses to the Letter of Interest. This week ODDS is holding meetings regionally to share with respondents expectations in the RFP. Three important points that people need to know are that 1) although collaboration is encouraged the entity that responds on behalf of the collaboration is considered the brokerage and ultimately responsible even if that entity subcontracts with other providers. 2) Agencies cannot use the brokerage arm to funnel business back into other parts of the agency such as vocational or residential. The broker needs to be free from conflict of interest with the agency. 3) There can be no intermingling between the service dollars and the admin dollars.
Waiver Update: DeAnna shared that some of the things we requested in our waiver application will probably not meet the test of "preventing institutionalization" as written according to a first review by HCFA Region 10 office. E.G. using generic items for specific needs (clothing, waterbed) would not be covered.
Deanna explained that the language we use in the waiver may not be what the group wanted but it is important to stay focused on the outcomes /concept.
Base & Base Plus: At the last meeting the workgroup reported that it was important to maintain as much flexibility as possible. The Division is currently recommending that plans that cost more than $800 will be reviewed and that access to additional dollars will be based on a scoring criteria that looks at disability and circumstances.
It is important to frame UA in the following way: Everyone who is 18 years old and DD eligible is entitled to access to a broker / service consultant to help them develop a plan based on their needs. All resources available to the individual will be considered in developing a plan with the necessary supports and services to meet the needs. The broker / consultant is authorized to include in the plan up to $800 in Universal Access funds. It does not mean that everyone is entitled to $800. It means that to implement the plan, the individual requires Universal Access dollars to meet their needs. If the plan requires more than $800 in Universal Access funds to be implemented, it will be reviewed using very strict guidelines. It is necessary to review and evaluate any plan requesting more than $800 in UA funds because of the limited budget and entitlement nature of the program.
Brokers who are practicing shared that many families come in with plans under $800 per month because needs can be met with other resources. They also shared that they do not talk about dollar figures with families or set limits. They start with a pure assessment and build from there.
Base Minu: There has been discussion about using General Fund only dollars if what is needed is not matchable under Medicaid or if the individual is not Medicaid eligible. When we do this we don’t capture the match and we reduce the over all funds available.
ODDS reports that in recent survey conducted by the Counties approximately 15% of the DD eligible population is not Medicaid eligible.
There are significant issues around Medicaid eligibility because it is different from DD eligibility. The lawsuit settlement is based on entitlement to Medicaid services. There may be a number of ways to help make individuals eligible. For example, James shared that there could be a possibility of a spend down or offset. Cynthia reminded us that we had previously agreed that anyone who is Medicaid eligible is expected to apply.
James suggested that the State would move forward tracking the budget closely and to be conservative in the first years. We will draw the distinction between those who are Medicaid eligible and those who are not. In addition to a broker and plan development those are not Medicaid eligible will only be able to use the General Fund portion of the dollars available.
Continuation of SDS Programs and expectations: A letter was sent recently to SDS Board members and DD Program Managers regarding the continuation of SDS programs. Attached was a document in a Q&A format to help board members understand the transition. The letter is available from Mike Maley at ODDS or through the local DD Program Office.
The new SDS Rule will govern plans that are written by SDS groups during this interim as new rules will not yet have been adopted related to universal access.
During FY02 brokerages will be identified. After that we will be phasing in service dollars and initiating services.
We need to continue to encourage boards to continue to participate in the process and have their voice heard. Some boards may chose to endorse a particular respondent but if they do so they are no longer considered neutral and cannot participate on the RFP selection committee. Other boards may chose to stay neutral regarding respondents with the intent to maintain eligibility to participate in the RFP review process.
There is significant confusion over the term "governance" as described in the Letter of Interest. Mike Maley explained that applicants who demonstrate consumer and self advocate governance may be weighted more heavily than those who describe advisory or oversight groups.
Counties explained that in their organizational structure only the Board of County Commissioners sets policy and "governs." Therefore Counties would be at a disadvantage during the RFP if that was a part of the scoring structure. Laurie shared that in many Counties there was no issue with County BCC’s and that autonomy by the SDS groups was automatic. In other Counties this was an issue however.
What are the criteria that the review group will use to weight governance? Lauri suggested that it was important that the review group have a clear understanding of what was meant by governance.
The RFP should say "Why" and "What". The applicant should say "How." After discussion, Mary Lee committed to giving definitions that are inclusive of possible models in the RFP. Mike explained that they will make sure the language will give enough definition so that reviewers will have a minimum bar/qualification that all applicants will have to meet. They can then exceed those if they are able.
RFP Discussion:
There are two possible roll-out plans.
- The "seed planting" idea would be to bring up brokerages all over the State at the same time and help them to grow.
- The "geographic" option would be to start brokerages in parts of the State before moving on to the next geographic area. The state has a t preference for this model because of the need to plan carefully and deliberately for implementation. The downside to this model is that in parts of the State people will have access to more resources because of where they live. However, the continuation of SDS until a brokerage is able to assume responsibility helps mitigate some of the issues.
Any roll out needs to paced out – not too slow and not too fast. Otherwise you run the risk of not meeting the 2005 deadline. It is also true that there is a roll-out within each roll out. E.G. Not everyone will be able to receive services on the first day of operation of a brokerage. Who gets access first? Are there priorities? That will also have to be discussed.
There was a recommendation that the state proceed with the geographic roll out option and that the extra time during the start up phase be used to help new agencies build capacity and build community capacity. This might actually make it possible for brokerages to get up to speed faster once they are actually ready to begin operation. There are some start up funds available to assist organizations to get set up and to develop structure. We anticipate the roll-out would take a total of a year. Many agencies could benefit from a year of extra planning and capacity building time.
The decision about what area of the State will go first cannot be made until the responses to the RFP are in.
The State is soliciting input on forming the group to review the RFPs. The State will select a group of people from their office without conflict of interest. But we also need to find a way to select family members and self-advocates who also don’t have conflicts.
Review of Parking Lot Recommendations: See minutes from the 3/6 Parking Lot meeting. The group identified some areas which needed discussion by the large group and others where we need to form subcommittees. One of the key areas is communication and how information about Universal access is going to be communicated. Several people expressed interest in working on this group "myth busters."
Quality Assurance was another key area that a subcommittee can be formed. There was a recommendation that we form one group to look at all the QA issues – and that we add people to the existing group formed by the DD Coalition that met once already. Jessica requested that the decision be tabled so she could check in with other DD Managers.
The committees who are currently meeting are:
- Employment subcommittee (Universal Access Committee)
- SDS Planning – format (DD Program Office)
- ISP Workgroup – but it is only looking at comprehensive services right now (DD Program Office)
- Rule writing/making - Rule making Advisory Committee (DD Program Office)
- Communication Workgroup – Myth Busters (Universal Access Committee)
- Training Committee – now focused on CM but could cross over (DD Program Office)
- QA group (DD Coalition)
- Children’s Group – yet to be formed (Universal Access / DD Program Office)
- Data and Information Systems – yet to be formed (UA/ ODDS)
Review of Decisions: Two handouts were distributed that summarize agreements and understandings with the Division and definitions. The group recommended word changes and clarified changes in decisions that had been made. It was clarified that the purpose of this document was for our own internal use to demonstrate the evolution of our thinking over this process. This document needs to be stamped DRAFT and FOR DISUCSSION ONLY. There also needs to be section called "topics still be discussed." Kent will make requested changes and put it out on the e-group.
Next Steps:
Our next meeting is April 11 from 9:30 to 4:00 with small groups meeting at 8:30.
Future meetings are May 9 and May 24, 2001
Previous Meeting Next Meeting Top of Page |
