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Official Minutes
May 19, 2005

Present: Bev Herrin, Jim Wrigley, Mike Maley, Tim Kral, Dan Peccia, Pat Allen-Sleeman, Caryl Knudsen, Sandra Stewart, Joanne Fuhrman, Joe Carroll, Cynthia Owens, Arlene Jones, Nancy Hazelett, Stafford Hazelett, Pam Ring, Bill Lynch, Mary Lee Fay, Kathryn Weit, Cindy Helvington, Judy Cunio, Kristine Merritt (PA), Marcie ingledue, Margaret Theisen, Tom Giles, Scott Pelham and Howard Klink.

Introductions and Announcements:

Review of Minutes: Correction – spelling of Charlene Dean. All approved

Updates:

~Brokerages

Letter was sent from the brokerages to request that the SIG Retreat address three areas: Relationship between brokerages and SPD; fiscal impact of case load; fiscal impact of Fiscal Intemediary Services. Brokerage directors are willing to come to the Retreat.

• New contract template. (see handout) Biggest change is on the front page which is written in person centered language and gives the customer a quick summary of what the customer is getting from the contractor

Q – has this been reviewed by the customer?

A – just implementing now

R – It is a good idea to have families and others signing these contracts, provide feedback on the documents. Should have the POG or other local brokerage advisory group take a look. Perhaps before the next SIG meeting, could talk with the family/sa group to review the samples. There are a lot of conversations about contracts in general. Make it simpler is the most frequent comment

A - Very complex – Always the question whether people are understanding what they are signing. What do we do to to train people to understand that they are employers? Most happens at the PA level.

More discussion needed from providers. Feedback given but no real discussion. Example, the issue of absence, where is that? It is added on the billing form.

The focus of the effort was to answer the question, “Is this agreement clear enough to everyone to generate the payment?” and then “Is the customer getting the information they need to make the right decisions?”

• Supported Employment Rate Change (see document) Rate change in Aug. 2004 to increase the reimbursement fee. Not all brokerages keep data in the same way. Providers indicated that they needed the change, but SIG was concerned that people might lose other services. Analysis is difficult because of the limitation in how brokerages keep the data. 7 of 9 use the categories of services but they have more than one category (job development, job support, enclave,…) Could only look at people getting

some SE some of the time. Great variability among rates – may be based on which category of services is being used. With the coming of eXPRS, we may want to see if we can build in some of the categories of discreet information.. Caution: balance the risk of discreet information with how it is entered and the work needed to enter it. A lot of work went into the document.

C – Low numbers of people in supported employment reflected in data.

A- If you ask a different set of questions it would give a different answer to people in community jobs.

Q - Can we ask on consumer satisfaction form?

A - Only getting about 30% response

Q- Can you poll PA’s about the case load??

Q – At annual plan review, can you ask about employment?

A - Just not in data base.

C – Work with VR to come up with a common data base to pull out that information. Consider for the retreat, what kind of data does this group want to have on an ongoing basis?

• Complexity of employment law is an issue that the brokerages are struggling with. IRS may conflict with BOLI. They would like to ask SPD to take a lead on resolving some of these employment issues. We are dealing with new situations, very complex.

Recommend that the SIG make it an action item to have the State take leadership.

Discussion: Need to have training so there is a consistent way of dealing with situations. Examples: Family member is a paid care giver. Are they self employed? Independent contractor? Our situations don’t fit with traditional wage and hour. Current plan is to go to BOLI and have them provide training for brokerage and other managers of in home programs. What does OR law say around wage and hour issues? At some point, after training, we would like a statement from the State that says this is how you do this particular thing…

Q - Is the law? Waiver? BOLI? There are conflicts.

A- Federal IRS and tax laws conflict with BOLI. Looking for consistency statewide. We need to generate a specific set of questions, that are the key issues. Find out informally what are the problems and possible solutions. Concern that if we ask questions the wrong way, we may get answers we don’t like.

Q- Why can’t we go to OAC ?

A - This is not their area of law.

Action: Put together a group to look at the employment / BOLI / IRS issues. Make sure some providers are present because some of them may have been dealing with the issues as well. Look at best practice. Make the group broad to include anyone who is interested. Brokerage, providers and others can share what they have learned and develop guidelines rather than a legal statement. Bev and Tim will pull the group together.

• Best Practice Retention / Training Discussion: Retention and training issues for PA. Brokerage use existing trainings – work with each other for new trainings. They are not using shared quarterly events

Q- How are new hires being trained? All are doing it internally, use more local resources.

County Updates:

• Participating in regional meetings with brokerages about new providers that might be needed or service gaps. Interesting conversation and very stimulating. At county level still dealing with cut backs in family support. Daunting task around MMA. Need COLA. Going to eXPRS training- Very intense. Case load sizes are continuing to be an issue. Over 100 to 1 in some areas and dealing with mandates. SPD conversations around billable contacts. Waiver conversations with CMS as well.

Customer/Family Updates:

• Like to make recommendation to the SIG to have a representation of independent providers.

Q- How does an independent provider represent others?

A - Challenge but possible to identify common concerns and perspective.

Important to bring different perspectives? There are about 400 people in that category in FAB alone. What are we wanting? 1 domestic employee and 1 Independent Contractor. Invite them to participate in Retreat.

• Discussion around the issues of families as providers / conflicts of interest meeting re relationships as family as providers. Deal with the legal and ethical issues around dealing with family members who sign plan and are employers. Also include issues of defining natural supports.

Action: We will plan a full day discussion after the retreat on the issue. In the interim a small group will form on this topic and discuss the potential waiver impact. Interested – Cynthia, Dan, Pat, Kathryn, Judy, MLF

Provider:

• Leg update – Two bills that would have hurt the state set aside laws are dead in committee. Bill will require the Dept of Human Resources to apply savings from Staley back into Staley.
• Provider response to Regional meetings – very unique meetings. Sustainablity and critical mass were big issues. It is very challenging in this environment to be a provider and be strategic. We need to keep reaching out to provider agencies.

SPD update:

• Review data (see data sheets) Under enrollment category, 55% are from wait list (element 1-6) Total enrollments are from day 1 – Current reflects most updated reflecting terminations.

Q – any particular data requests.

A - Break down how they are spending their resources. SPD does not have the data to break that down.

Q – Find out more about the people who moved to comp service – is there a trend? What is the interplay between crisis and support service.

Need to look at the expectations of cost to reality of costs. Plan v actuals.

Waitlist enrollment (see data sheet) shows the categories for enrollment numbers.

Q- Do members want to see this type of data? This is the first display. Shown as cumulative for the next SIG meeting.

• SILP. (semi-independent living program) Plan is that in OCT 06, this group will transition into brokerages. First need to clarify the interplay between Supported Living and SILP so that we are assuring that people are moving into the most appropriate group. Currently collecting data, test out in 3 counties and then go broader. Will have the work group meet.

• Comp 300 recommendations: (see minutes from work group):

Big issue is that the initial use of Comp 300 was focus on people who were care givers, age 75 and older. New recommendations have a broader expectation (see page 1)

Try to identify capacity, growth that will have a long term impact in the system. So, proposal is to not try to develop one person at a time, but looking at strategic need and broader development goals. Develop from a more regional perspective. Need to look at who is ready to include in the roll out of the plan. If there are major issues to this proposal then contact one of the members on the group. Work group to meet in June/July for next step strategies.

Action: Recommendation to include a provider representation – Joanne Furhman

• Proposal: (see memo) To consider children who are in the Inclusive Child Care program as part of category 4 for Staley enrollment. Memo shows small number of children being served that are age 16 – 18.

Action: SIG recommended consideration of the children that have been in the program for a minimum of a year and are in the Inclusive Child Care program for Category 4. SPD will communicate to counties the change in policy as for the enrollment.

Retreat Planning:

Dates July 21, 22. Establish a planning group. No other SIG meeting between now and the retreat. Tim, Kathryn, Cynthia, Dan, self advocate tbd, Janet/Tom, Lynn, Bill. Cynthia will take lead on getting the group together.

• Intent of the retreat – problem solving, planning,… next year, bigger picture,…??? This would be a time to look at what we are doing. What were the assumptions - how are things playing out. Develop an action plan on things to respond to. Prioritizing what needs to be focused on. Setting the agenda for the next couple years. Expense- organizations can help pick up some of the expenses? Brokerage directors want to all be there for a part of the meeting.

Quality Assurance: (see survey)

• Work of a committee that is looking at quality assurance for people who live at home and direct their own services. Developed a quality assurance survey. How do people feel about the length. Seemed OK, not too long to be answered. Question 9 – define “soon”.
• At Brokerage directors meeting the discussed survey. Don’t want to lose continuity. May have it sent from the county or state, so people are not thinking they have responded already. How many surveys are they getting?
• #2 under DD – confused, it is around “where you live” or sufficient staff to help? Staff may also be a bad word since you may not think of the family as staff. Go back and ask if the question meant to get at how hard is it to hire/get staff v about where you live.
• Question 1 under general and 2 under specific is too similar.
• Add a 5 th column “and this is really important to me – y/n”
• Recommend remove specific 1 and replace with “do you decide how you spend your free time.”
• Specific #2, ask, Do you feel you have enough supports/staff to help you implement your plan. Have Brokerages looked at these and compare with the core questions that they now use?
• Q 10 under the core: does your plan change when you need it to change. Q 11 Personal Agent/ case manager? How to distinguish one v other. Maybe change the wording to say “help explain your options”. Put in and/or around case manager personal agent. Are you getting the help you need from… or to understand what services are available to you…
• Don’t see question “are the services helping me get my goals”…
• Good cover letter needed
• #3 still feels very confusing. Do you ever feel at risk as a result of your choices? Is this question needed and does it fit into a satisfaction survey? Maybe, is there someone there who helps them weigh the risks? This question is not understandable, even the two examples are not enough.

Can add a column that says “not sure”

• Field Review: Doing second year of field reviews. Administrative Field Review. Results to date: seeing many of the complex issues are being reviewed. Looking at system issues that are being flagged., (ie. Incident reports,…)

Next SIG meeting: Sept. 29 – 9:30 – 2:30

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