Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
May 24, 2001

Representatives: Elaine Piper-Vardas, Randy Fulghum, Tom Giles Dianne Duerschiedt, Janna Starr, Nancy Hazelett, Cynthia Owens, Beth McHugh, Dayna Davis, Laurie Powers, Cindy Helvington, Mike Maley, JoAnn Furhman, Tim Kral, Marsha Clark, Jessica Leitner, Mary Lee FayeAlternates and Observers: Paul Gregory, Tara Asai, Joe Carroll, Don Myers, Paul Partridge, Bill Lynch, Cindy Stockton, Jean Olsen-Myers, James Toews, Sandy Stewart, Bev Herrin, Frank and Sherrie QuanKent Layden (facilitator)

Update:

RFP: Is Out! Bidders conference was last Friday. Written questions and those questions asked at the conference will be ? '3MEMORIALIZED? '´ and sent out the mailing list of bidders who attended the conference.

Role of SDS Groups: A copy of the memo James sent to SDS Groups is available. Each SDS Council is being asked to submit a name of someone from their local group to participate in scoring the responses to the RFP. Participants must be free from conflict of interest. There are 6
core members on the review team with local participants coming on to review proposals in their regions. The core members are from the State (Mary Lee, Vickie Storie, Mike Maley) local government, advocates (Charlotte Duncan) and providers. Marsha Wood will also attend and
keep scores and record decisions. Several vacant positions on the review team still exist including a spot for a self-advocate.

Several questions were asked about the RFP review process, the regionalization and scoring. Tim has an ? '3unofficial? '´ version of the questions from the bidders conference, which he will share.
Waiver: Was signed yesterday and is being submitted. Approval is expected on or around August 25, 2001. The entire waiver application is very thick so copies were not provided. If you want one let Mike Maley know and he will try and make arrangements to give you copies of the relevant sections.

Governor? '2s Budget Reshoot: Every legislative session, the governor? '2s budget gets re-done because new information that is more up to date gets provided as the fiscal year comes to an end. This new budget is sent to the legislature about one month before they adjourn and is
typically called a ? '3reshoot.? '´

We are expecting about a 4-month delay in the service payments for persons under the Support Service Waiver. The savings from not spending these 4 months have been identified by Ways and Means and could be taken away and used in other programs. We do not yet know
the status on this. James has been in communication with the plaintiffs and they are aware that although there is a delay, the Division believes it will still meet the timelines as put forth in Staley. The base budgets as described in the RFP and allocations given to
Counties is still the same. Next year? '2s SDS allocations are not
? '3flat? '´. But the State is not sure in local areas how much of the allocations for next year are already obligated. Parents shared that they would like to have increased allocations to be able to serve new people to bridge the gap between the first of the year and when UA kicks in. There is
no prohibition on local groups opening new SDS plans or enhancing existing plans if they can do that within the existing allocation.

James shared that this is a fairly concrete process. Once you get your local allocation, you need to identify how many plans you have and what dollars you have allocated. If you don? '2t have enough to cover your obligations the Division needs to know.

None of this affects the timelines or budgets for kids. Everything goes forward as planned except for the delay in new money for support services allocated through the brokerage under Self Directed Support Services for Adults.

Follow Up from Mental Health Directors: Marsha reported back on the concerns of the MH Directors. She prefaced with the statement that the Directors have reserved the right to continue have discussions about Self Directed Support Services for Adults at other levels and in
forums outside the Statewide planning process. At the last Local Government Advisory Committee (LGAC) the following issues were discussed:

1. Chapter 430: The State has a relationship with Counties defined in State Law under ORS Chapter 430. The Directors wanted to know if the money for universal access would flow through the Counties as service dollars typically do. The Division has not been able to answer that which creates concern for local government who are in the budget process. They are also concerned that Chapter 430 allows them to organize and form regions independent of the State and language from the State has been such that regions are defined or formed
independent of County government.

2. Directors are also concerned that this process is a ? '3dis-integration? '´ of local partnerships. Local government now has three separate regional processes: DD, A&D and Mental Health.
Directors shared their concerns regarding the RFP process. These concerns appeared to be shared by other groups, not just local government. The concerns have to do with the scoring and evaluation process and the regions as defined in the RFP.

3. Previously Directors discussed at LGAC the $800 cap level without review, recommended by this group and accepted by the Division. Their experience with this kind of system (OHP) indicates that the budget cannot support this cap level in an entitlement system. There is also
no ? '3risk pool? '´ which you would typically see in a system like this to address over expenditures and to protect the interests of families.

4. Directors also discussed monitoring and the need for a data system that tracks the movement of people from the system.

Parents responded that as a parent the County and its partnership should be seamless. The parents also do not want to see the additional administration costs associated with all of the flow through of dollars. Marsha shared that actually, County? '2s don? '2t object to reforming partnerships with other new Counties, but object to being told ? '3who? '´ to partner with. Counties have responsibility to all residents/taxpayers to be good stewards of public dollars.  Marsha clarified that Counties do not get additional administration for DD service dollars. Counties receive a 4% Local Administration percentage, which is not very much. All service dollars are untouched
and are passed directly to providers. SDS and its budget are a bit different ? '¶ depending on whether or not your County elected to operate it or subcontract for it.

Marsha shared that all of the discussion outside of this group are open and minutes are available. Counties, like all groups represented here, need to be able to go and have discussion, raise issues and concerns to their representatives and then bring those back to this group.

Rule Writing Subcommittees: We need to re-create the list of volunteers who agreed to work on the rule-writing committees from the last meeting. If you expressed interest please get your names to Mike Maley. These meetings may need to be weekly because we need a substantive draft by July.

Communication Subcommittee: A draft flyer was reviewed this morning and an information session will be held at the June SDS Quarterly. The group would like to develop a logo that would represent UA/SDS and would become recognizable. The group would like this to be handled professionally. There is also a ? '3fast fact? '´ sheet that has information about Self Directed Support Services for Adults. It should be available in time for the quarterly. The group also recommends a video be developed that would help communicate to folks what universal
access is about. The group would like to develop a definitions page as well but this may need to wait until the rule is written. It was suggested that we not use the abreviation of  UA since to the general public it means urinalysis. We need a description that describes the services that will be delivered. 

Some language needs to get cleaned up. We need to agree on terminology like ? '3personal agent? '´ or ? '3broker? '´ and then use it consistently. Also, is SDS Self Directed Support or Self Directed Support(s) Program?

Beth suggested that we consider presenting information at the Statewide In-service as well as the Quarterly. Bill is on that planning group and will share that with them. Anyone who is
interested in helping to shape that presentation should contact Bill Lynch.

It was suggested that we should approve the minutes from our last meeting at the start of each meeting so that corrections can be noted.

Referral Process and Plan Approval: Jessica, Mike, Sandy and Cindy reported for the Broker Matrix group that is attempting to flush out the roles and responsibilities in the original matrix material. Flow charts were passed out that diagram the typical situations we expect
to encounter during the phase in. Although the information is presented in a linear fashion it is not really a linear process. Many things happen simultaneously. The group also reviewed flow charts for how we might address individuals who go in crisis. There were good questions asked and clarification sought. Also some wording changes. Flow chart 2 was confusing because it refers to chart 1 but really people don? '2t start from the beginning. That can be changed. Also
there was request to change references to UA to support services.  With regards to chart 3,4 and 5 the policy decisions about funding transfers may be postponed for people receiving vocational services and SILP services.

Let? '2s revisit how we got here: James shared the history of this process and where we are going. There has been a lot of confusion over roles and responsibilities.

In the current system ? '¶ the State contracts with the Counties for services and the Counties contract with providers for residential etc. Case management is at the County. A couple of years ago the State developed the Diversion Regions. This occurs across a group of Counties that have agreements between them regarding delivery of services.

In the new system ? '¶ the State expected the system to stay the same for people in residential/comprehensive services. But the State had hoped, in keeping with the settlement agreement and the recommendations of this group that the services under the new waiver would be in the non-profit sector. Originally the plan was for the RFP to bestatewide with Counties actually convening the planning groups and selecting the providers for their region. Counties would not respond to the RFP. In areas of the State where insufficient capacity existed there was the option for the State to back up and have the County deliver the service.

Because many Counties expressed interest in being the brokerage, they could no longer participate in the local planning process. This meant that in the RFP process, some Counties would be competing with the private sector. This is difficult because the State is still wanting
the Counties to operate services as they have been under the comprehensive waiver and be responsible for case management and contracting for residential services.

As it stands today, both Counties and providers can respond therefore decisions about roles and responsibilities, contracting etc. cannot be made until the RFP awards have been made.

There was some concern that when the dust settles there will be two sets of administrations, County and Brokerage.

Joe shared that the spirit of Staley is that the system is changing. And hopefully we will ALL be able to do something about the waitlist.

The question was asked, if someone is unhappy with the services in their area, could they take their allocation and get services from someone else in the community? The answer was ? '3yes? '´ if the person they select meets the minimum provider qualifications AND they are willing
to pay for the cost of those services out of their available allocation. People are not entitled to the cash value of the personal agent (employed by the brokerage) time.

Jessica asked for clarification on what seems like a conflict between the statements that everyone is entitled to a personal agent and a plan not $800 and the statement that a person can take $800 and purchase a personal agent if they don? '2t like the person at the brokerage. This implies that the person is entitled to $800 and can also have an agent and FI services at no extra cost.

Randy shared that sometimes families chose to have someone who acts as their coordinator and the liaison with the personal agent/broker. This is similar. Several people had attended a presentation recently on the system in New Jersey. Randy cautioned that although the New Jersey model is good it serves a significant smaller group of people.

Mary Lee echoed what Joe said that the process to date reflects our best combined thinking. As we learn and discover more we need to alter our course. But we really need to move forward.

Definitions: What terms are most confusing to folks in the field?

Broker/Brokerage:
Personal Agent:
Fiscal Intermediary:
SDS:
Comprehensive Services:
CMHDD:

These need to be defined and used as a communication tool when talking to families and sharing information. Whenever possible we need to reference old names used to describe these services/functions.

There are definitions in both the SDS Rule and the RFP, which need to be reviewed and tri angulated, then brought back to the large group. This will be assigned to the Support Services Rule making group. After these definitions are written they can be adopted. They can be put
out on the list serve for feedback from this group between now and our next scheduled meeting.

Mike was complimented on the exhaustive but thorough definitions in the front of the RFP, which are consistent with the waiver language. The group agreed we would adopt these are the official definitions until we have our own written.

Sign Up sheets were distributed for people interested in working on the rules. There are three groups: administrative services (CM, PSI etc. Rules) comprehensive services (res,voc, etc) and support services (UA).

Roll Out: There are questions on the street that need to be addressed.
They include:

Q: Doesn? '2t the waiver have a roll out plan? A:Yes. It says we can? '2t go from 0-60 MPH in a day. It projects how many people we expect toserve over the next 4 years.

Q: When? A: The last brokerages start by June 2002. The first brokerages start in September 2001. The waiver also says the geographic roll out will happen in the following order: Metro,
mid-Valley, Eastern, Southern and then Cascade. It does not have to happen in this order. It will be decided based on the skills and abilities of the respondents to the RFP.

Q: Who? A: The people waiting and those currently in SDS will go first. The  current Voc Only folks and SILP folks will go last.

Q: Who buys what? A: In the wavier the State projects who buys what kinds of services. ODDS used the costs and utilization from the historical expenditures under SDS. It was based on a formula.

Q: When is money available? A: After awards are granted and a contract issued, the agency will need to get going. Money is available around 30 days after the award. After money is received the agency will have 3-4 months to be operational and begin accepting referrals.

Q: What is the roll ? '3up? '´ of SDS? A: Because current SDS is continuing we should not see gaps in services. We do expect there will be a transition period as current SDS staff phase out and the brokerage phases in. This will be negotiated on the brokerage-by-brokerage
basis.

Q: Kids? Will Counties have flexibility in planning?
The goal is to have all brokerages operational early in this process even though the service dollars do not support all eligible individuals until later on. The brokerages will need training. ODDS intends to look at the existing training budget and how it may be used to impact the training needs in the new system.

Training for new staff who will be personal agents is on a steep curve.  Parents and individuals need to have some kind of training also.  Forums by James?  Parents, individuals and parents together? Will be funded through the state and regional training budgets and there is some allowance in start-up for training.

Outstanding Issues:  Chapter 430. ODDS acknowledges that Counties do not have to accept
contracts and cannot be forced to partner with other agencies or Counties. What is an issue for Counties is the discomfort with the County role in monitoring services and how that will play out with the winners of the RFP. Some Counties feel that 430 gives them the right to refuse to deliver the service first before it gets subcontracted out. The State does not agree with this position. Marsha clarified that the real issue for Directors is not the right to first refusal
but the issue of relationships between multiple Counties if a large brokerage is operating across multiple Counties. There is a lot behind the scenes. The DHS reorganization may change the regions and at any time the diversion regions may change. There are no good answers
here. Everyone comes from a place of what makes sense given how he or she
has to operate. No one is wrong. Will the Counties be asked to carry the contract? If the County wins the award then yes. If it is not a County then it could go through the County but the State can also direct contract. ODDS has a strong preference to carry the contract directly to insure that everything is up and running and so that changes can be made if they discover the
population estimates are wrong or if funding changes occur. There are many compelling reasons to contract through the County from the State? '2s perspective. But this decision will have to be made after the RFP awards are announced.

System Integration: DHS is integrating other social or human services but there is a feeling that DD is being separated and/or pulled away from this planning process. Some directors feel that setting up these brokerages is adding an extra layer. Cynthia asked it that meant that

Directors did not support self-determination. Marsha stated? '3no.? '´ If you look at County services they tend to be self directed e.g. consumers working to develop their own treatment plans, consumer governed Mental Health Advisory Groups? '¥.

In the last minutes under the committee updates Marsha was misquoted as saying that the DHS reorg. could affect the delivery of services under Self Directed Support Services for Adults. What she said was that the DHS reorg. of  regions could affect the roll out of services
under universal access. The consensus was that we needed to continue to move forward.

It is possible to frame support services as another service that is provided just as an expansion in residential or vocational services would look. Counties would not generally go into direct services.

Counties shared that the need for the philosophy and values that underline this process need to apply to all services and that we need to find a way to integrate self-determination into comprehensive services.

Risk Pool and $800 cap: Directors feel it is important to plan conservatively and relax later if we have extra money than to blow the budget out early. There were statements made by folks that we could just go back to the legislature if we run out. Marsha shared that we need to look for holistically at the available dollars in the system and figure out how to meet the needs of everyone.

James feels that the State holds the risk. They want to get the money out the door. They acknowledge that if the plans all come in at $800 they may have to pull back. James is confident that will good training for personal agents most plans will come in at below $800.

Jessica shared that if the training is available and we think plans will come in lower, when what is the harm in setting the review lower?

What we do and how we train folks doing the work will form a lot of public opinion in the first 6 months of implementation. Randy shared he felt it was small victory that we had gone from 20K annually to $800 per month! Randy also shared that his experience with reviews at
lower funding levels is that they are time consuming and can impede service delivery.  Families don? '2t want to ? '3break thebank.? '´ They are responsible individuals who are used to working with limited resources.

James acknowledged that the real budget problems hit in the second biennium. The State will need to develop a way to track all of the obligations in every single plan so that early in the process we will have actual data about the cost of plans.

The 20K cap came out of the lawsuit settlement. It was not part of the original SB919 plan. The State did decide to put a clause in that it reserves the right to set rates. There are significant differences between rates in different parts of the State given the difference in
the cost of those services.

Parents shared that they do not want to have to fight for more resources. They have been expected to do that for a long time.

Non-Medicaid eligible individuals cannot plan up to $800. They will only get their GF portion. This now brings the conversation back to the level of funding at the front end. For Joe, who gave a good summary of the issue, this is reminiscent of having to demand approriate school services through the IEP process.

Process/Wrap Up:

Thank you to Kent for his facilitation.
Thank you to Jessica for minutes.
Thank you to Cynthia for the list serve.

Good work all!

Our next meeting is on August 7 from 9:30 to 4:00 at OTAC.

Previous Meeting     Next Meeting    Top of Page