Staley Implementation Group Meeting Previous Meeting  Next Meeting
Official Minutes
October 15, 2004
Attending:
Arlene Jones, Jim Wrigley, Cynthia Owens, Kathryn Weit, Judy Cunio, Kristine Merritt, Eddie Plourde, Lisa Williams, Pam Ring, Joanne Furman, Tim Kral, Caryl Knudsen, Pat Allen-Sherman, Roger Stanton, Molly Holsapple, Marylee Fay, Bill Lynch, Sandra Steward, Rod Branyon, Carol Steadham, Dan Peccia, Marcie Ingledue, Howard Klink, Jean Tuller
Introductions and Announcements
Monitoring/Updates
Issue of capacity vs number of potential customers: The current contract doesn’t fit with the projected number of customers. Response to this concern: This is not a major issue for this coming biennium. It is in the next biennium that everyone must be served that the projections and the brokerage capacity must be addressed.
September legislative hearing: The presentation by the brokerages, customers, and families received a positive reaction from legislators on the Committee. There was also an update on Fairview trust fund.
Disability Navigators: Disability Navigators is an organization that has formed to provide ombudsman services in the metro area. It is also committed to developing a web based I&R system for people with disabilities called the Disability Compass. Goal is to have a web based resource for anyone connected with developmental disabilities. Initially it is focused on the tri-county area. This site would be accessible to anyone, customers, families, providers and professionals.
A report on the Brokerage Referral Process had been requested during the June 25, 2004 SIG meeting. Carol Steadham summarized the process for responding to callers requesting to know where they are on the waitlist. The projected timeframe will differ from county to county based on the size of the county and number of people on the waitlist. Counties appear to be using a similar process. SIG recommended “user friendly” language be developed to explain the process in a consistent manner. Agreed to discuss this later today during the agenda item on publications. Request was made to make this information available to providers and others.
- Customer / Family / Advocates:
Publication to assist consumers and families will be discussed later in agenda.
Communication :Roll out on rate changes has been very slow. Question was raised about getting information out to people sooner. Mary Lee Fay indicated that the State uses a formal system of communication (memorandum) in order to make sure everyone gets the same information, which often results in over communication. Sometimes people may not get back to actually read them. Once published they go onto the web. If people are not seeing information, they can be directed to the website. Marylee Fay will bring some information from the web page for January meeting. Molly says they use the provider list to send out information. It is important to have current email address for all providers.
Team Rehab Oct 27 - 29 th: Focused on changing from facility based to individualized supports, and how to keep people employed in the community.
Providers are desperate for absentee decision.
Criminal Background Checks: Tim Kral reported some changes have proved to be not fiscally possible. LEDS checks can’t fit into the DHS system. Temporary rules are out, but they have not been seen. Providers are planning to be the authorized designee, which involves looking at the employee application form and determining whether they should be disqualified based on a criminal history. If you want to continue with employment, you send it to the state. It does cut out the State involvement during the first part. Has allowed provider to make a preliminary decision, and having employee working supervised while waiting for more information. This helps with some of the backlog at the State level. State wants to have benchmark of 3 day turn around time and 7 day for more complex. The new rule will require brokerages to be the authorized designee. There is concern about liability, however, nursing homes have been doing this for 20 years. Families can also go through the training and become the authorized designee. The training is half day. The counties are opposed to the rule change regarding employees of foster homes and family support. County counsels and brokerage boards are concerned about the liability. There is concern about communication with families and counties regarding this issue.
Committee that was formed to address Criminal Background check issues is no longer meeting.
The difference between temp rule and perm rule, is that temp rule takes effect immediately. It was suggested that we add this issue to the SIG standing agenda to track experiences customers and families are having. Families are still able to send in initial ID check and I9. The county can make the initial designation of the employee, but this may be someone they have never met or had contact with. Concern that this is very risky. When someone is approved for probationary status, they must be supervised until the check is complete. Point was made that you don’t have to hire people even if they are approved.
It was announced that the Support Rules are open for comment now. Rule hearing is on Oct 22 nd.
The changes in the rules reflect the agreements made during the renegotiation of the Staley Settlement. In addition, there are changes that address process for addressing services for individuals who had dual eligibility in both the DD and Physical Disability Waivers. They also clarify allowing a full 365 days for people who come in over $800.
Budget: Nov E board rebalance. A portion of the Staley funding was put into an E-board reserve. This is the E-Board that the State must come back to request funding. There are three policy recommendations on the table.
Mid–Level Base Plus: The State and the Base Plus Workgroup have been looking at how to include those people who have significant needs for physical and behavioral supports but do not currently qualify primarily because they have caregivers able to provide some support. Currently looking at what it would cost in terms what is available in this biennium and how would it roll up.
Personal Care: Looking a bringing the current State Plan Personal Care into the Support Services Waiver Service. If eligible, this could enhance and individual’s plan about $200 per month. Would result in more people being able to access Personal Care. Implementation of these modifications would put the average plan at about $800 in the next biennium.
Will also look at some funding for family support.
The E-Board not be a formal report. This is not a budget note, it is part of the Department rebalance.
2005-07
Next biennium budget the State will be in the hole. SPD is big user of General Fund in the Department.
Members asked that the data the State uses be made available to SIG in Dec. Numbers could change, but at some point need to make decision about what data to use, even though it could be changing everyday.
Staley Report due early November to plaintiffs.
Dual Waiver is completed.
CMS housing grant: The State received a CMS grant to look at using technology in housing for people with disabilities. Dollars to be contracted out, $800,000 for 3 years.
Wait List:
Kristin Duffy, State staff:
First steps on what to do around the waitlist now and in the future.
Handout of questions that have been generated through internal discussions. What needs to be done with the rule and what information needs to be gathered? What to do to make it useful? Data is muddy…ie current wait list for residential services includes people in comprehensive services. Need to adjust the rule on how / what information is gathered.
How to use it for planning? How to capture people who may want service in the future but don’t want it now. Meeting with program managers later in the month.
MLF: Next biennium is critical in projecting numbers for future implementation.
Need to figure how to project kids. DOE data not useful for forecasting.
How many people currently enrolled in waitlists? Don’t really know. We don’t know because of duplication, lack of clarity
People need to know that they can be waiting for comprehensive services even though they are getting support services.
Not capturing the need if people are told there is no option for services and so they don’t sign up.
Volunteers for Wait List Group:
Pam, Eddie, Kathryn
VR Training:
Update on the training. Molly provided an evaluation of training. Developed tools: customer manual; procedures and policies; tool kit for information sharing
52 people participated – brokerage and branch managers.
Each branch / brokerage was to go back and set up a local plan
Some editing of tools. Presentations to different audiences.
After getting the local plans will develop overall plan.
Strategic Priorities:
Review of session with Robin Cooper
Robin gave the group a “No list” that described what CMS will absolutely not pay for. The rest of the discussion focused on the ways to make it possible to pay for some of the expenditures the group had previously questioned.
She was brought out to look at absenteeism and she looked at lots of issues. What Medicaid prohibitions are based on state policy? Where are there places where we have opportunities for some flexibility? What will require a waiver change?
What is possible within current waiver?
She recommended that the State be able to articulate the decision process and criteria that would potentially allow us to say yes to things that we previously drew hard “no” lines. Need to think about things the same. Ask the same relevant questions each time.
Need to have a decision tree.
State may have a “no” list. Some places we may be overly aggressive. Sometimes things will simply be State policy that they will not fund something. More states are doing this to control costs.
Other things are possible….if properly justified. How do we decide what is on the State No list?
Need to have notes from Robin with responses on what action is possible not just the “no” list. Currently, we just have individual notes from the meeting. Suggestion that there is a work group to work on recommendations.
Some overall comments from Robin:
What really appears to be working include that the SIG exists and is broadly based.
Brokerage system separate from other systems. Many States are trying what we are doing but don’t have all the administrative pieces in place.
Concerns:
What are we doing when the family is the employee but also the person who is doing the decision making? How are you going to start looking at this? Who is addressing the potential conflict of interest?
Perhaps the consumer / family committee could start looking at this issue. (Premeeting discussion)
Workgroup:
Tim, Judy, Marcie, Bev, Cindy, Pam, Kathryn, Arlene
How do we track the impact of latest approved rate revisions on customers and services.. Report of the small group: What is the impact of raising rates? More complex than it appears. 7 out of 9 brokerages use the same data system, but concern that it would cost money.
SDRI has system to track some of the data. Can track changes in expenditure categories over time. We don’t know how many providers have made changes. How much is the change? What is the best way to gather the information?
State does not have data. They are studying how other states are looking at their rate information.
What is the impact??? Could take snapshots at the plan expenditures – increase in supported employment reduction in other expenditures?
Recommendation:
- Brokerages modify data system like SDRI to gather data on expenditures on regular basis… Analysis of data is a flag for taking a closer look at situation
- Brokerages report on provider rate changes to Staley team
- Staley team figure a way to spot check plan change
Will make these recommendations…However, this will not allow more refined information.
- Review of unplanned leave Policy
Review of handout. Question from consumer/ family group: Why provider organizations only?
State reply: Problem growing out of voc only transfers. Independent contractors have more opportunity to respond to problems. Designed to address the bigger capacity issues.
Comments: We need to include independent contractors. We are losing independent contractors. What is definition? Included domestic employees?? Do you include the family member?
New process: Customer will have a plan and a contract with the expectations of use of services for a certain number of units.
Are there any assumptions built into rate? Yes. Guidance in the rate setting manual. Administrative costs include some absenteeism and unplanned leave. In examples used it is 5%. What people actually used was supposed to be based on their own experience.
Previous caps did not address the unplanned absenteeism.
Distinguish between unplanned and planned absences.
Discussion:
Seems like 48 hours too long. Standard procedure is usually 24 hours. Response: What happens to the weekend? 24 hours not enough notice.
Suggestion: Make it simpler. Base it on the reason for not attending.
People need to understand that they have not purchased a slot. Customer must fully understand the consequences.
Planned or unplanned leave, it is the same for all providers. It is a contract with one person. It must balance a number of things.
- Person can purchase the service they need.
- People can do other things with services if they want.
Is this the proper course correction? How do we define it and still allow people say what amount they want to buy as opposed to folks just not showing up?
Positive that there is a review in three months.
Positive effort to start looking at the issue.
24 hour vs 48 hours?
Discussion reflected county, brokers, OAC, families and consumers recommend 24
Providers 48 hours
Still need to think about individual needs and designing plans around.
How to figure invoice? 100% or 75% of cost for absence.
This is a reactive policy. Disagreement on whether 100% -75%.
Point is that the money is usually used for staff and a percentage does not address the issue. Group did not give a clear mandate. Not a strong recommendation either way.
Why wait until March?
This is a contract issue. Need to change all the contracts and meet with customers.
Recommendation: do in 90days.
Recommendation:
March 1 st must be done. Do on plan renewal prior to that.
Start with small steps.
Will start with provider organizations. Group urged the State to not forget independent contractors.
New policy is a great communication tool. “I agree to make this service available to you and you agree to this…”
Request that brokerages provide the group some information on independent contractors.
Quality Assurance
Mattie Kimmich from HSRI provided a one page summary:
3 year contract with SPD / CMS Real Choice System Change Grant.
Focuses on QA – health safety and well being of people who receive services in own homes. Adults only – phys dis. / seniors / DD
Client employed provider / brokerages / in-home comprehensive
Will be making recommendations around the data and information management
Update:
State and local level discussions. Identifying what information is already being gathered and the tools being used. CAAPs on senior side / Customer surveys.
Looking at consumer satisfaction, complaint, risk report
Third year on the grant is the implementation phase. HSRI is doing the planning piece.
Refer to matrix: Certain assumptions that people have certain levels of self direction – Questions that need to be addressed include, How do you make sure crisis don’t occur without intervening in people’s lives….?
Group reviewed items on matrix:
Are these issues we need to pay attention to? What are the good indicators that lives are healthy and safe? What needs to be tracked? Will new tracking be required? Linking data bases that already exist.
Suggestions were made by the SIG:
Need to address behavior issues separately. Take out of Mental Status section.
Money and benefit management supports
Important to include informal supports information
Bill Lynch is the direct link to the project.
Concern about asking families to track information.
Tools: Only one registers consumer satisfaction.
- CMS QA Plans / Activities
Vicki Storie. Submitted report. CMS sent a series of recommendations. State is responding. They want us to show them how we monitor, predict, and take steps. Need to have Quality group up and running.
QA 2004-05 Work plan (Handout)
Things that were identified in the bigger plan that were highlighted by the SIG to be worked on in the next year. All the plan detail sheets are at the end.
Review on timelines.
Field Review will be part of January agenda. Allow about 1.5 hours. File review checklist at January meeting. Audit report
DD Quality Advisory Committee
December 18, 2004.
Send a representative to the Committee: Would be looking over all quality?
Joanne is volunteering.
Update: Seeing this on the Title 19 waiver review checklist completed by cty. How do we address the issue that the goal survey is older than the plan? Need have a way to indicate that at least that the goals were reviewed….Perhaps a discussion on this issue.
Some time ago the Customer and Family Group had recommended the development of a manual on Support Services for adults. OAC and the Council have met to begin planning a manual. The State is supportive and will assist. The importance of having consistent information was reinforced by Robin’s visit. The group brainstormed of some of the things to be included in the manual:
Waitlist
Eligibility
Grievance procedures
Appeals
Focus / intent of services
Philosophy
How to get to services
Roles
Simple resources
What can they expect? Roles?
Order of enrollment
Relationship with other agencies schools / VR
Benefit levels
Different benefit levels etc
What is difference between support services and comprehensive services
Crisis
Have lots of Flow charts / graphic
Use one tool for both levels.
More inclusive of physical and behavioral support issues
Recognition of individual support needs not just status of family. Trial showed that the tool did not eliminate the original people identified for base plus . Captured the majority of folks that were targeted. Helped make projections for the next biennium. Would probably address 200. Will capture the CIIS group and some of the dual waiver folks.
Still awaiting a legislative head nod that we can go forward into the next biennium.
No matter where you draw a line, you will miss someone
Plan for Next Meeting
January 28, 2005
- Brokerage – County Relations
Currently there are more formalized meetings between State, County, Brokerages. If there are natural meeting times, include State staff. Will provide updates – trends and issues
Desire to have some kind of forum for providers and families to also talk
- Reports
- PA / CM
- QA
- DSS guide
- Budget
Look at ways to use small groups to discuss some of the issues.
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