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Official Minutes
September 29, 2005
Staley Implementation Group
Meeting Location: Resource Connections of Oregon
In Attendance: Cynthia Owens, Bill Lynch, Kim Sellmann, Jim Wrigley, Margaret Theisen, Dan Peccia, Martha Stracener, Bev Herrin, Cindy Helvington, Marcie Alvarez, Judy Cunio, Kristine Merritt (Judy’s PA), Marcie Ingledue, Pam Ring, Nancy Hazelett, Cynthia Owens, Arlene Jones, Kathryn Weit, Caryl Knudsen, JoAnne Furman, Scott Pelhman, Tim Kral, Pat Allen, Sandy Stewart, Mike Maley, Kathy Holmquist
Introductions and Announcements
The meeting was called to order by facilitator, Bill Lynch, at 9:45 AM.
Review & Approval of Minutes – May 19, 2005:
Corrections and Recommendations:
- Within the Brokerage report, first bullet point should read “quality of service impact of case loads”, not just “fiscal impact of case loads”.
- A structure for follow up of agenda and action items is needed.
Minutes were approved by consensus with the corrections as stated above. The finalized May 19, 2005, minutes will be sent out to SIG members electronically, and posted on the Arc of Oregon website. Recommendation was made that the minutes be paginated. SIG was asked for people to commit to taking notes at future meetings. Kathryn Weit will send out a request for volunteers through the listserv. The following individuals volunteered—Marcie Avarez, Margaret Theisen—one of staff, Dan Peccia—one of staff, JoAnne Furman—one of staff, Pat Allen—one of staff)
Monitoring & Updates
Review of SIG Process Recommendations from Retreat
- OCDD will provide a laptop computer on which SIG meeting notes will be taken.
- Review of action items and parking lot items—will have a listing of these items at the next SIG meeting.
Brokerages
Change in brokerage stakeholder membership was announced. Martha Stracener will take the position of Larry Deal.
In regards to capacity building, the brokerages will be conducting face-to-face type meetings with customers to get information about what customers want and can not get. The format of these meetings is yet to be determined. This would be outside of the regular QA survey. After obtaining the information, an action plan would be crafted. This is an opportunity for the other SIG workgroups to have (3-5) questions formulated that can be added to what the brokerages will be asking. Brokerage directors believe that this process will take at least 6 months. Margaret Theisen will be the point person to receive questions. Following the action plan development would be identification of what can be done and where energies would be expended.
Request was made of the brokerages, that their annual reports to the State be sent to SIG members.
County
Comp 300—will be covered as an agenda item later in the meeting.
Crisis—funds are being spent quickly during this first year of the biennium, with an increase in numbers of individuals going into crisis. Question was raised as to whether this mirrors past history. A recent report indicates that counties are at 60%+ of spending and one is above their full adult crisis allocation. It is evident that more individuals are entering into crisis and individuals who are entering are tending to have higher needs, which raises the issue of capacity and provider retooling. Data is being collected in relation to the numbers going into crisis in relation to comprehensive. If a person is in the brokerage and leaves because of crisis, and then goes into comprehensive; then that brokerage spot is not backfilled by another customer.
Customer/Family/Advocates
To bring the Family stakeholder group to its full complement of members, Nancy Hazelett has done a broad search and located a parent, Nona Scott, as her replacement. Nancy will be mentoring this individual. Nona is the parent of an SDRI customer and board member. In locating this individual, the group encountered some questions about the process of membership. Recommendation was made by the Customer/Family/Advocates group that each stakeholder group craft a written paragraph on how they select members. This statement of process will help to demonstrate credibility in the broader community and also that the SIG is not a closed “insiders” group. Please send the written statement electronically or otherwise to Kathryn. These will then be sent out to the SIG.
Recommendation was made that table tents, name tags, or other identifiers be present at the SIG meetings to distinguish members and guests. It was further recommended that in the introductions at the beginning of meetings, a concerted effort be made to identify one’s self, and associated stakeholder group, and if member or guest.
Question was raised as to the number of members in the Advocacy group. Kathryn explained that the membership composition included four advocates and also invited technical support by OTAC and OAC.
Recommendation was made that stakeholder groups not send proxy substitutes to the SIG meetings.
Roadmap
Currently, the addendums (which include transition, employment) were being reviewed, and these will be added to the manuals. A sticker will be affixed on the front cover of the first printing with the website link to access the addendums. These addendums will also be available on the OCDD website. Brokerages have been given 50 copies. Brokerages and counties have given projected numbers needed to Cynthia Owens. The number of copies needed is more than what is presently available, so additional funds to pay for printing costs are being researched. Bill has obtained an interagency agreement with VR, which can allow some funds to be used towards reprinting the Roadmap manuals. Discussion followed.
No update on Spanish translation of the manual. The original commitment from the state had been to provide for Spanish translation. The state has confirmed that it will not translate the manual into Spanish. Recommendation was made from the SIG, that the State provide more support for further printing and Spanish translation of the manual. Mike Maley will take the information back to the state. Suggestion was also made to approach Special Education, Department of Education in seeking funding.
Manuals will first be distributed through counties, as county case management would be the first contact with individuals and take the lead to go through the manual with the individual entering into the brokerage system. The stickers/template with the website information for the addendums is available through Cynthia or Becky Thrash at OCDD.
Provider
In examination of the data provided by the state on plan dollars being utilized, question was raised as to low average plan dollars being used. Is this because of insufficient hours of support? Are we significantly under spending? It was brought up by Margaret that at least one month of no service could be assumed between writing of a customer’s plan and implementation of that plan. Plan may include the dollars as being allocated, but actual dollars used may not coincide. Is this a capacity issue?
SIG would like to have analysis data on ranges and differentiation of where the dollars are, which can be reviewed by the group.
When SIG was UA, then SIG was identified as the overarching group. In comparison, the Comprehensive side (very individualized) does not have a similar situation. It was agreed that there is a need for an overarching group to be present, but whether to have a separate oversight group or have this as a SIG function was not agreed upon. Discussion followed.
Decision was made that a workgroup be developed to examine this and bring their recommendation back to the December SIG meeting. Workgroup members: Sandy Stewart, Mike Maley or someone from state, Cynthia Owens, Martha Stracener, Kathryn Weit, Scott Pehlman, Judy Cunio. Sandy will convene the group.
Stakeholders meetings (ORA/SPD)
Report was distributed on Provider Brokerage meetings held during April and May, facilitated by ORA. These meetings were to assist in renewing conversations between providers and brokerages, to meet projected needs and kindle local discussions. Top two unmet needs were community employment and transportation. In response to recommendations, small examples occurred as in Washington County with the “Agency with Choice” concept.
SPD Update
Budget—cost data through April
Discussion of the Average Plan Cost per Customer data occurred earlier in meeting under Brokerage report. At future meetings, material will be available separating “how many plans in several areas.” A trend is being observed with some migration of $9600 into the midbase and base plus categories (11% increase). This data does not include PC 20.
Budgeting of DD149 (support plan dollars) is more closely following the actual amounts used versus the plan amounts. So as plans appear to be increasing in cost, the situation will put a strain on brokerages in regard to management of DD149 funds in terms of cash flow. In anticipation of this, the state will be attending brokerage directors meetings to do re-education on cash flow management, and (in reference to internal audit) run quarterly reports, so as to identify cash flow issues before they become problematic.
Implementation of HB 2797
HB2797 refers to the savings to Staley to move more people into brokerage.
Staley Report/data—enrollment/trends
Minimum and maximum contracted brackets to meet contract qualifications.
Enrollment datasheet looked at examining true waitlist category individuals and high school transition categories. Variability was seen among the counties as far as numbers in the different enrollment categories. Seasonal variation was also noted with high school transition.
SILP workgroup report
Mike handed out information about SILP info. Trying to identify folks who may require greater support. Currently testing tool to evaluate. Some folks will go into comprehensive. May need to take a look at the kind of services. May require greater flexibility…example contract to help with budgeting, but show up he has been kicked out of apartment.
Lots of things still to be discussed re policy decisions. Concern that some of the folks who used be in SILP need Comprehensive services.
Comp 300
Counties are meeting and beginning to identify people.
Concern that SILP people are on list. Lots of people want 300 Comp. Originally thought the Comp 300 was for folks without support. Still in the process of refining who will be served in the Comp 300.
Sandy – follow-up with people who had been initially contacted for Comp 300.
To develop a site it may be possible to combine folks from SILP with those receiving Comp 300 funding and services.
Need to be very clear Comp 300 was intended for people not currently receiving comprehensive services. Important that we are very careful about the crisis/pre-crisis language and SILP.
Comprehensive 300 will be rolled out by regions. Southern region will go first.
What was the funding amount based on? Foster care rate plus transportation and day services. Average amount. Does not reflect the individual rate. Concern was expressed about whether the budgeted amount is really enough money. Assumption that this be hard capacity development.
Do we have any knowledge of providers interested in this? This is just beginning to be discussed. Mostly will have to take people who really don’t have great need because the budgeted amount is so low. It will force individuals with greater need to go into crisis to get services. Is this what we intended?
Mike: We are seeing increased development of group housing options created by families. Often support funding is not available. Kathryn noted that Mainstream Housing and the Council Policy Committee is pulling together a group to have a conversation about this issue……No preconceived ideas about the outcome. Tim would like to be on group. They will bring a housing report back to the group
Follow-up: Action on recommendation related to youth in Inclusive Child Care
Youth transitioning from the Inclusive Child Care Program will be treated like those transitioning from family support. It was noted that the policy states that it is up to the coordinator of the program to inform the county as to children identified.
Retreat Committees Reports
Training Committee
Group has met several times. Two subcommittees: framework and targeted. Intent is to focus on self advocate / parent training. History: State did not have staff and time to work on this issue. SIG agreed to take this issue on. Created grant group. Submitted one grant. Arc of Multnomah is going to house the grant. May link with FACT / Family Voices grant. Some brokerage funding is available . The group wants to use money to do a train the trainer model. Maximize the funding. Perhaps the brokerages will be able to help make trainings happen through funding participation. Initial work will begin with how to use Roadmap book. Brokerages are in support, but many are concerned about budgets. May use some of the dollars budgeted to training. The goal of the group is to get consistent, ongoing training using local folks to keep it going.
Policy Question: Role of family
Group will meet before next meeting. Mike will e-mail waiver template.
Rates:
Has not met. Tim will pull group together prior to December meeting
Top Strategic Priorities
Ongoing Implementation
Need to begin planning / discussion on thepolicy questions. Must the new brokerage come from a organization? Individual? How large? Part of another organization? Need to think about what we want. Need more brokerage capacity by 07-09. Logistical issues: Projected capacity? Contracted capacity? When do we start? When do have to do RFP?
Need to look at geographic area. Changes how we would need to look at design.
Mike: SORB – CIS - If they are willing to expand there will be enough capacity and we don’t need another brokerage in the area
Multnomah - seems to need another brokerage. Need to look at data.
Mid-Valley - approaching the 700 limit.
Central – When an area only has one brokerage what happens when it starts going over 700?
Talk about this at next meeting: send out the old RFP
Caseloads:Group has not met. Mike is pulling the group together.
Please note: Cynthia is the only person who pulled her groups together!!!
Employment / IRS / BOLI
Group was established to look at Employment BOLI / IRS. Provider / brokerages were going to pull group together. Bev and Tim will be responsible.
A training was conducted by BOLI. Many questions were resolved. Issue is whether brokerages are going to be co-employers. Department of Labor / Department of Employment have different ideas. Recommend that Sue Stoner participate in the group.
Some of the discussion on this issue focused on the organizational structure part – brokerages IRS employer agency. Firewall must be maintained between the employer and the fiscal intermediary.
Once firewall is established, how to maintain the integrity of wall. For example: Is the PA is making hiring and firing decisions? How much do brokerages train employees? May compromise the firewall.
Action:Recommend that some of the knowledge and understandings reached should be put in writing so that other areas of the system can benefit from the knowledge gained.
Quality Assurance
Small group got together to talk about streamlining the QA work of the SIG. SIG would discuss key policy issues related to Support Services. Feed information to the larger SPD QA committee. Trying to keep it limited in time and scope. Originally thought that this group would be the only QA group. Perception is that SIG doesn’t want to see the raw data and detail on issues like protective services. Perhaps twice a year more detailed information and link with broader QA committee each quarter. When there are policy questions they should come to SIG. Personal outcome statements needed review.
SIG look at field reviews / consumer satisfaction. Request to get a summary of the QA:
Field Review:
Document handed out.
Specific areas reviewed.
Looked at every Incident report. 88% excellent 12% not as good. Saw some systemic issues. Training re protective services in home. Brokerages sometimes not getting information back. Working in the dark. Situation has improved.
Timliness of plans- 1.5% delay. 80% variance
Customer satisfaction – 13% said ok ; 2% not happy
Staff qualifications – not completed personnel files / doesn’t mean that folks are not qualified
Training – fiscal intermediary training
Field reviews: plan reviews / administrative reviews – lots of overlap. Team recommended that these should be combined. This would mean one review once a year per brokerage.
Certification reviews : licensing team reviews. Staley team participate.
What was the reason for doing two separate reviews? Thought there might be more issues than have been found in administrative reviews.
Systems issues: Brokerages did not have the support to address some of the complex people and complex family situations.
Proposed Benchmarks need to consider the combination.
State does a great job – QA in the best sense of the work. Interview and data reporting. Bev = good process
Action :Anytime there is aggregated information the SIG would like to see the field review.
Next meeting will see the combined benchmarks. Will look at personal outcome statements
Great to see how brokerage incorporates the information. QA website will have posted reports. Each brokerage got a copy of their own field review. This would be the group to address the issues that are identified.
SPD includes us in the reports sent to CMS. We want to track specific elements. We want to be involved in the discussions on QA policy issues. QA is an important part of our oversight function.
DAWGS
The group authorized a response to the letter from DAWGS. Draft letter and send it out to group.
Next meeting scheduled:
The next meeting is scheduled for Wednesday, November 30, 2005, location to be determined.
Adjournment:
The meeting was adjourned at 2:10 PM.
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