State I/DD Director Recognizes Work of Brokerage Personal Agents in Latest Service Status Report

In her latest weekly message, Oregon Developmental Disabilities Services Director Lilia Teninty acknowledged the work of Personal Agents and Service Coordinators statewide:

“I would like to say thank you to all of the Service Coordinators and Personal Agents supporting people with I/DD and their families. Your hard work you do and your dedication to the people and families that you serve is greatly appreciated. You have been patient and persistent implementing all of the changes that have come your way and have managed to work through them while ensuring that the people you serve have the services they need to live in their communities.

The work that ODDS does would not be possible without you. You are the foundation of our system! You all truly make a huge difference in the lives of Oregonians with I/DD.

For those of us who benefit from the dedication of a specific Service Coordinator or Personal Agent, please be sure to convey your thanks and appreciation to them, too!”

 

 

Changes to Provider Payments Are Still Planned for July 1st, 2014 – What You Need to Know (And Do)

By Ron Spence, Operations Director

The recent announcement that DHS listened to the community and delayed implementation of the eXPRS data system was welcome news to stakeholders across the state. However, in order to meet the terms of the collective bargaining agreement it made with SEIU, the state must collapse all payments to Personal Support Workers (PSWs) into a “single payment system” by July 1st In order to meet this obligation, DHS is in negotiations to contract with TNT Fiscal Intermediary Services (TNT FI) to make all PSW payments to providers in all DD programs (counties as well as brokerages) statewide.This change affects thousands of providers; brokerages and counties have been charged with making the transition in three weeks and some questions remain unanswered. Time is short and much work will need to be done to ensure every PSW in the state is paid on time in July. Please help us by spreading the word.  We will update the FAQ below as more information comes in. Our top priorities remain uninterrupted services to our customers and uninterrupted payment to their providers. 

Note: While there is much overlap in how things will work for providers working with different brokerages, the information in this post is specific to providers who work with Independence Northwest’s customers. The requirements of the transition to a single payer (TNT FI) are different depending on the provider type.

PERSONAL SUPPORT WORKER – DOMESTIC EMPLOYEE Because TNT already processes payroll for domestic employee PSWs who work with Independence Northwest’s customers, this group of providers will experience the least impact during the transition. If you’re a domestic employee, the changes you can expect are the following:

  • Timesheet due dates and pay days may change. Due dates, processing time, and pay dates are part of the state’s agreement with SEIU, but as of this writing the state has been unable to tell us what those dates are. We will let you know as soon as we know.
  • Reduced frequency of payroll: Independence Northwest has historically run DE payroll three (sometimes four) times a month. Under the collective bargaining agreement this number is reduced to twice a month. If you are someone who submits timesheets later in the month this may mean you will wait longer to be paid than you have in the past.

DON’T FORGET: You will still need to get a provider number for when the state rolls out eXPRS later in the year. If you don’t have a provider number yet contact the state immediately: 1-800-241-3013 or SPD.ProviderNumber@state.or.us 

PERSONAL SUPPORT WORKER – INDEPENDENT CONTRACTOR 

Effective July 1 all payments to PSW independent contractors will no longer originate from INW offices but will be processed by TNT FI from their office in Salem. In order to make this happen, all ICs will need to fill out a TNTFI_VENDOR ENROLLMENT PACKETICs must fill out a separate packet for each customer they work with. Please note that the packet includes a direct deposit form. Unfortunately the direct deposit form you have on file with INW will not transfer to TNT. The packet must be signed by the customer or the customer’s legal guardian. If you want to continue using direct deposit after July 1  you must fill out this new one and provide all the documentation it requires.   Below are some changes PSW-ICs who work with INW customers should expect:

  • Changes to invoice due dates and pay dates: Because INW cuts checks for independent contractors on a weekly basis, we do not expect ICs to adhere to any invoice deadline. However, under the new system, due dates, processing time, and pay dates are determined by the state’s agreement with SEIU, and as of this writing the state has been unable to tell us what those dates are. We will let you know as soon as we know.
  • Reduction in pay frequency and flexibility: INW cuts checks on a weekly basis for vendors so that a vendor can invoice us at any time during the month and expect timely payment. Under the collective bargaining agreement payment is reduced to twice a month. This may mean you will need to change the timing of your invoicing in order to avoid delays in payment. With payment no longer occurring in-house, INW unfortunately loses the flexibility to accommodate same-day check runs and other special requests as we have in the past.

PROVIDER ORGANIZATIONS, NON-PSW INDEPENDENT CONTRACTORS, AND OTHER VENDORS 

Payments to all entities not covered by the collective bargaining agreement (provider organizations, non-PSW ICs) will continue to be paid by INW until eXPRS is implemented. If you are the rare IC who provides both PSW services and non-PSW services you will receive separate payments from TNT FI and TNT FI.

FAQ: July 1 Changes to Provider Billing and Payment

Note: Most of this information is brand new and as such is subject to change. We will update this FAQ as we get new information so please check back frequently.

Q. What is changing about how provider payments are made? A. All payments to Personal Support Workers (PSWs) across the state are being consolidated so that they are paid by a single entity, TNT Fiscal Intermediary Services (TNT FI). This affects thousands of providers.

Q. Why is this change happening?  A. Under the collective bargain agreement DHS made with the Service Employees International Union (SEIU), the state agreed that it would adopt a centralized payment system for all of SEIU’s PSW members in Oregon.

Q. I thought eXPRS was going to be the payment system. Is TNT replacing eXPRS? A. Yes and no. The state has delayed implementation of eXPRS, in part, as a result of questions about its readiness voiced by the community. However, that delay did not absolve the state of its collectively-bargained mandate to adopt a centralized payment system by July 1. Moving PSW payments to TNT FI is a transition plan to meet that mandate.

Q. Will eXPRS make PSW payments in the future? A. To the best of our knowledge TNT will continue to handle all PSW payments for the foreseeable future because eXPRS lacks the complexity to handle payroll under the brokerage customer-as-employer model. Once implemented, eXPRS will act as a “front-end” interface for billing data entry; TNT will process payments using the data entered into eXPRS.

Q. Is there paperwork I need to fill out for this change? A. If you are a PSW-DE there is no additional paperwork for you at this time. If you are a PSW-IC you need to fill out a TNT FI Vendor Enrollment Packet immediately and return it to INW.

Q. Will my direct deposit remain in place? A. It depends on whether you are a PSW-DE or a PSW-IC. Domestic employee direct deposits will be unaffected by this change. PSW independent contractors will need to fill out the new direct deposit form included in the TNT FI Vendor Enrollment Packet if they want to continue using direct deposit. 

Q. Who do I sent my invoices or timesheets to? A. Nothing changes in the short run. Continue to submit your bills to Independence Northwest as you always have.

Q. Will the day my timesheets or invoices are due change? A. Probably. Due dates, processing time, and pay dates are determined by the state’s agreement with SEIU, and the state has been unable to tell us what those dates are. We will let you know as soon as we know.

Q. Will my pay day change? A. Probably. See answer to previous question and check back here often.

Q. What if I need an out of cycle check or if my check is lost or stolen? A. The state has not yet shared how it plans to handle out of cycle checks and other special exceptions after July 1.

Q. What if I am overpaid or underpaid? A. The state has not yet shared the details of how error corrections will occur after July 1.

Q. Does the July 1 change affect me if I am not a PSW? A. The most current information we have is that non-PSW payments will not change on July 1.

Q. Will INW continue to verify my income and employment for housing and other credit applications? A. Because we are not privy to the details of the contract negotiations between TNT FI and DHS, we are unsure whether this duty will remain with INW or will be taken over by TNT FI. Once we have the answer to this question, we will update you.

Q. Will INW continue to respond to unemployment claims? A. We have not been told by DHS if this will remain our responsibility. Stay tuned.

 

State Delays eXPRS Implementation and Employment Rate Changes to Fall 2014

Late Friday afternoon (05.30.2014), Interim DD Director Trisha Baxter released the following statement to the I/DD community:

“As you are aware we have many priorities that we are focusing on, all with a July 1 implementation date. We have heard from many of you that these converging priorities are causing angst, stress and strain on you, and on the system. We, as well, are discovering the complexities of handling so many moving parts all at once.  As such, based upon feedback from many of you and weighing our internal priorities and commitments with SEIU, CMS and others, we have come up with the following strategy to delay portions of the work and to stage implementation in a more manageable way.  Additional information will be coming out over the coming weeks about the details behind these strategies so please pay close attention to emails and other communications over the coming days.

First, July 1 is a milestone for new employment services to be offered. These services are included in the Medicaid waivers that will be submitted for approval with a July 1 effective date. These new services will still be offered as of July 1. July 1 was also a targeted date for implementation of a new rate structure for employment services for both the comprehensive and support service system. The new rate structure will be finalized next week, however, at the request of multiple providers, we will hold off on implementation of those rates, with the exception of the rates for the new services, until September 1, 2014. The new services, which include Discovery and Job Development will be paid at the new outcome based rates. All other services will continue to be paid at the current, daily rate. This additional time will allow providers of employment services an opportunity to analyze how the new rates will apply to their service arrays. Additional information about the rate transition schedule, and expectations for tracking, billing and reporting of services provided during July and August will be coming shortly.

Additionally, we have been challenged to provide training to the large number of personal support workers, CDDP and Brokerage staff, and other providers on the new plan entry and claims process within the eXPRS system. In order to allow more time for training and other associated activities, we are delaying the implementation of Plan of Care functionality to September 1, 2014 as well. We will be working with partners, including SEIU and providers, to develop an implementation plan from September 1 forward, beginning with employment services. The delayed schedule and restaging of activities is important to assure successful implementation, but it does not deter or alter the strategic or programmatic outcomes the changes are designed to achieve.

There is much work to be done over the upcoming months to ensure that individuals experiencing intellectual and developmental disabilities continue to receive services and that those providing the services are paid accordingly. We thank all of you for your continued work with us as we pull together plans for full implementation. As always, if you have questions or concerns, please feel free to contact me.”  – Trisha Baxter

What to Expect Between Now and July 1st, 2014

By Larry Deal
Executive Director

There are just 40 working days left between now and the end of the current fiscal year, June 30, 2014. Over the past year, that mid-summer date has been a much-publicized target for many changes in the Oregon’s developmental disabilities brokerage system. You’ve no doubt heard many times over: “this, that, or the other has to be done by July 1st”. This includes significant changes such as ensuring all 7,500 or so brokerage customers have been assessed with the new Functional Needs Assessment, ensuring that all providers are signed up in the state’s payment system, and preparing for having the state take over direct payment to all brokerage providers.  In some areas of the state, customers are changing fiscal intermediaries as well. (Here at INW, this is not the case.)

There’s a lot happening. We understand that change can be confusing, frustrating and overwhelming. Sometimes all three. So here’s a cheat sheet for what you need to tend to in the next forty days.

If you’re a customer or a representative designee:

  • Be sure to respond to your Personal Agent’s (or a state worker’s) call to complete the new Functional Needs Assessment. It’s essential these are completed for everyone by June 30th. This allows the state to draw down increased federal funding via the new K Plan. Additionally, be ready to revise your plan to make some language changes. Your PA will help you with that.
  • If you have a provider, be sure that s/he has filled out a Provider Enrollment Agreement. We want to be sure they can continue to get paid after the state takes over payment (currently planned for July 1st.)
  • One great way to better understand the changes is to attend one of INW’s community forums. We have two scheduled in May.

If you’re a provider of brokerage services:

  • Make sure the customers you serve have scheduled a Functional Needs Assessment with their PA (or a state worker.) If they need some support during the assessment and would like you to assist, offer your help.
  • If you have not already, you must apply for and receive a Medicaid provider number. Sign up by filling out the Provider Enrollment Agreement form as soon as possible.
  • If you have already applied for a provider number, but haven’t heard back from the state, please contact them directly at DD-MH.OHCC@state.or.us
  • If we’ve contacted you about updating your Criminal History Check, be sure you respond quickly. All PSWs must have a CHC completed every two years. You cannot be paid without a current check on file.
  • Attend one of the upcoming Personal Support Worker webinars. There are currently three scheduled. The webinars will give you basic details on the state’s payment system (eXPRS) and how the way you’ll be paid is changing. Click here to learn more.
  • Attend one of INW’s community forums.

If there are changes to the deadlines or expectations (and there may be), we’ll keep you updated via additional mailing. In the meantime, keep an eye on the INW blog or our Facebook page for the latest. As always, thank you for the opportunity to serve you, your family, and this community.

 

 

May 2014: Join Independence Northwest for a Community Forum on Changes to Brokerage Services

Our May 2014 Big Changes in Brokerage Services Community Forum dates are set! Join us on Thursday May 22nd at 6pm or Friday May 23rd at 10am. Learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates, and much more. We’ve got lots of details to share. Join us!

RSVP to Rachel at 503.546.2950 or by emailing rkroll@independencenw.org.

May2014CustomerForum

An Interview with Brokerage Association Leader Kathryn Weit

By Larry Deal
Executive Director, Independence Northwest
Communications Director, Oregon Support Services Association

I recently sat down with newly-appointed Oregon Support Services Association Executive Director Kathryn Weit to discuss her history, her thoughts on the brokerage system, the implementation of the K Plan, and where she sees brokerage services headed.

Kathryn has been a hugely influential player in services for people with intellectual and developmental disabilities both in the northwest and nationally. She played an integral role in the development of brokerage services in Oregon and brokerages statewide could not be more pleased that she’s signed on to lead us into Oregon’s next phase of services. Sometimes the best way to figure out where you’re going is to remember how you got where you are. Our conversation started there.

Larry: What did services look like in Oregon twenty years ago?

Kathryn: Looking back fifteen years plus, prior to the filing of the Staley lawsuit and the creation of the brokerage system, Oregon was in the process of downsizing an institution and we had very, very long wait lists.

Larry: Wait lists for community-based-services?

Kathryn: For everything. I use the term wait list loosely because it really never was a wait list. It was a crisis list. If you went into crisis, you got services. There were very few services for adults except group homes. Any family of a child under 18 who needed any kind of support had to go through the Child Welfare system. And they had to say they were on the verge of having to place their family member out of home, usually into foster care. It had to be that serious before there was a possibility of getting in-home supports. The stories you’d hear families tell about trying to survive without any support and then having to say this. It was devastating.

Larry: And your son, Colin – you were in this situation with him, right?

Kathryn: When my son was sixteen, we had a major crisis in the family and we had to go the crisis route. We had to go to Child Welfare and we had to tell people why we couldn’t handle our situation any longer by ourselves.  It was one of the hardest things I have ever done in my life.

Larry: And when you say services – what are we talking about here? What did these services look like?

Kathryn: Early on the services through Child Welfare were designed to support families with respite, in home support, and things like behavior support. Later the Developmental Disabilities Program created some very small, grant funded, family support programs for families with children under 18. It was later expanded to include families of adults. Services were extremely limited. For example in Multnomah County there were only fifty families who had access to supports. (Ed: for comparison, there are thousands in services in Multnomah County today.) It was very limited, but it gave advocates a model to draw from. First, someone needing supports got a “guide” (much like a Personal Agent) to help find and engage with community resources. And second, you got a little bit of funding. But for the first time it was funding that was family-controlled. The satisfaction level in that program was incredibly high. People thought it was amazing. And when the state asked, people told them that their “guide” was the most important thing. These pilot programs helped shape some of the understanding of policymakers.

Larry: The structure sounds very much like the structure and services offered by brokerages today.

Kathryn: Yes. Then later, before the Staley lawsuit was filed, the state applied for and received a Robert Wood Johnson Foundation grant. The idea was to look at what was becoming a national agenda in terms of self-determination and to apply some of those principles to adult services. They set up a small model brokerage (Self-Determination Resources Inc.) and this really pushed systems change.

Larry:
At the time, over 5,000 people were waiting for services, which led to Staley v. Kitzhaber.

Kathryn: If you consider both adults and children who were eligible but not receiving services, yes. Yes, the lawsuit was based on the fact that there were people who were eligible for services but denied them. The State chose to negotiate a settlement of the lawsuit.

Larry: After the lawsuit was settled, the state set out to develop services for everyone on the wait list. How did the brokerage model emerge?

Kathryn: Oregon chose very specifically to say: “This is Oregon, we have economic ups and downs, we are not a rich state, we cannot afford to provide 24 hour, seven days a week residential services to everybody on our wait list.” Many people don’t need that level of service. We learned that people are good decision makers about what they need in their lives when given support and guidance that’s meaningful to them. A crucial element was that families and individuals with disabilities needed to be in the leadership role. Through much discussion, stakeholders arrived at the conclusion that small, decentralized nonprofit and community-based programs would provide a solid foundation for choice-driven services.

Larry: And then we fast forward thirteen years. Oregon chooses to pursue higher federal funding through the Community First Choice Option (the K Plan.) What are your thoughts on this change?

Kathryn: I think that for years we have argued that we needed more resources in the DD system. We all know that there are people with significant support needs who aren’t receiving the level of supports that they actually require and need. We knew that the existing Support Services funding was not adequate for many people. I think the K is an incredible opportunity for Oregon to bring more resources into the state. The challenge is in the implementation.

Larry: Do you think the state expects us to deliver services differently now as a result of the K Plan’s implementation?

Kathryn: Well, additional resources are wonderful but we need to remain focused on the goals, the vision that people with disabilities, with appropriate supports, can create a full life, rich in friends and meaningful community connections, employment and significant relationships.  It is what we want for all our children. There’s no reason we have to lose those values, though I believe they are significantly endangered. The K has forced change in what I believe are the fundamentals: self-determination, choice and control. We have moved to a system that is deficits-based. That being said, I think there are ways- could have been ways – that didn’t undermine these cardinal values. Brokerages are committed to keeping the conversation about these values alive. It hasn’t been popular because it isn’t easy. I think we all recognize that any kind of system change is difficult and that the implementation process is the hardest part. That being said I am struck by the lack of planning that has ignored the hydraulics of a lifespan service system, the failure to listen to the lessons learned in the past, and the failure to listen to operational wisdom of stakeholders. The result has caused long-held priorities to be turned inside out. We will continue to  push for involvement in these conversations, before decisions are made.  It is important to have our core values drive decision-making instead of being after-thoughts that are an inconvenience to the process.

Larry: You mentioned a deficits-based approach. This brings to mind the Functional Needs Assessment or Adult Needs Assessment, which is a tool we now use when people enter brokerage services. The tool measures a person’s support needs and determines what services they’re eligible for. When you think about having a needs assessment completed – well, that’s something many states require. This isn’t a new idea, it’s not out of left field. But what you’re saying is that it’s not the tool that is the concern, it’s the approach.

Kathryn: It’s the implementation that’s the problem. Most states have some kind of assessment like this – a functional needs assessment. I think the key is in how the process gets framed. I recently went through an assessment with my son. I think the person who did it is wonderful and I understand that time is short. But I would have liked to hear “What would he like to be doing? What would he like his life looking like?” It would help focus on the idea that these supports are being offered for a purpose. There is great power in starting an assessment by talking to someone about who they are and what they hope to be. It’s not just powerful for people with disabilities. It informs the way we all think and behave.

Larry: I think brokerages are focusing on goal development first and finding a way to fit the needs assessment in as naturally as possible. It’s a shift and we’re still learning how to make all the pieces fit. One of the bigger concerns right now is that the tool being used is temporary, just a placeholder. This is an untested experience and, as it stands right now, Oregon plans to change the assessment tool we’re currently using and replace it with a different tool by January of next year.

Kathryn: What we must not lose sight of is that this may be just a pilot project in some people’s eyes, but for the people going through this assessment having their support plans radically changed, there is nothing “pilot” about it. This is about their lives. It’s about getting the resources they need and are being told they’re entitled to under the new funding model. I think it’s a really important message that people making these decisions need to understand. This is not a pilot. These are people’s lives. Clearly, the introduction of any new assessment tool and process must be thoroughly planned and implemented in a way that does not disrupt the lives of customers and families or cause chaos in the system. January 2015 is too soon. The dust will have not settled from this last effort.

Stay tuned next week for Part 2 of our talk with Kathryn. She discusses the brokerage response to the K plan, the concern over monthly versus annual budgeting for customer plans, and thoughts on appropriate long-term strategies to assure a sustainable future for services for Oregonians with intellectual and developmental disabilities.

The Needs Assessment for Brokerage Customers: How We Got Here and Where We’re Going

By Larry Deal
Executive Director

You might have heard that there are some changes to the way brokerage services are administered and funded. One of the most significant changes is that all brokerage customers must now have a formal functional needs assessment at least once a year.

A functional needs assessment is a series of questions that asks what kinds of living supports a person needs to live independently in the community. Oregon has chosen the Adult Needs Assessment as its current tool. You may view the tool by clicking here. The assessment asks questions about what kinds of independent living supports you need, why you need them, and how often you need them. Once the assessment is completed, it determines certain services you are eligible for and how often you can access those services.

Brokerages have been actively involved in conversations with the state and other stakeholders regarding the implementation of the assessment. Since summer of 2013, brokerages were instructed that we would have a year from the time we received the assessment tool to implement the changes. The state spent several months developing what was to be a brand new needs assessment, but the tool was abandoned for myriad reasons. We received a final tool in November 2013 and immediately began conducting assessments as our customers’ plan years rolled over. Because we typically plan with our customers up to six weeks in advance of a plan’s start date, the first assessments we completed were for customers whose plan years began in January of this year.

Under the original plan, brokerages expected to complete all assessments by October of 2014 for the approximately 7,500 customers receiving our services statewide.

However, we were informed in February 2014 that an agreement between the state and federal oversight entities would force a significant shortening of that timeline. The Centers for Medicare and Medicaid Services (CMS) insisted that all assessments be completed within one year of when Oregon began receiving Community First Choice Option/K Plan dollars (July 1st, 2013.) Leadership in Oregon argued for more time. It wasn’t granted and the deadline was shortened. Instead of October, Oregon was now instructed to have all assessments completed by the end of June 2014 or risk losing its federal funding.

Brokerages expressed ample concern about this change – we would need to complete nearly 2,000 additional assessments in less than five months – and requested additional funding to add staff, hire contractors, or pay overtime to existing staff to meet the charge. Instead of funding brokerages, the state decided to deploy its own staff to complete the additional assessments.

Which brings us to the present.

As a system, we are faced with a June 30, 2014 deadline to complete all assessments. Last week, we sent out letters informing some of our customers that they would be receiving an assessment from a non-Independence Northwest assessor. We have been assigned three state employees (Rachel, Kay and Ana) to complete the assessments in Multnomah and Washington counties. For our Clackamas county customers, Robyn Hoffman (a Clackamas county employee) will be the primary assessor. If you didn’t receive a letter, you won’t be affected.

The staff of INW have met with the assessors and they all carry a great amount of experience working with people with intellectual and developmental disabilities. Independence Northwest is providing designated office space, workstations, and meeting rooms for them and they have begun calling customers and scheduling assessments.

Here at Independence Northwest, we estimate that somewhere around 125 customers will receive their assessments from state or county staff. INW Personal Agents are responsible for conducting the remaining 300+ assessments. Additionally, a plan revision must be completed after each assessment. INW Personal Agents will be completing revisions for all 435 customers in our services, in addition to any necessary job description or contract amendments. The workload for our organization is significant and we are working hard to meet the charge.

Once this implementation phase is completed, your Personal Agent will meet with you at least annually to complete a needs assessment – usually right before your ISP meeting. The state and county involvement is a one-time situation to allow the state to catch up and meet the terms of their agreement with CMS. Moving forward, it becomes a part of our regular service delivery. We’ve posted a set of frequently asked questions. Check them out here.

The functional needs assessment implementation is one of many, many changes occurring in our system right now. Since last August, we have been holding community forums at least twice a month to update the community on what’s changing, why, and how. If you would like to learn more, join us for one of our upcoming sessions.

Additional Resources:

 

 

April 2014 Community Forum Dates Announced – Learn About the Big Changes to Brokerage Services

Our April 2014 Big Changes in Brokerage Services Community Forum dates are set! Join us on Wednesday April 2nd from 10AM – 11:30AM or Wednesday April 23rd from 6PM – 7:30PM. Learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates, and much more. We’ve got lots of details to share. Join us!

RSVP to Rachel at 503.546.2950 or by emailing rkroll@independencenw.org.

BigChangesApril2014

March 2014 Brokerage Changes Forums Filling Up Fast! Reserve Your Spot Today

Seats are filling up very fast this month! Our March 12th forum is at capacity, but there’s still space for our March 26th evening session. Save your space by calling Rachel at 503.546.2950 or emailing rkroll@independencenw.org. Lots of developments this month. We look forward to seeing you there.

bigchangesMarch2014

ODDS Interim Director Pens Message to Community on Needs Assessments for Brokerage Customers

quill-pen

Just last week, ODDS Interim Director Trisha Baxter released a message geared toward families and customers. She will continue these messages on a monthly basis. In the message below, Trisha talks about the new Adult Needs Assessment, why it’s now a part of brokerage services, and what to expect. Thanks to Trisha for reaching out and developing clear communication on a complicated topic.

“Because it is important for you to have the best information for yourself and your families, I want you to know about the work that is happening in Oregon’s Developmental Disability Services (ODDS) program. Each month, I will be writing a new update for families and self-advocates so you’ll have the most current information. We will post the updates on the ODDS Facebook page and send them to your provider, CDDP or brokerage so they can get the update to you.

The new “K Plan” brings changes to some of our DD services, but leaves other services as they were and adds new services. To help you understand what the DD system now offers, ODDS created two new brochures, one for services to children and one for services for children and adults:
Services for Children: http://www.oregon.gov/dhs/k-plan/Documents/Developmental%20Disability%20Family%20Brochure-form%200339.pdf
Services for Children and Adults: http://www.oregon.gov/dhs/k-plan/Documents/Children%20and%20Adult%20Service%20Brochure-form%200338.pdf

Brokerages and CDDPs will have these publications at their offices, but you can also print them from the links provided here.

I have heard many questions from families and self-advocates about the changes in ODDS services and one of the most common is about why we have to assess what you need before your Individual Support Plan (ISP) and what you can expect at your next assessment. I will address that in today’s message.

Why you have to have an assessment:

• In order to understand your goals, strengths, choices and needs as they relate to your disability, the K Plan requires Oregon to do a face-to-face assessment.
• The assessment helps ODDS and those who help you develop your ISP understand which services you need to help you meet your goals.
• You will have the assessment once a year, but you can ask for a new assessment before a year has passed if you want a new assessment.

What to expect at your assessment meeting:

• You will be treated with respect.
• The person asking the questions will listen to you.
• ODDS needs to know about your goals and strengths, but also needs to know when you need help and what kind of help you need.
• During the assessment, you will be asked questions that will help ODDS understand what kind of supports will help you meet your goals.
• Before the assessment, you should think of all the different kinds of support you use. Think of the supports you use in the community, at work and at home.
• Remember: the assessment helps ODDS understand what you need to be successful, so stay positive and think about all the supports you need to meet your goals.

I encourage you to send your questions to me and I will answer them. You can also find a lot of current information on our Facebook page at: https://www.facebook.com/pages/Oregon-Developmental-Disabilities/179862702153136?ref=hl

Trisha Baxter
ODDS Interim Director and Chief Operating Officer

Guest Blog: Proposed Rate Cuts to Provider Organizations Threaten Innovation

Our first blog post of 2014 is an important one. Late in 2013, word came from the Oregon Office of Developmental Disabilities Services that they were planning to significantly reduce Small Group Inclusion and Skills Training rates paid to provider organizations. Upon review, brokerages immediately responded explaining such a decision would put many small business completely out of business, reducing key resources for our customers statewide.  In the weeks since that exchange, small provider agencies in the Portland metro area (led by On The Move Community Integration, Creative Goal Solutions and Trellis) have come together to form a grassroots coalition (known as The Coalition of Provider Organizations.) Their aim is to educate the state, legislators and the general public on their services and fight the potential reductions in rates. The group developed a comprehensive white paper on their concerns (read it here: Provider Organization Coalition Paper) and, in December of 2013, presented to and gained the support of the I/DD Coalition. As a result of their efforts, state leadership has agreed to meet with some small agencies this week as they reconsider the rates. Our understanding is that the state will need to publicly share their methodology and reasoning and has committed to entertaining stakeholder input and education throughout the process. Given the stakes, full engagement is key.

Sasha Vidales, Owner and Director of Creative Goal Solutions, one of the most sought-after agencies in the Portland area is today's guest blogger for the Independence Northwest blog. Below, she shares what this all means from a provider organization, small-business owner and concerned community member perspective.

Sasha Vidales, Director of Creative Goal Solutions


Sasha Vidales, Director of Creative Goal Solutions, one of the most sought-after agencies in the Portland area is today’s guest blogger for the Independence Northwest blog. Below, she shares what this all means from a provider organization, small-business owner and concerned community member perspective.

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“Proposed Rate Cuts to Provider Organizations Threaten Innovation”

By Sasha Vidales, Director of Creative Goal Solutions

While Oregon is moving to the K-Plan, many customers are seeing increased access to funding for their services. But simultaneously, provider organizations’ hourly rates are slated to be cut by almost 18%. Perhaps most affected by these cuts are smaller, local, grass-roots organizations who have sprung up in response to the diverse needs of brokerage customers; programs like Creative Goal Solutions, which I started in 2011 to offer fully-integrating community-based services to adults with developmental disabilities. Already operating on a shoe string budget and my personal investment, the proposed rate would unquestionably force Creative Goal Solutions to close its doors within just a couple of months.


The greatest detriment would be to the individual customers served by Creative Goal Solutions, customers like Annie Rose. When Annie Rose started working with Creative Goal Solutions, she had the same goals as most twenty-somethings—to move out on her own, get a job, have new life experiences, and exert her independence. Through working with CGS, she had the opportunity to explore her greater community in a group setting. “I like Creative Goal Solutions because it gets me out of the house. I like meeting new people. I discovered new foods…I enjoy going to the park… camping was lots of fun. I like going to the library and art showings.” Soon after her start, Annie decided to move into her own apartment. CGS staff helped her establish a routine around cooking and cleaning that would increase her success as she transitioned. Knowing the importance of community connectedness, staff also helped Annie explore her immediate community on foot and on bus to find new hang-outs. She now independently works out at her local community center and has some favorite local shops and cafes, all the while staying involved in CGS’ group community inclusion. A while later, Annie also took on various volunteer jobs. With staff support, Annie Rose works alongside community members and other customers to gain job skills and give back to her community.
“I like doing Zenger Farms,” says Annie Rose, “I really like gardening and don’t do enough. Now I get to go out once a week and it’s a relief. I’m suddenly happy! I’ve noticed the weeds have gotten enormous and tough to pull out. I’m proud that I can pull them out.”Annie is just one of the over 40 customers flourishing with the support of Creative Goal Solutions’ unique service model. When I started Creative Goal Solutions, I was excited to use innovative strategies to develop meaningful, community-integrating experiences for our customers. I envisioned services that would empower each customer to become involved citizens and create meaningful visibility for themselves. Over the past two and a half years, I’ve assembled a team of highly creative, motivated and skilled employees to put this vision into action. Now, we boast a diverse array of programs to accomplish that vision.What I didn’t realize upon CGS’ inception, was the tremendous value of the group-model. Customers learn so much from each other and there is often a lot of camaraderie, connectedness and natural support developed. At the same time, the model differs drastically from facility-based models in that customers are making daily, “real-life” contact with their communities through recreation and volunteering. Many customers and parents, including Laurie Burk, have noticed the difference.
“[The facility-based program he attended prior to CGS]… provided little or no outside community activities. There was nothing special about the program. I likened it to a daycare center. Since attending CGS, he has shown much improvement. We believe this to be directly related to attending outings to places that “regular” people go. I don’t think many people who are not affected by developmental disabilities understand the secluded life of a young person with disabilities and what they face day in and day out… Just because he has a disability doesn’t mean he doesn’t have worth.”Our Volunteer Program connects and teaches customers at six different community organizations, including The Rebuilding Center, SCRAP, Hoyt Arboretum, Impact NW, the Bike Farm, and Zenger Farms. All of these sites give our customers job-like experience where they can gain skills and confidence working right alongside community volunteers. The program has been tremendously impactful in our customers’ social well-being and sense of worth and individual contribution.

Nightlife Group at local pub

Nightlife Group at local pub

We also provide fully-integrating recreation experiences. The programming is diverse, offering many activities not commonly accessible to people with developmental disabilities. We fill the monthly calendar with customer-preferred activities, such as bowling and libraries and unique experiences, such as attending the Feast of Guadalupe concert, Leech Botanical Gardens, and a tour of the Human Society. We also offer a Nightlife Group. Through this, many customers have their first experiences going to activities like stand-up comedy, salsa dancing and pub trivia. Additionally, our camping trips afford customers the opportunity to be away from home with a group of friends and foster budding friendships through exploring nature.


At Creative Goal Solutions, we continually challenge what others think possible. Those with seemingly significant barriers are equally engaged through our program. Oxana Betska, a mother of one such customer wrote, “[Though he is] nonverbal, he is very social. He wants to be around people, go places, learn new things… [at CGS] he is taught how to behave around other people, how to treat them properly. We can definitely see the progress he has made paying attention to the instructions he was given, evaluating the situation which can be new for him, becoming more independent and mature. The program has helped my son gain self-esteem. Through the program our son volunteers at the retirement center. He has a wonderful time there!”
Volunteering at Bike Farm

Volunteering at Bike Farm


Writes Matthew Burk, customer and self-advocate, “I like the format where we meet at the office and board mass transit and go to different places like Fazio Farm, The Old Church for a lunch time concert, the Rose Garden up near the zoo, the zoo, and the game room down at PSU among other cool places. My favorite part of the program is that being a boy from SE Portland I get to see the other parts of the city that I never knew existed. If cuts were to be made I’m not sure what I would do. Without CGS I would go back to being a couch potato and having no routine.”


Despite our customer’s successes, we’ve experienced significant barriers when it comes to a functional and sustainable business model, having to fit a square peg in the proverbial round hole. Our program model of fully-integrating group experiences does not fit well in the current provider rate structure. Most traditional services are provided with one staff per one customer or take place in a facility. Our services don’t fit either of those models and our way of providing services comes with substantial added costs as well as barriers to be able to bill for the full rate. Despite these barriers, we’ve persevered. We’re proud to be one of the handful of truly unique, local, grass-roots organizations with truly unique services to offer.

Rock wall climbing

Rock wall climbing


It’s hard to imagine the local impact of all of these customers losing the visibility and community presence that we’ve worked so hard to promote. Observing our customers’ growth in confidence and self-efficacy over the past two years has been one of the most impactful experiences of my life. Equally important, I’ve seen our community’s response to our customers. I believe that through our work, we’ve begun to shift how people understand disability. They are witnessing all that people with developmental disabilities are capable of contributing, and, with time, learning how essential they are to the fabric of our community.


We’ve accomplished a lot in just over two years. I have many more ideas that I’m actively implementing: a self-employment program, a healthy lifestyles group, and leveraging our culturally-competent, 50% Spanish-speaking staff to better engage Latino customers. Yet, my intense passion and enthusiasm is met with a very real possibility of closure. I’m working hard to push back against the proposed cuts. I’ve co-formed a coalition of small provider organizations, including On-the-Move Community Integration and Trellis to express our alarm and the potential impact of cuts. We’re meeting with decision-makers at the State level as well as other affected provider organizations. I am also counting on the support of families, professionals, self-advocates, community members and the decision-makers at DHS to halt rate cuts and make the growth and development of our innovative program, and others like it, to flourish… for the betterment of our customers and the betterment of our communities.


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ABOUT

Sasha Vidales has worked in community services for 14 years in mental health, policy research, training development, case management, quality assurance and other capacities. She has a BA in Psychology and an MBA in Organizational Behavior and is trained as an Autism Specialist and Social Sexual Consultant. Sasha founded Creative Goal Solutions in 2011 because of her belief in and commitment to strong communities. She knows that strengthening communities requires meaningful and full integration for all people. If you are interested in learning more or joining the coalition, contact Sasha at sasha.vidales@creativegoalsolutions.org.

Join Us for a Community Forum at INW this Month

2013JanuaryForum

Independence Northwest continues its community outreach on big changes to brokerage and I/DD services in Oregon. Since August, we’ve held many highly successful community forums presenting to over 400 community members – and we’ve got two more scheduled for the month of January!

Join us if you’d like to learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates and much more.

Remember to RSVP by calling our front desk 503.546.2950. You may also email us at rkroll@independencenw.org. Space is limited, so reserve your space at one of our evening or day sessions today!

Big thanks to all the families, customers, providers and community members who have joined us in the past few weeks. Your questions, comments, concern and input continue to make a difference in the restructure of the I/DD system!

State Announces Payment Systems Change Delay; Provider Enrollment Agreements Still Needed

Dear Providers,

Yesterday, newly-appointed ODDS Interim Director Trisha Baxter announced that Oregon is putting the brakes on its move to centralize payment to providers of brokerage services.

The new target date for the change is now July 1st, 2014.

For quite some time, there has been great concern amongst brokerages, providers, and customers regarding what has been a rather rocky implementation process. Payment to our essential provider base must be top priority for our community and system. We applaud ODDS’ move to delay for solid planning and pledge to work with the Department on development of a thoughtful and thorough approach to this transition.

That said, all providers still need to turn in their Provider Enrollment Application and Agreement. Regardless of how long this process takes, one thing is certain: you will need a provider number to do business in Oregon. It’s in your best interest and in the best interest of your customers that you take this important step now.

To recap:

  • Continue to send your timesheets and invoices to INW as you always have. We’ll continue payment to you until at least June of 2014.
  • If you haven’t sent in your Provider Enrollment Agreement, do so now. This is an essential action on your part, regardless of changing timelines. The state should then follow up with you and provide you details on how to sign up and sign in to the eXPRS payment system.
  • If you have turned in your PEAA and have received no response back from the State, contact them directly at DD-MH.OHCC@state.or.us.
  • Additionally, all providers must have a criminal history check completed every two years.

Thanks for your work and support of our community. Stay warm out there!

Best,

Larry Deal
Executive Director

Join INW in December for a Community Forum on the Big Changes Happening in Brokerage Services

bigchangessmalldecember2013

Independence Northwest continues its community outreach on big changes to brokerage and I/DD services in Oregon. Since August, we’ve held many highly successful community forums presenting to over 300 community members – and we’ve got two more scheduled for the month of December!

Join us if you’d like to learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates and much more.

Remember to RSVP by calling our front desk 503.546.2950. You may also email us at larry.deal@independencenw.org. Space is limited, so reserve your space at one of our evening or day sessions today!

Big thanks to all the families, customers, providers and community members who have joined us in the past few weeks. Your questions, comments, concern and input continue to make a difference in the restructure of the I/DD system!

Update for Providers Regarding Provider Numbers and Forthcoming Payment Changes

numbersDear Providers for Customers of Independence Northwest,

I’m writing to give you a general update regarding upcoming changes to provider payments. There’s been a flurry of activity around this topic in recent weeks and here’s the latest as we know it.

As you know, the State of Oregon Office of Developmental Disabilities Services plans to take over payments to brokerage providers in the near future. The deadline has changed multiple times and their current public target is January 1st, 2014.

In preparation for this change, all providers must obtain a Provider Number. In order to receive a Provider Number, you must turn in a Provider Enrollment Application and Agreement (Word or PDF). The Provider Number will allow you to go into the State’s payment system and make your claims. Without this number, you won’t be paid.

Many of you have contacted us via phone, email, on Facebook and in-person concerned because you submitted the required paperwork, yet you’ve heard nothing from the State. Communication and direction has been spotty, for sure.

Here’s how INW can help.

A day ago, the thirteen support services brokerages received a spreadsheet from the Oregon Home Care Commission. This spreadsheet contains the names and contact information for about 3,400 providers statewide. It includes assigned Provider Numbers. We are currently in the process of sorting through the list to determine which providers are attached to Independence Northwest.

  • If your name is on the list, we will email you your Provider Number early next week. (Some providers are getting email notifications with their Provider Number from the Home Care Commission and some aren’t, so you may receive this info twice.)

 

  • If your name is not on the list, we will email you early next week and tell you that the State has not assigned you a Provider Number yet. This may be because you didn’t submit a PEAA or perhaps the State hasn’t processed your PEAA yet. We have no way of knowing which is the case (or if there are other variables), so concerned providers will need to follow up with the State at that point by emailing DD-MH.OHCC@state.or.us. At this time, the State has not provided a direct contact person or phone number. If that changes, we will update you.

We expect to receive updated Provider Number lists from the State from time to time, but don’t yet know what the frequency will be. As we receive those lists, we will update you where applicable.

If you haven’t submitted your Provider Enrollment Application and Agreement, please don’t delay – do it today.  As of right now, less than half of the Personal Support Workers in the State have been assigned Provider Numbers. It’s essential everyone is assigned a number on or before Monday, December 2nd, 2013. We can’t let a bureaucratic change affect payment for essential services to adults with I/DD.

Brokerages will continue payment (at the very least) through the end of 2013. As deadlines shift, we’ll keep you informed. You will continue to send your invoices and time sheets directly to your customer’s Personal Agent, as before.

To Recap:

  •  If you haven’t sent in your Provider Enrollment Agreement, do it now.
  •  If you have turned it in and we send you a notice saying the State hasn’t included you on its list, contact them via email at DD-MH.OHCC@state.or.us.
  • Continue to send your timesheets and invoices directly to us at Independence Northwest. We will notify you when the State is formally taking over payment. Even after the State takes over payment, you’ll still send proof of services to us for review.
  • The State will take over payment to you sometime in the new year. They are planning trainings and support for providers to get acclimated to the eXPRS system. Hold tight, information forthcoming.

We promise to communicate changes with you quickly to ensure as smooth a transition as possible. We are continuing our series of customer and community forums and welcome you to join us. It’s a great place to discuss the changes with other community members and get the latest details. I also encourage you to Like us on Facebook and subscribe to the Independence Northwest Blog to get updates as we have them.

Thank you for the essential work you do for our customers, their families and the community at large.

Best,

Larry Deal
Executive Director

PS – Provider organizations with current eXPRS log in information need not be concerned with this notice. As I currently understand it, provider organizations who are awaiting a Provider Number and eXPRS log-in will be contacted in the next week or so by the State.

Join INW in November for a Community Forum on the Big Changes Happening in Brokerage Services

bigchangesnovember2013

Independence Northwest continues its community outreach on big changes to brokerage and I/DD services in Oregon. In the last eight weeks we’ve held nine highly successful community forums presenting to nearly 190 community members – and we’ve got two more scheduled for the month of November! (We will also be presenting details about the changes at the upcoming Portland Public Schools Transition Fair the week of Thanksgiving. Details forthcoming.)

Join us if you’d like to learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates and much more.

Remember to RSVP by calling our front desk 503.546.2950. You may also email us at larry.deal@independencenw.org. Space is limited, so reserve your space at one of our evening or day sessions today!

Big thanks to all the families, customers, providers and community members who have joined us in the past few weeks. Your questions, comments, concern and input continue to make a difference in the restructure of the I/DD system!

ATTN: Providers – Updated Information on Payments and Provider Enrollment Agreement Timelines

calendar changeProviders, Customer Employers, and Community Members,

As you have likely heard by now, the State of Oregon Department of Human Services (DHS) has been moving toward changing the way providers of brokerage services are paid.

Since 2001, brokerages have operated as a fiscal intermediary for our customers and we have been responsible for provision of provider payment. For many years, DHS has shared its intent to update its systemic capabilities and pay providers of brokerage services directly instead. It looked like 2013 would be the year things changed.

In May of 2013, DHS sent out a missive to all Personal Support Workers, which included a copy of a Personal Support Worker Provider Enrollment Application and Agreement. The mailer stated “completion of this document is required for you to be on the State Registry” and that “by signing this agreement the state will issue a provider number which will be necessary for payment on or prior to October 1, 2013.”

However, the state’s payment change efforts have experienced continued delays and as a result of these delays payment will continue through brokerages for the time being. We are being told that January 1st, 2014 is the new target date for when you’ll be paid directly through the State.

Our office has begun receiving multiple calls from providers concerned about their payment and where it will come from as a result of the registry and the October 1st, 2013 deadline. We request two things:

1. Please continue to send your invoices and time sheets to Independence Northwest as you always have. We will follow our regular payment schedules for providers and you should experience no disruption in payment.

2. If you have not yet completed a Provider Enrollment Agreement, we implore you to do so. While we can’t be certain the new January 1st, 2014 date will be met, we know that eventually you *will* receive payment through the DHS payment system and you must be set up in order to avoid delay in payment. It’s imperative you have a provider number assigned to you before being paid. Please take a moment to take care of this important piece of business.

Thank you for your continued partnership, efforts and support of our customer base. And thank you for your patience during the current transition.

*Please note: We were told by state employees that provider organizations who are not already set up in the state’s payment system will receive a provider number via the state’s licensing unit. If you have questions about this, please contact Larry Deal at larry.deal(at)independencenw.org. Thanks.

Join Us in October for a Community Forum on Big Changes in Brokerage Services

CustomerForumOctober2013Image10/04/2013: Please note – we have cancelled the October 7th forum. Please join us on either the 9th or 21st!

Independence Northwest continues its community outreach on big changes to brokerage and I/DD services in Oregon. In the last six weeks, we’ve held six highly successful community forums presenting to nearly 150 community members – and we’ve got three more scheduled for the month of October.

Join us if you’d like to learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates and much more.

Remember to RSVP to Rachel at 503.546.2950. You may also email her at rkroll@independencenw.org. Space is limited, so reserve your space at one of our evening or day sessions today!

Big thanks to all the families, customers, providers and community members who have joined us in the past few weeks. Your questions, comments, concern and input continue to make a difference in the restructure of the I/DD system!

Concern Over Talk of Reduction in Pay to Providers

By Ron Spence, Operations Director and
Larry Deal, Executive Director

Last Tuesday, August 20th, Independence Northwest hosted a community forum focusing on the big changes afoot in brokerage services and how those changes will affect providers and the provider community. We had an excellent turnout and lively conversation. A couple dozen providers (primarily Independent Contractors and a few Domestic Employees) came together to discuss upcoming systemic shifts including a change to how providers will be paid and quite possibly, how much they’re paid. As mentioned in earlier articles published by Independence Northwest, these changes are a result of the K Plan and poor audit findings. Read more about that here.

Significant Rate Reductions Potentially Ahead for Providers?

At present, SEIU (Service Employees Union International) and the State of Oregon Department of Human Services are in the process of bargaining rates for SEIU’s provider members. Thanks to House Bill 3618, all Domestic Employees and the majority of Independent Contractors serving brokerage customers are represented by SEIU. You’ll often hear these providers referred to as PSWs [Personal Support Workers] as a result).

Elvyss Argueta, an SEIU organizer who showed up to Tuesday’s forum, dropped a bombshell when he announced that there is movement by the State in current negotiations to reduce the top amount an Independent Contractor can be paid from $24 per hour to a paltry $14.00.

On Wednesday, August 21st, 2013, SEIU sent an email blast out to its members confirming Elvyss’s claims. Per SEIU: “We met with the state last Tuesday and bargained into the evening… The State is continuing to press for significant cuts to Independent Contractor rates … (and) is proposing that Independent Contractors’ current wages will only be kept whole until July 2014, at which point IC wages will drop to $14 per hour. This is unacceptable.”

We agree. Dropping rates down to such a measly rate would create a true crisis for the providers affected and the families and customers who receive services from them. There’s really no way to sugarcoat this. If SEIU’s claims become a reality, this type of service provider (with very few exceptions) will cease to exist as an option for brokerage customers.

Understanding the “Wage” of an Independent Contractor

First things first: employees and contractors are completely different animals. Decision-makers must understand this. The mere suggestion of cuts this deep points to a misunderstanding of not only the unique supports provided by these small businesses, but also of the very definition of an independent contractor.

On the surface, $14 per hour may sound like a fair and decent wage. It’s several steps above minimum wage and is considerably higher than the average direct support professional’s wage in Oregon. However, a closer look at what an Independent Contractor is and does reveals a completely different picture (please stick with us while we offer some context.) Independent Contractors get “paid” rates like $24 per hour because they assume all responsibilities for their own taxes, insurance and benefits; as a result, they take home much less than you’d think. The State was keenly aware of this important distinction as it developed a set of published rate ranges at the onset of brokerage services in the early ’00s.

Let’s start with a typical employee situation. If you are employed by a company and earn $14 per hour, that fourteen dollar figure does not represent the whole story. For starters, add 12% due to the taxes your employer must pay just to employ you and the cost jumps to $15.68 per hour or more. Then, let’s say you get health benefits – even low level benefits – from your employer. That’s probably another $300 per month (about $3,600 per year). That ends up costing your employer another $1.73 or so an hour, bringing your “wage” up to $17.41. Now, let’s throw in two weeks paid vacation and another week of sick time. That costs your employer about $1,881 for the three weeks (another 90 cents an hour) and now we’re up to $18.31 per hour. Maybe you have 401(k) or retirement benefits or if you are a government employee, maybe there’s some PERS being stashed away on your behalf. Your employer buys the supplies you need to do your job, pays for you to attend trainings, pays business insurance and liability insurance, pays for Workers Compensation insurance and mileage reimbursement and on and on… Anyway, you get the idea. $14 to you isn’t $14 to your employer.

Now let’s reverse all of that and look at it from the perspective of a contractor.

A properly classified Independent Contractor is a walking business. Unlike an employee, a contractor has no employer to offer them benefits, liability insurance, mileage/travel costs, computers, office supplies, software, training, sick or vacation time. Everything *starts* at the hourly rate which is exactly why they charge more. Your Independent Contractor might charge $24 to your Plan of Care, but his/her take-home is nowhere near that. Chances are pretty high that your Independent Contractor doesn’t drive a Lexus.

If Oregon starts paying Independent Contractors $14 per hour, these workers will very likely take home less than minimum wage for a professional service. Why would someone do all this work to make less than the guy across the street employed by a brokerage customer or provider organization? Why carry the headache of purchasing liability insurance, ensuring proper deductions, paying self-employment taxes (15.3% in 2013), worrying about your own health insurance only to make less?

If rates really are reduced to this level, we will witness hundreds of small businesses shutter and close up shop. Small businesses truly are the engine fueling Oregon’s current economic recovery.

The Need for Diversity of Provider Types to Serve a Diverse Population

We are lucky to have at our fingertips a rich community of Independent Contractors with varied backgrounds and specialties: former teachers, former case managers, people from the business community who decided they wanted to something more rewarding with their lives. Just as we value diversity in the people we serve, we value diversity in our provider base. We don’t just value that diversity for its own sake. We value it because it promotes choice and increases the quality of supports customers receive. Brokerage customers have wildly variant needs and that calls for a wildly variant set of skills in the provider community. Caregivers in the home meet certain essential needs for our customers. Skills trainers meet others. Provider agencies meet still others. It’s the diversity of choice that makes brokerage services exemplary and completely unique in the system.

A Need for Capacity and a Pledge of Support

In the Portland metro area, we work with hundreds of independent contractors. They have played an integral role in the development of brokerage services over the last twelve years and are a highly valued, essential part of this system.  As the K Plan rolls out, more services will be available for our customer base. This is a great thing. But all those extra financial resources mean nothing unless we have qualified, competent providers who can make a living doing the work. If we price them out, we all lose. Reducing capacity makes no sense.

We realize all too well that information is changing rapidly. This reduction may not even be on the table in a week. But, presently, this conversation is on the table. We feel an obligation to respond to this public information and to support the providers we, our customers, and their families rely on each day for critical health and safety supports. Independence Northwest stands in unequivocal opposition to a reduction in the rates of any provider who serves brokerage customers. 

We encourage providers to communicate with their legislators and leadership at the State to advocate for no reduction to the rates and to educate them on the services they provide. We promise to do the same.

Any reduction in rates for providers serving our customers is a step backward for all of us.

Get Involved!

Independent Contractor Patricia Lawrence is organizing Independent Contractors in the Portland metro area. Visit her new Facebook group for Independent Contractors  or send her an email directly at plawrence@tds.net to get involved.

Please Note: The proposed $10 per hour reduction is specific to those providers who fall under the Personal Support Worker/Independent Contractor designation. Services such as Behavioral and Social/Sexual Supports are not included in the announced proposed reduction.

Oregon Developmental Disabilities Director: “Guardians Can Be Paid with Right Processes in Place”

Oregon Developmental Disabilities Patrice Botsford makes a big announcement on the payment to guardians issue this afternoon:

“WE HAVE GOOD NEWS!!!! Today our federal partner, the Centers for Medicare and Medicaid Services (CMS) informed Oregon that guardians can be paid to provide care to their loved ones with the right processes in place. We are working quickly with CMS to clarify those processes and to develop a new notice for beneficiaries, but we wanted to share this information with you as soon as possible. When those details are worked out, we will provide you with an update and more information about next steps.

Thank you for your patience as we have been working through this difficult issue. We know that this issue is important and that the uncertainty about how we are moving forward is stressful for families and their loved ones. We appreciate the care and concern we have heard these past weeks and we remain committed to providing you with the most up-to-date, accurate information that we have.” Patrice Botsford Director, DHS Office of Developmental Disabilities Services

Schedule of Upcoming Forums and Events | August & Sept 2013

There have been a lot of announced events in the last couple of weeks. Here’s a quick list of what’s happening and where (UPDATED 08.22.2013)

August 20th – 6:30pm
Provider Forum at Independence Northwest
Note: This forum is at capacity and is no longer accepting RSVPs. Future forums forthcoming
(Portland) Details

August 21st – 6:30pm
Community Forum at Independence Northwest
Note: This forum is at capacity and is no longer accepting RSVPs.
(Portland) Details

August 22nd – 6:00pm
Customer and Family Forum with State DD Director Patrice Botsford at Edwards Center
Please RSVP to Dan Peccia at 503.292.7142 x11 or dan@sdri-pdx.org
(Aloha) Details

August 22nd – 4:30pm
Craft Night at Independence Northwest
Please RSVP to Melissa at 503.546.2950
(Portland) Details

August 27th – 6:30pm
Provider Forum at Independence Northwest
Note: This forum is at capacity and is no longer accepting RSVPs. Future forums forthcoming
(Portland) Details

August 28th – 1:00pm
Community Forum at Independence Northwest
Please RSVP to Rachel at 503.546.2950 or rkroll@independencenw.org
(Portland) Details

August 28th – 6:30pm
Community Forum at Independence Northwest
Please RSVP to Rachel at 503.546.2950 or rkroll@independencenw.org
(Portland) Details

September 11th – 6:30pm
Community Forum at Independence Northwest
Please RSVP to Rachel at 503.546.2950 or rkroll@independencenw.org
(Portland) Details

September 12th – 10:30am
Community Forum at Independence Northwest
Please RSVP to Rachel at 503.546.2950 or rkroll@independencenw.org
(Portland) Details

 Keep an eye on our blog for future announcements!

Big Changes in Oregon’s I/DD Service System | Part Two: Payment to Legal Guardians

Part Two: Payment to Legal Guardians
By Larry Deal, Independence Northwest Executive Director

NOTE: The State has reversed its take on payment to Guardians. Check out the latest details from Patrice Botsford here.


As mentioned in last week’s piece, Oregon’s Department of Human Services has chosen to change its primary funding source from Title XIX Waiver services to the new Community First Choice Option/K Plan. This change increases federal revenue for Oregon and expands services for seniors, people with physical disabilities, and children and adults with intellectual and developmental disabilities. With the additional revenue comes new mandates and expectations.

Perhaps the most controversial change thus far is the mandate that legal guardians no longer be paid as care providers through brokerages. Keep in mind that legal guardianship requires a court order and is not something that automatically occurs when an individual with a developmental disability turns eighteen. Guardianship also requires annual renewal action by the guardian.

Per ODDS (Oregon Office on Developmental Disability Services), CMS (Centers for Medicare and Medicaid Services) views payment to a legal guardian as a conflict of interest (see CFR 441.505.) When the funding was coming primarily through waivers, guardianship payment was permitted, but because Oregon has chosen to change its primary funding to Community First Choice Option/K Plan, the expectation has changed. It is now consistent with the regulations for how services are implemented for seniors and people with physical disabilities.

Statewide, well over 400 guardians are paid to provide services, the majority of them supporting people served by brokerages.  At present, brokerages and CDDPs (Community Developmental Disabilities Programs) have been directed by the state (ODDS) to begin conversations with our customers and their legal representatives about how to come into compliance with the new standards. We have requested clear, written materials to be shared with families and individuals regarding this directive.

As you can imagine, there has been a lot of concern and discussion on this topic. There’s quite a bit at risk here and clear, direct communication from all parties is key right now.

In a recent mailer to its members, SEIU (Service Employees International Union) claimed “some brokerages and CDDPs have incorrectly informed parent providers that they can no longer be their child’s guardian if they want to be paid as a provider. This is not true.” We share SEIU’s concerns on this change, but their mailer is misleading. ODDS has clearly and publicly stated this is their policy and has instructed brokerages and CDDPs to share this mandate and begin the conversation on this planned change. If one follows the directive up the chain, its genesis is with the government, not brokerages and CDDPs.

Two weeks back, ODDS Director Patrice Botsford released an extensive statement explaining the state’s position. “Families must make a decision whether the guardian will remain in place and not continue as the paid service provider and a new service provider chosen, or the guardianship may be terminated or transferred… We are asking that their decision be relayed to us via their case manager no later than December 1, 2013 for January 1, 2014 implementation. Read her entire statement here.

In addition to the statement, ODDS released a two-page Frequently Asked Questions document highlighting the specifics of the change. It’s worth a read.

Long-time disability rights advocate Representative Sara Gelser (D-Corvallis District 16) has become involved in the discussion. She recently began requesting stories through posts on her Facebook page. Per a post on August 7th, Rep. Gelser had met with Patrice Botsford and others at ODDS. Wrote Gelser: ” I had a very good meeting today with Patrice Botsford and her Deputy (Director) from the Office of Developmental Disabilities. I am feeling hopeful that we can find a solution that will meet everyone’s needs and will cause minimal disruption. Thank you for your stories. Please keep sending them, as they are very helpful.” She went on to thank Patrice and her team for partnering for a solution. Sara Gelser is beginning to look at potential legislative action that could influence the future.

At present, ODDS is developing an exception policy that will potentially allow for some guardians to be paid under the K Plan. The exception policy is still in draft format and will be reviewed by CMS in the next week or so.

Advocates throughout the system continue to comb through federal regulations and state law to see if there are other approaches that can be taken to address the situation. In the meantime, if you would like to be involved in the discussion and share your story, you have a few options.

Later this week, we’ll send out another missive on the Designated Representative piece. The representative issue is linked to the guardianship discussion, but deserves its own attention due to its complexity. For the sake of clarity, we’ll address it separately.

Additional Resources:

08/15/2013 UPDATE:
DD Director Patrice Botsford shared the following new information on ODDS’ Facebook page: “I wanted to quickly update you on where we are on our request for exception on guardians as paid caregivers. Our request is currently in the hands of CMS and their attorneys. We have near daily communication with them, and are looking forward to the best possible outcome. We are as anxious as you are, and we will post here as soon as we have any updates. Keep up the good work, and thank you all again for your advocacy and support.”

Big Changes in Oregon’s I/DD Service System | Part One: The Functional Needs Assessment Tool

Part One: The Functional Needs Assessment Tool
By Larry Deal, Independence Northwest Executive Director

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Customers, Families, Providers and Community Members,

As you might have heard, there’s a series of significant changes happening in services for adults with intellectual and developmental disabilities here in Oregon. This is the first of several short(ish) articles to update you on changes to your services and to solicit your feedback, thoughts, and concerns. Let’s start with an explanation of why some of the changes are happening.

Why Are Things Changing?

In short, the Oregon Department of Human Services (the state) gets money from the federal government (about 60% of service dollars) and during a recent review by CMS (Centers for Medicare and Medicaid Services), Oregon was found deficient in several areas. As a result, the feds are demanding a series of changes on a short timeline. At this point, CMS has submitted its findings only for Oregon’s comprehensive (24/7) services; findings from their review of brokerage services are forthcoming.

In addition to the audit findings, Oregon has experienced some budgetary shortfalls, specifically with regard to the program – Aging and People with Disabilities Services – that serves seniors and people with physical disabilities. The Department of Human Services and the Oregon legislature have determined that migrating all services to a new program called the Community First Choice Option (or K Plan) will bring about 6% more federal funds into the state. This means many changes for brokerage customers and providers.

I will address these changes in future articles, but for this piece, let’s focus on one big change that will affect brokerage customers in the very near future: CMS’s mandate that Oregon create and implement a Functional Needs Assessment tool to be used on all individuals receiving services paid for by federal funds. For the record, this change isn’t related to the K Plan or the budget, just the CMS review.

Historical Assessment Practices in Brokerage Services

Historically, brokerages have not used extensive formal assessments to determine your service needs and budgets. Everyone has been eligible for just about the same amount of service dollars (around $14,000 per year, give or take.) For the last eleven or so years, when a person has been referred to brokerage services, we sit down and speak with you about your support needs and personal goals. From there, we seek out natural supports and resources in the community to help you achieve those goals. If there’s a need for funded services, we support you to find the right provider, we assist you with hiring/contracting with the provider, and we provide quality support and oversight for the services you receive. We have to prove that you have a disability-related need for every service purchased. We glean support needs through conversations with you and fill out a state document called the Customer Goal Survey. This document, when completed, resides in a customer’s file at the brokerage and is reviewed by the state when they visit for annual audits.

Starting this fall, things will change. In addition to our usual practices, we will begin completing a Functional Needs Assessment on each and every brokerage customer, new or old. The FNA must be administered annually and will usually take place before we complete your annual ISP (Individual Support Plan.)

The state recently released a transmittal explaining expectations and timelines for implementation.

So, What is a Functional Needs Assessment?

Oregon’s Functional Needs Assessment (FNA) is a scored tool that asks for in-depth information on your support needs in the following areas:

  • Mobility
  • Transferring
  • Positioning
  • Eating/Drinking
  • Toileting
  • Bladder Control
  • Urinary Catheter Care
  • Bowel Control
  • Hygiene (Menses, Bathing, Dressing and General Care)
  • Housekeeping
  • Meal Preparation
  • Shopping
  • Transportation
  • Money Management
  • Communication (Expressive and Receptive)
  • Personal Safety
  • Fire/Emergency Evacuation
  • Medication Management
  • Health Management Supports
  • Complex Health Management Supports
  • Equipment
  • Behavioral Supports (Supervision and Interventions)
  • Legally Mandated Supervision
  • Nighttime Needs

The FNA, based on locally utilized tools as well as materials from other states,   has been developed primarily by state employees, with input and review by stakeholders from a variety of backgrounds, including brokerages. The FNA was created in Excel spreadsheet format so that scores will automatically calculate when the questions are answered on the document. However, the state has not yet completed the algorithms and formulas that will determine the services brokerage customers will be eligible to receive. They have recently brought on an outside contractor to complete the project.

Once the state finishes building the FNA, your Personal Agent will be responsible for administering the tool and assigning values for each question answered. Since the tool is still incomplete, we have not yet seen how someone’s needs will equate to actual services, but expect to soon.  The current estimate for a fully functional tool is October 1st, 2013.

Will This Affect Individual Funding?

Yes.

As mentioned earlier, the historical practice has been to offer you a set sum of service dollars (on average $14,000 a year.) If brokerage services were inadequate to meet your needs, crisis services and comprehensive services (group home, foster home, etc.) were offered as an option.

The Functional Needs Assessment tool will not have a dollar amount attached. Instead, it will determine how many units of most services you will be eligible for. The FNA will determine what you have access to, based on your disability-related needs.  For example, it may say you are eligible for 100 hours of respite per year, 350 hours of skills training and it will suggest appropriate resources to build a ramp on your home for safety and access. Those pre-determined resources are then utilized to bring on providers and build the plan of care.

Additionally, your benefit level will no longer be capped. The services a person is eligible to receive will be wholly individualized. Although no one can be sure of precisely what the results of the new model will be, the state expects that some people will be eligible for more services than they currently receive and some people will be found eligible for fewer services than they currently receive.

Can Changes Be Made to the Tool?

Yes.

This isn’t the first tool the state has created. The SNAP tool (used to set rates for providers in foster care) is now on iterations into the double digits. There are likely to be many revisions to the FNA over the first couple of years as the state fine-tunes and hones it through feedback and inquiry.

The state will be receiving copies of all completed assessments conducted on customers. You or your legal representatives may request a copy of the FNA tool at any time. The Department will be sharing when there are major changes to the tool, but state representatives have stated that the state will not be releasing information related to the scoring algorithms and may or may not share when the algorithms have been changed. There is currently an advisory group comprising stakeholders from a variety of backgrounds who will continue meeting well into the future.

You always have the right to request a new review of the assessment; brokerages are responsible for performing the assessment within 45 days of request. Higher level review details are forthcoming.

Want to Learn More?

Information changes, literally, by the hour. Oregon’s DD services have never seen such sweeping change so swiftly. Portions of this article might be out-dated within a day or two, in fact. If there are significant changes or amendments, I will note them below this article on Independence Northwest’s blog.

To help customers, families and their advocates better understand what’s happening, Independence Northwest will begin hosting a series of informational sessions at our office a couple of times a month. The sessions will cover information on the Functional Needs Assessment as well as other changes.

Scheduled Sessions:

When:         Wednesday August 21st 6:30 – 8:00pm

                     Wednesday August 28th 6:30 – 8:00pm

Where:        541 NE 20th Avenue Suite 103, Portland

Please RSVP by calling Rachel Kroll at INW (503.546.2950) so we are sure we have ample materials and space for the presentations.

Keep an eye out for additional articles in the coming days and weeks on the K Plan, changes to guardian payment, changes to case management options, changes to the brokerage ISP (Individual Support Plan) and more.

Questions?

If you have questions, please don’t hesitate to contact your Personal Agent for the latest details. You may also drop me a line at larry.deal(at)independencenw.org and I’ll do my best to either answer your question or refer you to someone who can.

Changes to services come with some degree of difficulty and we recognize that some of these changes are significant. We will do all we can to share the information we receive and offer transparency and support through each transition.

Thank you for being part of the Independence Northwest and the brokerage community. We are honored to serve you.

Additional Resources