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!”
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 PACKET. ICs 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.
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
By Larry Deal
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.
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 firstname.lastname@example.org.
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.