A Comment on Changing Rates and Service Definitions from Metro Brokerage Directors to Provider Organizations

Dear Portland Metro-Area Provider Organizations,

We, the six metro-area support services brokerages, wanted to send out a quick note regarding the current status of transitioning service codes, amending plans, and adjusting rates given the potential September 1st changes.

First, we’d like to briefly comment on our current understanding of DSA and Attendant Care services. Based on the DRAFT Expenditure Guidelines we received from the Department of Human Services just last week we believe that provider organizations can perform both Day Support Activities (DSA) as well as Attendant Care services. For details, follow this link to their current work-in-progress: August 2014 Expenditure Guidelines

We have been in talks with the state to request a delay of the September 1st implementation of these changes. Our primary reason for the delay request has to do with the impossible time frames we are faced with as a system to implement this latest sea change. Brokerages need appropriate time to do planning and coordination with customers prior to amending Individual Support Plans (ISPs) and  service agreements, and Providers need time to evaluate the changes and revise their business plans in order to meet the new regime. We hope to hear back from Interim DD State Director Trisha Baxter within the next day or so regarding our request for delayed implementation. (Please note: we are requesting to delay implementation of DSA, but we are not asking for a delay to implementation of Supported Employment changes.)

Our hope is to work with the State on a reasonable timeline for implementation this fall or winter in a thoughtful process that  includes  a stakeholder work group charged with leading and influencing the transition.

As always, we appreciate your patience and partnership as we manage such significant systemic change. Your recent and ongoing advocacy is very much appreciated. Surely, we all agree that a  thoughtful, proactive approach to transition is key to serving our customers and community in the most respectful and productive way possible.

We know there are scores of unanswered questions out there and we are preparing to gain the understanding necessary to respond to them given our limited resources during this transition. Without clarification and without the full participation of our customers, we are not able as of now to amend goals, plans, or service agreements.   Please stay tuned – more details shortly.

Best,

Dan (SDRI), Katie (Mentor), Jennifer (CPI), Larry (INW), Rachel (Inclusion), and Sarah (UCP)

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

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

Oregon Council on Developmental Disabilities Launches “Expect Me to Succeed, I Will” Campaign

The Oregon Council on Developmental Disabilities kicked off DD Awareness Month at the Oregon State Capitol this past Friday. At the event, they premiered a brand new video: “Expect Me to Succeed, I Will.” Take a minute or two to check out this excellent message and beautifully executed content from OCDD. Great start to the month!

INW Presents a Free 3-Day Healthy Lifestyles Class in February

Healthy_Lifestyles_Flyer

Healthy Lifestyles for People with Disabilities is a holistic wellness workshop designed for people with disabilities.  The workshop embodies the self-determination model, and its ultimate goal is to give participants the tools they need to evaluate their lives and identify the areas in which they would like to improve to make positive changes.

The workshop is divided into five modules including: Emotional Health, Social Health, Physical Health, Spiritual Health & Health through Meaningful Activities.  Be prepared to share stories, participate in fun exercise activities, identify your dreams and learn useful tools that will help you live a happy, healthy and fun life!

  • When: Feb 12th, Feb 13th and Feb 14th from 8:30AM – 4:30PM
  • Where: East Portland Police Precinct (737 SE 106th Ave in Portland
  • Free lunch and snacks provided!

RSVP your space by calling Rachel at 503.546.2950 or emailing rachel@independencenw.org. We look forward to seeing you there!

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.

________________________________________________

“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.


________________________________________________
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!

Tomorrow 11/26/2013: Join Us at the Portland Public Schools Community Transition Resource Fair from 12 – 7

resourcefairsmall

Join Us at the Portland Public School Transition Resource Fair tomorrow from 12 noon to 7PM. The fair will be held on the Green Thumb campus: 6801 SE 60th Avenue in Portland. INW will be there along with the other metro area brokerages. We’ll also be putting on a couple of presentations related to brokerage services. See you there!

SPEAKERS

  • 1:00- Transition Requirements:  Setting the Stage for successful Movement from High School to Adulthood
  • 1:30- PCC Disabilities
  • 2:00-Portland Public Schools
  • Community Transition Program                    
  • 2:30- Brokerage Service Basics
  • 3:15- Changes to Brokerage Services
  • 4:00- Transition Students and Alumni
  • 4:45- Plan for Work: Work Incentives Planning and Assistance- Plan for Work
  • 5:30- Phame/Club Impact

Meet up with many organizations supporting adults with I/DD in our community, including:

  • PPS Transition Program
  • Student-Run Businesses
  • PCC- Culinary Program
  • PCC- Skills Center
  • PCC-Disability Services
  • Incight
  • Trips Inc.
  • Special Olympics
  • Off the Couch
  • Club Impact
  • Mt. Hood Kiwanis Camp
  • PHAME
  • ARC
  • Oregon RISE
  • 211 Info.
  • IEP Partners
  • Safety Zone
  • SPEAC
  • Oregon First
  • Disability Rights of Oregon
  • Autism Society of Oregon
  • FACT Oregon
  • NAMI
  • Vocational Rehabilitation
  • Portland Habilitation Center- PHC
  • CTP Vocational Training
  • DePaul- Project Search
  • Pathways to Independence
  • Independence Northwest
  • Inclusion
  • Mentor Oregon Brokerage
  • UCP Connections
  • Multnomah County Aging and Disabilities
  • Multnomah County DD
  • WIPA Program
  • RideWise
  • Albertina Kerr
  • On the Move

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!

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!

Fri Oct 4: Next Self Advocates Taking Action Meeting at INW

CALLING SELF ADVOCATES!
Join Self-Advocates Taking Action, a NEW self-advocacy group in Portland for people with developmental disabilities who want to speak up.

What: October Meeting

Agenda: Talk about the vision and mission of our group and advocacy for our community

When: Friday, October 4th 2pm

Where: Independence Northwest 541 NE 20th Avenue Suite 103

Why: Meet new friends, share ideas, learn new things, and have fun

For more information, contact Gayle (503-239-3407) or Kaaren (503-287-7946).

1st Annual Cuts for a Cause Event a Great Success!

brian_brian_CFACYesterday was not only the first day of autumn – it was also the 1st Annual Cuts for a Cause Benefit for Independence Northwest. Heritage Barbershop, a local Portland business, sponsored the event offering free haircuts and styles to brokerage customers and their caregivers. Despite the blustery weather, we had a great turnout and the event raised $600 for the Independence Northwest Emergency Fund! The Emergency Fund helps people with intellectual/developmental disabilities in times of need.

We owe a huge debt of gratitude to Heritage Barbershop’s owner, Brian Porteous, for this event. What a guy. Brian pulled together a fantastic raffle including donated goods and gift certificates from local businesses including:

donationtable_CFAC

Huge thanks to these businesses for donating to this cause. We appreciate your support! For those who couldn’t stick around until 4PM for the raffle drawing, we’ll be notifying winners by phone shortly.

Additionally, we’d like to extend gratitude to the barbers Jen Mattson and Tariq B for volunteering their professional services to our customers and their caregivers. They did a fantastic job and gave some very fine cuts yesterday. And big thanks to Lorissa Prestwood Porteous, provider De Linda French Davis, INW Operations Director Ron Spence, and INW Board President Bill Beckett for helping the event run so smoothly!

This was truly a community event and we look forward to the 2nd Annual Cuts for a Cause event next summer!

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!

Announcing the 1st Annual CUTS FOR A CAUSE Benefit for INW Customers – Sept 22, 2013

C4C-jpgWe’re proud to announce what we hope will become an annual tradition: Cuts For a Cause, an event on Sunday, September 22nd, that will offer free haircuts to our customers and their caregivers and will raise money for our emergency fund, a small pool of money we keep to help out our customers in times of extreme need. We will be partnering for this event with Heritage Barbershop, a newly-opened business that has generously offered the time and talent of its barbers to make this event possible.

Heritage proprietor Brian Porteous is no stranger to giving haircuts to people with disabilities. He spoke to me recently during a haircut of my own about his experiences early in his barbering career in California. “There was a group who came in every couple of months and I learned really quickly that just like everyone else, people with disabilities are all different from one another,” he told me. “Next to giving a good cut, a barber’s most important skill is communicating with the person in the chair, and that’s all about treating every person as an individual.”

 

Space is limited and must be scheduled ahead of time. Please call Rachel at our office (503.546.2950) to schedule an appointment. If the free haircut slots fill up we’d still love it if you’d stop by and say hello. We’ll have free popcorn and will be having drawings for prizes every 30 minutes or so. And of course we’ll be accepting donations from those of you are able to give a few dollars to what we think is an important cause. We can’t thank Heritage Barbershop enough for their support and generosity and look forward to a long partnership with Brian and his barbershop.

 

If you’d like more information or would like to donate please contact me at 503.546.2950 or ron.spence@independencenw.org

 

Thanks,
Ron Spence, Operations Director

 

  • What: Cuts For a Cause, a fun benefit offering free haircuts to Independence Northwest’s customers and their caregivers
  • Where: Heritage Barbershop, 22137-B East Burnside in Portland
  • When: Sunday September 22nd from 11 am to 4 pm

Remember, all free haircuts must be schedule ahead of time. Please call today to reserve a spot. Contact Rachel at 503.546.2950.

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.”

August 22nd, 2013: SDRI Hosting Customer Forum with State DD Director

sdriguardianmtgAnnouncing an upcoming self-advocate and parent meeting with Patrice Botsford, State Director for Oregon’s Office of Developmental Disabilities. Many changes are ahead that will affect services for people with intellectual and developmental disabilities. Washington County brokerage SDRI is hosting an evening discussion on August 22nd from 6 – 8pm. Join them to discuss the changes and have your questions answered! The meeting will take place at Edwards Center: 4375 SW Edwards Place in Aloha.

Be sure to RSVP to Dan Peccia at 503.292.7142 x11 or dan@sdri-pdx.org.

Thanks to Dan, SDRI and Edwards Center for pulling this important evening together.

 

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

Independence Northwest Celebrates 6 Years as a Support Services Brokerage

6yearsSix years ago today Independence Northwest became a fully-funded Oregon support services brokerage. Thank you to our founding and current board of directors, our many stellar staff members past and present, CDDP and provider partners, fellow brokerages, and customers and families for your belief, support, guidance, and partnership these past six years.

We are proud to be part of Oregon’s I/DD community and look forward to many more years with you!

Brokerages Weigh In on K Plan and Systems Changes; DHS Offers Responses to Concerns

paperOn June 12th, 2013, several brokerage directors met with Erinn Kelley-Siel (Director of the Department of Human Services), Trish Baxter (Chief Operating Officer for Aging and Disability Programs) and Patrice Botsford (Director of the Oregon Office of Developmental Disabilities Services) to discuss concerns related to planned changes to services for brokerage customers and individuals throughout the system. During the meeting, we shared a formal position document (see below*) outlining concerns, questions, and recommendations. Given the significant amount of systems change occurring in Oregon right now, the paper touched only on high level, immediate issues.

Within a week of that meeting, Erinn, Trish, and Patrice followed up in writing on each of our concerns and their responses are included below. Some questions have now been answered and others are still in process. We appreciate the Department’s willingness to meet with us, their openness to feedback and input from the field and we look forward to regular, ongoing engagement on forthcoming changes and implementation strategies.

________________________________

*Positions and Recommendations on the K Plan, Its Implementation, and Additional Department-mandated Changes (June 2013)

OSSA (Oregon Support Services Association) is a non-profit organization comprising the thirteen support services brokerages in Oregon. Collectively, the association represents over 7,000 adults with intellectual and/or developmental disabilities (I/DD) who live independently throughout Oregon’s 36 counties. Brokerages have been in operation since 2001 and OSSA since 2010.

We envision a world in which all people live the life they choose in communities where they are valued, respected, and honored. In this world, individual strengths are celebrated; high quality supports are ample and readily available; labels are absent; and self determination is universal. This vision is realized from neighbor to legislator.

Present Situation: Community First Choice State Plan (K Plan) Implementation

In June of 2013, responding to budgetary shortfalls and weak findings from a statewide CMS audit, the Oregon Office on Developmental Disabilities (ODDS) sent its Community First Choice State Plan Option K (K Plan) application to the federal government for approval. The K Plan, if approved, will bring a 6% increase in federal match funds to Oregon. ODDS has formed workgroups and brokerage representatives have participated over the last month and a half.

This paper is an effort to capture the support services brokerage perspective in a publicly available set of thoughts, concerns, and issues surrounding the K Plan and its implementation in Oregon.

OSSA supports many of the aims of implementing the K Plan including:

  • Bringing additional federal funding into our state to preserve services for Oregonians with support needs
  • Developing options for fluidity and portability across service elements
  • Expanding of choice to the I/DD community

Additionally, OSSA has specific concerns about current implementation strategies including:

  • Ensuring the principles of self-determination are at the foundation of implementation
  • Offering true choice in Targeted Case Management across the system
  • Lack of extensive testing of the Functional Needs Assessment prior to implementation and the potential repercussions on populations (e.g. people with autism) whose needs it may fail to capture
  • Quality assurance review and customer/brokerage authorization of services prior to provider payment
  • Significant loss of flexibility caused by changing from annual benefit levels to monthly fixed allotments
  • Long term fiscal sustainability

Ensuring the Principles of Self-determination are at the Foundation of Implementation
In developing a new service delivery model, it is important to validate the importance of self-determination as the cornerstone of Support Services, and not just a salvaged component of yesterday’s service delivery model. We support a model that honors the aspirations of the individuals while adhering to the funding criteria that brings needed federal matching funds to Oregon’s Medicaid funded programs.

We believe that there is room for both. A person centered service delivery model based upon the principles of self-determination relying upon a Functional Needs Assessment to determine the disability related supports that are available in pursuit of life goals is a workable model.

Recommendation: We recommend that ODDS continue to commit to retaining the principles of self-determination as defined in statute and rule to drive planning and implementation of the Community First Choice State Plan Option K. We recommend that the Functional Needs Assessment exist in a supportive role to determine those disability-related expenditures available in support of self-determined life goals.

DHS Response: The Department agrees. Person-centered planning and self-determination are foundations of the I/DD system. Although the functional needs assessment is required, plans will continue to be developed in support of an individual’s life goals with the functional needs assessment driving the ADL and IADL supports necessary to support the individual in achievement of their goals.

True Choice in Targeted Case Management Across the System

In the current system, CDDPs provide Targeted Case Management (TCM) to children and adults receiving comprehensive care. In addition, they serve a small number of people receiving In-Home Comprehensive Services. Brokerages currently provide TCM exclusively to adults with I/DD who live independently in the community (support services).

Over the past couple of months, ODDS representatives have stated that CMS is “mandating choice in who provides TCM” under the K Plan. We are told that, per CMS mandate, customers must now be offered the choice of a CDDP case manager OR brokerage Personal Agent for support services.

When reviewing the system as described we find the decision to offer choice only in one area (support services) puzzling and inconsistent. As you see below, choice is decidedly limited to just one subset of the recipient base – the program recipients brokerages currently serve. Recipients in all other service elements continue to have no choice in who provides TCM.

Brokerage Provides TCM CDDP Provides TCM
Support Services

In Home Comprehensive

Residential

Supported Living

“Not in Service” Case Management

Child Case Management

Family Support

The vast majority of brokerage customers currently have at least two different entities providing Targeted Case Management to choose from. Many have four or five choices. Customers in every other service delivery program in the state currently have no choice. The proposed change marginally increases choice for a small percentage of brokerage customers while continuing to leave half or more of Oregon’s I/DD population with no choice whatsoever.

Further, we are concerned about conflict of interest free choice counseling under the new proposal. We understand that there have been conversations about third party choice counsel for people entering adult services. While we welcome any attempted neutral approach to assuring appropriate counsel, we are concerned about the viability of neutrality in a system that offers choice only to a select group.

An example: We think this model’s flaws are particularly evident during the period when recipients transition from child to adult services. Turning 18 is a time of enormous stress and change for an individual and his/her family. They are dealing with becoming their own decision-maker, an independent signer and they no longer have a de facto guardian. Further, they are applying for Social Security, updating their Medicaid status and possibly undergoing additional eligibility testing related to their I/DD diagnosis. Additional changes, particularly changing case managers, during such a period of upheaval seems an unlikely preference for most families. Real choice should be offered from the beginning so that people have time to form and maintain their relationship with their case manager, be they from the CDDP or the brokerage.

Recommendation: We recommend that ODDS provide universal choice by permitting brokerages to provide targeted case management in all service elements serving people with I/DD (including children). In the absence of full choice, we believe ODDS should create a distinction between CDDP and brokerage case management by assigning facility-based services to CDDPs and community-based adult services to brokerages. Our recommendation is consistent with the Oregon IDD Coalition’s recommendation on this topic.

 DHS Response: There is a statutory change that would be required in order to allow brokerages to serve children under the age of 18. However, as noted in the revisions to the chart (below), brokerages will be allowed to serve In-Home Comprehensive and “Not in Service” Case Management individuals. Residential and Supported Living services are to be phased in at a later date. It is the intent of ODDS that brokerages will be allowed to serve these populations within the next 12 months. Full choice of service providers (CDDP or Brokerage) will be given to individuals in all areas, with the exception of services related to children. This is a statutory change that can be explored during a future legislative session if so desired.

ODDS has added updates to the chart. Please see below:

  Brokerage Provides TCM CDDP Provides TCM
Support Services

In Home Comprehensive

7/1/13

Residential

7/1/14

Supported Living

7/1/14

“Not in Service” Case Management

 7/1/13

Child Case Management

Planned, pending statute change 

Family Support

Planned, pending statute change  

Functional Needs Assessment Development and Testing

ODDS representatives have been developing a new Functional Needs Assessment tool (FNA). Under the K Plan, services and supports are based upon a tool designed to determine a number of hours of service. Because this is a Medicaid requirement, it has been placed front and center as the driver of services. While we respect the necessity of the FNA, we believe the drivers of services should continue to be self-determination and the individual’s aspirations for his or her own life.

A person centered planning process based upon self determination is first and fundamental. From there, the FNA acts as the funding mechanism enabling the provision of disability-related supports to meet the aspirational goals of the individual, not the other way around.

We believe that an assessment tool intended to be placed at the center of all individual service decisions should be supported by comprehensive testing and computer modeling prior to implementation. The FNA has not yet been subjected to either. Data and real-word application should be established in advance of placing thousands of individual lives at the mercy of any assessment mechanism.  We have particularly strong concerns that some needs related to autism, behavioral and psychosexual disorders in particular will not be effectively articulated in the FNA form. Testing will allow for thoughtful examination of the value the FNA may bring to our Employment First and Executive Order requirements.

Our understanding is that the FNA will not be linked to rates on the comprehensive services (24/7) side during initial phases of implementation. We support this approach and ask that similar caution be taken on the support services side. Such an approach allows for testing and modification without disrupting the lives of recipients or the businesses of those who serve and support them.

A great many of our customers have exactly the same needs as those in 24/7 settings such as group homes and foster care homes. While the average brokerage customer has a budget of $14,000 per year, a full 7% of our customer base has been assessed through the Base Supplement Criteria Inventory process. They receive an enhanced budget between $20,000 and $24,500 per year due to extensive needs with personal care, caregiver capacity, behavioral support needs, and other high level support with activities of daily living.

Recommendation: We recommend a minimum 20% sampling of brokerage customers be tested to prior to formal implementation to determine a baseline from which to budget and consider future options, as well as to address employment and specific disability support issues. It seems the legislature and other administrative staff would require something of this sort in order to budget appropriately for Oregon’s future. There are very real fiscal and human repercussions at play here. We will partner in any way possible to help Oregon achieve this aim.

DHS Response: The department agrees that the new functional needs assessment is going to need extensive field testing and we appreciate the offer of brokerages to assist in this effort. We anticipate having a draft ready for some testing as early as the week of June 24. Testing the tool with individuals that we already know will be of great benefit. Initially the new assessment will be used for new people coming into service, and for existing individuals as their assessment renewal is due. This needs to begin on July 1, assuming CMS approval for a July 1 effective date, however, we know that the tool will be a work in progress and will need modifications as we gain experience in utilizing the tool with the I/DD population.

Pre-Payment Review and Quality Assurance

Since brokerages first began operation in 2001, we have always practiced high standards of quality assurance by reviewing direct services documentation prior to payment to qualified providers. Every single invoice, timesheet or bill is reviewed by the Personal Agent prior to payment. In order for us to move forward with payment, we must confirm:

Customer (or legal designee) signature confirming services

  • Progress notes confirming Medicaid-allowable services and how they relate back to the individual’s disability-related support need and person-centered goal
  • Units, rates, and dates that fall within the terms of the service agreement between the customer and the provider

The review of these invoices offers an immediate opportunity for education, feedback and correction when necessary. We currently employ a proactive approach and work with the customer and provider to assure CMS and state mandates are met. Not a single invoice, timesheet or vendor bill is paid in any of our thirteen organizations without thorough review and vetting.

This process permits us to do everything from fixing a basic pro-ration error to identifying fraud. Close review of these documents has led to protective service investigations, sanctioning of fraudulent providers, and the immediate intervention to address health and safety concerns.

Currently, these strong quality assurance mechanisms are at risk for a major change. As ODDS moves the brokerage plan of care into its payment system (eXPRS) there has been serious consideration given to permitting providers to go directly into the system to claim payment, bypassing essential quality assurance review and oversight. We have been told that we could do a “statistical sampling every three months or so” and follow up on errors after the fact.

We strongly object to a pay and chase system such as this and believe it’s at odds with CMS’ general shift over the past several years. By reviewing these documents ahead of time, we’re playing a proactive role not a reactive one. We believe this approach is consistent with the Department’s core values and practices.

Recommendation: As fellow custodians of public funds and strong believers of fiscal accountability, we urge ODDS to continue to permit brokerages to provide quality review on 100% of invoices, timesheets and bills received prior to payment to providers through the state’s payment system. The current processes within the brokerages have been proven to be principled and effective in financial management. 

DHS Response: The department has already revisited this decision and will be building functionality into the eXPRS system to allow for review and approval by brokerage staff prior to payment being issued. Brokerages will be able to determine their business process for accomplishing this task, including requiring customer authorization, invoices, etc. No payments will be issued without brokerage staff review and approval.

Monthly Fixed Allotments Versus Annual Benefits

In the current system, when a brokerage customer enters services, he/she has an annual benefit amount of around $14,000. She can purchase supports when she likes, as required based on disability-related needs. This sometimes means  she needs zero services for X months and then needs a significant number of services during, say, the summer. The current system allows for her to utilize her services when she needs them based on current availability of resources both paid and not paid.

Under the K Plan, there’s no such thing as an annual benefit cap. The Functional Needs Assessment (FNA) determines how many hours a person is eligible for per month. If you don’t use it, you lose it. For twelve years, brokerage customers have been operating under the annual benefit and have enjoyed the flexibility to meet real-life needs such a system allowed. In our discussions with customers and family members, this is a primary area of concern right now.

Recommendation: We understand that the monthly versus annual budgeting model is an Oregon design decision and not something mandated by CMS under the K Plan. We recommend maintaining utmost flexibility for those receiving services and therefore a customer budget developed on an annual basis. Programs should be crafted to fit the needs of people. When we attempt the inverse, the system can’t meet needs in the moment and small issues become compounded. People lose options and control.

DHS Response: With the implementation of the “K” State Plan Option, individuals will receive the supports that they need each month. In essence, the idea of monthly or annual budgets goes away – individuals will be authorized for services determined to be necessary through the functional needs and service planning processes. This means individuals with support services can budget at an annual level if that works best for them.

Long Term Fiscal Sustainability Concerns

Prior to 2001, services for adults with I/DD in Oregon were pretty much limited to those with significant need. People living independently (with family or on their own in the community) received very little by way of services and this resulted in a lawsuit brought by concerned families (Staley v. Kitzhaber.) As a result of the 2000 Staley Agreement, a new way of providing services was born. Enter the brokerage system. Well over 7,000 people have enrolled in brokerage community-based services statewide in the last decade. Most people have somewhere around $12,000 to $14,000 available to them annually through their brokerage. This model doesn’t provide for every single need – but it does provide support to every single eligible individual.

Our concern is this: We serve people with very significant support needs, far beyond anything brokerages can fund. Family members, neighbors, friends, partners, community members and spouses play a role in each person’s support system. They provide natural supports to the individual to ensure his/her success without creating dependency on a paid system. A person, whose plan is currently $14,000 per year, could easily be reassessed and suddenly that plan will pencil out to $75,000. Conversely, those with $14,000 today could shrink to $3,000 tomorrow.

While we absolutely support the concept of providing disability-related support wherever needed, we must also consider what our budget can sustain over time. Proper assessment of available natural supports is key to the long-term sustainability of our service delivery system.

How do we avoid reinventing the system we deconstructed just a little over a decade ago? If costs grow beyond what Oregon’s budget can handle, what happens? Do we start re-determining eligibility for these services? Do we start leveling individuals? Do we begin eliminating people from accessing services (as we did with General Fund customers) so that they go back to relying on emergency state and county systems? Do we say “this year we serve people in levels 1 – 12, but next year we can only serve 1 – 10?” Oregon has done it before with Oregon Health Plan and we fear it will happen again here. Do we recreate a system where we can only afford to serve Oregonians with the highest needs while categorically denying services to those with perceived “lesser needs”?

One of the most fantastic features of brokerage services has been creating an environment where individuals who had little exposure, integration and inclusion in their communities were finally afforded the opportunity (via disability-related supports) to fully participate. That has been of immeasurable benefit not only to the individuals who are now participating, but to society as a whole. When communities are exposed to people with I/DD, societal opinions, prejudices and assumptions change. We have thousands of people with limited support needs now engaging and flourishing in their communities. We cannot roll backwards – we must ensure the new system serves all people with I/DD, no matter how “limited” their support needs might seem to the outside world. Oregon has made promises to this population and we must make good on them.

Recommendation: Again, we recommend extensive testing on the Functional Needs Assessment prior to formal implementation.

DHS Response: The department shares this concern and will be watching expenditures very carefully. Our hope is that we will be able to serve more individuals in the community, costing the state less in the long run. Thorough testing and ongoing review of the assessment tool and associated service plans will be a must.

Closing Comments

The Oregon Support Services Association membership has effectively managed significant changes throughout the twelve year history of brokerage services. Today, change is present on all fronts. We are prepared as always to adapt to the next system. By communicating concerns and offering solutions, we hope to create a dialogue whose end result maintains and hopefully enhances services for the more than 7,000 adults with I/DD we currently serve.

Download a PDF of the Position Paper and DHS’s response here: DHS Response to Position Paper from Support Service Brokerages 6 18 13

FAQs about the K Plan: http://www.oregon.gov/dhs/k-plan/Pages/faq.aspx

May 30th, 2013: Great Expectations – Preparing for Life After School Workshop

greatexpectationsflyerFACT (Family and Community Together)Oregon Consortium of Family Networks and the DD Coalition present “Great Expectations: Preparing for Life After School,” a workshop for students and families. It’s scheduled for May 30th, 2013 from 9am to 3pm. The event will be held at the Ambridge Event Center at 1333 NE MLK Jr Boulevard in Portland. Cost is $5 and lunch is included.

The training is for parents, students and professionals.