On October 30th, 2017, Oregon Developmental Disabilities Director Lilia Teninty released the following statement regarding the Oregon Needs Assessment:
“We’ve reached some important milestones I want to share with you. The summary below reflects a great deal of work done by everyone in our service system – ODDS staff, CDDP and Brokerage staff, providers, people with I/DD and their families. Thank you for your thoughtful feedback and your efforts to help us get to this point.
The journey to create the ONA started in 2013. The Legislature told ODDS to implement a single, uniform assessment tool. It would be used for everyone we support, regardless of setting.
We engaged a stakeholder group for the project. We also hired Mission Analytics Group. Mission Analytics’ role was to ensure the ONA is a validated tool for all service settings.
The project team members have been diligent. They worked through technical challenges, revisions to the questions, and more. They conducted hundreds of assessments that were used to test the validity and reliability of the ONA. They managed two rounds of pilot testing.
We are close to rolling out the ONA. All individuals receiving I/DD services will be assessed using the ONA in 2018. We need to start the ONA assessments in January to be able to collect data needed for the Compass Project.
Based on input from advocates and partners, we asked CDDPs and Brokerages to work with us to identify staff to administer the ONA. CDDPs and Brokerages are identifying staff in their entities to perform the assessments. The ODDS assessment team will also assist with administering ONAs in rural areas of the state.
From January through June, staff will use both the ONA and the current assessment tool. In July, the ONA will be the official assessment. The ODDS assessment team will train the CDDP and Brokerage staff who will use the tool. The team will also provide technical assistance and quality assurance. They will do this to ensure the tool is administered consistently across the state.
The ONA will be administered by a staff person who is not the person’s case manager.
Benefits of separating case management from the assessment include:
- Removes real or perceived conflicts of interest.
- Improves objectivity and consistency.
- The case manager may still take part in the assessment. The case manager will not be responsible for the results of the assessment itself. Instead, the case manager can support the person and provide information to inform responses.
Our journey to create the ONA is reaching its destination. Thank you to the many people who are making it possible.”
You may have heard that Brokerages and CDDPs/counties are facing serious cuts.
Locally, we expect a pretty significant hit to disability services, primarily in the case management and crisis arenas. At the federal level, not only is case management in the cross hairs, but so are your in-home brokerage supports. When you hear politicians talking about healthcare reform, it’s not only about medical care with your doctor or at a hospital. It’s important to understand that Brokerage services are Medicaid services. Most county/CDDP services are Medicaid services. The K Plan is a Medicaid service. For the past four-plus years, the vast majority of services for thousands of children and adults with disabilities in Oregon has been funded through the Affordable Care Act (Obamacare) – a Medicaid program. And the Senate proposal (now called the Better Care Reconciliation Act of 2017) led by Mitch McConnell directly targets the reduction of home and community based services for people with disabilities (including brokerage services.)
This message is a simple ask: please contact your legislators and tell them your story as soon as possible. You can send an email or make a call. A vote is possible following Independence Day.
The great folks at the Oregon Developmental Disabilities Coalition have created easy-to-use advocacy instructions to help you get started. This is a key moment in the history of services for people with disabilities. Please take a moment to share your story and let your voice be heard.
WHAT CAN YOU DO?
Everyone has a story, and there is power in sharing it. If Medicaid matters in your life, NOW is the time to share your Medicaid story with members of the United States Senate. They need to understand the positive impact Medicaid has in lives of millions of Americans with disabilities each and every day.
WHAT DO YOU SAY?
- I am your constituent.
- I am a person with a disability [or I am a family member of someone with a disability or I am a professional in the disability field].
- “Please do NOT allow cuts or caps to Medicaid.”
- “Because of Medicaid, I have healthcare and supports to live in my community. For example, I use my services to _____________________________________.”
- “If I don’t have these Medicaid-funded supports, my life will be harder because _____________.”
HOW TO CONTACT UNITED STATES SENATORS
Oregon’s Senators, Senator Ron Wyden and Senator Jeff Merkley, are both very supportive of the disability community and will not be voting for this bill. However, they still need to hear your story because they can share it with their Senate colleagues and they are keeping tallies of the contacts they have with their constituents so each contact you make is extremely important. Even if you have reached out to them already, please share your story again and ask for their support in stopping this legislation that would have a devastating impact on the disability community. Reach out to them by phone or email or via their website or on social media – whatever modes work best for you. Make calls to their offices in Washington DC at 202-224-3121
Send them an email at:
Share your personal story about Medicaid in their story banks: www.merkley.senate.gov/share-your-aca-story and www.wyden.senate.gov/trumpcare-story
Reach out to your family and friends across the nation to support your advocacy efforts to save Medicaid by contacting their United States Senators and urge them to vote NO on the BCRA! Please encourage your family and friends to call their United Senators via the Congressional Switchboard at 202-224-3121 to reject the current draft of the BCRA.
We want all U.S. Senators to be urged to reject Medicaid Cuts & Caps, including:
- Alabama: Shelby
- Alaska: Murkowski & Sullivan
- Arizona: Flake
- Colorado: Gardner
- Florida: Rubio
- Georgia: Isakson
- Indiana: Young
- Louisiana: Cassidy
- Maine: Collins
- Missouri: Blunt
- Montana: Daines
- Nebraska: Fischer & Sasse
- Nevada: Heller
- North Dakota: Hoeven
- Ohio: Portman
- Pennsylvania: Toomey
- South Carolina: Graham
- South Dakota: Rounds & Thune
- West Virginia: Capito
- Wisconsin: Johnson
Thank you for your continued support and advocacy for essential services for Americans with intellectual and developmental disabilities! And thank you to the I/DD Coalition for the materials to share.
In the last few weeks, Personal Support Workers and brokerage customers should have received information directly from the State of Oregon and/or SEIU regarding an important change just around the corner. For a good many years, TNT Fiscal Intermediary Services has issued paychecks for PSWs serving our customers. TNT’s contract with the state ends at the end of 2016 and a new agency, PCG Public Partnerships LLC (known as PPL) will be taking over this responsibility. So in the very near future, Personal Support Workers will stop getting payment from TNT and start getting payment from PPL.
What does this mean to Personal Support Workers and Customer-Employers?
Generally speaking, it means that Personal Support Workers and employers (be they a brokerage customer or a legal designee) have some paperwork to fill out. Right now, PPL is sending out mailers to three groups of folks:
- Employers (customers or their designees) who employ PSWs (You’ll get a packet by mail on or around November 4th, 2016)
- Personal Support Workers who work for one Employer (customer or their designee) (You’ll get a packet by mail on or around November 7th, 2016)
- Personal Support Workers who work for two or more Employers (customers or their designees) (You’ll get a packet by mail on or around November 8th, 2016)
Customer-Employers and Personal Support Workers can return their packets in a variety of ways: by mail, fax, or secure email.
What Help Is Available?
If you’d like some hands-on help, consider attending one of the optional Enrollment Information and Help Sessions for Employers and PSWs. Multiple sessions will be held here at Independence Northwest and there are sessions in all three metro area counties. RSVP for a session by clicking here. If you have received your packet, you can bring it to the session in your area to receive hands-on help. If you haven’t received it by the time the session you want to attend happens, they’ll print a packet for you there and assist you in person.
You can also call PPL Customer Services for help. Their number is listed on this flyer or you can visit this website.The state’s eXPRS Facebook page has a ton of resources related to the change as well.
Transition time is very tight on this, so be sure you’re responsive and get the help you need! If packets are not completed and processed by the end of the year, payment for services may be affected. If you have questions, don’t hesitate to reach out to PPL for help.
Resources and Help
Here’s a great list of resources to help you get started:
Since the State of Oregon Department of Human Services began taking on Personal Support Worker and provider payment through its eXPRS system, one of the most common questions brokerages have received from providers is “Did you get my timesheet?”
There’s a relatively easy way for providers to access this information via eXPRS. ODDS’ Julie Harrison and her team have created a How To guide entitled “How to Find/View Plan of Care Service Claims”. Check out the guide by clicking here. You’ll learn how to read the eXPRS screens and determine where your payment claim is in the process. Be sure to bookmark this guide for future reference. (Of note: eXPRS refers to hours or miles keyed into its system as SDEs – Service Delivered Entries.)
One additional note: If you are sending invoices or timesheets via email, please be sure to use the firstname.lastname@example.org email address. If you are faxing invoices or timesheets, please be sure you receive a return confirmation that the fax was received.
Thanks for your continued partnership through the ongoing systemic changes. Your work is very much appreciated.
By Larry Deal, Executive Director of Independence Northwest
Over the past year and a half, so much time has been spent deconstructing and reconstructing Oregon’s Intellectual and Developmental Disabilities system, there’s been little opportunity to sit back and celebrate some of the successes. Here are five things that are currently working well – and that deserve their moment in the sun.
People are getting more services. With the change from 100% Title XIX Waiver to a mix of K Plan and Waiver funding, Oregonians with intellectual and developmental disabilities are getting more services than ever before. This is a wonderful thing. Historically, people in crisis situations had limited resources and little option other than out of home placement (group homes and foster care homes) whether that was their preference or not. In the new system, many Oregonians now have the resources to continue living at home; the current design supports true individual and family choice. The importance of this change cannot be overstated. (That said, there’s still a very real fiscal sustainability discussion that must be had to support these efforts long-term.)
Providers are beginning to expand capacity. This one’s a slower burner, but it’s beginning. Customers, families, and professionals have all been highly concerned about the increase in funding since it came without an ounce of provider capacity expansion planning or incentives. Oregon put the funding before the resources. In recent weeks and months, many agencies have begun reaching out to brokerages and are expanding their services to our community in everything from in-home to employment supports; in 2015, I believe we will see a tangible increase in options for our customer base.
There’s a recent willingness for course correction when things aren’t working. If you haven’t heard of DSA (Day Support Activities,) consider yourself lucky. In short, DSA was an exercise in rushed change implementation. Ultimately, it changed rates, it changed processes, and it changed the definition of certain services. The process upended Brokerage, CDDP (Community Developmental Disabilities Program) and provider organization operations and damaged the integrity of reporting systems statewide. However, collaborative efforts (led by ODDS) amongst brokerages, CDDPs (counties), providers, and state has made a real difference. Recent changes in leadership have assured a common sense, customer-first approach to problem solving. In other words, there’s strong collaboration happening again in Oregon. This is a very good thing – let’s do more of it.
We’re sticking with our current needs assessment tool. One of the major concerns brokerages have been facing while implementing the still-new functional needs assessment has been knowing full well we’d have to change assessments again at the beginning of 2015. Recent actions from the state suggest that we will be working to make the current brokerage tool (the Adult Needs Assessment) work well into the future. For brokerage customers, this is promising. We need consistency, stability, and some time to do some in-depth analysis on the efficacy of the current tool first. This decision deserves kudos.
Perhaps most significantly, Oregon is focusing on individual goals – again. If you have been working in the system or receiving services for the last year and a half, you’ve no doubt noted the troubling focus on deficits-based language and approach. I remember being in a meeting very, very early on in the K Plan implementation when it was announced by someone with significant influence that “this is no longer about goals, it’s about needs.” Soon, that refrain began to echo. Fortunately, that interpretation is no longer alive and well. What some people didn’t understand early on in the transition process was this: Brokerages have always addressed disability-related support needs. And we have done so while helping people reach their goals. You don’t provide publicly-funded services without making sure needs are documented and necessary. A sophisticated, supportive, holistic system addresses health and safety while placing a premium on the wants, needs, and goals of the individual. We know it can work because we’ve been doing it for thirteen years. I can’t say enough how pleasing it is to hear high-ranking leaders in our state stating that goals matter.
There are many issues we must continue wrestling with: the eXPRS payment system and pending Personal Support Worker entry, the monthly versus annual services issue, the ongoing review of Behavioral Supports, changes to supported employment, and many more. But as we inch ever closer to the new year, it’s safe to say that we all hope for continued positive developments in the Oregon I/DD service delivery system. We’re a resilient, engaged, and growing community. Fingers crossed we can focus the coming year’s efforts on enhancing, expanding, and enriching the lives and experiences of the individuals, families, and communities we support. Oregon was once at the forefront of community-based services in our country; with continued focus, effort, and partnership there’s no reason that can’t be a reality again.
Effective 09.01.2014, the State of Oregon Office of Developmental Disabilities has made significant changes to day program, sheltered workshop, and supported employment services offered by provider organizations. Please see below for some Frequently Asked Questions related to the September 2014 transition and translation of Day Support Activities and Employment Activities.
What is DSA? DSA stands for Day Support Activities. This is a new title (with new rates) for a subset of services offered exclusively by provider organizations. DSA includes both attendant services and skills training and may be provided in either a facility or the community.
Why is this change being made? The State is aligning rates and service descriptions across both brokerage and 24/7 comprehensive services. Unfortunately, brokerages and brokerage-specific providers weren’t included in the planning for this change, which has resulted in a rocky implementation process.
What’s changing? Effective September 1st, 2014, many traditional services (like Community Inclusion and Skills Training,) when provided by provider organizations, will be collapsed into the new DSA heading. There are rate changes associated with this change. Further, these services must now be billed through Oregon’s online payment system, eXPRS.
What’s happening with Employment Services? Employment services and rates have been adjusted and amended as well. As with DSA services, billing will now go through eXPRS for services provided September 1st, 2014 forward.
Where did the new rates come from? The rates were determined by the State of Oregon Office on Developmental Disabilitiesas part of its ReBAR efforts.
Are these rates and definitions permanent? We don’t know. The state has pulled together a workgroup, set to begin meeting in late September and through October 2014. The workgroup has provider organization, county, brokerage, customer, and family representation. The group will give recommendations for everything from rates to service definitions. The first meeting is on September 29th, 2014.
Do provider agencies charge the same rate for every customer? No. Each customer has an individual rate based on his/her assigned Tier. The Tier is determined by the Adult Needs Assessment his/her Personal Agent conducts prior to ISP planning.
Can Personal Support Workers or Independent Contractors provide DSA? No. DSA is a provider organization-specific service. Similar services are provided by other provider types, but they are labeled differently and have a different set of rates.
What if my agency isn’t in eXPRS? You should contact Julie Harrison or Acacia McGuire Anderson directly. You need to ensure you have a properly set up provider number.
What’s a Medicaid provider number? A Medicaid provider number is assigned to you by the State. You must have a Medicaid provider number in order to bill in eXPRS and be paid for certain services provided September 1st, 2014 forward. If you provide DSA or Employment services to brokerage customers, you need a provider number ASAP. Brokerages can no longer pay you directly for these services. Nate Deeks and Acacia McGuire Anderson are responsible for assisting provider organizations having trouble with this particular issue.
What services to brokerage customers will be billed through eXPRS? For services PROVIDED September 1st, 2014 forward, all DSA, employment and employment path related services will be billed and paid through eXPRS. This includes: Day Support Activities, Individual Supported Employment, Small Group Supported Employment, Discovery/Career Exploration, and Employment Path Services.
What are the steps a provider agency needs to take to get paid for DSA and/or employment services? The provider agency must log into eXPRS, find the specific customer for whom services was provided, locate their active Plan of Care, then bill against that Plan of Care. At the same time, the provider organization must send a copy of their customer-approved invoice and progress notes to the Personal Agent (as you always have.) From there, brokerage staff will review your invoice, go into eXPRS and give the state the thumbs up to release payment.
How do I know if my agency and customers are affected? We have been in direct contact with many provider organizations over the past month. Additionally, INW sent out mailers in the last week of September, notifying provider organizations directly of what we believe the translation will look like. However, if you have questions or believe we should make adjustments to the changes, Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.)
Will provider organizations receive new service agreements from INW? INW will not be sending new service agreements, but will send you a translation document which amends the current agreement. If you require additional documentation, please call us directly.
Do I have to submit an invoice to the brokerage anymore? Yes. You should submit your customer-approved invoices and progress notes to your Personal Agent as you always have. Nothing has changed there. Brokerages are not a pay and chaseenvironment.
Can I bill for two different services on the same invoice? Yes, you can, but you’ll need to itemize and clearly spell out the differences in services.
Are there changes to what provider organizations can/cannot bill for? One large change is that provider organizations cannot bill for miles driven while concurrently providing Day Support Activities.
Are DSA services pro-rated? No. DSA services are never pro-rated, regardless of the number of people served at one time.
Why are services in eXPRS limited to a monthly allotment when brokerage plans are written at an annual allotment? We hope this will be corrected in eXPRS very soon as it is already causing issues for providers and customers. We have a commitment from the new DD Director that annual authorizations are allowable in the system. In the meantime, the monthly limit in eXPRS creates a false restriction of services (counter to how plans were written.) If you see that the monthly restriction is too tight for a customer’s actual utilization (but keeps within the customer’s annual contracted agreement with you) give us a call and we will work towards correction in eXPRS. Thanks for your patience while this gets sorted out.
What happens if I submit “old” invoices for services provided before September 1st, 2014? Those services will not be billed through eXPRS. So, you can skip going into eXPRS and just send the bill directly to your PA. Payment will come via direct deposit or paper check from Independence Northwest.
What if I run into issues with billing? Please call Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.) We will respond to provider organization issues within 1 working day. Our aim is to work with providers to clear up issues as soon as possible.
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.
Dan (SDRI), Katie (Mentor), Jennifer (CPI), Larry (INW), Rachel (Inclusion), and Sarah (UCP)
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 email@example.com.
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.
By Larry Deal
You might have heard that there are some changes to the way brokerage services are administered and funded. One of the most significant changes is that all brokerage customers must now have a formal functional needs assessment at least once a year.
A functional needs assessment is a series of questions that asks what kinds of living supports a person needs to live independently in the community. Oregon has chosen the Adult Needs Assessment as its current tool. You may view the tool by clicking here. The assessment asks questions about what kinds of independent living supports you need, why you need them, and how often you need them. Once the assessment is completed, it determines certain services you are eligible for and how often you can access those services.
Brokerages have been actively involved in conversations with the state and other stakeholders regarding the implementation of the assessment. Since summer of 2013, brokerages were instructed that we would have a year from the time we received the assessment tool to implement the changes. The state spent several months developing what was to be a brand new needs assessment, but the tool was abandoned for myriad reasons. We received a final tool in November 2013 and immediately began conducting assessments as our customers’ plan years rolled over. Because we typically plan with our customers up to six weeks in advance of a plan’s start date, the first assessments we completed were for customers whose plan years began in January of this year.
Under the original plan, brokerages expected to complete all assessments by October of 2014 for the approximately 7,500 customers receiving our services statewide.
However, we were informed in February 2014 that an agreement between the state and federal oversight entities would force a significant shortening of that timeline. The Centers for Medicare and Medicaid Services (CMS) insisted that all assessments be completed within one year of when Oregon began receiving Community First Choice Option/K Plan dollars (July 1st, 2013.) Leadership in Oregon argued for more time. It wasn’t granted and the deadline was shortened. Instead of October, Oregon was now instructed to have all assessments completed by the end of June 2014 or risk losing its federal funding.
Brokerages expressed ample concern about this change – we would need to complete nearly 2,000 additional assessments in less than five months – and requested additional funding to add staff, hire contractors, or pay overtime to existing staff to meet the charge. Instead of funding brokerages, the state decided to deploy its own staff to complete the additional assessments.
Which brings us to the present.
As a system, we are faced with a June 30, 2014 deadline to complete all assessments. Last week, we sent out letters informing some of our customers that they would be receiving an assessment from a non-Independence Northwest assessor. We have been assigned three state employees (Rachel, Kay and Ana) to complete the assessments in Multnomah and Washington counties. For our Clackamas county customers, Robyn Hoffman (a Clackamas county employee) will be the primary assessor. If you didn’t receive a letter, you won’t be affected.
The staff of INW have met with the assessors and they all carry a great amount of experience working with people with intellectual and developmental disabilities. Independence Northwest is providing designated office space, workstations, and meeting rooms for them and they have begun calling customers and scheduling assessments.
Here at Independence Northwest, we estimate that somewhere around 125 customers will receive their assessments from state or county staff. INW Personal Agents are responsible for conducting the remaining 300+ assessments. Additionally, a plan revision must be completed after each assessment. INW Personal Agents will be completing revisions for all 435 customers in our services, in addition to any necessary job description or contract amendments. The workload for our organization is significant and we are working hard to meet the charge.
Once this implementation phase is completed, your Personal Agent will meet with you at least annually to complete a needs assessment – usually right before your ISP meeting. The state and county involvement is a one-time situation to allow the state to catch up and meet the terms of their agreement with CMS. Moving forward, it becomes a part of our regular service delivery. We’ve posted a set of frequently asked questions. Check them out here.
The functional needs assessment implementation is one of many, many changes occurring in our system right now. Since last August, we have been holding community forums at least twice a month to update the community on what’s changing, why, and how. If you would like to learn more, join us for one of our upcoming sessions.
The Oregon Support Services Association (OSSA) is pleased to announce the hiring of Kathryn Weit as our Executive Director. Kathryn is well known as an advocate and leader for services to people with intellectual and developmental disabilities. Her extensive history in our State includes participating in launching the Oregon Support Services Brokerage system, leading the Oregon Developmental Disabilities Coalition and serving as the Executive Director of the Oregon Council on Developmental Disabilities.
Her primary roles are advisory to OSSA regarding advocacy needs on major policy, budget and customer issues for support services brokerages and the broader IDD system; representation of OSSA at key DHS, legislative and other organizational meetings; recommending advocacy actions to OSSA and to function as the key communicator for the association. Additionally, she will be working in support of spotlighting client success stories with the advent of the K plan and addressing implementation concerns identified in our current advocacy position, posted here for your information. Kathryn will report to the OSSA Board of Directors, which consists of the 13 Executive Directors of the Oregon Support Services Brokerages. http://ossaweb.wordpress.com/about/
Kathryn is reachable at KathrynWeit@oregonsupportservices.org and 541-520-7461.
10/04/2013: 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 firstname.lastname@example.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 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 email@example.com.
Thanks to Dan, SDRI and Edwards Center for pulling this important evening together.
Part One: The Functional Needs Assessment Tool
By Larry Deal, Independence Northwest Executive Director
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:
- Bladder Control
- Urinary Catheter Care
- Bowel Control
- Hygiene (Menses, Bathing, Dressing and General Care)
- Meal Preparation
- Money Management
- Communication (Expressive and Receptive)
- Personal Safety
- Fire/Emergency Evacuation
- Medication Management
- Health Management Supports
- Complex Health Management Supports
- 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?
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?
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.
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.
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.