In her latest weekly message, Oregon Developmental Disabilities Services Director Lilia Teninty acknowledged the work of Personal Agents and Service Coordinators statewide:
“I would like to say thank you to all of the Service Coordinators and Personal Agents supporting people with I/DD and their families. Your hard work you do and your dedication to the people and families that you serve is greatly appreciated. You have been patient and persistent implementing all of the changes that have come your way and have managed to work through them while ensuring that the people you serve have the services they need to live in their communities.
The work that ODDS does would not be possible without you. You are the foundation of our system! You all truly make a huge difference in the lives of Oregonians with I/DD.
For those of us who benefit from the dedication of a specific Service Coordinator or Personal Agent, please be sure to convey your thanks and appreciation to them, too!”
In January 2015, the Oregon Department of Human Services is putting on a series of trainings on their electronic billing system eXPRS. The trainings are specifically geared toward Personal Support Workers. You may attend a training at any of the sites below, whether or not you serve individuals at the hosting brokerage or county. The Independence Northwest training will be held on January 13th. Be sure to RSVP by emailing ODDS.firstname.lastname@example.org.
This morning, brokerages received the following information from the Oregon Office of Developmental Disabilities Services:
Approximately 400 Home Care Workers and Personal Support Workers checks will be issued tonite and put in the mail tomorrow. These checks are a fairshare correction. Even if a person has direct deposit, a check will be issued for them…
If the HCW or PSW have questions please refer them to contact SEIU at 877-451-0002.
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.
UCP Connections, a fellow support services brokerage, recently began a field testing of the Oregon Office of Developmental Disabilities‘ upcoming transition to paying Personal Support Workers (both Domestic Employees and Independent Contractors) through its payment system (eXPRS.) Effective January 1, 2015, all PSWs will be paid directly through the state’s eXPRS payment system. As part of the field testing, UCP and ODDS’s Julie Harrison are offering up trainings for Personal Support Workers They have opened up these opportunities to PSWs throughout the metro area. Please see dates below.
On Monday, November 10, 2014, Kathryn Weit, OSSA Executive Director and I participated in a vision and values discussion organized by the Office of Developmental Disabilities Services and the Oregon Council on Developmental Disabilities. Later in the day I stopped on the way home for groceries and when asked how my day was by the clerk, I said my day was excellent. I can’t recall the last time I said that about work! I surprised myself with that comment.
We spent an entire day discussing and refining the language for the values and vision statements that will be used to guide the system that provides services to people with Intellectual / Developmental Disabilities. The people attending the meeting represented all parts of the DD system, including State staff, and all were highly engaged, respectful and positive. It was the first meeting with a constituent group in my recent memory that was not dominated by complaints, whining, and finger pointing.
We don’t have final outcomes on vision or values statements, but within a week we will have the vision statement and we will have values work after that. I feel very inspired by the day, and I am eager to see the final vision product by the work group. When that is done later this week, final definition of the values statements we worked on will go forward. I am on that work group with 6 people including Lilia Teninty, the State DD Director. Finalized, these statements will be shared widely and used to guide future decision making.
Next steps include scheduled discussions on Medicaid and the K Plan with Robin Cooper, an expert on these issues from The National Association of State Directors of Developmental Disabilities Services in Washington DC. Once we increase our knowledge base with, and understanding of Medicaid and K, Lilia plans to pull together groups to address specific topical areas beginning with case management.
I think Lilia is very much on track and as always, Bill Lynch’s facilitation was important and focused. While our work didn’t address many of the day-to-day issues we are struggling with, I feel more confidence in our direction than I have in over two years! I think Monday was a great start to a different/better future!
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.
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’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.
Friend and advocate of brokerages and the brokerage community Molly Mayo, founder of On-the-Move Community Integration, recently spoke with folks at KBOO about the state’s planned changes to provider organization services. Follow the link below (start at 18 mins or so) to hear Molly explain the community’s serious concerns about changes to service descriptions and provider rates. We share her concerns and applaud her public advocacy efforts and outreach.
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)
“At the request of the Service Employees International Union (SEIU), DHS has ceased collecting agency fees, also known as fair share payments, from Homecare Workers and Personal Support Workers (“Providers”) who are non-members. Local staff and management may receive inquiries from Providers about this change or questions about membership. Staff should not advise nor attempt to advise these Providers on issues of dues or union membership. If inquiries are received from Providers, staff must refer them directly to SEIU’s Member Resource Center at 1-877-451-0002.
Important note: This request was made by SEIU on behalf of only the Homecare Workers, Personal Support Workers and Child Care Providers for whom they represent.”
Update: TNT has communicated to us that independent contractor checks will go out in today’s mail.
Dear Independent Contractors,
There seems to be pandemonium in the field because independent contractors haven’t been paid. Unfortunately this post isn’t going to clear anything up but I wanted to send something out regardless since we are being inundated with phone calls asking questions we cannot answer. Here’s the short version of what we know and don’t know:
Neither TNT nor the state has communicated to us when ICs should or will be paid. We assumed that they would be paid according to the terms of the collective bargaining agreement.
We have heard rumors of a problem with payment but there has been no direct communication to us from TNT or from ODDS about this delay.
TNT assured us that missing vendor packets would not impact payment this month.
We met TNT’s deadline for submission of our bills, which was at 10:00 am on July 8th. It wasn’t easy.
A Message from Trisha Baxter, Interim DD Program Director:
Dear Personal Support Worker,
As you know, our state is making a number of changes throughout the programs supporting individuals with intellectual and developmental disabilities. These changes are needed to be in compliance with federal regulations and our collective bargaining agreement, as well as to improve service delivery. The Department of Human Services has been working collaboratively with SEIU, Brokerages, Community Developmental Disability Programs (CDDP), providers and other advocates in making sure these changes do not negatively impact the people we serve or our workers.
The most immediate and direct change, coming up on July 1, is how you will be paid. Beginning in July, we are moving to a centralized state payment system, with TNT Fiscal Intermediary Services, Inc., with common payroll dates twice a month. This is going to help streamline eligibility for medical, dental and vision benefits. As we have previously communicated, there is a delay to other program changes, specifically around the Plan of Care functionality in eXPRS. We will be sharing more information around those timelines as it becomes available.
You may have recently been contacted by the CDDP and/or brokerage that you work with to complete information required for the transition to TNT Fiscal Intermediary Services for the purpose of processing payroll on July 1. Please complete and return any paperwork you have been provided so that we can ensure you are paid timely. Once you have completed and submitted your paperwork you have nothing else to worry about – TNT will contact you, through your CDDP or brokerage, should additional information be needed. TNT has indicated that if paperwork is delayed, they will still do everything in their power to ensure timely payments, even to the point of running an extra payroll cycle if needed. It is important to us that you are paid accurately and timely. You will need to sign a new direct deposit form if you chose direct deposit. This form was included in the information you received from your CDDP or brokerage. If you need another copy of the form, please contact the CDDP or brokerage, or you can contact TNT directly at (503) 463-0134.
In accordance with the collective bargaining agreement, beginning with services provided after July 1, 2014, claims for payment should be submitted to the Brokerage or CDDP no later than three (3) business days (excluding Oregon and Federal holidays) before the eighth (8th) and/or the twenty-third (23rd) of each month. You will be paid three (3) business days (excluding Oregon and Federal holidays) after the eighth (8th) and/or the twenty-third (23rd) of each month. Click here to see the full details http://www.seiu503.org/wp-content/blogs.dir/10/files/2014/03/SEIU-OHCC-2013-2015-Collective-Bargaining-Agreement-FINAL-SIGNED-COVER-LETTER.pdf. Payment for June or earlier services will be paid in accordance with current practice.
If you have questions regarding this transition, please contact your CDDP, Brokerage, or TNT. Be watching for additional information over the next couple of weeks, including a calendar outlining payment dates, options for payment, and other information for your reference.
At the end of last week, I sent a quick update to folks who have attended INW’s community forums over the past year and thought I’d post some of those details to our blog as well. As always, keep the questions coming and we’ll do our best to keep you updated with the latest info during this time of change. Happy Monday!
The State hasn’t yet released the updated version of the Adult Needs Assessment (which scores for inclusion-type supports) but we’ll let you know once it’s out. In the meantime, here is the version currently being used.
If you are a provider and you still have not received your provider number, the DHS Provider Relations Unit is the party responsible for helping sort the issues out. Please call 1-800-241-3013 or email them at SPD.ProviderNumber@state.or.us.
The Oregon Home Care Commission has recently updated its website. Check out the new Personal Support Worker forms and training options here.
At the end of last week, the State has posted a brand new eXPRS Payment System Facebook page. This is a good opportunity for you to get information, ask questions, and comment directly in a public format. Visit the page here.
This is a big one: The State is in contract negotiations with TNT Fiscal Intermediary Services to take over payment to all Personal Support Workers (Domestic Employees and most Independent Contractors) effective July 1st. This requires that some providers (namely ICs) fill out additional paperwork immediately.Read about it here in the INW Blog post and FAQ written by Ron Spence. Time is of the essence on this, so be sure you take a few minutes to read the details.
The TNT FI change also creates paperwork for some customers. Approximately 90 INW customers will be receiving some fiscal intermediary forms in the mail. If you need help understanding the forms or their purpose, we’re here to help. Give your PA a ring.
On the new rates front, there’s a version of Supported Employment and Day Habilitation rates circulating. The final version is due out via State transmittal by the end of the month. If you’d like to view the most recent version of the Expenditure Guidelines, check them out here. Keep an eye on our blog and Facebook page for the final release.
And, last but not least – Brokerages and Counties will be trained on the new Supported Employment expectations in July and August. As we get finalized details on changing expectations and processes, we will get those out to you. We look forward to partnering with you to bring the increased employment outcomes our community so sorely needs.
The recent announcement that DHS listened to the community and delayed implementation of the eXPRS data system was welcome news to stakeholders across the state. However, in order to meet the terms of the collective bargaining agreement it made with SEIU, the state must collapse all payments to Personal Support Workers (PSWs) into a “single payment system” by July 1st. In order to meet this obligation, DHS is in negotiations to contract with TNT Fiscal Intermediary Services (TNT FI) to make all PSW payments to providers in all DD programs (counties as well as brokerages) statewide.This change affects thousands of providers; brokerages and counties have been charged with making the transition in three weeks and some questions remain unanswered. Time is short and much work will need to be done to ensure every PSW in the state is paid on time in July. Please help us by spreading the word. We will update the FAQ below as more information comes in. Our top priorities remain uninterrupted services to our customers and uninterrupted payment to their providers.
Note: While there is much overlap in how things will work for providers working with different brokerages, the information in this post is specific to providers who work with Independence Northwest’s customers. The requirements of the transition to a single payer (TNT FI) are different depending on the provider type.
PERSONAL SUPPORT WORKER – DOMESTIC EMPLOYEE Because TNT already processes payroll for domestic employee PSWs who work with Independence Northwest’s customers, this group of providers will experience the least impact during the transition. If you’re a domestic employee, the changes you can expect are the following:
Timesheet due dates and pay days may change. Due dates, processing time, and pay dates are part of the state’s agreement with SEIU, but as of this writing the state has been unable to tell us what those dates are. We will let you know as soon as we know.
Reduced frequency of payroll: Independence Northwest has historically run DE payroll three (sometimes four) times a month. Under the collective bargaining agreement this number is reduced to twice a month. If you are someone who submits timesheets later in the month this may mean you will wait longer to be paid than you have in the past.
DON’T FORGET: You will still need to get a provider number for when the state rolls out eXPRS later in the year. If you don’t have a provider number yet contact the state immediately: 1-800-241-3013 or SPD.ProviderNumber@state.or.us
PERSONAL SUPPORT WORKER – INDEPENDENT CONTRACTOR
Effective July 1 all payments to PSW independent contractors will no longer originate from INW offices but will be processed by TNT FI from their office in Salem. In order to make this happen, all ICs will need to fill out a TNTFI_VENDOR ENROLLMENT PACKET. ICs must fill out a separate packet for each customer they work with.Please note that the packet includes a direct deposit form. Unfortunately the direct deposit form you have on file with INW will not transfer to TNT. The packet must be signed by the customer or the customer’s legal guardian. If you want to continue using direct deposit after July 1 you must fill out this new one and provide all the documentation it requires. Below are some changes PSW-ICs who work with INW customers should expect:
Changes to invoice due dates and pay dates: Because INW cuts checks for independent contractors on a weekly basis, we do not expect ICs to adhere to any invoice deadline. However, under the new system, due dates, processing time, and pay dates are determined by the state’s agreement with SEIU, and as of this writing the state has been unable to tell us what those dates are. We will let you know as soon as we know.
Reduction in pay frequency and flexibility: INW cuts checks on a weekly basis for vendors so that a vendor can invoice us at any time during the month and expect timely payment. Under the collective bargaining agreement payment is reduced to twice a month. This may mean you will need to change the timing of your invoicing in order to avoid delays in payment. With payment no longer occurring in-house, INW unfortunately loses the flexibility to accommodate same-day check runs and other special requests as we have in the past.
PROVIDER ORGANIZATIONS, NON-PSW INDEPENDENT CONTRACTORS, AND OTHER VENDORS
Payments to all entities not covered by the collective bargaining agreement (provider organizations, non-PSW ICs) will continue to be paid by INW until eXPRS is implemented. If you are the rare IC who provides both PSW services and non-PSW services you will receive separate payments from TNT FI and TNT FI.
FAQ: July 1 Changes to Provider Billing and Payment
Note: Most of this information is brand new and as such is subject to change. We will update this FAQ as we get new information so please check back frequently.
Q. What is changing about how provider payments are made?A. All payments to Personal Support Workers (PSWs) across the state are being consolidated so that they are paid by a single entity, TNT Fiscal Intermediary Services (TNT FI). This affects thousands of providers.
Q. Why is this change happening? A. Under the collective bargain agreement DHS made with the Service Employees International Union (SEIU), the state agreed that it would adopt a centralized payment system for all of SEIU’s PSW members in Oregon.
Q. I thought eXPRS was going to be the payment system. Is TNT replacing eXPRS?A. Yes and no. The state has delayed implementation of eXPRS, in part, as a result of questions about its readiness voiced by the community. However, that delay did not absolve the state of its collectively-bargained mandate to adopt a centralized payment system by July 1. Moving PSW payments to TNT FI is a transition plan to meet that mandate.
Q. Will eXPRS make PSW payments in the future?A. To the best of our knowledge TNT will continue to handle all PSW payments for the foreseeable future because eXPRS lacks the complexity to handle payroll under the brokerage customer-as-employer model. Once implemented, eXPRS will act as a “front-end” interface for billing data entry; TNT will process payments using the data entered into eXPRS.
Q. Is there paperwork I need to fill out for this change?A. If you are a PSW-DE there is no additional paperwork for you at this time. If you are a PSW-IC you need to fill out a TNT FI Vendor Enrollment Packet immediately and return it to INW.
Q. Will my direct deposit remain in place?A. It depends on whether you are a PSW-DE or a PSW-IC. Domestic employee direct deposits will be unaffected by this change. PSW independent contractors will need to fill out the new direct deposit form included in the TNT FI Vendor Enrollment Packet if they want to continue using direct deposit.
Q. Who do I sent my invoices or timesheets to?A. Nothing changes in the short run. Continue to submit your bills to Independence Northwest as you always have.
Q. Will the day my timesheets or invoices are due change?A. Probably. Due dates, processing time, and pay dates are determined by the state’s agreement with SEIU, and the state has been unable to tell us what those dates are. We will let you know as soon as we know.
Q. Will my pay day change?A. Probably. See answer to previous question and check back here often.
Q. What if I need an out of cycle check or if my check is lost or stolen?A. The state has not yet shared how it plans to handle out of cycle checks and other special exceptions after July 1.
Q. What if I am overpaid or underpaid?A. The state has not yet shared the details of how error corrections will occur after July 1.
Q. Does the July 1 change affect me if I am not a PSW?A. The most current information we have is that non-PSW payments will not change on July 1.
Q. Will INW continue to verify my income and employment for housing and other credit applications?A. Because we are not privy to the details of the contract negotiations between TNT FI and DHS, we are unsure whether this duty will remain with INW or will be taken over by TNT FI. Once we have the answer to this question, we will update you.
Q. Will INW continue to respond to unemployment claims?A. We have not been told by DHS if this will remain our responsibility. Stay tuned.
Late Friday afternoon (05.30.2014), Interim DD Director Trisha Baxter released the following statement to the I/DD community:
“As you are aware we have many priorities that we are focusing on, all with a July 1 implementation date. We have heard from many of you that these converging priorities are causing angst, stress and strain on you, and on the system. We, as well, are discovering the complexities of handling so many moving parts all at once. As such, based upon feedback from many of you and weighing our internal priorities and commitments with SEIU, CMS and others, we have come up with the following strategy to delay portions of the work and to stage implementation in a more manageable way. Additional information will be coming out over the coming weeks about the details behind these strategies so please pay close attention to emails and other communications over the coming days.
First, July 1 is a milestone for new employment services to be offered. These services are included in the Medicaid waivers that will be submitted for approval with a July 1 effective date. These new services will still be offered as of July 1. July 1 was also a targeted date for implementation of a new rate structure for employment services for both the comprehensive and support service system. The new rate structure will be finalized next week, however, at the request of multiple providers, we will hold off on implementation of those rates, with the exception of the rates for the new services, until September 1, 2014. The new services, which include Discovery and Job Development will be paid at the new outcome based rates. All other services will continue to be paid at the current, daily rate. This additional time will allow providers of employment services an opportunity to analyze how the new rates will apply to their service arrays. Additional information about the rate transition schedule, and expectations for tracking, billing and reporting of services provided during July and August will be coming shortly.
Additionally, we have been challenged to provide training to the large number of personal support workers, CDDP and Brokerage staff, and other providers on the new plan entry and claims process within the eXPRS system. In order to allow more time for training and other associated activities, we are delaying the implementation of Plan of Care functionality to September 1, 2014 as well. We will be working with partners, including SEIU and providers, to develop an implementation plan from September 1 forward, beginning with employment services. The delayed schedule and restaging of activities is important to assure successful implementation, but it does not deter or alter the strategic or programmatic outcomes the changes are designed to achieve.
There is much work to be done over the upcoming months to ensure that individuals experiencing intellectual and developmental disabilities continue to receive services and that those providing the services are paid accordingly. We thank all of you for your continued work with us as we pull together plans for full implementation. As always, if you have questions or concerns, please feel free to contact me.” – Trisha Baxter
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.)
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.
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.
The Oregon of Office of Developmental Disabilities (the state) is putting on a series of training for brokerage PSW providers. The training is called “Using eXPRS for DD Personal Support Workers and DD Independent Contractor PSWs.”
Per the state, “Use of the eXPRS Payment System will begin July 1st, 2014. This training is a repeat of the April 22nd webinar training session and will cover the information PSW or IC-PSWs need to know to get ready for July 1st. These trainings are online, computer-based trainings.
Training participants will need a computer and internet to view the training materials AND access to a phone to listen to the discussion. Pre-registration for these trainings is required as each session has a limit to the number of participants.”
Once registered, participants will receive an email with the training site link, conference phone number and instructions on how to connect to the training on the date you are registered to participate. If you have questions, contact Julie Harrison at JULIE.A.HARRISON@dhsoha.state.or.us.
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.
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.
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.
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.