To: All ODDS Staff and Stakeholders
From: Lilia Teninty, Director, Office of Developmental Disabilities Services
This message includes two timely topics important to the I/DD community: DD Awareness Month and the 2018 legislative session wrap-up.
The Oregon Legislature holds its short session in even-numbered years. Short sessions usually include re-balancing budgets and a limited number of policy items. This year’s session wrapped up last Saturday.
Here are highlights of the ODDS-related items:
The Legislature approved an investment for the Background Check Unit (BCU) to cover the costs of providing background checks, as well as to increase staffing levels to reduce the current backlog and waiting time.
Funding for 10 positions for the Children’s Intensive In-Home Services (CIIS) and Children’s Residential programs that were included in the workload model for 2017-19.
Our plan to achieve the required $12 million overall budget reduction was approved. We expect to meet the full reduction through administrative and management actions, including reducing contracts, taking steps to maximize federal funding, and maintaining cost per case. The plan is designed to prevent reductions in services, eligibility or rates in the current biennium (through June 2019).
ODDS’s significant legislation includes SB 1534. It directs DHS to collaborate with the Home Care Commission to establish minimum training standards for home care workers and personal support workers. More than 30,000 home care workers and personal support workers serve more than 25,000 vulnerable Oregonians each month. Developing a highly trained, culturally appropriate, and person-centered workforce requires an investment in training opportunities to enhance the safety, stability, and quality of life for those served in-home through the Aging and People with Disabilities and ODDS programs. This bill is waiting the governor’s signature.
March is Developmental Disability Awareness Month!
Every March, the Oregon Council on Developmental Disabilities (OCDD) takes the lead in helping Oregonians recognize and celebrate DD Awareness Month. OCDD’s 2018 #BetterTogether photo rally will celebrate people with disabilities as valued members of their communities and highlight the many ways in which people with and without disabilities come together to form strong, diverse communities.
We encourage you to participate by sending photos to OCDD of people with I/DD with friends, family members, co-workers, neighbors or other members of the community. You can also post pictures on the Council’s Facebook page. Use the hashtag #BetterTogether18. Details are online on the Council’s website.
Lilia Teninty, Director
Office of Developmental Disabilities Services
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.
Vermont offers the best Medicaid services for individuals with intellectual and developmental disabilities while Mississippi provides the worst, according to United Cerebral Palsy’s 2011 report “The Case for Inclusion.” Oregon comes in at 26.
4. New Hampshire
11. New Mexico
16. South Carolina
17. New York
19. West Virginia
23. South Dakota
25. Kansas 26. Oregon 27. Florida
34. Rhode Island
36. North Dakota
40. New Jersey
43. North Carolina
47. District of Columbia
There are currently five support services brokerages supporting individuals with developmental disabilities in the Portland metro area. In the last year, capacity in brokerages has become an issue as we all reached our contracted limits with the Department of Human Services.
After discussions with stakeholders, the Department of Human Services has announced initial expansion plans to create capacity for those who have been waiting. During the months of August and September, four of the five metro brokerages will add staff to allow for an additional 90 individuals to begin receiving services. The expansion of services was announced prior to the recent across-the-board budgetary cuts. Due to the current climate, plans beyond October are not yet clear.
This expansion is a statewide effort and capacity is being added to counties and brokerages statewide.
Developmental Disabilities Services funding is at risk as Oregon faces a significant budget deficit. Oregon’s Department of Human Services (DHS) and the newly-created Oregon Health Authority (OHA) are now formulating budget priorities for the current and upcoming two year fiscal cycle. If DD services are important to your family, friends, business and/or community, EMAIL DHS TODAY at email@example.com.
The budget projections are grim and there will be cuts! Community Forums have been held throughout Oregon over the past few weeks to discuss DHS/OHA budget and funding priorities. However, the number of people speaking on behalf of DD services were minimal.It is essential that DHS / OHA leadership hears about the importance of the services to individuals with developmental disabilities and their families.
DHS / OHA SPRING 2010 COMMUNITY FORUMS
1) Protect Funding for Services to People with Developmental Disabilities
DD services support one of Oregon’s most vulnerable populations across the lifespan through a diverse array of services. DD services are cost effective and efficient. Many of these services have already experienced reductions over the past several fiscal cycles including employment / day services and family support. There are no budget reductions that will not significantly impact the lives of vulnerable individuals with developmental disabilities and their families.
Background: The challenge facing Oregon is how to maintain funding even for existing services. The DD Coalition will join with other organizations to prioritize human services to vulnerable populations and to address the resource issues in the Oregon budget.
2) Protect Access to Adult Support Services
The Staley Settlement Agreement has resulted in cost effective and efficient delivery of services to adults with developmental disabilities entitled to Medicaid services. Access to Adult Support Services provided through the system of nonprofit brokerages must be preserved.
Background: The Staley Settlement Agreement ends in June of 2011. There are discussions occurring to extend the Agreement but it is not a given that will happen. It is important to maintain the current service structure, services, and access to supports.
3) Memorandum of Understanding Needed between DHS and OHA
Seniors and People with Disabilities, Developmental Disabilities Program must maintain the ability to operate services and implement quality assurance / quality improvement even if DHS no longer has the Medicaid Authority. There must be a detailed Memorandum of Understanding to protect the integrity of DD services.
Background: When DHS splits and OHA is created, the actual authority for Medicaid moves to OHA. A detailed agreement between the two agencies is needed to assure that the DD program can continue to implement and improve services.
4) Continue to Utilize the Fairview Community Housing Trust for its Intended Purposes
The Fairview Trust represents a promise made to Oregonians with developmental disabilties and families. By providing small amounts of funding for physical adaptations and accommodations, it fulfills a committment to community based living for hundreds of Oregonians with developmental disabilities each year.
Background: The Fairview Trust was established with the assets from the sale of the Fairview Training Center property. It is designed to serve generations of Oregonians with developmental disabilities.The funding is most often used for critical home modifications that address the health and safety issues. If the trust fund dollars are used by the state for other purposes, it is very unlikely that they would ever be replaced.
***Additional Public Participation Opportunity***
DHS and OHA have created new mission statements, and have created surveys that provide an additional opportunity for stakeholders to express their opinion regarding agency priorities. Please visit the DHS/OHA agency transition web site at www.oregon.gov/OHA/transition/vision.shtml to see the proposed mission statements and take the surveys.
Disability Scoop is the first and only nationally focused online news organization serving the developmental disability community including autism, cerebral palsy, Down syndrome, fragile X and intellectual disability, among others.
Five days each week Disability Scoop sifts through the clutter to provide a central, reliable source of news, information and resources. Plus, Disability Scoop is the only place to find original content and series like “Scoop Essentials” that take an in-depth look at what lies beyond the day’s headlines.
Final tallies for Independence Northwest customer plan expenditures have just been compiled and reported to the Oregon Department of Human Services. From July 1st 2008 through June 30th 2009, Independence Northwest customers have received nearly $1 million in support services.These dollar amounts reflect actual expenditures (and not amounts allocated). Services are listed in ISPs (Individual Support Plans) and Personal Agents assist INW customers with accessing resources to meet their needs. The expenditures listed here do not reflect natural supports accessed on behalf of our customers (services such as Vocational Rehabilitation, Fairview Housing Trust, private insurance, Oregon Health Plan, etc.)
In the coming year, we expect the overall spending to increase significantly since over 80% of our total customer base have only been with us for one year (we enrolled over 370 people since July of 2008). Experience has taught us that customers tend to access more services in their second and third year as they become more familiar with resources available to them.
A pair of federally funded studies on autism rates is about to make news — big news — and it isn’t good: It would appear that somewhere around one percent of all US children currently have an autism spectrum disorder. The rate is even higher among six to 11 year olds and among boys, according to data from at least one of the new studies.
If you are an expectant parent, or planning to have a child soon, you might want to sit down before absorbing these staggering statistics, recently released by the National Survey of Children’s Health (NSCH), which is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services.
According to data from the 2007 telephone survey of parents of nearly 82,000 US children, the odds of a child receiving an ASD diagnosis are one in 63. If it is a boy, the chances climb to a science fiction-like level of one in 38, or 2.6% of all male children in America.
But there was also some surprisingly good news. Enormous numbers of children originally diagnosed with ASD went on to shed their diagnosis as they got older, parents reported.
Among all children aged two to 17, according to respondents, one in 100 (100-per-10,000) currently have an ASD diagnosis, which is considerably higher than the previously (CDC) estimated rate of 1-in-150, (or 66-per-10,000).
But researchers were also told by parents that 60-per-10,000 children “had autism, Asperger’s Disorder etc. at some point, but not currently.”
This suggests two rather remarkable things:
1. At some point in their lives, 1-in-63 US children (160-per-10,000) will have an ASD diagnosis and;
2. Out of every 160 children diagnosed with ASD, 60 of them (37.5%) will somehow go on to lose that diagnosis.
United Cerebral Palsy released its 4th annual report on The Case for Inclusion yesterday. The report ranks all 50 States and the District of Columbia on how well they are providing community-based supports to Americans with intellectual and developmental disabilities being served by Medicaid.
Oregon ranks 20th. Our state-specific details are here.
State by state ranking:
4. New Hampshire
11. New Mexico
14. New York
17. South Carolina
19. Rhode Island
21. New Jersey
23. West Virginia
26. South Dakota
36. North Carolina
40. North Dakota
48. District of Columbia
From the UCP website on the 2009 report:
Positively, there are 1,536 fewer Americans living in large state institutions (more than 16 beds). This is a bigger drop than seen last year. However, there remain 169 large institutions (4 fewer) housing 36,175 Americans;
Negatively, only nine states (down from 11) report more than 2,000 residents living in large public or private institutions – California, Florida, Illinois, New Jersey, New York, North Carolina, Ohio, Pennsylvania & Texas;
Sustaining the 2008 level, 19 states, but up from 16 in 2007, have more than 80 percent of those served living in home-like settings;
Positively, seven states – Alaska, Arizona, Michigan, New Hampshire, Oregon, Rhode Island, and Vermont- direct more than 95 percent of all related funds to those living in the community rather than in large institutions. Colorado directs a very close 94.6% of funds;
Positively, five states – Idaho, Louisiana, North Carolina, Ohio and Texas – as well as the District of Columbia experienced at least a five percent increase in people served in the community (HCBS waiver).
Negatively, Wisconsin reduced number of people served in the community (HCBS waiver) by more than five percent;
Nationally, 29 states direct more than 80 percent of all related funding to those living in the community;
Positively, 39 states, up from 33, report having a Medicaid Buy-In program supporting individuals as they go to work and increase their earnings; and
In terms of rankings, in total, 15 states had a sizable change in rankings over last two years. Pennsylvania (to #16 from #29 in 2007, dropping one place from 2008) and Missouri (to #29 from #41, dropping one place from 2008) improved the most with Wyoming (to #28 from #17) and Maine (to #35 from #24) dropping the most in the rankings.