Team 1: Support Coordination Enhancement (3-13-14)

Location of Meeting: Service Inc, Joilet IL

Handout for this meeting (pdf)

Members Present

Members Absent

• John Knight, DDD
• Gary Hake, SICCS
• Mary McGlauchlen, CISA
• Andrea Medley, DDD
• Mary Spriggs-Ploessl, DDD

Meeting Notes

Background to the Process per Mary Lou: The Senior Managers of DDD have been meeting for about a year to discuss the service coordination system. The Waiver 1115 is directly wrapped up in the Affordable Care Act. The question is how can we get simple and consistent so we know what we are doing and people come to us knowing what to expect and get results that they want? CMS on January 10th passed a rule that talks about Community-based services and gives explanations for what they are and are not. States have 7 years to get their waiver to comply. There is a person-centered part of the rule that states every state will offer person-centered planning that is important for and important to the person.

Agenda Item #1:  What we want and don't want from the process

1. What we want

   • To start with the sky is the limit
   • Worth my time and effort (not just an empty exercise)
   • As a work group we all have to come to consensus and own what we recommend-actively participate, if we have concerns or questions bring them up at the meeting
   • Clear set of recommendations
   • Communication improves among PAS agency
   • Meet in a central location and enough notice of the meetings.Set dates of when we can meet
   • Start and stop on time
   • Be productive
   • Share and receive information from some of the other groups
   • Not drag on forever.  Get to recommendations quickly to stay focused

2. What we don't want 

   • To forget the individuals we support
   • Find out that there were elephants in the room that we don't know about
   • To find out there are boundaries after we do our work
   • Don't let the past prevent possibilities
   • To miss something that is key
   • Getting off task or doing unproductive things
   • People to lose their jobs as a result of the recommendations

Agenda Item #2: Illinois DD System Guideposts

Discussion of how the System is NOW as of January, 2014, versus what Illinois would like the system to BE (refer to handout attached and shared at the meeting)

1. Current system

   • Intake and basic screening
   • PUNS
   • DD eligibility/waiver eligibility and enrollment
   • Provider availability determined
   • Services authorized
   • Plan initiated by provider
   • Service monitoring

2. Changes proposed

   • Eligibility will be considered right up front: the process needs to be done efficiently and accurately; you have to introduce people to Medicaid and let them know they are eligible to apply (changes in eligibility paperwork: Physical good for 1 year, No new psychological needed for those who are severe/profound, if moving from ICF-DD to Waiver services no level 2 PAS will know be needed)
   • People are enrolled in PUNS
   • HCBS Waiver eligibility and formal enrollment in the waiver
   • Person-Centered profile developed by the ISSA in conjunction with the person, family and guardian
   • Services authorized
   • Qualified providers identified; person select provider (6 and 7 may flip)
   • Service monitoring

3. Further Discussion for later

   PUNS: discuss later and perhaps recommend to the PUNS team to tie in with Medicaid and make sure it is still accurate when annual updates are completed.  Can Medicaid eligibility be streamlined to a shortened form for adults and not have to be renewed every year?  Would the form be able to go to Springfield?  Sideline Recommendation: Provider capacity is an issue and somebody needs to address it.

Agenda Item #3: Roles on the Work Team

• Facilatator: Mary Lou Bourne
• Chair: Darlene Kloeppel, Jennifer Gilmore as backup
• Communicator: Denise Oligney-Estill
• Recorder: Denise Oligney-Estill
• Timekeeper: Alise Raisbeck

Agenda Item #4:  Vision Statement

Vision Statement

All children and adults with developmental disabilities living in Illinois receive high quality services guided by a person-centered plan that maximizes individual choice and flexibility in the most integrated setting possible. All areas of the state have available a full array of services that meet the needs of children and adults with developmental disabilities living in their local communities regardless of intensity or severity of need. There is no waiting list for services. 

Further Discussion for later: Need to look at provider rates and how they are paid/being paid in a timely manner, also need to look at provider capacity.

Agenda Item #5:  Our Team's Purpose and Responsibilities

1. Purpose

   • What have we been tasked with doing?
   • How do we describe our purpose as a workgroup?
   • How will we know we have accomplished our purpose?
   • Team will define the role of service coordinators under the new system.

2. Team focus

   • will look at competencies/knowledge/training/resources needed
   • identify changes needed in structure/business processes to support the service coordinators
   • identify a set of performance measures for use in ascertaining the effectiveness of the ISC/ISSA agencies

3. Team Responsibilities

   • Identify the strageties for implementing recommendations
   • How do we overcome any obstacles in impeding successful implementation of the change initiative?
   • Keep stakeholders apprised of the progress
4. Further Discussion for next meetings
   • Statewide consistency
   • Minimize interpretations
   • Clear/matching interpretations
   • Increase ISSA hours
   • Increase number of mandated visits with the increased hours

Agenda Item #5: What COULD Be

The system that is in place today was designed in the 1970's and it just doesn't fit with expectations in 2014.

• Gapminder web site presentation
• Watched Microsoft health future vision video (What Microsoft is really good at--finding a problem/things that are a nuisance and fixing it)

1. Discussion

   • ROCS system should be replaced; not functional in its current state
   • Possible developmental disability application.  Will have all the information about a person in an application
   • Having portable data about a person that stays with them: this is who I am, what I nee; this is what matters to me; how to communicate with me. People want control of their own information and to be able to input their own information
   • Mobile information for when a person transfers from one agency to another
   • In the DD world we tend to have a relatively cynical approach to data.  Look at data turned information; difference of input data and output data; what data would be most helpful to us? How would we know the results? How would we be able to show that, measure that? Mapping programs to look at ideas such as living within an hour of your family, etc.
   • As you are looking at this whole design piece.  What are the outcomes and results that we want to measure?

2. Further discussion

   • Feedback to committee #2 for eligibility with changes in eligibility performance measures
   • PUNS database or screening tool that has more detailed information regarding preferences not just tied to the services we currently offer (a way to look at demographics and specific services that they want)
   • Streamlined system from birth to death
   • Person-centered process needs to include shared common interests, friendships, and how to stay in contact with family
   • How do we take the Outcomes for People We Support and make those performance indicators
   • Be healthy and safe
   • Have real relationships with family and friends
   • Have a paying job if they want to work\
   • Make decisions about their lives
   • Have opportunities to contribute to their community

3. Crisis situation

   Local communities have a 1-3 crisis beds in place for folks who are in crisis (state of Georgia-having crisis beds filled immediately and can't get crisis people out). How crisis situations are handled needs to be improved; how people in a crisis situation are moved; what is the BEST outcome for the person; currently not focused on the person and how it impacts them; often very traumatic and disruptive to the person.Statewide process in place of what everyone's role is: BQM, Region Facilitator, ISC Agency.

   Also a type of respite situation/time share for out of home short term care; need a break as a caregiver, family having surgery, etc. ONLY for people who are supported in their own home.

   What if state came up with system that a person was entitled to a certain amount of money per month and alloted it to the person and the person could go to different providers to get the services that they want

4. Action items

   Discussion with Team 2 for performance measures for eligibility and intake.  Additional Stakeholders for the group-family members? A parent who is just on PUNS and hasn't gone through the system, a person who has been through the whole process.

Next Meetings

• Tuesday April 15th, CISA in Lincoln from 10am-3pm
• Wednesday April 30th Service Inc, Joilet from 9am-3pm
• Hold May 20th from 9-3 if needed (tenative meeting place is Service in Joilet)

Minutes Prepared By: Denise Oligney-Estill