Team 1: Support Coordination Enhancement (4-30-14)

Location of Meeting: Services Inc, Joliet IL

Members Present

Members Absent

• John Knight, DDD
• Gary Hake, SICCS
• Vickie Stillman-Toomey, NASDDDS

1. Agenda Item #1: Discussion of what has happened since our last meeting?

   Steve discussed the recent ARC conference. At the conference, Greg Fenton gave a presentation on the current committees created to look at enhancing service coordination. At that presentation, parents expressed concern that we not build a system that is too restrictive in its approach to services. Rather than having a proscribed schedule of visits (i.e. monthly) that there is flexibility is the visits. Greg tried to make it clear that the role of service coordination is going to change in regards to the support plan. The support plan will consist of goals and desires that the person has and will be completed by the ISC's.

   Lori stated that from a family perspective when her daughter was in school she wasn't aware of service coordination agencies since she wasn't requesting services at that time. Lori's family became involved with service coordination when her daughter was initially put on the PUNS. During the last conversion process, her daughter started receiving adult home based services.

   Further discussion is needed in the area of "Do we need to have more of a lifeline process/connection in service coordination?"

2. Agenda Item #2 Annual Waiver Redetermination Process (for continued eligibility)

   Lori brought up the point that the annual waiver redetermination process can be confusing for a family regarding the assessments. There was a discussion of the ICAP assessment tool and its limitations. The ICAP score can also impact the funding level for a person receiving cila services. Lori stated that it would be helpful to have a "fact Sheet" of assessments to give to parents so they are aware of what each assessment is used for and why. The purpose of each step needs to be described in better detail to families so there is transparency throughout the process. Our current process is a deficits based approach rather than a strength based approach.

   Mary Lou asked the group "How often would you say with all of the people who are initially eligible, receive waiver services and supports from your agency, how many people are identified as no longer eligible to needing that level of care?" Across the board, each person stated that less than 5% of people are found ineligible. Mary Lou noted that we spend time doing eligibility and redetermining eligibility when the percentage of people who are found ineligible (after initially being determined eligible) is very low. It was noted that many folks are no longer eligible due to not qualifying for Medicaid.

   There was discussion regarding other ways that we could "redetermine" eligibility rather than what the State of Illinois is currently using. Active treatment is not a requirement in home and community based services. On the federal level, it is only a requirement for institutions. Federal government requirements: Do they have a need for these supports? Do they have a need for this level of care? The federal requirement is based on the idea of support, not treatment. In the absence of support, how would this person do?

   Mary Lou reported that yesterday the Bureau of Community Services, the Bureau of Transitional Services staff, some staff from the Bureau of Quality Management and staff from Money Follows the Person met for a training. The topics discussed were:

   • What is a person centered system?
   • Why does the system need to change?
   • How do you change the system?
   • How do we understand resistance to change?
   • The perspective is to help people understand that this is an opportunity for change since the environment around the DD system has changed.

   The Challenge of Independent Service Coordination:

   • What is it that families/individuals need from us?
   • What does the State of Illinois need from us?
   • Both questions are equally important

3. Agenda Item #3: What are the benefits of changing the System and addressing the role of Service Coordination?

   • role clarification, clear definition of roles, transparency, statewide consistency
   • reflecting on services, opportunities for the future
   • better connect existing services
   • enhancing: we know better so we can do better
   • streamline steps/work better with what we have
   • able to meet needs of families/individuals (currently feel like serving state of IL needs)
   • move toward person centered approach/enhance PCP
   • quicker response to service delivery
   • better consumer outcomes
   • rates changed to cover costs
   • will be taken seriously by providers-have backing of DHS-DDD
   • smarter paperwork: in theory spend advocating/helping rather than paperwork (someone will need to do work of changing forms/manuals/etc)
   • education by DHS Division of DD/Agencies about services and what that entails: more transparency

4. Agenda Item #4: What are the benefits of NOT changing the service coordination system?

   • familiar process
   • families know current system/provider agencies know system
   • won't have to hire new staff/expand
   • no new learning/training/forms
   • no time investment in changes
   • no pressure for outcomes
   • no growing pains/change is uncomfortable
   • process can be slow-has to go through various levels at the State of Illinois
   • Will ISC agencies we have support if the system does change? Is this actually going to work?

5. Agenda Item #5: SDA Handout: Paradigm Shift

   Rethink the referral process of how it is now? Providers allege that ISC agencies aren't sending referrals their way or are playing favorites. How do we make it work so it is transparent, and works for all of us, including families, providers and service coordination agencies?

6. 1. 2. Discussion regarding the Possibility of Choosing your ISC agency: There needs to be in the current system that someone doesn't say "no". If somebody chooses you as an ISC agency, you don't get to say no. The current mandate is to serve everyone in your area. If there is going to be choice, make sure you ask questions when choosing an agency that is going to coordinate services for you. Mary Lou noted that there is a very unique relationship between the State of IL (DHS-DD) and ISC agencies. If choice of service coordination agency is available, then there needs to be clarity about how it occurs, and what the service coordination agency's role is in servicing people who are extremely challenging.
      • allowing choice of ISC agencies doesn't fix deficits of services in the state-ISC agencies
      • overall are not the problem
      • there are already have 2 different service coordination systems between birth to 3 (Child Family Connections) and other services (Independent Service Coordination).
      • We are doing families a disservice by continuing to fragment the system.

7. Agenda Item #6: Additional Monitoring Visits

   We first engaged in a brief review of what exactly additional monitoring visits consist of:

   • if there is an agency that has a safety concern, DHS-DD will contact the ISC agency with the request to the ISC agency of how many/often visits with the provider until the provider comes into compliance and DHS gives you the ok to stop the visits
   • If people are in immediate danger they may be moved that same day to another agency.
   • Currently the process is not written down anywhere at DHS-DD of how the process should be completed if individuals need to move immediately.

   What's working/not working?

   • There needs to be a natural disaster preparedness plan for each Individual Service Coordination agency
   • The division internally needs to have a clear process of how they make the decision to close a facility which in turn requires a clear process of the expectations for the ISC agency and expectations for the receiving provider. Providers will come and "cherry pick" who they want to serve and who they don't want. There is no choice of provider on the part of the person receiving supports in these emergency situations.
   • It needs to be written down what the service provider agency is going to be told by DHS and ISC agencies when additional monitoring visits are completed.
   • ISC agencies/DHS bringing equipment along with to get information for records: portable scanners/copiers
   • Needs to be a timeline for compliance for the service provider agency. There also needs to be a clear description for providers-what are situations that call for immediate jeopardy? Providers need to have compliance within 7-14 days to have things fixed (i.e.…rodents, no food, no staff)
   • Payment: there should be an additional increased rate for ISC agencies: being paid more for overtime/holidays/nights (further discussion for the business process team).
   • Additional ISSA hours overage request process needs a lot of attention. DHS-DD needs to look at that process for consistency
   • Discussion of Receivership when an agency needs to close: the people don't have to go; the provider has to go so an individual isn't expected to move from their home. This would be the ideal.

8. Agenda Item #7: What does that mean for any changes to Service Coordination enhancement?

   Team discussion that for most families that interact with ISC agencies that receive home based services families are looking for information and resources beyond what the DD system would pay for. The team noted that this illustrates why these positions are not first year positions for QIDP's but for QIDP's who are experienced and have knowledge to convey information. The QIPD's really need to be skilled in how to do active listening with a family so they can reflect back to a family. There also needs to be additional focused staff training and the funding to go with it. Other states have a very defined curriculum of what 1st year QIPD's skills set, 2nd year QIDP skills set, etc. In Illinois, DHS-DDD does not have a separate training specifically for ISC agencies. It was noted that there should be enhanced training for ISC agencies available within the DD division. DHS-DDD is also discussing having internal requirements for training for Community Services staff in the division.

   The DHS-DDD needs to find a solution of how to find a consistent population to draw QIPD's.

   There needs to be Development training modules that move people from an entry level position QIPD position with no skills to a highly skilled QIDP position. A long term goal would be to develop a curriculum for a college degree.

9. Agenda Item #8: What does a Service Coordination manual need to address?

   A small team will meet via Go to Meeting to review the ISSA manual. The team will go through the ISSA guidelines prior to our 5/20/14 meeting to address all of our responsibilities as a service coordination agency. The team will also review Attachment A pages that Apply to ISC agencies. The team will consist of Mary Lou Bourne (Facilitator), Jennifer Gilmore, Lisa Jacino, and Denise Oligney-Estill.

   Thought to consider: Do we change to have one manual to reflect all the duties including ISSA, Bogard, PAS, and PUNS/Program 500. Team will consist of Denise, Jennifer, Lisa (Mary Lou will facilitate)

Potential Recommendations/Ideas

• The business process team include in their work how payment is made for additional monitoring visits
• Recommendation to look at what is currently the ISSA manual and attachment A. Possibility of one manual that encompasses all ISC duties.
• Additional Monitoring Visits: set of procedures/process and specifics of visit, roles of division and service coordination agency
• Provider capacity building
• Qualifications for QIPD, ongoing skill and knowledge development
• What DHS-DD does and what service coordination agency does as relates to a specific topic?
• Referral process to providers
• Choice of service coordination process for families
• Look at Illinois waiver (children/adults/home based) re: implementation issue
• What do we want to say about service facilitation?
• How we redetermine eligibility: recommendation around active treatment

Action Items (to be completed before our next meeting)

1. Mary Lou is going to send active treatment Medicaid letter to committee
2. Small group team will look at current ISSA manual/attachment A and report back findings to Team 1 at our next meeting.

Next Meeting

Tuesday May 20th at Service Inc in Joliet from 9am-3pm

2300 Glenwood Avenue, Joliet IL

Minutes Prepared By: Denise Oligney-Estill