Case Management Redesign Conference Call (1-28-14)

Representatives from the Division of Developmental Disabilities

Representation from all 18 PAS Agencies

Agenda Items 

1.  Welcome, Introductions and Opening Remarks

   Greg Fenton, Deputy Director for the Bureau of State Operated Developmental Centers (SODC) and Project Manager for the Case Management Redesign initiative, introduced himself and welcomed all who participated on the call. He thanked everyone for making themselves available, given the recent weather conditions, and explained the need to not lose momentum for this very important initiative. Greg expressed the need for future meetings to start and end on time, and stated what he wished to accomplish during this meeting.

   Greg introduced Mary Lou Bourne as the meeting's Facilitator. Additionally, he introduced Sandy Ryan, Director of Programming/Planning Unit for the Illinois Council on Developmental Disabilities (ICDD), and recognized and thanked Sheila Romano, Director of ICDD (who was not on the conference call), for her support of this project.

   The following Division of Developmental Disabilities (DDD) staff introduced themselves:

   • Reta Hoskin - Associate Director for DDD
   • Michael Hurt - Deputy Director for the Bureau of Quality Management
   • Mary Spriggs-Ploessl - Deputy Director for the Bureau of Community Services
   • Kit O'Brien-Cota - Bureau Chief for the Bureau of Transitional Services
   • Maureen Haugh-Stover - Bureau Chief for the Bureau of Regional Services

   • Kevin Byrd - Northwest/North Suburban Region Facilitator
   • Andrea Medley - North Central Region Facilitator
   • Linda Gonulsen - Central/Southern Region Facilitator
   • Janine Gudac - South Suburban Region Facilitator
   • Sean Walsh - City of Chicago Region Facilitator

2.  Agenda Review, Work Group Purpose and DD Update

   Mary Lou provided the group with some background information about herself, citing that she had recently worked with Support Development Associates, most recently in Ohio and Georgia, and assisted in the complete redesign of their Case Management System from start to finish. Mary Lou explained how we would approach the call. First step was to provide a high level review from DD Senior Staff for each work group.

   Members of the Senior Leadership staff described each of the six teams, and what is expected of each team:

   1. Intake and Eligibility Work Group

      Reta Hoskin explained that this Team will review the current assessment process and find ways to streamline it. For families and self-advocates, make materials more user friendly and self-explanatory. Reta announced four proposed changes to the current PAS manual and processes. Reta is working with HFS to make these changes and hopes to launch them in the next couple of weeks. They are as follows:

      • Physical Exam requirements will change from 30 days to 1 year;
      • For individuals within the Severe - Profound range, a Psychological will no longer be required to be updated within the last 5 years. A Clinical Psychological will be accepted anytime;
      • For an individual moving from one DD Waiver to another, there will no longer be another Level 2 Assessment required (from Child - Adult, and vice versa); and
      • For an individual moving from ICF/MR (private or one of the 7 state operated), we will no longer require a Level 2 when they move into the Waiver.

   Reta added that we have a lot of volume underway because of Ligas and transition. We hope this will help with the volume; however, we do not want to shortcut the work group --- we hope they will have additional information, ideas and suggestions.

   Mary asked the question: does this mean anyone who is working on a level 2 right now for a person in an ICF/DD should stop this activity immediately? Reta responded, yes, they can stop that now, but we need to still make sure the choice is offered and documented. Later in the meeting, Reta clarified that if you have already pursued a Psych eval and are underway with a Level 2, go ahead and finish it, as we still need to document the changes to the process. The manual will change, but we need to make sure we are documenting that the person requires the ICF/MR level of care. There might be multiple ways to accomplish this. Reta's staff is looking into how the ICF's document the need for ICF level of care with Greg's staff. The bottom line is documenting the Level of care will be required.

3. PUNS and HCBS Waiver Enrollment Team

   Reta Hoskin explained that the PUNS listening tours have been completed by Celia Feinstein, and she is drafting the report. Once we have the report in hand, we hope to have a work group formed regarding implementation and alignment with other work teams.

4. Profile and Provider Selection Team

   Michael Hurt made reference to the document that was distributed during our Dec. 2nd meeting. We have made an effort to put a first version in front of this workgroup, but we are excited about the prospects of the workgroups to give this additional thought. The primary purpose is to give more emphasis to the person who receives services and to emphasize the person centeredness of the service system. We solicited input from staff who are involved in the Ligas activities, as we believe this document will work in any location or any environment - no matter where the person will live, or what the funding is.

5. Monitoring and Quality Team

   Michael Hurt reported that the Division currently conducts review activities with all 18 of the ISSA agencies annually. What we would like to do with the leadership along with this work team is agree upon and identify service measures for the whole service system. We start with the profile, but providers will still develop and implement SERVICE PLANS. One of our responsibilities is indeed to monitor. As such, we must identify how the choices and preferences in the PROFILE align with the service plan.

6. Business Process Team

   Reta Hoskin (on behalf of Dan Blair) indicated that we realize some of the changes being discussed may not be able to take place without additional resources. We'll need to determine what is currently underfunded, what needs to be realigned, etc. Some of this activity will need to be staggered with some of the progress of the other work groups, as we need to know what they will recommend first. But to start with, we want to collect data on current case load ratios. It is difficult to identify these because each agency organizes and manages a little bit differently. We will try to come up with a way to compare and effectively collect meaningful data on case loads.

Summary of Feedback and Questions on Work Group Proposal

Each of the 18 PAS agencies provided their feedback and posed questions, concerns and suggestions regarding the Work Group Proposal:

• Southern IL Case Coordination Services
  • Will notes be available in a "work group cloud"?
• DD Services of Metro East
  • Asked about addressing the impetus for the redesign.
  • Adhering to the concept of Teams will not be a problem.
  • Volunteered their Agency for Teams 3 and 4, and happy to participate in any Team in which DD feels they can contribute.
  • How are families and current providers going to be blended into the process?
  • Inquired about an implementation date.
• Great Rivers Service Coordination
  • Streamlining, resources, synchronization, and timelines are all very important to the entire process;
  • Added that Providers are an active part of the process.
• Prairieland Service Coordination
  • How will Service Providers be chosen if it is decided to include them?
  • Team sequence of work is very important.
• Central IL Service Access
  • Inquired about a notetaker for each meeting;
  • Inquired about closing an individual from PUNS, and stated that it's important that everyone does it the same way;
  • Inquired about the number of hours DD is expecting ISSA people to do their monthly jobs, and take a look at those 25 hours.
  • Excited about doing this and that everyone will commit the time to do this.
• West Central Service Coordination
  • Excited about the proposal, and that the focus for Team 1 would be to define the role of the Service Coordinator.
• Champaign County Regional Planning Commission
  • Likes the way it is being organized with work groups, rather than committees;
  • Does feel that it is important to include the Service Providers either in the workgroups or outside of the work groups.
• Western IL Service Coordination
  • Looking forward to the change, and feels that all agencies should be represented in at least one of the work groups;
  • Looking at the ROCS data input program - needs to be more user-friendly;
  • Look into encryption for the safe and confidential transport of documents.
• Livingston County Mental Health Board
  • Had no comments, and looks forward to getting started.
• Service, Inc.
  • Stated that members of these workgroups need to not limit their thinking and think outside of the norm; and
  • Inquired about the process for acceptance and implementation.
• CSO for Rock Island/Mercer Counties
  • Excited about the process and the workgroups; and
  • Suggests looking at the geographic composition of the workgroups (metro and down state).
• Access Services of Northern IL
  • Wants to make sure that we always have on our screen the person who is being supported - not the system - what is the desired outcome for the entire service system?
  • Inquired about holding people accountable?
  • Suggests that we delete the phrase "case management".
  • Inquired about how we will define quality, and how it will be measured?
  • Resources are very important.
  • Suggests that we look at the time involved, if we are going to involve program managers in this. Suggests that this be done right, not just fast.
• Options and Advocacy for McHenry County
  • Excited about the changes.
  • They travel four hours to get to one meeting - they want to make sure that the meetings are substantial.
• Community Alternatives Unlimited
  • This is a welcomed opportunity - as there have been past efforts, and this one seems to be much more comprehensive;
  • Regarding Teams, it appears that there is some overlap in focus. Teams 1 and 5 and Teams 2 and 3 are closely related - they will need to share their work together;
  • Stated that the process for identifying family and self- advocates for participation is really important.
  • In the stakeholder community, they are hoping there will be renewed clarity and confidence about who to call; State-wide it becomes an issue that families don't know who to call;
  • Capturing the data and a method for analyzing and interpreting meaning from the data is important;
• Community Service Options
  • Are really thrilled and delighted about the process, and hopes that it goes even further than previous attempts - if it's well-implemented it will take it to a whole new level.
• PACT, Inc.
  • Hopes that all of the documents have a common vision statement - stated that it's important that we're all working towards the same goal. What do we expect the system to look like in a year?
  • Analytics are critical - insisting resources in this must be done;
  • A good, robust training that is ongoing will be critical for staff to be all that they can be.
  • This should not be seen as a "one and done" process….that would be the kiss of death. Instead, it is the beginning of a new process.
  • Everyone must be willing to have an ongoing process with the work groups and commit to long-term refinement and engineering.
• DayOne Network
  • Improvements need to be made with the use of technology (ROCS) - an independent document management firm did a data audit….we were entering information 37 times;
  • Stakeholders is really important - there may be concern from families regarding changes to monthly contacts;
  • Suggests clarification to provider agencies on our role (PAS) and their role (providers);
  • Equity related to caseloads that match up with funding.
• Suburban Access, Inc.
  • Advises that everyone keeps an eye on who is the focus;
  • Suggests that providers and self-advocates be brought in early - there are a number of underserved communities that are largely disenfranchised from the system - SAI would like to see them involved.

Timeframes for Completing Objectives

It was stated that the original document projected that all objectives would be accomplished by March 31, 2014, but we recognize that date needs to change.

 Discuss Workgroup Composition

• Greg asked that the PAS Agencies email him their nominations (to include email and phone number) to participate in the workgroups, and to copy his Administrative Assistant, Rose Ann Kohrt, no later than Friday, January 31, 2014. Mary Lou stressed the need to be as specific as possible on which workgroup your nominations are to be added to.
• Additionally, Greg asked the PAS Agencies to email him, and copy Rose Ann, their ideas and suggestions on the best way to involve the Service Providers in this process, as well as self-advocates and families.
• Further establishment of the workgroups, including identifying each Workgroup Chair, Co-Chair, minute-taker, etc., will occur at the next face-to-face meeting.
• Additionally, it is recommended that members of the various workgroups talk to others, not just their own workgroup.

 Review of Documentation Requirements

• Greg informed the group that each Workgroup will be responsible for identifying actions that need to be taken, reporting decisions that have been made, providing status reports, and taking minutes - of which Greg is requesting to receive from each workgroup. Additionally, he stressed the need for each workgroup to promote consensus building as a primary objective.
• Greg indicated that meeting minutes may be placed on the DHS Website, upon approval from the Division. If and when this occurs, it is our intent that all workgroups will have access to the minutes.
• The notes from today's meeting are being recorded by Rose Ann Kohrt, Greg's Administrative Assistant, and Mary Lou. Both sets of notes will be combined into one document and distributed to all participants on the call.

 Open Discussion/Questions

• It was reported that the establishment of a Steering Committee is being discussed, which could potentially include members of DDD Central Office and Senior Leadership.
• Greg and Mary Lou would appreciate everyone's support in arranging the next meeting, as well as future meetings. It was noted that the need to have full-day, face-to-face meetings (anywhere from 4 - 5 hours) would be necessary, as conference calls do not lend themselves to the type of workgroup activity we envision for future meetings.
• Mary Spriggs-Ploessl asked that the "desired outcomes document" from the 12/2/13 meeting that Kevin Casey held, be re-distributed to the participants on this call.
• Deb Sheppard from CISA has agreed to continue to help with the arrangement of future meetings.
• Rose Ann Kohrt identified herself as Greg's Administrative Assistant, and provided her email address (Roseann.Kohrt@illinois.gov) to the group. She asked that she be copied on any communication sent to Greg.
• Greg thanked Mary Lou for being able to call-in and for facilitating this meeting, and thanked everyone on the call for their participation. He looks forward to collaborating with everyone and their continued partnership.

 Next Steps, Review of Action Plan and Adjourn

• Next meeting date, time, and location have yet to be determined.
• Meeting was adjourned at 1:53 P.M.

Summary submitted respectfully by,

Mary Lou Bourne

Rose Ann M. Kohrt