Audience
Open to the general public.
Time
10:00 am to 1:00 pm
Location
Double Tree Hotel
5000 West 127th Street
Alsip, Illinois
Agenda
- Call to Order
- Introduction of Council Members
- Approval of October 6, 2016 Draft Meeting Report
- Lead Poisoning Eligibility Workgroup 1 Report
- DRAFT Annual Performance Report (APR)/State Systemic Improvement Plan (SSIP) Update
- Ongoing Updates
- IMPACT
- Service Delivery Approaches (SDA) Workgroup Recommendations
- Cornerstone
- Parent Reimbursements
- Budget Update
- Bureau Update
- Electronic/Digital Signatures
- Early Hearing Detection & Intervention (EDHI)/Joint Committee on Infant Hearing (JCIH) Workgroup
- Tele-Practice
- Adjournment
Meeting Report
Present
J. Diane Adams-Alsberry, CALM, Inc.
Karen Berman, Ounce of Prevention Fund
Teresa Bertolozzi, Parent
Bob Cammarata, ICG Health Care Services
Benny Delgado, Leaps and Bounds Family Services, Inc.
Brenda DeVito, CFC 6 Program Manager
Ann Freiburg, Part C Coordinator, DHS, Bureau of Early Intervention
Donna Emmons, Illinois Head Start State Collaboration
Laura Kotelman, Illinois Department of Insurance
Ginger Mullin, IL Dept. of Public Health
Rosalina Perez, Parent
Deanna Pratscher, Parent
Kristin Doan, IL State Board of Education
Kathy Schrock, Easter Seals DuPage & Fox Valley
Ralph Schubert, Division of Specialized Care for Children
Lynette Strode, Illinois Assistive Technology Program
Therese Wehman, Elmhurst College
Constance Williams, Ph.D., DHS, Division of Mental Health
Absent
Margaret Harkness, IL Council on Developmental Disabilities
Roselyn Harris, DHS, Bureau of Child Care & Development
Vicki Hodges, ISBE, McKinney-Vento
Patricia Hooper, Parent
Brandy O'Connor, Parent
Sylvia Riperton-Lewis, IL Dept. of Healthcare & Family Services
Cynthia Tate, Governor's Office of Early Childhood Development
Rita Wahl, CFC 20 Program Manager
Kathy Ward, DHS, Division of Developmental Disabilities
Angel Williams, IL Dept. of Child and Family Services
Amy Zimmerman, Legal Council for Health Justice
1) Call to Order
The meeting was called to order at 10:26 am by Kathy Schrock.
2) Council Member Introductions
Members introduced themselves and the role they represent on the Council.
3) Approval of October 6, 2016 Draft Meeting Report
Benny made a motion to approve the minutes. Bob C. seconded. J. Diane recommended the following correction to the item 5 in the minutes. The second to last sentence should be changed to read "…are bound by open meeting act requirements". With this correction, the motion carried.
4) Lead Poisoning Eligibility Workgroup
Karen Berman shared information that Amy Zimmerman had prepared about the EI and Lead workgroups that have been convened since the last Council meeting. The first workgroup is working to define what the automatic eligibility criteria would be. The second workgroup will discuss what services might look like for these children. The workgroups are being convened by Amy Zimmerman and Anita Weinberg. So far, two meetings have occurred. The first workgroup has collected a lot of data to better understand how to define what lead level is of concern. This group consists of Council members, advocates, physicians, and relevant agency staff. This work has been adopted as a priority in the children's Cabinet Lead workplan.
Based on 2015 numbers, if we serve 25-75% of children with blood lead levels (BLLs) at 5 or above, we would be serving an additional 2,532- 3,797 children across the state. Not all of the children within this range, however, would be new referrals as some may have been served for another reason as well. Dr. Shah leads the Governor's Cabinet lead poisoning work and met with the conveners requesting more information to bring the issue forward to the Governor. The next step is determining level for eligibility and appropriate services (DT, ST, SW, and Nutrition services are most likely). Karen then asked for questions and/or information that should be taken back to the workgroup.
Bob is looking forward to participating in the second workgroup regarding services. Kathy says the groups contain diverse membership and there has been lots of good discussion and interaction. She then asked Ann about what would be next for the Council. Ann said that the Council will be asked to respond to any recommendations made by the workgroups. Brenda asked if 5 is the blood lead level that other states use as their eligibility cutoff. Ann said that it varies across states. J. Diane asked if there were certain areas that were more impacted by this issue. Karen said that the group has a heat map that shows where the risk of exposure is greatest and offered to share the information from the workgroup that the Council wanted to see. The entirety of Chicago is a concerning area. Research shows that irreversible damage occurs at a lead level of 5. Donna asked about the age at which screening occurs and wondered if this should start earlier. Some think that screening is typical at a year, depending on the child's caregiving arrangements, e.g. childcare may require screening to begin earlier. Risk, however, increases as children become more mobile and shift to drinking tap water given the typical mechanisms of exposure (lead pipes and paint). Rosie asked to get more information about when the screening occurs for children who are not involved in childcare. Karen will have to get back to them with that answer.
5) Annual Performance Report
The draft report was included in the Council Packet. Ann reminded members that we have both compliance and results indicators. We continue to submit via the GRADS360 system. Some information is pre-populated and states can correct any errors. The only information missing from the presented draft is regarding our number of corrections to longstanding noncompliance. Ann explained that we may have been holding people to too high of a standard for correction. We have been working with our OSEP contact and other states to better understand our options for reporting and correction. Ann still needs more information about how much she can correct in this year's data. Ann would like members to share questions or feedback about the proposed report.
Kathy applauded the Bureau for the amount of work that goes into producing this report. She reported that one thing that appeared to be more apparent in this report was how the fiscal uncertainty with the state budget has impacted providers. Benny feels that it is important to make this impact known to our legislators. The uncertainty of consistent payments has had an impact on provider willingness to work in this system. Bob asked when this report is due. Ann responded that it is due February 1st. Bob thanked Ann for preparing the report in time to give it consideration during a Council meeting.
Ann mentioned a few indicators whose performance have changed over time. Nothing was too surprising. Number served has been declining slightly and service delays may have been impacted by budget concerns. Kathy asked about the number of providers that may serve multiple states and whether we might have lost these providers to a neighboring state as a result of budget concerns. Ann is not sure we track this in a meaningful way.
Therese congratulated system stakeholders for the exceptional performance in regard to getting IFSPs developed within 45 days and improving performance around transition. Benny also shared how rewarding it is to work in our system now with so much collaboration occurring. He cited the recent example of the Provider Handbook webinar conducted by EITP. The partners participating in the call handled rapid fire questions in a very efficient manner. Ann asked for questions or comments to be sent to her by the end of next week (1/20/17).
6) Ongoing Updates
a) Illinois Medicaid Program Advanced Cloud Technology (IMPACT)
Bureau has been worried about the number of EI providers getting enrolled as this could impact our reimbursements, and ultimately, the funding to our system. As of February 1st, providers who are not enrolled will be removed from the HFS system. Claims submitted to HFS on their behalf will be rejected. A little under 700 providers who needed to revalidate did not begin the process. We have around 1,000 who are in the system but not correctly associated. The Bureau is working toward a plan for getting people to enroll as they renew credentials, but there is still work to do around those who are not correctly associated. Ann also reminded people that this is just Phase 1 of the process and it only impacted certain provider types and those who needed to revalidate. No date currently available for begin of Phase 2. IMPACT system is in use by several other states as well. This migration is not an EI specific change, it is required for all HFS programs.
Brenda asked if there is a way to determine which of the 670 may have current authorizations. Brenda feels that CFCs would be happy to assist with outreach to this group of providers. Kathy asked about the ability to sort the providers by CFC. Ann is going through the list and trying to determine how many are actually active. Perhaps after this determination has been made, outreach to CFCs could occur. Bob shared some of the challenges in getting providers enrolled from misinformation about how to enroll to a lack of support staff when errors occurred. Since the determination of "active" providers could take a while, Benny encouraged all those who have interactions with providers to share the importance of enrolling by February 1st and the potential consequences of not enrolling. Therese asked about the support available to individual providers. Rob Derry reported that Provider Connections staff provide support around the issues they can address, but there are some issues that require assistance by IMPACT staff. In general, the new providers enter much more easily. Brenda is worried that a number of providers who have tried to enroll may not know that they are in the system incorrectly and need to do more work with additional support.
Brenda asked Ann to consider a "pilot" with providers to test Phase 2 before opening it to the masses.
b) Service Delivery Approaches (SDA) Workgroup Recommendations
Ann has not had a chance to address these since last meeting. Karen asked if between now and the next meeting we could have a discussion about those that could potentially be moved forward in the coming year. She is concerned about just letting items rest and wants to think about how members could partner to help the Bureau move them forward. Ann wants to finish her review/reorganization of the items that includes progress, but she feels that a discussion could be useful after that. Karen wants us to think about how we can continue the momentum given the current system constraints. She would like us to be more proactive rather than just hustling during times of crisis. Kathy is hoping that members can help with identification of resources for those items most in need of being moved forwarded. Benny wondered if a small group within the Council could assist Ann with the effort of reviewing and prioritizing.
Ann will begin by finalizing review and sending it out. Goals could then be identified and people could offer to assist with those that could benefit from their expertise. Therese reminded people of the work that went into the recommendations over a four year period and her hope that recommendations weren't going to be rehashed by additional groups. Karen clarified that her suggestion was not to convene a workgroup to further explore the recommendations but was more geared toward prioritizing recommendations for action and implementation, increasing awareness and coordination across systems. She is concerned that the recommendations are not publicly posted yet. She feels that these recommendations represent, and can be a platform for discussing, our "gold standard" ideas around service delivery.
Teresa asked about how things typically move forward. Gina shared from her experiences how items ultimately get moved forward and it is, rarely, a quick process that doesn't benefit from support from agencies, families, and advocates. She also provided a suggestion for organizing the recommendations around cost and impact to determine feasibility. Ann feels that the spirit of many of these recommendations has been incorporated in the Procedure Manual and the Provider Handbook and will be accomplished from activities planned through the SSIP.
c) Cornerstone
A process has been started to understand the breadth of data systems being used within DHS. WIC will be getting a new data system in 2020 (no later than 9/30/20). WIC was the primary user of Cornerstone and then other programs were added. Cornerstone has outlived its utility in regard to WIC reporting needs. WIC's data system is determined by the USDA, their funder. Ann has participated in many discussions to describe EI's programmatic requirements and data needs. She is awaiting the response as to which data system has been chosen and whether or not the state has a system that can meet our program's needs. Therese asked if we have to be tied to WIC's selection. Ann does not have an answer to that question, but she will ask. DOIT is attempting to integrate and align the state's data systems. Bob feels that we should be linking to other groups, e.g. Early Learning Council, efforts to identify and bring resources to coordinated data systems. Karen asked about EI's involvement in the Illinois Longitudinal Data System work. Ann shared that EI has contributed some aggregated information for a dashboard. As she understands it, that data system is not really something that could support the entirety of our system needs.
d) Parent Reimbursements
Nothing new has occurred. Ann will work to schedule a meeting with Karen and Amy.
e) Budget Update
No budget has been approved however, providers are still being paid via the court decree. Payments from GRF have been a little slower but Ann is not sure why. Ann feels that most of the delay is due to more programs now being paid and efforts to catch up with past payments. Bob expressed his appreciation for the postings about provider and administrative payments and shared that, from a provider perspective, 2-3 months payment delays seem to be the time period that most cause concern. He also spoke of an upcoming organization's sponsorship of an opportunity to ask the Comptroller questions. He plans to submit a question about early intervention.
OT/PT evaluation codes' memo has already started raising concerns among providers. Ann was aware of the change ahead of time but cannot get a clear answer about how this will impact our system. She expects annual guidance to be available by the end of the month. HFS shared with Ann that it is typical to get the federal information over the course of January. Ann hopes to use a process similar to what was used for changed SLP codes. If this can be used, it should be relatively seamless. Benny asked if there is any indication that there will be a change in rates. This is unknown, but Arkeitha Monroe shared how the CBO is currently handling this shift in terms of claim denials or holding submissions.
Benny recommended that the Council write a letter again encouraging a budget resolution to prevent programmatic challenges. Kathy agreed to share the past letter with Council members for edits and clarification as to who would both author and receive it.
f) Bureau Update
Should know in the next week or two for one of the open positions. Data manager position has not yet been posted. Ann is also hoping to get her past position posted since she has officially accepted Chief position.
g) Electronic/Digital Signatures
This issue has resurfaced with the recent posting of the Provider Handbook. Ann has spoken to the EI security officer to discuss HIPAA/FERPA requirements. This person is currently reviewing information that Ann has given her. Some of the options that people have been offering do not adhere to our system's requirements. They are working towards clearer definitions that fulfill all requirements. Ann is confident that they will find a workable solution once the definitions are clear. Bob talked about providers' confusion regarding Monitoring violations around electronic signatures and the need for greater clarity.
7) Early Hearing Detection and Intervention (EDHI)/Joint Committee on Infant Hearing (JCHI) Workgroup
Ginger Mullin discussed the EDHI collaboration (www.illinoissoundbeginnings.org) between 3 state agencies- Public Health, DHS, and DSCC. The program identifies about 300 children a year with a congenital hearing loss. They may also identify children who have a transient hearing loss that impacts language delay. She provided a handout for Council members that included important link, contact information and workgroup participants. The Joint Committee on Infant Hearing statement came out in 2007. A supplement to the Position Statement came out in 2013 and has focused guidelines for intervention (citation on handout). A toolkit was developed to support implementation of recommendations. Council members received a copy of the toolkit. Illinois workgroup was convened in 2016 and facilitated by Tracy Meehan. The workgroup prioritized intervention recommendations, determined feasibility, and provided feedback on where Illinois was starting in regard to the recommendations. Goals 1, 2, 3 and 7 (described on handout) were determined most important. The workgroup developed an action plan and items are already being addressed. The final paper from the workgroup should be released soon. Ginger would like to present this paper at the next Council meeting.
8) Tele-Practice
Kathy and Ann will be reconvening to share some additional resources that they have each received since the issue was last explored. The plan is to share this information with Council members at the next Council meeting. Depending on what is determined, a workgroup may be re-established. Karen shared that while she knows tele-practice will benefit in ways beyond just service delays, she is requesting that information about service delays also be discussed at the next Council meeting. Ann suggested including the Improving Access workgroup's work in this discussion as well.
9) Adjournment
Motion made by Dee; seconded by Brenda. The meeting adjourned at 1:10 pm.
Contact Information
Jenni Grissom
IDHS - Bureau of Early Intervention
823 East Monroe
Springfield, IL 62701
Ph: 217/524-1596
email: jennifer.grissom@illinois.gov
