Notes from October 15, 2008 meeting

Notes from the Waiting List Meeting

Oct. 15, 2008

1:00 pm

Represented in attendance:

4 – DHS/DDSD

0 – OHCA (Oklahoma Health Care Authority)

18 – Parent, Family member or Self advocate

(8 – First time attendees)

(Agencies/Organizations represented by family member in attendance – Center for Learning and Leadership/OU Health Science Center, OASIS, Down Syndrome Society of Central Oklahoma, Oklahoma Infant Transition Program, OASIS, Noble High School, Apex, Family Support 360 & Hispanic Mother’s Support Group)

Area’s represented by attendance:

  • Norman
  • Noble
  • Edmond
  • Oklahoma City
  • Blackburn
  • Anadarko
  • Midwest City
  • Yukon

Families waiting or receiving DDSD services:

11 families/individuals on the DDSD Waiting List

7 families receiving DDSD services

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Notes for July 30, 2008 Meeting

Notes from the Waiting List Meeting

July 30, 2008

1:30 pm

 

Represented in attendance:

4 – DHS/DDSD

1 – OHCA (Oklahoma Health Care Authority)

18 – Parent, Family member or Self advocate

 

(5 – First time attendees)

 

(Agencies/Organizations represented by family member in attendance – Center for Learning and Leadership/OU Health Science Center, OASIS, Down Syndrome Society of Central Oklahoma, Oklahoma Infant Transition Program, OASIS, SoonerSUCCESS & OASIS)

 

Area’s represented by attendance:

  • Norman/Noble
  • Edmond
  • Oklahoma City
  • Pawnee
  • Tulsa
  • Guthrie

 

Families waiting or receiving DDSD services:

10 families/individuals on the DDSD Waiting List

8 families received DDSD services

 

Status of the Waiting List – There are currently 4,069 on the Waiting List as of July 14th.  DDSD is working applications dated April 26, 2004.  Jim Nicholson reports that due to the state’s budget problems the waiting list is virtually stalled.  But with that being said, he also reported that at the end of the legislative session that the Governor and the Senate and House leaders sent DHS $500,000 specifically for the Waiting List.  Mr. Nicholson feels this is a direct result of families informing their legislators and advocating for more funding for those on the waiting list.  (Side note – if you were one of the families who called during that last week, pat yourself on the back, if you weren’t next time I’m sure we’ll be able to count on you.  Additionally, please call those you spoke with that week and thank them for listening and supporting our families.  This is a must if we want to continue to have the legislators respect us when we call them with our needs).  Mr. Nicholson also reported that with this funding they are currently working 80 applications from the Waiting List.  I requested that when a final number of approved applications are finalized they send that information so I can get this information out to families.  It was also noted that families need to be aware that this money is a “one time” allotment and not a line item for the Waiting List.   It was also explained that DHS has made some budget adjustments to the Resource Centers to help support individuals receiving Home & Community Based Waivers.  One point of interest mentioned was that currently and for the next year, possibly, our state’s budget will continue to be negatively affected by the nation’s financial crisis, but there is some hope for the future since our state has a large number of business’ who are positively affected by the high energy cost, which will eventually have a positive affect on our state’s finances.  This isn’t expected until the end of next year.

 

Status of Self Directed Services – Jim Nicholson gave an update to the Self Directive Services pilot program.  They are currently working with Oklahoma Health Care Authority to finalize the amendment being sent to CMS (Centers for Medicare and Medicaid) for final approval.  He did note that once CMS gives its final approval there is still some technical steps before it can move to the full In-Home Supports Waiver.  Some of these things include sending out an invitation for bid to find a fiscal agent to provide the employment part of the payment process, and then they have to make needed adjustments to OHCA and OKDHS’ billing system to work with the SDS payment model.  There was no estimated time of implementation. 

 

Family Question & Comments: There was comments given regarding the difficulty families are having obtaining HTS staff for those receiving supports in their home.  It was mentioned that there is a staffing shortage across the board.  The situation mentioned was when an agency provides residential supports and supports for those living in their own home, the agency is required to provide someone to work in the residential setting regardless of the staffing issues.  What this causes is if a family has a staff working in their home and if the agency has a shortage in the residential setting, they will put the staff from the private home to fill their obligation at the residential setting.  This leaves families vulnerable and without staff during this staffing crisis.  It was also mentioned that it seems there is a new movement for agencies, which is taxing on families.  This new movement is to offer the family of being their own HTS support and get paid while there is a staffing shortage.  The problem with this is families are not receiving any relief or respite during this time.  Additionally, it was said that once the family accepts this situation, even for a temporary time, the agency seems to stop trying to obtain staff for that family.  (This is only happening with adults on the both IHSW and HCBW, not people under 18)  On this same topic there was some discussion regarding low pay for direct care staff (HTS) and that seems to be the reason for the staffing shortage.

 

Jim Nicholson reports that the agencies have a high over head cost to provide training to direct care staff.  They pay for staff hourly pay for time they spend in training and also hourly pay to cover the shift they are missing while attending the training.  He explained that starting August 1st that agencies will be giving the opportunity to participate in something called the “College of Direct Supports” which is a web based training for much of the required training.  He explained that training can be done at the convenience of the staff, and any place there is high speed internet access.  Mr. Nicholson also explained that this training option is not a requirement but only an option for agencies since there is a “start up” cost for those agencies who want to participate.  His hope is that once a few agencies come on board that other agencies will follow and find that this will be a way to reduce the high cost of training. 

 

One family asked about if they need to leave the state for a short time, whether for vacation or even to care of a sick family member, would this cause a problem with their waiver services.  Mr. Nicholson said this wouldn’t have an affect on waivered services, but to let the case manager, the agency and the direct care staff know so they won’t plan to come out and no one there.  It was asked would this be true for an extended amount of time out of state, example given was three months, and Mr. Nicholson said that shouldn’t be a problem.

 

Another family wanted clarification regarding the writing of the plan of care.  She explained that her daughter’s plan was written with an “exact” amount of hours for HTS for each week.  This mom explained that there are some weeks she may only need 4 hours but when summer comes around she might need as many hours as she can.  She was told by her agency that she can’t just “do it” even though she hasn’t used up her full amount of waiver units because the agency is at risk to have to pay the money back.  Ray Hester, DDSD, explained that when a plan of care is written up, the plan will have a “prescribed” amount of units per week for HTS.  He said the plan can be written in a way to not be so restricted in hours per week.  But he also said it can’t be written so loosely that it can’t be tracked to show needs.  (My understanding of what he said was the plan of care can have written something like 10 – 20 units of HTS per week.  If there is a time when more than 20 hours is needed the case manager will need to request an amendment to the original plan of care.  This may not be exactly correct, but its close)

 

 

 

Schedule Next Meeting – Wednesday, October 15, 2008 at 1:30 pm.

 

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Notes from the Waiting List Meeting April 30, 2008

Notes from the Waiting List Meeting

April 30, 2008

1:30 pm

 

Represented in attendance:

4 – DHS/DDSD

3 – OHCA (Oklahoma Health Care Authority)

30 – Parent, Family member or Self advocate

2 – Agencies (SoonerSUCCESS, Phoenix Provider Agency – Tulsa)

 

(Agencies/Organizations represented by family member in attendance – Oklahoma Family Network, Center for Learning and Leadership/OU Health Science Center, OASIS, Oklahoma Family Support 360’ Center, Down Syndrome Society of Central Oklahoma, Oklahoma Infant Transition Program)

 

In attendance we had:

11 families/individuals on the DDSD Waiting List

18 families received DDSD services

Area’s represented by attenance:

Norman

Tulsa

Noble

Moore

Yukon

El Reno

Midwest City

Edmond

Pawnee

Stillwater

Oklahoma City

Status of the Waiting List – There are about 3,854 currently on the Waiting List. Jim Nicholson explained that the budget is at a “stand still”.  The Waiting List is not being worked and has not been worked in several months*.  There is no expectation for improvement because the budget for fiscal year 2009 approved by the Governor has the same amount of funding for DDSD as last year.

 

He was asked to explain why the waiting list will not be reduced once the fiscal year budget starts. He explained that due to the “federal match” being reduced and the budget from the state not being increased, OKDHS will have a significant loss in available funds.  Additionally, Jim Nicholson explained that the federal agency (CMS) which oversees the Medicaid and Medicare payments to each state had a policy change regarding how states can bill for and be paid for “targeted case management”.  This change in policy could have a financial impact to OKDHS estimated at 24 million dollars.  If this happens, this could be a huge issue in our ability to provide DDSD services to those on the Waiting List.  Jim Nicholson did reassure families that there is NO waiting list for families applying for the Family Support Payment which is funded through TANF dollars. 

 

There were several family members who were aware of the CMS policy change and explained that there is a legislation** currently approved in Congress but having issues in the Senate that would put a moratorium to “hold” this change in policy. 

 

Status of Self Directed Services – Jim Nicholson explained that Self Directed Services (SDS) is in the process of being added (amended) to the In-Home Supports Waiver, child and adult.  The Oklahoma Health Care Authority is currently making final adjustments before sending it to CMS (Centers for Medicare/Medicaid) for final approval.  It was explained that once CMS receives the request to amend the current waivers they will have 90 days to make a decision.  It was also explained that CMS can “freeze” that timeline if they need more information from Oklahoma to make a decision. 

 

TEFRA – Debbie Harmon, LPN from the Oklahoma Health Care Authority was present to explain TEFRA.  TEFRA*** (Tax Equity and Fiscal Responsibility Act) began in October 2005.  It provides Medicaid eligibility for children with high health care needs.  This program does not look at the family’s income, but rather only the child’s income.  Additionally, the child must meet one of three “high” levels of care qualifications to be eligible. Several families at the meeting have children that are difficult to test to obtain an IQ score but are known to have intellectual/cognitive disabilities.  Debbie Harmon explained that for the children who cannot have an IQ test performed and a doctor is not able to give an “estimated” IQ score; there are several ways a child can be evaluated.  She also explained that to qualify under the ICF/MR level of care the child must be “functioning” at least 50% lower than his/her chronological age.  For example, if a child is 8 years old and has an IQ above 70, they must be “functioning” at less than a 4 year-old level in order for the child to qualify for TEFRA under the ICF/MR level of care.  (This was a very technical section and it’s very difficult for me to put into words.  Please if you have any questions feel free to contact Wanda Felty)

 

Family Question & Comments: One family member discussed the change in her support staff due to them getting older.  She wanted to express her concern that the new staff she has to hire come through an agency as opposed to the staff she currently has which have a direct contract with Medicaid.  Utilizing an agency reduces the hours she can have staff due to the overhead of the agency.  It was explained to her that the federal agency (CMS) that oversees payments will not approve that program any longer.  Several families explained to her that Self Direction would be a similar program, but her children are both on the Home and Community Based Waiver, which will not have SDS at this time.

 

Another family discussed her issues with county DHS officials who are not familiar with different programs or policy.  She was told by her local office that families on the Waiting List cannot qualify for the Respite Voucher Program.  It was explained to her that people receiving any waiver service cannot qualify but those ‘waiting” can and should apply by calling OASIS 1.888.771.4550 local 271-4550.

 

Schedule Next Meeting – Wednesday, July 30, 2008 at 1:30 pm.

  

 

*According to OKDHS.org the waiting list is stalled working applications at or about April 7, 2004.

**H.R. 5613 – Protecting the Medicaid Safety Net Act of 2008

***More information at www.okhca.org TEFRA

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Meeting notes from Jan. 16, 2008

Represented in attendance:
3 – DHS/DDSD
1 – OHCA (Oklahoma Health Care Authority)
1 – TARC
12 – Parent, Family member or Self advocate
Total – 17

Areas represented:
Norman
Oklahoma City
Pawnee
Stillwater
Tulsa

DDSD is currently working applications from April 7, 2004.  We were told the waiting list is virtually stalled at this time.  The only person’s moving onto Waiver services are those who are in DHS custody, those who meeting the Emergency guidelines or those in the Public Guardian program.  We were also told that during the month of December 2007 that a total of 34 people were removed from the waiting list.  Of those taken off the waiting list 21 began receiving services and 13 were either closed, declined, or were not eligible.  Also in the month of December 93 people were added back to the waiting list.  You need to note that some of those who “declined” did so because they were receiving the Family Support Payment which meets their needs at this time.  Thus would then be added to the bottom of the waiting list.  It was also said that of those on the waiting list only about 15% have been waiting for more than three years.Jim Nicholson discussed the issue of high cost to agencies for required training of HTS staff, and the high turnover/retention rate of staff as well.  One of the ways DDSD is trying to help with this issue if by contracting with an online training program what would allow HTS staff and agencies to train at times convenient to both.  The online training would also allow for the HTS to have access to all previous completed courses which will make moving from agency to agency a smoother and less costly transition.  This project is estimated to be released in the next 30 days.  Additionally, he said this training would be available to families as well.

Jim Nicholson explained that there is a Rate Review Committee which has met two times already.  The committee has prepared a report to take to the legislators suggesting a rate increase of $18 an hour for HTS.
Regarding the Self Directive Services pilot Jim Nicholson said that it is a slow process to begin offering the SDS to the IHSW.  Currently the Health Care Authority is finalizing what they need and then the amendment (request to add this to the IHSW) will be send to the National Centers for Medicare/Medicaid (CMS) for their approval.  Once the amendment is sent to CMS DDSD will begin training of their staff so when approval is received the next plan of cares will have the ability to choose SDS. 

One more note of interest.  It was said that dental services were added as eligible services for those on the Community Waiver as of October 2007.

Sue Robertson with the Oklahoma Health Care Authority,  Child Health Program Coordinator spoke about a request that has been sent to CMS requesting the expansion of eligibility for children (birth – 19) applying for Medicaid.  CMS is still in the process of reviewing and has not made a decision as of yet.  If the request is approved it will change the income eligibility from 180% of poverty to either 250% or 300%.  What this could mean to families, if you had applied for Medicaid in the past and were denied do to your families income being too high, you may qualify once this program comes into effect.  This would help many people waiting for services on the waiting list.

Someone had mentioned to Sue Robertson the difficulties some families are having at qualifying for TEFRA.  The point was made that to qualify for TEFRA under the ICF/MR (Intermediate Care Facility for persons with MR) the person must have an IQ score of 70 or below.  When a child under that age of 6 is applying they are having 1) difficulty in finding someone who will give an IQ score for a person that young and 2) affording the cost of these evaluation.  Director Hendrick said if the problem is affording a Psychologist to perform the evaluation, that DHS could possibly afford to have a Psychologist on staff to do these.  Also, he has asked Jim Nicholson and Sue Robertson get together and figure out what is the issue with getting kids qualified if they should qualify.

The next meeting is scheduled for April 30th at 1:30.

 

 

 

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