Why Vision Matters

We have talked a lot about the series of policy changes back in late 2013 that resulted in the statewide Community First Choice K Plan, in consolidating services and payment into the eXPRS Plan of Care, and the rise of the Adult Needs Assessment as a primary point of departure for service planning and funding. Today, we believe that more change is necessary if Oregon is to regain a functional, sustainable structure for IDD services.

In our last post, we talked about the series of changes that reshaped the landscape for intellectual and developmental disability (IDD) services in Oregon. From the summer of 2013 until the close of 2015, we were taking on new processes, new forms, new rules, and new roles as fast as we could implement them. (And quite often, faster than we could implement them.) Now, as we take a breath, it feels wrong to be talking about system change again. But we are talking about it, and we have to keep talking about it, because where we have arrived isn’t where we get to stay. Our services are too costly, and they aren’t netting the kind of outcomes that we’d like to see for people in services. And therein lies the problem–how will we know success when we see it? To get to the right end, you have to go about things the right way.

binoculars

source: freeimages.com

Start with a vision.  Unfortunately, just because you put a lot of energy and effort into a project doesn’t guarantee its success. We started the 2013 change process with the goal of funding our services through the Community First Choice Option (K Plan), instead of through the collection of Medicaid Waivers through which services were previously authorized. At the outset, state leadership held the belief that this change in funding authority would be a back-end change, imperceptible to people using the services. It didn’t turn out that way. Making a federal funding authority our North Star didn’t lead us very far. This perceived lack of direction was part of what compelled OSSA to come up with our Vision for the Future of Disability Services in Oregon. It’s not enough to know how we’re going to pay for the services, we need to start with why we want to have the services in the first place. What is our vision for Oregonians with IDD? How should people be treated? What place should they hold in our communities? We need to start with a destination in mind, and then figure out how to get there.

Think long-term. It’s hard for public policy to plan for the long-term. Lawmakers come and go, appointed officials change office, public opinion supports a project one day, and has forgotten it the next. This capricious nature is why stakeholders must come together and do the long-term planning and visioning with state leadership, in an effort to safeguard funding and services for future Oregonians with IDD and their families. Many of the changes enacted with the K Plan in 2013 were reactionary. We were reacting to budget holes and to federal compliance issues. Though budgetary concerns and federal compliance are both important considerations, budgets are in a state of flux, as is federal law. Responding to their whims without balancing the long-term needs of a system will not get us the results we want.

planning for the future

source: freeimages.com

Plan for a Whole Life, not a Service Life. When evaluating a social service, it’s easy to focus on what you can get–how many hours, how much money, what’s the upper limit? But focusing on the benefit itself won’t get a person the outcomes they desire. You have to start with an idea of the life you want–who do you want to be, what do you want to do, what’s the upper limit of your happiness? We call this approach seeking a Whole Life instead of a Service Life, and it is key to making the most out of the services available. As a community, we have to refocus on the people using these services, and the lives they want to live, connected to their communities, building relationships, and benefiting from paid and unpaid supports. When we start with a goal, we often find that we can balance the imperative to be good stewards of public funds with the necessary funding and supports to live a full life.

This isn’t a detailed plan, but it is a place to start. There will be debates and arguments, differences in opinion about where to spend and where to save. We don’t have to agree on everything. But, in the end, what matters is we are all pulling in the same direction–toward rich and fulfilling lives for all Oregonians.

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Oregon I/DD Advocates Testify to Senate Committee on eXPRS State Payment System Implementation Concerns

Senator Sara Gelser, Chair of Senate Committee On Human Services and Early Childhood

Senator Sara Gelser, Chair of Senate Committee On Human Services and Early Childhood

On Tuesday, Oregon Support Services Association’s Executive Director Katie Rose testified to a Senate committee regarding the state’s roll out and implementation of its payment system, eXPRS.

Additional testimony was provided by Margaret Theisen (CEO of the state’s largest brokerage Full Access), Chris Burnett (Executive Director of Oregon Rehabilitation Association,) Gary Zenzen and Chris Schwartz (from provider organization Partnerships in Community Living,) Lilia Teninty (Director of Oregon’s Intellectual and Developmental Disabilities Program,) and Don Erickson (Chief Operating Officer for Oregon’s Aging, Disability, and Developmental and Intellectual Disabilities Programs.)

The five advocates testified to the Senate Committee on Human Services and Early Childhood: Senator Sara Gelser, Senator Michael Dembrow, Senator Laurie Monnes Anderson, Senator Alan Olsen, and Senator Jeff Kruse.

If you’d like to learn more about the issues surrounding the implementation of eXPRS in brokerage and county services statewide, click here to watch a full video of the testimony.

If you’d like to read testimonies from some of the participants, follow the links below.

Katie Rose Testimony 02.10.2015 eXPRS
Margaret Theisen Testimony 02.01.2015 eXPRS
Chris Burnett Testimony 02.01.2015 eXPRS

State Delays eXPRS Implementation and Employment Rate Changes to Fall 2014

Late Friday afternoon (05.30.2014), Interim DD Director Trisha Baxter released the following statement to the I/DD community:

“As you are aware we have many priorities that we are focusing on, all with a July 1 implementation date. We have heard from many of you that these converging priorities are causing angst, stress and strain on you, and on the system. We, as well, are discovering the complexities of handling so many moving parts all at once.  As such, based upon feedback from many of you and weighing our internal priorities and commitments with SEIU, CMS and others, we have come up with the following strategy to delay portions of the work and to stage implementation in a more manageable way.  Additional information will be coming out over the coming weeks about the details behind these strategies so please pay close attention to emails and other communications over the coming days.

First, July 1 is a milestone for new employment services to be offered. These services are included in the Medicaid waivers that will be submitted for approval with a July 1 effective date. These new services will still be offered as of July 1. July 1 was also a targeted date for implementation of a new rate structure for employment services for both the comprehensive and support service system. The new rate structure will be finalized next week, however, at the request of multiple providers, we will hold off on implementation of those rates, with the exception of the rates for the new services, until September 1, 2014. The new services, which include Discovery and Job Development will be paid at the new outcome based rates. All other services will continue to be paid at the current, daily rate. This additional time will allow providers of employment services an opportunity to analyze how the new rates will apply to their service arrays. Additional information about the rate transition schedule, and expectations for tracking, billing and reporting of services provided during July and August will be coming shortly.

Additionally, we have been challenged to provide training to the large number of personal support workers, CDDP and Brokerage staff, and other providers on the new plan entry and claims process within the eXPRS system. In order to allow more time for training and other associated activities, we are delaying the implementation of Plan of Care functionality to September 1, 2014 as well. We will be working with partners, including SEIU and providers, to develop an implementation plan from September 1 forward, beginning with employment services. The delayed schedule and restaging of activities is important to assure successful implementation, but it does not deter or alter the strategic or programmatic outcomes the changes are designed to achieve.

There is much work to be done over the upcoming months to ensure that individuals experiencing intellectual and developmental disabilities continue to receive services and that those providing the services are paid accordingly. We thank all of you for your continued work with us as we pull together plans for full implementation. As always, if you have questions or concerns, please feel free to contact me.”  – Trisha Baxter

State Looks to Reduced Rates for Supported Employment and Day Program Providers; Community Responds

On May 9, 2014, during a monthly meeting with brokerage directors, ODDS staff shared potential rate decreases to providers of Supported Employment and Day Habilitation (ATE programs). The proposed reduction would occur across the comprehensive and brokerage systems and go live as early as July 1st, 2014. 

Last week, the Oregon Support Services Association, the Oregon I/DD Coalition, the Oregon Rehabilitation Association and the Oregon Council on Developmental Disabilities each submitted letters to state leadership asking the state to reconsider any rate reductions. We all await responses and will update you once we have additional information on the direction the state decides to take on this important subject. 

As always, the brokerage association will continue to advocate for appropriate payment to providers of these essential services – particularly during a time of need for increased provider capacity and better employment outcomes for Oregonians with intellectual and developmental disabilities.

Stay tuned.

– The OSSA Communications Team
OSSA Executive Director Kathryn Weit
Margaret Theisen
Larry Deal
Katie Rose

 

An Interview with Brokerage Association Leader Kathryn Weit (Part One)

By Larry Deal
Executive Director, Independence Northwest
Communications Director, Oregon Support Services Association

I recently sat down with newly-appointed Oregon Support Services Association Executive Director Kathryn Weit to discuss her history, her thoughts on the brokerage system, the implementation of the K Plan, and where she sees brokerage services headed.

Kathryn has been a hugely influential player in services for people with intellectual and developmental disabilities both in the northwest and nationally. She played an integral role in the development of brokerage services in Oregon and brokerages statewide could not be more pleased that she’s signed on to lead us into Oregon’s next phase of services. Sometimes the best way to figure out where you’re going is to remember how you got where you are. Our conversation started there.

Larry: What did services look like in Oregon twenty years ago?

Kathryn: Looking back fifteen years plus, prior to the filing of the Staley lawsuit and the creation of the brokerage system, Oregon was in the process of downsizing an institution and we had very, very long wait lists.

Larry: Wait lists for community-based-services?

Kathryn: For everything. I use the term wait list loosely because it really never was a wait list. It was a crisis list. If you went into crisis, you got services. There were very few services for adults except group homes. Any family of a child under 18 who needed any kind of support had to go through the Child Welfare system. And they had to say they were on the verge of having to place their family member out of home, usually into foster care. It had to be that serious before there was a possibility of getting in-home supports. The stories you’d hear families tell about trying to survive without any support and then having to say this. It was devastating.

Larry: And your son, Colin – you were in this situation with him, right?

Kathryn: When my son was sixteen, we had a major crisis in the family and we had to go the crisis route. We had to go to Child Welfare and we had to tell people why we couldn’t handle our situation any longer by ourselves.  It was one of the hardest things I have ever done in my life.

Larry: And when you say services – what are we talking about here? What did these services look like?

Kathryn: Early on the services through Child Welfare were designed to support families with respite, in home support, and things like behavior support. Later the Developmental Disabilities Program created some very small, grant funded, family support programs for families with children under 18. It was later expanded to include families of adults. Services were extremely limited. For example in Multnomah County there were only fifty families who had access to supports. (Ed: for comparison, there are thousands in services in Multnomah County today.) It was very limited, but it gave advocates a model to draw from. First, someone needing supports got a “guide” (much like a Personal Agent) to help find and engage with community resources. And second, you got a little bit of funding. But for the first time it was funding that was family-controlled. The satisfaction level in that program was incredibly high. People thought it was amazing. And when the state asked, people told them that their “guide” was the most important thing. These pilot programs helped shape some of the understanding of policymakers.

Larry: The structure sounds very much like the structure and services offered by brokerages today.

Kathryn: Yes. Then later, before the Staley lawsuit was filed, the state applied for and received a Robert Wood Johnson Foundation grant. The idea was to look at what was becoming a national agenda in terms of self-determination and to apply some of those principles to adult services. They set up a small model brokerage (Self-Determination Resources Inc.) and this really pushed systems change.

Larry:
At the time, over 5,000 people were waiting for services, which led to Staley v. Kitzhaber.

Kathryn: If you consider both adults and children who were eligible but not receiving services, yes. Yes, the lawsuit was based on the fact that there were people who were eligible for services but denied them. The State chose to negotiate a settlement of the lawsuit.

Larry: After the lawsuit was settled, the state set out to develop services for everyone on the wait list. How did the brokerage model emerge?

Kathryn: Oregon chose very specifically to say: “This is Oregon, we have economic ups and downs, we are not a rich state, we cannot afford to provide 24 hour, seven days a week residential services to everybody on our wait list.” Many people don’t need that level of service. We learned that people are good decision makers about what they need in their lives when given support and guidance that’s meaningful to them. A crucial element was that families and individuals with disabilities needed to be in the leadership role. Through much discussion, stakeholders arrived at the conclusion that small, decentralized nonprofit and community-based programs would provide a solid foundation for choice-driven services.

Larry: And then we fast forward thirteen years. Oregon chooses to pursue higher federal funding through the Community First Choice Option (the K Plan.) What are your thoughts on this change?

Kathryn: I think that for years we have argued that we needed more resources in the DD system. We all know that there are people with significant support needs who aren’t receiving the level of supports that they actually require and need. We knew that the existing Support Services funding was not adequate for many people. I think the K is an incredible opportunity for Oregon to bring more resources into the state. The challenge is in the implementation.

Larry: Do you think the state expects us to deliver services differently now as a result of the K Plan’s implementation?

Kathryn: Well, additional resources are wonderful but we need to remain focused on the goals, the vision that people with disabilities, with appropriate supports, can create a full life, rich in friends and meaningful community connections, employment and significant relationships.  It is what we want for all our children. There’s no reason we have to lose those values, though I believe they are significantly endangered. The K has forced change in what I believe are the fundamentals: self-determination, choice and control. We have moved to a system that is deficits-based. That being said, I think there are ways- could have been ways – that didn’t undermine these cardinal values. Brokerages are committed to keeping the conversation about these values alive. It hasn’t been popular because it isn’t easy. I think we all recognize that any kind of system change is difficult and that the implementation process is the hardest part. That being said I am struck by the lack of planning that has ignored the hydraulics of a lifespan service system, the failure to listen to the lessons learned in the past, and the failure to listen to operational wisdom of stakeholders. The result has caused long-held priorities to be turned inside out. We will continue to  push for involvement in these conversations, before decisions are made.  It is important to have our core values drive decision-making instead of being after-thoughts that are an inconvenience to the process.

Larry: You mentioned a deficits-based approach. This brings to mind the Functional Needs Assessment or Adult Needs Assessment, which is a tool we now use when people enter brokerage services. The tool measures a person’s support needs and determines what services they’re eligible for. When you think about having a needs assessment completed – well, that’s something many states require. This isn’t a new idea, it’s not out of left field. But what you’re saying is that it’s not the tool that is the concern, it’s the approach.

Kathryn: It’s the implementation that’s the problem. Most states have some kind of assessment like this – a functional needs assessment. I think the key is in how the process gets framed. I recently went through an assessment with my son. I think the person who did it is wonderful and I understand that time is short. But I would have liked to hear “What would he like to be doing? What would he like his life looking like?” It would help focus on the idea that these supports are being offered for a purpose. There is great power in starting an assessment by talking to someone about who they are and what they hope to be. It’s not just powerful for people with disabilities. It informs the way we all think and behave.

Larry: I think brokerages are focusing on goal development first and finding a way to fit the needs assessment in as naturally as possible. It’s a shift and we’re still learning how to make all the pieces fit. One of the bigger concerns right now is that the tool being used is temporary, just a placeholder. This is an untested experience and, as it stands right now, Oregon plans to change the assessment tool we’re currently using and replace it with a different tool by January of next year.

Kathryn: What we must not lose sight of is that this may be just a pilot project in some people’s eyes, but for the people going through this assessment having their support plans radically changed, there is nothing “pilot” about it. This is about their lives. It’s about getting the resources they need and are being told they’re entitled to under the new funding model. I think it’s a really important message that people making these decisions need to understand. This is not a pilot. These are people’s lives. Clearly, the introduction of any new assessment tool and process must be thoroughly planned and implemented in a way that does not disrupt the lives of customers and families or cause chaos in the system. January 2015 is too soon. The dust will have not settled from this last effort.

Stay tuned for Part 2 of our talk with Kathryn. She discusses the brokerage response to the K plan, the concern over monthly versus annual budgeting for customer plans, and thoughts on appropriate long-term strategies to assure a sustainable future for services for Oregonians with intellectual and developmental disabilities.

State Announces Payment Systems Change Delay; Provider Enrollment Agreements Still Needed

Dear Providers,

Yesterday, newly-appointed ODDS Interim Director Trisha Baxter announced that Oregon is putting the brakes on its move to centralize payment to providers of brokerage services.

The new target date for the change is July 1st, 2014, pending agreement between the State and SEIU.

For quite some time, there has been great concern amongst brokerages, providers, and customers regarding what has been a rather rocky implementation process. Payment to our essential provider base must be top priority for our community and system. We applaud ODDS’ move to delay for solid planning and pledge to work with the Department on development of a thoughtful and thorough approach to this transition.

That said, all providers still need to turn in their Provider Enrollment Application and Agreement. Regardless of how long this process takes, one thing is certain: you will need a provider number to do business in Oregon. It’s in your best interest and in the best interest of your customers that you take this important step now.

To recap:

  • Continue to send your timesheets and invoices to the appropriate brokerage as you always have. We’ll continue payment to you until at least June of 2014.
  • If you haven’t sent in your Provider Enrollment Agreement, do so now. This is an essential action on your part, regardless of changing timelines. The state should then follow up with you and provide you details on how to sign up and sign in to the eXPRS payment system.
  • If you have turned in your PEAA and have received no response back from the State, contact them directly at DD-MH.OHCC@state.or.us.
  • Additionally, all providers must have a criminal history check completed every two years.

Thanks for your work and support of our community. Stay warm out there!

Best,

– The OSSA Communications Team
Larry Deal, Katie Rose and Margaret Theisen

11/26/2013 Update on Provider Payment Changes and Provider Enrollment into the State’s System

Dear Providers,

There continues to be a lack of timelines and details regarding the State’s move to take over payment to providers of brokerage services.

Representatives from the Office of Developmental Disabilities Services promise there’s continued work on a solid plan, but as of right now they have produced no clear plans or feasible timelines. What we understand is this:

  • Due to the lack of a transition process presently, payment will not be coming through the State effective January 1st, 2014  
  • Brokerages will continue to provide your payment until an appropriate plan is developed and agreed upon.

Given the amount of work left to do during implementation, our best guess is a transition several months into the new year at this point.

If you haven’t sent in your Provider Enrollment Agreement, do so now. This is an essential action on your part, regardless of changing timelines.  You also need to be sure your criminal records check has been completed within the past two years.

If you have turned in your PEAA and have received no response back from the State, contact them directly at DD-MH.OHCC@state.or.us. Please email the State for assistance on this matter.

Provider organizations who need a provider number should be hearing from the State shortly. We are aware of a transmittal being developed and have heard it should be out within the next week or so.

Unfortunately, the State has not provided a phone number to field your questions. If that changes, we will update you and share the resource. We will continue to update you as we have more clear information.

Thank you for your continued patience during this process. Rest assured that your payment will continue to come through us in the interim while these bureaucratic and procedural tangles are dealt with.

– The OSSA Communications Team
Larry Deal, Katie Rose and Margaret Theisen

 

Notice to Providers Regarding Issues with State Payment System Changes and Processes

bingonumbers-564x272Dear Personal Support Workers, Domestic Employees and Independent Contractors,

Recently, there have been some mixed messages regarding the new State payment system and the Provider Enrollment Number you will need in order to access it – including what you need to turn in and to whom you should submit those items. Many of you have reported getting conflicting information from one contact person to the next. Once the brokerages were alerted to the issue by calls from providers, we quickly made contact with leadership at ODDS (Office of Developmental Disabilities Services) and the OHCC (Oregon Home Care Commission) to address the communication breakdown and resulting misunderstandings.

The continued message from ODDS is that Brokerages will maintain local control of provider payments until December 31, 2013, with payments moving to a consolidated system run by the state on January 1, 2014. If this message changes, we will work to get that update out to you. This Friday, the thirteen brokerages are meeting with ODDS and OHCC and we will work together to develop a workable plan to get everyone on the same page and get you the information you need.

In the meantime, please hold tight. Your payments will not be affected at present and we will do our best to release information that’s clear and consistent.

Thanks for your patience and support during this time of great transition. And thank you for the essential work you do for our those we serve and the community at large.