5 Myths About Brokerages Services

Information can be hard to come by sometimes in the IDD service system. We’ve heard these five myths thrown around like facts over the years, and we’re here to set the record straight.

1. MYTH: Brokerage services are only for people who don’t need much help.

FACT: Brokerages serve people with all levels of support needs, from those who are more independent to people who need frequent assistance. Support Services are meant to keep people out of Medicaid-funded residential placements and in their own or their family homes for as long as possible by supplementing the help they already receive with paid supports. This combination of family/community help and paid help can help even medically-fragile folks stay out of facility-based care, and at home with their loved ones.

2. MYTH: I have to come to Brokerage services knowing exactly what I want, or they won’t be able to help me.

FACT: We can figure it out together. Brokerages are all about helping you create goals for the life you want to live, both long and short term. Sometimes it only takes a meeting or two to talk over the possibilities and decide on a plan. Other times it’s a longer process. Your Personal Agent will be there with you, whatever you need, with more formal Person-Centered Planning, or just the time to talk it over.

3. MYTH: Each Brokerage has its own rules.

FACT: While each Brokerage is a separate, independent agency, we all follow the same state rules and guidelines. The Oregon Administrative Rules can be found online here. The rules specific to Support Services only can be found here, though we are beholden to many of the other rule areas, such as Case Management. In addition to the administrative rules, the state Office of Developmental Disabilities Services gives us guidance on specific topics in the form of worker guides, manuals, and documents such as the In-Home Expenditure Guidelines. That said, we are independent agencies, with our own business models and operational policies and procedures. While we devote a lot of time to aligning our understanding of the rules, there are times that we will come to different conclusions. We hope you’ll be patient in bringing issues to our attention so that we can find a solution.

4. MYTH: I don’t have a lot of money, why do I need services from a broker?

FACT: We aren’t fiscal brokers, we’re disability services brokers. This means that in addition to basic case management, our Personal Agents help connect people to direct service providers that fit their needs. People who qualify for these services are all eligible for Medicaid, which means that not having a ton of money in savings is part of the enrollment criteria. The funding you get through Support Services is a social benefit, through state and federal funding sources. This means that your service funds are tax-payer dollars, and while it’s important that we are good stewards of these funds, it won’t cost you anything to access them.

5. MYTH: Brokerages are all full, if you choose one you’ll be stuck waiting for services.

FACT: Most Brokerages currently have capacity to serve new customers, and all of them work with local Community Developmental Disability Programs (CDDPs, often your county) to take new enrollments as you request them. We serve adults (18 and over) with a documented intellectual or developmental disability. If you aren’t yet eligible for IDD services, you need to call your local CDDP and ask for an intake worker. The CDDP staff will help you through the eligibility process from there. Click here for the county phone directory. Once you’ve been found eligible for IDD services, all you need to do is let your intake specialist or current county case manager know that you’d like to work with a Support Services Brokerage. Visit the My Brokerage, My Choice website to find out more about the Brokerage(s) serving your area. Please feel free to contact your chosen Brokerage to let them know that you’ve selected them; this helps us ensure a smooth referral process.

So, now you are in the know. Have you heard other rumors or myths? Tell us in the comments!

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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.

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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.

Nothing Endures But Change

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. The entire system still struggles to find equilibrium in the wake of such wholesale change. Equity in service allocations, rates of pay, and time spent on face-to-face services vs. paperwork has been disrupted due to choices made during the implementation of these policies. Today, we believe that more change is necessary if Oregon is to regain a functional, sustainable structure for IDD services.

Disintegrating-DollarSpending  When Support Services were founded back in the early 2000s, the eligibility requirements for IDD services were intentionally broad to serve as many people as possible. The hard caps on service allocations, averaging around $14,000 annually by 2012, kept service spending well in hand despite increasing enrollment. Hard caps such as this were eliminated under the K Plan, and we have seen a corresponding rise in cost-per-case within Support Services. Another reason for this rise is Oregon’s choice of assessment tool, which currently determines service allocations. The Adult Needs Assessment (ANA) is an Oregon invention, adapted from the SNAP assessment used for years to determine Adult Foster Care rates. The ANA had to be adapted quickly, and there was not time for the Office of Developmental Disability Services to ensure that the tool was a valid measure of needs, nor that it was reliable from one person to another. The resource allocation mechanism was likewise completed without adequate time to test and ensure that funding was allocated at an appropriate level. The result of the rush to implement the ANA is a tool that allocates substantially more funds than are being used, on average. It is also more medical and deficits-focused than most stakeholders would like. The ANA and uncapped service structure have combined for a precipitous increase in spending by Support Services customers–a 42% increase from April 2014 to April 2015, according to the Department’s report to the Joint Interim Subcommittee on Human Services on September 28, 2015. These spending trends are not sustainable, and a core feature of any high-quality service system for people with IDD is that they are dependable and assured from year to year.

Case management  K Plan policy created a sea-change for Personal Agents, who were essentially forced to relearn their jobs while continuing to perform them. Anyone who has had a Personal Agent since before 2013 has probably felt the crunch–less face time, slower response time, more paperwork. New reporting requirements, mandated forms, and the eXPRS database have all added layers of additional responsibility to the Personal Agent position, moving them further and further away from the people they would like to serve. Strong case management is critical to a healthy, functioning IDD system–case managers serve as the pivot point for all services, a single focus of coordination to ensure that we adhere to state and federal rules, and keep the individual’s direction and wishes primary. A change in the job description for case managers, and in the structure of case management, is necessary to refocus worker time and workforce strength.

Pay rates  Service hours have become abundant for many people in the IDD service system. However, the rate of pay attached to those hours has decreased, or failed to keep pace with rising inflation. The result of this is that individuals are simply not able to find providers for all of the service hours for which they are currently eligible. Agency providers of IDD services have hundreds of open positions across the state that remain unfilled. As the economy improves and the reimbursement rate for these services remains low, skilled, experienced providers leave the system for jobs in unrelated fields. For a more detailed discussion of this phenomenon, please check out The Cost of Compassion, a short film created by the Oregon Rehabilitation Association.

Change is coming, and we need to be prepared. In our next post, we will discuss the methods and approach we will need to employ during the coming period of policy change. We have to learn from our recent history, improve on our own performance, and learn from our mistakes if we hope not to repeat them.

A Diversity of Services Requires A Diversity of Providers

Community-based services are different.  In 2001, Oregon made a deep investment in community supports when it began to develop Support Services Brokerages.  This style of service, which seeks to serve people where and how they wish to live, is very support servicesdifferent from the institutional settings of the past.  People make different choices when you let them, they express different needs than you might have anticipated–they surprise you.  Oregon found that community-based services demanded a wider diversity of providers.  People inviting workers into their homes expected different things from those providers: willingness to take direction directly from the individual as to how to do the job, and an understanding and respect for self-determination.  Brokerage customers made use of established provider agencies for some tasks, direct employees for others; and over the years, Independent Contractors, or professionals in the field who go into business for themselves, have also sprung up around in-home services and customer needs.

Independent Contractors often offer a professional level of skills and experience, as well as ancillary expertise such as sign language, to provide the targeted training needed to build a more independent life.  For many people, an experienced, capable, autonomous, self-employed trainer has meant the difference between continuing to rely on others and acquiring the skills to live more independently.  Over the years, Independent Contractors have been essential to providing this kind of high-level skills training to Brokerage customers.

In 2014, the Independent Contractor stakeholder work-group mandated by the SEIU/DHS collective bargaining agreement issued a report concluding that changes to the system had likely made legitimate classification of independent contractors next to impossible.  The group’s work included consultations with The Oregon Employment Department.  Systemic changes due to the K state plan, overlay of union representation, implementation of the eXPRS payment system, and new rate structures have all resulted in incremental shifts, accumulating to a significant transformation of the business of Independent Contractors within the field.  This shift has jeopardized their correct classification as Independent Contractors by moving them closer and closer to the appearance of employees.rob_olga2

Brokerages believe and have always believed that Independent Contractors fill a particular need among brokerage customers.  Diversity of providers has been a hallmark of the brokerage system since its inception.  The elimination of Independent Contractors as a distinct class of providers with a distinct set of skills to offer people with IDD will be a significant loss to the people being served by Oregon.  When high-caliber skills training and the people who provide it are no longer supported by appropriate compensation, it starts to disappear as an option for the people who need it.  Community-based IDD services require people who can offer strength-based supports–people who can work with a person to understand a goal, create achievable steps, and get there.  OSSA supports a true diversity of provider options to meet the diversity of individual needs.

PSW-ICs deserve our support.  This group of people who have established businesses around the unique needs of Oregon’s IDD community, people who have built these skills and relationships, deserve a solution that allows them to continue to flourish and contribute their professional talents to serve the unique needs of Oregonians.