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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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.

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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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Vision, January 2016: A Second Look at the Future of IDD Services in Oregon

Nearly one year ago, the Oregon Support Services Association shared our February 2015 Vision for the Future of Disability Services in Oregon. It was meant to be a comprehensive look at what we want for our service system, with ideas about how we might get there. While the ultimate vision hasn’t changed substantially, the ideas for how we get there have been refined to fit a January 2016 understanding of the world. Click here to view the OSSA Vision For the Future of Disability Services in Oregon, January 2016.

As OSSA President Larry Deal and I reviewed our vision one year in, we were both struck by how much the IDD field has learned over the past 12 months. We have necessarily been on a crash-course education in Medicaid policy, Oregon law, and the

January 2016 deserves a second look.

It’s January 2016! IDD services in Oregon deserve a second look.

realities of working in the field. Oregon’s IDD system has been asking itself what is possible, what it values, and at what cost. A centerpiece of our original Vision was the suggestion that

Oregon seek two distinct K Plan options–one for Self-Directed services, and one for Agency-Directed services. Oregon’s current K State Plan is approved under Agency-Directed authority, which does not allow for the level of individual direction and control that we would seek to return. Subsequent work locally and with federal CMS has taught us that there can be only one K State Plan. However, that single plan can be written for a more complex authority that blends Agency-Directed structures with Self-Directed options. We hope that Oregon will move forward with this in the coming months as the K Plan renewal enters planning stage.

Each section has been updated with a paragraph at the bottom detailing major developments relevant to the topic. The highlights will give you a good idea of what our 2015 work has accomplished. However, we have also made comprehensive updates to every page throughout the document–if you can, please read it through.

Highlights of this January 2016 update:

  • Pg. 7 Case Management Funding is new. Funding mechanism (currently, billable encounters) has increasingly dictated structure in this area (case management time is only spent on billable activities), and we need to find ways to decouple the two.
  • Pg. 8 Eligibility is under scrutiny in Oregon, which has a long history of casting the doors open wide for those who need support services; we support a broad front door.
  • Pg. 9 Choice Advising is given its own page, due to the rise in problems stemming from our current lack of direction in this area.
  • Pgs. 11-15 describe our vision of the IDD service structure; Brokerages provide case management to adults living in their own or family homes, CDDPs provider case management to adults and children living in licensed/certified home settings, and both Brokerages and CDDPs are able to serve children in their own or family homes. There is a lot to say about how to get to this! Take a look at the details of this section.
  • Pg. 16 Plan Development has changed a lot in one year, with the introduction and full roll out of the Oregon ISP document for every individual in service.
  • Pg. 17 Assessment is an area in which a lot of work has been done, and even more is left to do.
  • Pg. 19 Community Provider Capacity hasn’t changed a lot in the vision, but there are a lot of large structural forces at work (federal laws, collective bargaining, etc.) driving this part of the system. 2016 is a make-or-break year for this area of the system.
  • Pg. 22 Data Systems have not seen the improvement that we would have hoped. We will continue to advocate for a functional, supportive statewide data system.

Our Vision for the Future is meant to be a living document, changing as conditions change and our understanding expands. We have committed to updating this every six months, especially during the rapid pace of change that seems poised to continue in Oregon’s IDD service system. Contribute your unique perspective in the comments below. Tell us what we got wrong, and what we got right. It is up to all of us to decide what comes next for Oregon.

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.

OSSA’s Vision for the Future of Disability Services in Oregon

Sometimes, in the midst of change, it is hard to see the way forward.  Oregon’s system of services to people with intellectual and developmental disabilities once felt like it had a clear identity as a national leader for progressive, community-based service.  We closed down institutions.  We gave control to the people using the services.  We showed that giving people self-determination can not only be right, it can also be cost-effective, good business.  Somewhere, in the crush of change and hurtling, forward momentum, we have lost the clarity of that identity.

Oregon the beautiful, through and through.

Oregon the beautiful, through and through.

Now is the time to work to reclaim that pioneering spirit at the heart of our state.  Make no mistake, it will take work–no one else in the nation is using the K Plan in the same way that Oregon has.  We’re out on the grand stage, we’re under the watchful eye of the national Centers for Medicare and Medicaid Services, and we need to make this work.

It is in the spirit of collaboration, excellence, and service that we offer our Vision for the Future.  As is stated in our Opening Thoughts on page 2, this is “intended to be a starting point for discussion,” not a perfect, finished product.  We start with the vision and we fill in the rest, together.ossacoverforfacebook

Take a look, let your gears turn, and share your thoughts with us.

Thank you!