April 12, 2021
Minutes
Minutes
Attendees via Zoom: Theresa Scott, Karen Berry, Barbara Beaulieu, Ann-Marie Mayberry, Holly Randall, Linda Lee, Stacy Lamontagne, Ray Nagel, Beth Morse, Alli Vercoe, Alex Twombley, Samantha Leuschner, Maureen Libby, Victoria LaBelle, Amanda Ware, Jessi Wright, Erin Vogel, Andrew Cassidy, Bonnie-Jean Brooks, Brenda Smith, Jodi Benvie, Dennis Strout, Debbie Dionne, Tyler Heydolph, Teague Morris, Kathy Rickards, Mark Kemmerle, J Richardson Collins, LyAnn Grogan, Margaret Cardoza, Kim Humphrey, Jeff Hooke, Julie Brennan, Carol Snyder, Frances Ryan, Gregory Bush, Heidi Bechard, Kath Holland, Laurie Kimball, Jim DeFreitas, Rachel Dyer, Pamela Belisle, Laura Cordes, Ed & Suellen Doggett, Darryl Wood, Dan Bonner, Chris Call, Brian Braley, Betsy Mahoney, Helen Hemminger, Betsy Hopkins, Becca Emmons, Andrea Liming, Amanda Hodgkins, Ann Havener, Benjamin Martin, Bonnie Robinson, Lorraine Defreitas, Mariah Mitchell, Richard Estabrook, Tammy Pike, Moira Leighton, Todd Goodwin, Staci Converse, Timothy, David Cowing, Darla Chafin, Teresa Barrows, Vickey Rand, Cullen Ryan, and a few people who joined the meeting in progress and/or left prior to its conclusion.
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speakers: Ann-Marie Mayberry, Executive Director, Group Main Stream, gmsme.org; Dennis Strout, Director, Momentum, www.momentumme.com; Barbara Beaulieu, CEO, and Jodi Benvie, Southern Maine Area Support Coordinator, KFI, www.kfimaine.org; with an introduction by Laura Cordes, Executive Director, Maine Association for Community Service Providers, meacsp.org. Topic: Home and Community Based Services (HCBS) Settings Rule Change Panel Discussion – Implications for programs in Maine.
Cullen: Today we have a neat presentation. We’ve been hearing a lot about the Home and Community Based Services (HCBS) Settings Rule change. We thought that we would have a panel discussion on this Rule change and what it means for programs in Maine. I am very pleased to have Ann-Marie Mayberry, Executive Director of Group Main Stream, Dennis Strout, Executive Director of Momentum, and Barbara Beaulieu, CEO, and Jodi Benvie, Southern Maine Area Support Coordinator, both with KFI, presenting on this topic, with Laura Cordes, Executive Director of MACSP (Maine Association for Community Service Providers), providing a brief introduction. This should be very informative and aptly timed. Thank you all for being here!
Begin Presentation
Laura Cordes: The Department has a dedicated page regarding the HCBS Settings Rule change and Maine’s path towards compliance. There are other experts in the room on the Rule, but I’m happy to provide an overview introduction. I haven’t spoken with a person who doesn’t like the transformation and the promise of the HCBS Settings Rule; it’s how we get there, collaboration, and overcoming some pretty significant challenges. To take a step back, the Rule was introduced in 2014 by CMS (Centers for Medicare and Medicaid Services). The rule states that people who receive home and community-based services (HCBS) and supports funded through Medicaid (MaineCare in Maine) must receive those services and supports in settings that meet specific standards. The standards are designed to ensure the settings are truly home and community based. This means that individuals receiving services in these settings have full access to the greater community and can enjoy all of the benefits of community living. The rule came into effect after a five-year federal rulemaking process with multiple public comment periods during which more than 2,000 comments were submitted from across the country, including comments from individuals with disabilities and their families. The overall goal is to ensure all HCBS programs provide a setting and experience that is very distinct from what an institution offers.
The previous administration did not do much as the deadline for compliance with the Rule approached. As such, the new Administration has been working against the clock to meet the deadline. The deadline has been extended a few times, but currently it is March 22, 2023. In addition to the dedicated HCBS page, the Department also has a helpful FAQs document, which has a lot of helpful information. (Click here for the OADS HCBS Settings Rule FAQs which provides a background on the Rule, who is affected, what the rule requires, and more important information.)
MACSP represents 70 organizations across the state, of which about 85% provide services under HCBS rules. I think for those of you who have been around this table, many of our members were some of the first to drive community integration and deinstitutionalization efforts in the state and have continued to lift up promising and best practices over the last decade. We’re in the enviable position in Maine as being the last state in the country to comply.
In my mind there are five “buckets” of challenges and/or concerns:
Everyone is working in good faith to get to compliance, and MACSP will be doing our best to ensure HCBS becomes the reality.
Begin Ann-Marie Mayberry’s Presentation (Click here for Ann-Marie’s presentation.)
Ann-Marie Mayberry: Each presenter might have a different take on HCBS and how to come into compliance because we all have different lenses. It’s worth noting that heightened scrutiny programs have to come into compliance sooner, in July of 2021. Other programs have until 2023 to come into full compliance. We have these new regulations coming down the pike, and we have several providers trying to work collaboratively across the state to come into compliance in such a tight timeline. We have years’ worth of work to do in a very short period of time.
Begin Dennis Strout’s Presentation (Click here for Dennis’ presentation.)
Dennis Strout: We’re all still learning about the HCBS Settings Rule change, but it is a philosophy we embrace. The State is under a tight timeline, as are providers. The desk reviews and validation findings have been challenging because if a finding is not accurate, providers still need to remedy. We as providers want to think we’re providing top-notch services, and that’s our goal, and we want people to be empowered. That’s sometimes hard to look at internally, but it’s healthy to do so in order to do a better job supporting people.
-It was asked what a desk review is. It was stated that a desk review involves the provider filling out a lengthy survey detailing all aspects of the individual's services. This does not involve direct interviews, it’s someone reviewing a survey.
-A provider stated that one example of an HCBS deficiency they experienced in a 2-bed licensed home involved an inability to provide community inclusion without transporting both of the residents into the community at the same time. When the provider approached OADS for additional staffing for that home, it wasn’t approved. The home lacks two vehicles to provide transportation to the separate individuals at the same time. And, if the provider wanted to use NET (Non-Emergency Transportation) transportation to access the community there must be a corresponding NPI+3 number (National Provider Identifier) to make it eligible for NET transportation. So, it seems that unless every potential community venue has an NPI+3, NET transportation cannot be used.
Begin Jodi Benvie and Barbara Beaulieu’s Presentation (Click here for Jodi and Barbara's presentation)
Jodi Benvie: I’m a Support Coordinator for KFI, we provide home, community, and work services. Everyone we support lives in their own home or with their family. For us the HCBS Settings Rule largely affects community supports. We provide one-on-one community supports currently, but the current rates don’t make this truly viable. As an advocate for about 10 years, I can see this huge change in the way we deliver community support programs. I think back to day habilitation centers, where people were in basements playing cards and watching movies. We’ve developed a system in which people are taking the bus, learning different mediums of art, gardening, visiting community resources, volunteering, etc. The HCBS Settings Rule is the next step in the evolution of our service system, so we can provide individualized opportunities for people to discover what they love and explore things as an individual. Barbara and I are going to illustrate this opportunity by each telling a story.
We have been supporting Carrie for about five years. She came to us after being at another program. She was involved with some volunteering activities at the Animal Refuge League (ARL). She found a passion in that work. She wanted to pick up a different shift there and asked for help. We called the volunteer coordinator with ARL and they didn’t have her listed as a volunteer. The community support program she had previously been attending had a special arrangement with the ARL to come in and visit with the animals, but she wasn’t an official volunteer, which involves specific training. This upset her, but we signed her and her support staff up to take the official training, and she got her t-shirt and her name tag and went to work one shift a week there. During that time, she met someone who worked there who also loves WWE wrestling as much as she does. Since then she and this gentleman have gone to WWE events in Maine. We believe if she had continued with that group there wouldn’t have been that opportunity to create that relationship as she did with her one-on-one support. Now she works 20 hours per week, she volunteers at ARL, and importantly she has been able to develop individual relationships and friendships through this. She also loves knitting. We set her up with staff people who know how to knit; they not only helped to improve her skills but connected her with knitting groups in the community. We set up her staff to take her to knitting on Sunday and Thursday evenings. Staff would sit somewhere else and knit, and just be there if she needed them. Eventually the staff left, and Carrie would ride home in a taxi. Now, Carrie gets rides to and from these groups from her friends who also attend. The new rate proposal and the HCBS Settings Rule will allow for his type of community inclusion.
Barbara Beaulieu: I’m the CEO at KFI. I’m also a parent. My daughter Courtney is featured in the pictures you see. She receives waiver services 24/7 from Section 21. She is fully integrated into her community. She lives in her own home for which she pays the mortgage. She interacts with and knows her neighbors. She attends church and is a participating member. If she misses church, I receive calls asking if she’s ok. Her pastor has been part of our planning process. Pre-COVID, she would have girls’ nights on Tuesdays where her girlfriends would come over and prepare and eat a meal together. Since COVID, staff have helped her stay connected with her girlfriends through Zoom, and she really enjoys it. She participates in the maintenance of the home, laundry, cooking, shopping, paying bills, all of those ordinary things everyone has to do. She’s also self-employed. She has vending machines out in the community, so she does her work at her own pace. One of the benefits of being self-employed is she’s made enough money to take herself and staff on vacations, such as a trip to Boston where she stayed in a hotel and went to the zoo and the aquarium. Through this we discovered she has a huge interest in giant fish. So, we decided to get her a fish tank. To expand on that interest, she’s gone to the Maine State Aquarium. She’s really enjoyed those things that her having employment has afforded her. On occasion we’ve taken her to the movies, and she watched a movie where someone was playing classical music and she became mesmerized. It was so obvious how much she enjoyed it, we introduced her to other classical music. From there we’ve taken her to Orono for different concerts. She’s now a patron of the arts, contributing money to programs when she can. She’s also done volunteering in her hometown, work with Relay For Life, and donated to a homeless shelter. She also likes kayaking and swimming. All of these activities happen with the DSP seamlessly. They help her come up with ideas, which of course change over time, and see them through. The person supporting her at home also supports her in the community and with her employment. This has worked very well for her. The HCBS Settings Rule is for someone to experience the life that we all have and for people to participate and belong to the greater community. Some people may hear this story and think that this can’t happen for them or the people they support, but it can. I don’t often say this, but Courtney has had two strokes, she has Cerebral Palsy, Autism, a seizure disorder, a sleep disorder, an eating disorder, she doesn’t use words to communicate, she’s incontinent. Even with all of these obstacles we have found ways around them so that she can have full access to her community. Her life is extraordinary because it’s so ordinary.
Jodi: We know this will take time, and we know we don’t have a lot of that time because of the delays. It’s going to take some rich person-centered planning and digging deeper into that process. It also means we have to expect more from the community, but we believe they’re up for it. It will take more cross-agency collaboration to keep people in touch with friends as people choose one-on-one supports. That will be a key component to this being successful.
Cullen: Thank you all. I think these presentations have given us all a good perspective of the HCBS Settings Rule and what is on the horizon for Maine. Certainly, things are going to change, and it will open up a lot of opportunity, as well as challenges.
Discussion:
-The presenters were thanked for laying out exactly what the HCBS Settings Rule change entails. A parent stated that though he supports the philosophy he has questions about financing and staffing. Additionally, the expectations are supposed to pertain to everyone, but there are lots of different fits for lots of different kinds of people. It was asked how exactly this can evolve in a way that works for everyone and make it possible for providers to continue to do their work in a positive way with very limited resources.
Ray Nagel, Executive Director, Independence Association of Maine: I appreciate the stories shared today, which were wonderful examples of communities in action and individuals supported accessing their community. The HCBS Settings Rule criteria are a template for every single person, and every single person can’t meet those. There are a lot of ideals in there that are unrealistic, and unless there’s a whole lot of financing and a whole lot of transportation flexibility I don’t see it happening. I’ve been in the field for more than 30 years and we provide significant community inclusion. I don’t see how we’re going to be able to have three people who want to go to church on Sunday, and with only one staff person, how those three people can be brought to three different places at a time and staff it. The idea of everyone having access to their own money at all times is a wonderful idea, but who is held liable if that money is stolen? Who determines how much money the person can handle at any one time? Having visitors in at any time of the day or night and not allowed to maintain a sign-in roster – how safe is that? Are providers going to be held responsible for that? These are questions other providers may not be saying out loud but they have. I went to CMS five years ago with some of my peers, and the spirit of the Settings Rule was really done to make states comport to the norms already established in Maine and Minnesota. The Settings Rules has requirements; the interpretations are what every state would identify on their own. I question the interpretations Maine has undertaken and to what degree and detail they’re holding providers responsible, compared to other states such as Florida that hasn’t done the same things. I’m not saying the bar should be low, but providers shouldn’t promise something they can’t provide. And saying that they can do all of these things but knowing they can’t financially support it.
-A parent stated that it is an impossibility everyone is facing, but it always has been. She added that what is worrying is when we set goals and then interpret those goals as musts. That can change a person’s life from being joyful to being a stressor. Regulations ought to have soft edges around them, because there is always someone for whom this would be detrimental. She stated that she’s pleased that agencies are talking to each other more. Things ought to be improved without censure. The Coalition is a saving grace, because it has people talking to one another.
Dennis: There are always different perspectives on things, but so much of the work involves philosophy. Then there’s the logistical component. If the philosophy is there to empower people and to embrace people having lives that are fulfilling and where autonomy is created, that’s an important piece. Someone said to me once, “you can know what to do, and how to do something, but you have to want to do it.” I do think the community is up for it, as are the people we support, if we embrace the philosophy in a way that’s inclusive.
-A provider stated that we’re reaching such a critical point where we are racing towards compliance, but compliance is very different than philosophical and cultural transformation. We are last in the nation. We are racing towards compliance now. A transformative and cultural shift in how we best serve individuals in Maine with ID/DD is a very different conversation than compliance to the services as outlined in the HCBS Settings Rule. Unfortunately, there isn’t a lot of time for transformation and cultural change. Maine is at a point where the compliance aspects and how it’s been defined is almost like smashing into the cultural pressure point amongst pandemic recovery, amongst the majority of providers losing more than 20% of their workforce in less than a year, compounded by the deficits of our system and the inadequacies of Medicaid funding as a whole. We have an opportunity to reform and transform our system, and own this moment as providers and participants, but because we have a deadline and compliance mindset it’s like we’re missing our moment. We have all this power and momentum that we could pull out of the depths of this, but if we’re not in compliance money won’t flow into Maine. This is a real pressure point on the front lines. If you’re a parent talking to providers, or if you’re someone who receives services, or a provider yourself, it is suggested that you try to separate compliance and philosophical/cultural transformation.
Ann-Marie: We are trying to meet compliance, so we’re not focusing on how we’re going to put it into practice. Providers go into this field for a reason, it’s because we have a passion to support and empower and make services better for people with ID/DD. Though how we got into the field doesn’t matter, for the HCBS Settings Rule compliance we must meet a deadline, so we’re going to spend the next two years in crunch time, then the next several years determining how we’re going to make this work. Anyone can write a policy but it’s how the policy affects the person and how we can make it work and benefit the people served.
Ray: One of the things we learned at the provider summit in Portsmouth, NH is that they were way ahead of us in the transition planning for the Rule. The State worked with the providers in defining, for example, what constitutes rural. An empirical value – what is defined as being included in the community? The State worked with the providers in NH because they were so far ahead of us. I refuse to write a policy until I know what the rules and regulations are because I don’t want to write a policy that’s not going to follow a rule – that’s putting the cart before the horse. I spoke with my attorney who told me to put a disclaimer on all my responses stating that it’s subject to proper resourcing, financing by the State of Maine, as well as the changing of the rules and regulation within the State of Maine. Every one of us wants to comply with this, but I feel like I’m a blind man in a dark bedroom trying to find my way around and not getting any help.
-A case a manger stated that with this population on any given day you can be supporting someone transitioning from high school, coming out of corrections, etc. All things are individualized, and we all embrace the HCBS Settings Rule, but there’s a lot of training that also needs to be done.
-A self-advocate stated that the pressure is on the Department to address the situation, and with any pressure mistakes are made. It was asked if the Department is looking to providers, self-advocates, families, etc. for input. She added that transportation is also a very large obstacle that needs to be addressed. It was also asked what the grievance process is - if one currently exists.
Laura: Regarding the history of the communication between the Department and the providers – I didn’t come here until late 2019, but I can say in the time we’ve been working with them on the HCBS Settings Rule, they created a lot of spaces for people to discuss this. Unfortunately, stakeholders and providers have been advised not to talk about the funding and resource aspect. What this looks like on the ground for folks, having programs discuss what transformation looks like, and the viability of the rates under consideration now, is important.
-It was asked if Jodi or Barbara could explain how they made changes to allow for one-on-one services before there was even talk of the HCBS Settings Rule.
Barbara: We looked to programs in other states. We had time to figure it out and did it one person at a time. We used to have center-based services, but people wanted to stay in the community. To address transportation, we have figured out a transportation budget. We’ve never received an appropriate rate to provide this – we’ve used surplus from other services to support the costs for this. The biggest challenges coming is figuring out transportation, and there is a DSP shortage. We’re also looking at minimum wage increases, and that is a challenge.
Teague Morris – Senator King’s Office: I noticed that Senators Hassan, Casey, and Sherrod Brown, along with Representative Dingell, released a draft bill which would ensure that people receive the services they need to be included as part of the community. They are soliciting comments on this, which are due by 4/26. That might be of interest to this conversation.
Cullen: I’m so glad that you’re sharing this, Teague, and that as always Senator King’s office is tuned into everything! I can provide a little information on the draft bill to which Teague referenced, the HCBS Access Act, which would require Medicaid to provide home and community-based services (HCBS) to everyone who is eligible and establish a minimum set of services that states must offer. The draft concept bill includes:
However, this would be a mechanism on the federal level to end waitlists which has paralyzed everyone. The final contents of this bill are still forthcoming, but this group ought to be poised to contact Maine’s Delegation advocating for this bill when more information is available. Right now, this sits as a discussion draft on which people can comment. Commenting on this discussion draft bill is easy – simply email your own comments before April 26 to [email protected]. (Click here for information on this from NCSA.)
Ann-Marie: ANCOR is planning on presenting comments on the bill as well. What really caught me is that there are 65 million unpaid family caregivers in the United States currently. This bill would support the family members providing this unpaid care.
Cullen: We’ll be watching this very closely as this progresses through Congress.
Cullen: Thank you Laura for starting us off with such a clear overview, and thank you Ann-Marie, Dennis, Barbara, and Jodi, for illustrating the HCBS Settings Rule changes as they pertain to services and the people receiving them. This started a wonderful discussion. This presents further opportunity for collaboration between agencies, and an opportunity for further dialogue between everyone and the Department so that we ensure we get this right. Thank you all for being here today, well done!
Helpful links pertaining to the discussion and the HCBS Settings Rule Change:
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins – Associate Director, DHHS-OADS Disability Services: Both Heidi and I have been listening to everyone’s comments and the information they’ve shared. I would say there were some pieces of information that were not quite accurate, and we would welcome the opportunity to come back and share where the State is coming from with HCBS Settings Rule compliance. We have provider meetings every month, which includes opportunities to provide feedback. Having said all of that, we absolutely understand that this is challenging. We come at this with trying to understand what those challenges are and trying to find remedies for them. We are all under tight timelines.
Cullen: I would love to have you present on this next month and continue the discussion.
Betsy: Thank you, we would be pleased to do so. As far as OADS updates, we’ve had a number of agencies sign up to provide vaccination clinics, targeting people in their communities with ID/DD, and their families and/or supporters. (The first one will be this Friday from 8am to 12:30pm at OHI. Click here for more information, including how to sign up.) This is one of about six or seven pop-up clinics the Department is working to hold. We’re trying to provide additional opportunities for folks. There’s a lot in the news about the American Recovery Act funds coming into Maine and what that means. We have the same information as anyone else. We’re waiting for further guidance from CMS. When we receive that we’ll be gathering information through a fairly involved stakeholder process before we move ahead with that funding. We submitted our most recent K amendment to cover the provider retainer payments funded in the FY 22 budget. We’re waiting to hear back from CMS about what that looks like. The first year of the Governor’s Budget includes the rate increases. We’re working to see what happens with the supplemental budget to carry those rate increases forward into the second year of the biennium. And, OADS is still holding its weekly Stakeholder call.
Cullen: Thank you very much, Betsy, for being here!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows: The transition work will be a slow process because we want to be able to have a process that sustains through administrations. We’re finding it’s quite an undertaking and will be a long-term project. I don’t have any new information on that today. We’re working on some pilot crisis projects for youth as well.
Cullen: I want to thank OCFS, as they have worked diligently to implement the Blueprint for Effective Transition in their long-term planning process.
Special Education – No update
SMACT (Southern Maine Advisory Council on Transition)
SMACT meetings occur on the first Friday of each month, currently via Zoom, at 1pm. The April meeting featured DRM (Disability Rights Maine) and SUFU (Speaking Up For Us) presenting on self-advocacy and advocacy for youth in transition (click here for a link to the meeting recording). The May 7th meeting will feature Cullen presenting on the Blueprint for Effective Transition. SMACT’s new website is up and running. The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy Peavy ([email protected]).
Disability Rights Maine (DRM) Update:
Staci Converse: We have a training coming up on April 14th “Rights of People with Intellectual Disabilities and Autism.” You can register for that training here. All of our trainings have been recorded and are on our website here. We do have our 2020 Annual Report on the website, and in that report it talks about the number of clients we served in 2020 with ID/DD and that number is 645 individuals. We always have a lot of trainings going on and you can check our website out for more information on those. (Click here for DRM’s website, scroll down and events are on the right.)
Federal & Housing Updates:
Cullen:
State Legislature Update:
Cullen: Laura has done an immense amount of work following various bills in the Legislature that pertain to the ID/DD world. Thank you, Laura, for your work to keep us up to date on what’s going on in the Legislature!
Laura Cordes – MACSP (Maine Association for Community Service Providers): Since we last met the Legislature considered the Supplemental Budget, which is how lawmakers are addressing the budget under which we’re currently operating, as well as the Back to Basics Budget for fiscal year 2022. Both have been signed into law.
Laura’s 130th Legislative Session Bills and & Key Committees document was shared with the group, which also includes information on the different budget processes:
Supplemental Budget:
Back to Basics Budget for FY 22:
Laura: At this point in time the Committees are usually about 70-80% of the way done with bills, and now I would say they are about 30% done. The pandemic has definitely slowed things down in the Legislature. I want to review a set of bills that might be helpful for this group. (Click here for the HHS, AFA, and Education Committee member contact information, and the list of bills Laura reviewed.) A few bills have come out which are highlighted in yellow in which the Coalition might be interested. I’ll call your attention to a hearing on Thursday afternoon on LD 415, which will be in front of the Health and Human Services (HHS) Committee on Thursday, 4/15 at 1pm. This bill would increase the rates for Targeted Case Management under Sections 13 and 65.
Cullen: Thank you, Laura, for all of this information! Thank you to everyone who has testified on bills in this legislative session, as doing so is very important so that Legislators clearly understand what is needed to sustain the system of care for people in Maine with ID/DD. For those who haven’t testified in this Legislative Session, the process has changed but it’s very simple. You can provide live testimony during the hearing and/or submit written testimony (Click here for more information). The process for testifying live is very smooth, you’re essentially watching a video feed of the hearing until you’re called upon to testify and then you pop onto the panel with the Committee and unmute.
Announcements:
The next meeting will be on Monday, May 10, 2021, 12-2pm, via Zoom.
Featured Speakers: Betsy Hopkins, Associate Director, DHHS-OADS Disability Services. Topic: Continued discussion on the HCBS Settings Rule and Maine’s path towards compliance.
And, Dr. Anne Ryan, STRIVE Online Program Director, PSL STRIVE. Topic: Overview of STRIVE WorldWIDE, an online program that teaches independent living skills to individuals with intellectual disabilities and Autism.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2021 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speakers: Ann-Marie Mayberry, Executive Director, Group Main Stream, gmsme.org; Dennis Strout, Director, Momentum, www.momentumme.com; Barbara Beaulieu, CEO, and Jodi Benvie, Southern Maine Area Support Coordinator, KFI, www.kfimaine.org; with an introduction by Laura Cordes, Executive Director, Maine Association for Community Service Providers, meacsp.org. Topic: Home and Community Based Services (HCBS) Settings Rule Change Panel Discussion – Implications for programs in Maine.
Cullen: Today we have a neat presentation. We’ve been hearing a lot about the Home and Community Based Services (HCBS) Settings Rule change. We thought that we would have a panel discussion on this Rule change and what it means for programs in Maine. I am very pleased to have Ann-Marie Mayberry, Executive Director of Group Main Stream, Dennis Strout, Executive Director of Momentum, and Barbara Beaulieu, CEO, and Jodi Benvie, Southern Maine Area Support Coordinator, both with KFI, presenting on this topic, with Laura Cordes, Executive Director of MACSP (Maine Association for Community Service Providers), providing a brief introduction. This should be very informative and aptly timed. Thank you all for being here!
Begin Presentation
Laura Cordes: The Department has a dedicated page regarding the HCBS Settings Rule change and Maine’s path towards compliance. There are other experts in the room on the Rule, but I’m happy to provide an overview introduction. I haven’t spoken with a person who doesn’t like the transformation and the promise of the HCBS Settings Rule; it’s how we get there, collaboration, and overcoming some pretty significant challenges. To take a step back, the Rule was introduced in 2014 by CMS (Centers for Medicare and Medicaid Services). The rule states that people who receive home and community-based services (HCBS) and supports funded through Medicaid (MaineCare in Maine) must receive those services and supports in settings that meet specific standards. The standards are designed to ensure the settings are truly home and community based. This means that individuals receiving services in these settings have full access to the greater community and can enjoy all of the benefits of community living. The rule came into effect after a five-year federal rulemaking process with multiple public comment periods during which more than 2,000 comments were submitted from across the country, including comments from individuals with disabilities and their families. The overall goal is to ensure all HCBS programs provide a setting and experience that is very distinct from what an institution offers.
The previous administration did not do much as the deadline for compliance with the Rule approached. As such, the new Administration has been working against the clock to meet the deadline. The deadline has been extended a few times, but currently it is March 22, 2023. In addition to the dedicated HCBS page, the Department also has a helpful FAQs document, which has a lot of helpful information. (Click here for the OADS HCBS Settings Rule FAQs which provides a background on the Rule, who is affected, what the rule requires, and more important information.)
MACSP represents 70 organizations across the state, of which about 85% provide services under HCBS rules. I think for those of you who have been around this table, many of our members were some of the first to drive community integration and deinstitutionalization efforts in the state and have continued to lift up promising and best practices over the last decade. We’re in the enviable position in Maine as being the last state in the country to comply.
In my mind there are five “buckets” of challenges and/or concerns:
- Lack of Time: The State has been given another year to come into compliance, providers have not. Simultaneously, providers have been significantly affected by the pandemic. The State has a backlog and is behind on validation reports and remediation plans, which is adding to challenges.
- Lack of policies – The State hasn’t promulgated new rules yet, though they intend to soon. And, they intend to develop new policies. Providers have to follow strict rules and licensing requirements, so they are looking for those polices to determine what’s acceptable or not. The Department said they would be putting out sample policies by June, but this may not give providers enough time based on their own deadlines.
- Lack of resources – Our sector has been under-resourced for years. There are outdated rates, and there is hope in the long term about rates being adjusted, as well as adjusted FMAP (Federal Medicaid Assistance Percentage for federal Medicaid match funds) which might help in the short term. At the same time, the Department has proposed a tier-rate model, lifting up one-on-one supports. However, the Department has yet to create a venue in which people can discuss this proposed structure.
- Workforce challenges – The pandemic has compounded the existing workforce crisis. Unlike pre-pandemic times when we were seeing a high turnover rate, now folks aren’t coming in the door to be DSPs (direct support professionals). We need to stabilize the workforce and attract and retain staff.
- Transportation challenges – If we don’t solve the transportation issues, access to the community will be very limited for the people we support. We need better plans for transportation than relying on natural supports or DSPs taking on that role.
Everyone is working in good faith to get to compliance, and MACSP will be doing our best to ensure HCBS becomes the reality.
Begin Ann-Marie Mayberry’s Presentation (Click here for Ann-Marie’s presentation.)
Ann-Marie Mayberry: Each presenter might have a different take on HCBS and how to come into compliance because we all have different lenses. It’s worth noting that heightened scrutiny programs have to come into compliance sooner, in July of 2021. Other programs have until 2023 to come into full compliance. We have these new regulations coming down the pike, and we have several providers trying to work collaboratively across the state to come into compliance in such a tight timeline. We have years’ worth of work to do in a very short period of time.
Begin Dennis Strout’s Presentation (Click here for Dennis’ presentation.)
Dennis Strout: We’re all still learning about the HCBS Settings Rule change, but it is a philosophy we embrace. The State is under a tight timeline, as are providers. The desk reviews and validation findings have been challenging because if a finding is not accurate, providers still need to remedy. We as providers want to think we’re providing top-notch services, and that’s our goal, and we want people to be empowered. That’s sometimes hard to look at internally, but it’s healthy to do so in order to do a better job supporting people.
-It was asked what a desk review is. It was stated that a desk review involves the provider filling out a lengthy survey detailing all aspects of the individual's services. This does not involve direct interviews, it’s someone reviewing a survey.
-A provider stated that one example of an HCBS deficiency they experienced in a 2-bed licensed home involved an inability to provide community inclusion without transporting both of the residents into the community at the same time. When the provider approached OADS for additional staffing for that home, it wasn’t approved. The home lacks two vehicles to provide transportation to the separate individuals at the same time. And, if the provider wanted to use NET (Non-Emergency Transportation) transportation to access the community there must be a corresponding NPI+3 number (National Provider Identifier) to make it eligible for NET transportation. So, it seems that unless every potential community venue has an NPI+3, NET transportation cannot be used.
Begin Jodi Benvie and Barbara Beaulieu’s Presentation (Click here for Jodi and Barbara's presentation)
Jodi Benvie: I’m a Support Coordinator for KFI, we provide home, community, and work services. Everyone we support lives in their own home or with their family. For us the HCBS Settings Rule largely affects community supports. We provide one-on-one community supports currently, but the current rates don’t make this truly viable. As an advocate for about 10 years, I can see this huge change in the way we deliver community support programs. I think back to day habilitation centers, where people were in basements playing cards and watching movies. We’ve developed a system in which people are taking the bus, learning different mediums of art, gardening, visiting community resources, volunteering, etc. The HCBS Settings Rule is the next step in the evolution of our service system, so we can provide individualized opportunities for people to discover what they love and explore things as an individual. Barbara and I are going to illustrate this opportunity by each telling a story.
We have been supporting Carrie for about five years. She came to us after being at another program. She was involved with some volunteering activities at the Animal Refuge League (ARL). She found a passion in that work. She wanted to pick up a different shift there and asked for help. We called the volunteer coordinator with ARL and they didn’t have her listed as a volunteer. The community support program she had previously been attending had a special arrangement with the ARL to come in and visit with the animals, but she wasn’t an official volunteer, which involves specific training. This upset her, but we signed her and her support staff up to take the official training, and she got her t-shirt and her name tag and went to work one shift a week there. During that time, she met someone who worked there who also loves WWE wrestling as much as she does. Since then she and this gentleman have gone to WWE events in Maine. We believe if she had continued with that group there wouldn’t have been that opportunity to create that relationship as she did with her one-on-one support. Now she works 20 hours per week, she volunteers at ARL, and importantly she has been able to develop individual relationships and friendships through this. She also loves knitting. We set her up with staff people who know how to knit; they not only helped to improve her skills but connected her with knitting groups in the community. We set up her staff to take her to knitting on Sunday and Thursday evenings. Staff would sit somewhere else and knit, and just be there if she needed them. Eventually the staff left, and Carrie would ride home in a taxi. Now, Carrie gets rides to and from these groups from her friends who also attend. The new rate proposal and the HCBS Settings Rule will allow for his type of community inclusion.
Barbara Beaulieu: I’m the CEO at KFI. I’m also a parent. My daughter Courtney is featured in the pictures you see. She receives waiver services 24/7 from Section 21. She is fully integrated into her community. She lives in her own home for which she pays the mortgage. She interacts with and knows her neighbors. She attends church and is a participating member. If she misses church, I receive calls asking if she’s ok. Her pastor has been part of our planning process. Pre-COVID, she would have girls’ nights on Tuesdays where her girlfriends would come over and prepare and eat a meal together. Since COVID, staff have helped her stay connected with her girlfriends through Zoom, and she really enjoys it. She participates in the maintenance of the home, laundry, cooking, shopping, paying bills, all of those ordinary things everyone has to do. She’s also self-employed. She has vending machines out in the community, so she does her work at her own pace. One of the benefits of being self-employed is she’s made enough money to take herself and staff on vacations, such as a trip to Boston where she stayed in a hotel and went to the zoo and the aquarium. Through this we discovered she has a huge interest in giant fish. So, we decided to get her a fish tank. To expand on that interest, she’s gone to the Maine State Aquarium. She’s really enjoyed those things that her having employment has afforded her. On occasion we’ve taken her to the movies, and she watched a movie where someone was playing classical music and she became mesmerized. It was so obvious how much she enjoyed it, we introduced her to other classical music. From there we’ve taken her to Orono for different concerts. She’s now a patron of the arts, contributing money to programs when she can. She’s also done volunteering in her hometown, work with Relay For Life, and donated to a homeless shelter. She also likes kayaking and swimming. All of these activities happen with the DSP seamlessly. They help her come up with ideas, which of course change over time, and see them through. The person supporting her at home also supports her in the community and with her employment. This has worked very well for her. The HCBS Settings Rule is for someone to experience the life that we all have and for people to participate and belong to the greater community. Some people may hear this story and think that this can’t happen for them or the people they support, but it can. I don’t often say this, but Courtney has had two strokes, she has Cerebral Palsy, Autism, a seizure disorder, a sleep disorder, an eating disorder, she doesn’t use words to communicate, she’s incontinent. Even with all of these obstacles we have found ways around them so that she can have full access to her community. Her life is extraordinary because it’s so ordinary.
Jodi: We know this will take time, and we know we don’t have a lot of that time because of the delays. It’s going to take some rich person-centered planning and digging deeper into that process. It also means we have to expect more from the community, but we believe they’re up for it. It will take more cross-agency collaboration to keep people in touch with friends as people choose one-on-one supports. That will be a key component to this being successful.
Cullen: Thank you all. I think these presentations have given us all a good perspective of the HCBS Settings Rule and what is on the horizon for Maine. Certainly, things are going to change, and it will open up a lot of opportunity, as well as challenges.
Discussion:
-The presenters were thanked for laying out exactly what the HCBS Settings Rule change entails. A parent stated that though he supports the philosophy he has questions about financing and staffing. Additionally, the expectations are supposed to pertain to everyone, but there are lots of different fits for lots of different kinds of people. It was asked how exactly this can evolve in a way that works for everyone and make it possible for providers to continue to do their work in a positive way with very limited resources.
Ray Nagel, Executive Director, Independence Association of Maine: I appreciate the stories shared today, which were wonderful examples of communities in action and individuals supported accessing their community. The HCBS Settings Rule criteria are a template for every single person, and every single person can’t meet those. There are a lot of ideals in there that are unrealistic, and unless there’s a whole lot of financing and a whole lot of transportation flexibility I don’t see it happening. I’ve been in the field for more than 30 years and we provide significant community inclusion. I don’t see how we’re going to be able to have three people who want to go to church on Sunday, and with only one staff person, how those three people can be brought to three different places at a time and staff it. The idea of everyone having access to their own money at all times is a wonderful idea, but who is held liable if that money is stolen? Who determines how much money the person can handle at any one time? Having visitors in at any time of the day or night and not allowed to maintain a sign-in roster – how safe is that? Are providers going to be held responsible for that? These are questions other providers may not be saying out loud but they have. I went to CMS five years ago with some of my peers, and the spirit of the Settings Rule was really done to make states comport to the norms already established in Maine and Minnesota. The Settings Rules has requirements; the interpretations are what every state would identify on their own. I question the interpretations Maine has undertaken and to what degree and detail they’re holding providers responsible, compared to other states such as Florida that hasn’t done the same things. I’m not saying the bar should be low, but providers shouldn’t promise something they can’t provide. And saying that they can do all of these things but knowing they can’t financially support it.
-A parent stated that it is an impossibility everyone is facing, but it always has been. She added that what is worrying is when we set goals and then interpret those goals as musts. That can change a person’s life from being joyful to being a stressor. Regulations ought to have soft edges around them, because there is always someone for whom this would be detrimental. She stated that she’s pleased that agencies are talking to each other more. Things ought to be improved without censure. The Coalition is a saving grace, because it has people talking to one another.
Dennis: There are always different perspectives on things, but so much of the work involves philosophy. Then there’s the logistical component. If the philosophy is there to empower people and to embrace people having lives that are fulfilling and where autonomy is created, that’s an important piece. Someone said to me once, “you can know what to do, and how to do something, but you have to want to do it.” I do think the community is up for it, as are the people we support, if we embrace the philosophy in a way that’s inclusive.
-A provider stated that we’re reaching such a critical point where we are racing towards compliance, but compliance is very different than philosophical and cultural transformation. We are last in the nation. We are racing towards compliance now. A transformative and cultural shift in how we best serve individuals in Maine with ID/DD is a very different conversation than compliance to the services as outlined in the HCBS Settings Rule. Unfortunately, there isn’t a lot of time for transformation and cultural change. Maine is at a point where the compliance aspects and how it’s been defined is almost like smashing into the cultural pressure point amongst pandemic recovery, amongst the majority of providers losing more than 20% of their workforce in less than a year, compounded by the deficits of our system and the inadequacies of Medicaid funding as a whole. We have an opportunity to reform and transform our system, and own this moment as providers and participants, but because we have a deadline and compliance mindset it’s like we’re missing our moment. We have all this power and momentum that we could pull out of the depths of this, but if we’re not in compliance money won’t flow into Maine. This is a real pressure point on the front lines. If you’re a parent talking to providers, or if you’re someone who receives services, or a provider yourself, it is suggested that you try to separate compliance and philosophical/cultural transformation.
Ann-Marie: We are trying to meet compliance, so we’re not focusing on how we’re going to put it into practice. Providers go into this field for a reason, it’s because we have a passion to support and empower and make services better for people with ID/DD. Though how we got into the field doesn’t matter, for the HCBS Settings Rule compliance we must meet a deadline, so we’re going to spend the next two years in crunch time, then the next several years determining how we’re going to make this work. Anyone can write a policy but it’s how the policy affects the person and how we can make it work and benefit the people served.
Ray: One of the things we learned at the provider summit in Portsmouth, NH is that they were way ahead of us in the transition planning for the Rule. The State worked with the providers in defining, for example, what constitutes rural. An empirical value – what is defined as being included in the community? The State worked with the providers in NH because they were so far ahead of us. I refuse to write a policy until I know what the rules and regulations are because I don’t want to write a policy that’s not going to follow a rule – that’s putting the cart before the horse. I spoke with my attorney who told me to put a disclaimer on all my responses stating that it’s subject to proper resourcing, financing by the State of Maine, as well as the changing of the rules and regulation within the State of Maine. Every one of us wants to comply with this, but I feel like I’m a blind man in a dark bedroom trying to find my way around and not getting any help.
-A case a manger stated that with this population on any given day you can be supporting someone transitioning from high school, coming out of corrections, etc. All things are individualized, and we all embrace the HCBS Settings Rule, but there’s a lot of training that also needs to be done.
-A self-advocate stated that the pressure is on the Department to address the situation, and with any pressure mistakes are made. It was asked if the Department is looking to providers, self-advocates, families, etc. for input. She added that transportation is also a very large obstacle that needs to be addressed. It was also asked what the grievance process is - if one currently exists.
Laura: Regarding the history of the communication between the Department and the providers – I didn’t come here until late 2019, but I can say in the time we’ve been working with them on the HCBS Settings Rule, they created a lot of spaces for people to discuss this. Unfortunately, stakeholders and providers have been advised not to talk about the funding and resource aspect. What this looks like on the ground for folks, having programs discuss what transformation looks like, and the viability of the rates under consideration now, is important.
-It was asked if Jodi or Barbara could explain how they made changes to allow for one-on-one services before there was even talk of the HCBS Settings Rule.
Barbara: We looked to programs in other states. We had time to figure it out and did it one person at a time. We used to have center-based services, but people wanted to stay in the community. To address transportation, we have figured out a transportation budget. We’ve never received an appropriate rate to provide this – we’ve used surplus from other services to support the costs for this. The biggest challenges coming is figuring out transportation, and there is a DSP shortage. We’re also looking at minimum wage increases, and that is a challenge.
Teague Morris – Senator King’s Office: I noticed that Senators Hassan, Casey, and Sherrod Brown, along with Representative Dingell, released a draft bill which would ensure that people receive the services they need to be included as part of the community. They are soliciting comments on this, which are due by 4/26. That might be of interest to this conversation.
Cullen: I’m so glad that you’re sharing this, Teague, and that as always Senator King’s office is tuned into everything! I can provide a little information on the draft bill to which Teague referenced, the HCBS Access Act, which would require Medicaid to provide home and community-based services (HCBS) to everyone who is eligible and establish a minimum set of services that states must offer. The draft concept bill includes:
- Minimum standards to be provided by state HCBS
- Sufficient rates to support required services and provide adequate pay for direct support staff
- Workforce development and support, wages and benefits, recruitment, training and retention
- HCBS infrastructure in states that support family caregivers, provider agencies and independent providers
- Role of managed care in providing HCBS including network adequacy standards and consumer direction, etc.
However, this would be a mechanism on the federal level to end waitlists which has paralyzed everyone. The final contents of this bill are still forthcoming, but this group ought to be poised to contact Maine’s Delegation advocating for this bill when more information is available. Right now, this sits as a discussion draft on which people can comment. Commenting on this discussion draft bill is easy – simply email your own comments before April 26 to [email protected]. (Click here for information on this from NCSA.)
Ann-Marie: ANCOR is planning on presenting comments on the bill as well. What really caught me is that there are 65 million unpaid family caregivers in the United States currently. This bill would support the family members providing this unpaid care.
Cullen: We’ll be watching this very closely as this progresses through Congress.
Cullen: Thank you Laura for starting us off with such a clear overview, and thank you Ann-Marie, Dennis, Barbara, and Jodi, for illustrating the HCBS Settings Rule changes as they pertain to services and the people receiving them. This started a wonderful discussion. This presents further opportunity for collaboration between agencies, and an opportunity for further dialogue between everyone and the Department so that we ensure we get this right. Thank you all for being here today, well done!
Helpful links pertaining to the discussion and the HCBS Settings Rule Change:
- https://www.medicaid.gov/sites/default/files/2019-12/requirements-for-home-and-community-settings.pdf
- https://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/exploratory-questions-re-settings-characteristics.pdf
- https://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/exploratory-questions-non-residential.pdf
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins – Associate Director, DHHS-OADS Disability Services: Both Heidi and I have been listening to everyone’s comments and the information they’ve shared. I would say there were some pieces of information that were not quite accurate, and we would welcome the opportunity to come back and share where the State is coming from with HCBS Settings Rule compliance. We have provider meetings every month, which includes opportunities to provide feedback. Having said all of that, we absolutely understand that this is challenging. We come at this with trying to understand what those challenges are and trying to find remedies for them. We are all under tight timelines.
Cullen: I would love to have you present on this next month and continue the discussion.
Betsy: Thank you, we would be pleased to do so. As far as OADS updates, we’ve had a number of agencies sign up to provide vaccination clinics, targeting people in their communities with ID/DD, and their families and/or supporters. (The first one will be this Friday from 8am to 12:30pm at OHI. Click here for more information, including how to sign up.) This is one of about six or seven pop-up clinics the Department is working to hold. We’re trying to provide additional opportunities for folks. There’s a lot in the news about the American Recovery Act funds coming into Maine and what that means. We have the same information as anyone else. We’re waiting for further guidance from CMS. When we receive that we’ll be gathering information through a fairly involved stakeholder process before we move ahead with that funding. We submitted our most recent K amendment to cover the provider retainer payments funded in the FY 22 budget. We’re waiting to hear back from CMS about what that looks like. The first year of the Governor’s Budget includes the rate increases. We’re working to see what happens with the supplemental budget to carry those rate increases forward into the second year of the biennium. And, OADS is still holding its weekly Stakeholder call.
Cullen: Thank you very much, Betsy, for being here!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows: The transition work will be a slow process because we want to be able to have a process that sustains through administrations. We’re finding it’s quite an undertaking and will be a long-term project. I don’t have any new information on that today. We’re working on some pilot crisis projects for youth as well.
Cullen: I want to thank OCFS, as they have worked diligently to implement the Blueprint for Effective Transition in their long-term planning process.
Special Education – No update
SMACT (Southern Maine Advisory Council on Transition)
SMACT meetings occur on the first Friday of each month, currently via Zoom, at 1pm. The April meeting featured DRM (Disability Rights Maine) and SUFU (Speaking Up For Us) presenting on self-advocacy and advocacy for youth in transition (click here for a link to the meeting recording). The May 7th meeting will feature Cullen presenting on the Blueprint for Effective Transition. SMACT’s new website is up and running. The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy Peavy ([email protected]).
Disability Rights Maine (DRM) Update:
Staci Converse: We have a training coming up on April 14th “Rights of People with Intellectual Disabilities and Autism.” You can register for that training here. All of our trainings have been recorded and are on our website here. We do have our 2020 Annual Report on the website, and in that report it talks about the number of clients we served in 2020 with ID/DD and that number is 645 individuals. We always have a lot of trainings going on and you can check our website out for more information on those. (Click here for DRM’s website, scroll down and events are on the right.)
Federal & Housing Updates:
Cullen:
- On 3/11 the President signed the $1.9 trillion American Rescue Plan Act, which was welcome news. This bill included an additional $5 billion in rental subsidies, which is a major investment in affordable housing and very much needed.
- On 3/31, President Biden released details on his “American Jobs Plan,” an approximately $2 trillion infrastructure and recovery package. This package includes $213 billion to produce, preserve, and retrofit more than two million affordable and sustainable places to live, through grants, formula funding, targeted tax credits, and project-based rental assistance. It is very evident that the Administration is very dedicated to increasing the supply of affordable housing, which as many of you know is sorely lacking in Maine and across the country.
- On 4/9 President Biden released his “budget blueprint” previewing his full FY 22 budget request, which is expected to be released in the coming weeks. The President’s blueprint proposes a $9 billion or a 15% increase to HUD’s budget from FY 2021. If enacted, the budget would provide substantial federal investments in affordable homes and increase the availability of housing assistance to families with the greatest need. Importantly, the FY 22 budget is the first annual budget bill in a decade that is not confined by the arbitrary spending caps required by the Budget Control Act.
- There are various efforts in Congress to increase the National Housing Trust Fund, which funds the development of housing for people with very low incomes and is the primary funding mechanism for permanent supportive housing in Maine.
State Legislature Update:
Cullen: Laura has done an immense amount of work following various bills in the Legislature that pertain to the ID/DD world. Thank you, Laura, for your work to keep us up to date on what’s going on in the Legislature!
Laura Cordes – MACSP (Maine Association for Community Service Providers): Since we last met the Legislature considered the Supplemental Budget, which is how lawmakers are addressing the budget under which we’re currently operating, as well as the Back to Basics Budget for fiscal year 2022. Both have been signed into law.
Laura’s 130th Legislative Session Bills and & Key Committees document was shared with the group, which also includes information on the different budget processes:
Supplemental Budget:
- The Supplemental Budget, which has been signed into law, includes retainer payments for community supports.
Back to Basics Budget for FY 22:
- The House and Senate passed a pared down “back to basics” budget for FY 22 on March 30th that was signed into law by the Governor the same week.
- While it was unclear during the presentation of the budget, OADS and Office of MaineCare Services have confirmed that the budget does include increases for Sections 21 & 29 (for FY 22 only) that are designed to bring the wage component of the rate up to minimum wage and adjust to support a newly proposed community supports tiered service model with tiered rates for 1:1, 1:2 and 1:3 supports.
- The CDC position for the Mortality Review Panel and the waitlist dollars were not included in this budget but will hopefully be considered in the Supplemental Budget process for FY 22 and FY 23, which will include the American Rescue Plan Act money.
- Legislators will consider another budget - a supplemental budget - to address supplemental funding for FY 22 and funding for FY 23 (which has not yet been addressed). This process will include Maine’s allocation of federal dollars from the American Rescue Plan Act, and likely happen in May/June.
- There has been a lot of advocacy around the American Rescue Plan Act funding going towards hiring and retaining DSPs and HCBS Settings compliance.
Laura: At this point in time the Committees are usually about 70-80% of the way done with bills, and now I would say they are about 30% done. The pandemic has definitely slowed things down in the Legislature. I want to review a set of bills that might be helpful for this group. (Click here for the HHS, AFA, and Education Committee member contact information, and the list of bills Laura reviewed.) A few bills have come out which are highlighted in yellow in which the Coalition might be interested. I’ll call your attention to a hearing on Thursday afternoon on LD 415, which will be in front of the Health and Human Services (HHS) Committee on Thursday, 4/15 at 1pm. This bill would increase the rates for Targeted Case Management under Sections 13 and 65.
Cullen: Thank you, Laura, for all of this information! Thank you to everyone who has testified on bills in this legislative session, as doing so is very important so that Legislators clearly understand what is needed to sustain the system of care for people in Maine with ID/DD. For those who haven’t testified in this Legislative Session, the process has changed but it’s very simple. You can provide live testimony during the hearing and/or submit written testimony (Click here for more information). The process for testifying live is very smooth, you’re essentially watching a video feed of the hearing until you’re called upon to testify and then you pop onto the panel with the Committee and unmute.
Announcements:
- Click here for information on MACSP’s Community Supports Transformation Webinar Series
- Click here for information on the recently released Maine Children’s Alliance 2021 Maine KIDS COUNT Data Book
- Click here for information on OADS’ Supporting Community Relationships, Valued Roles & Belonging-Save the Dates
The next meeting will be on Monday, May 10, 2021, 12-2pm, via Zoom.
Featured Speakers: Betsy Hopkins, Associate Director, DHHS-OADS Disability Services. Topic: Continued discussion on the HCBS Settings Rule and Maine’s path towards compliance.
And, Dr. Anne Ryan, STRIVE Online Program Director, PSL STRIVE. Topic: Overview of STRIVE WorldWIDE, an online program that teaches independent living skills to individuals with intellectual disabilities and Autism.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2021 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].