December 13, 2021
Minutes
Minutes
Attendees via Zoom: Lisa Letourneau, Sharon McDonnell, Alli Vercoe, Amy Moller, Betsy Hopkins, Betsy Mahoney, Bryan Gordon, Carol Snyder, Cedric Mfuranzima, Chris Call, Craig Patterson, Darla Chafin, David Cowing, Debbie Dionne, Greg Bush, Heidi Mansir, Helen Hemminger, J Richardson Collins, Jamie Whitehouse, Janet Dibiase, Jennifer Putnam, Jesse Greenbaum, Jodi Benvie, John Tabb, Julie Brennan, Kim Humphrey, Kristin McPherson, Laura Cordes, Lauren Wille, Libby Stone-Sterling, Linda Lee, Lorraine DeFreitas, Maggie Hoffman, Margaret Cardoza, Mark Kemmerle, Melissa Camire, Paula Bush, Rachel Dyer, Ray Nagel, Sarah Robinson, Shelly Zielinski, Spring, Stacy Lamontagne, Ed & Suellen Doggett, Teague Morris, Trena Jackson, Michaela York, Lily Mazu, Vickey Rand, Cullen Ryan, and about five 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. Minutes from the last meeting were accepted. For the sake of time, Cullen read the names of participants.
Featured Speaker: Rachel Dyer, Associate Director, Maine Developmental Disabilities Council. www.maineddc.org Topic: The DD Council’s new State Plan, National Core Indicators outcomes, and a preview of upcoming attractions regarding the ABLE act.
Cullen: Today we have Rachel Dyer, Associate Director, with the Maine Developmental Disabilities Council, presenting on the DD Council’s new State Plan, National Core Indicators outcomes, and a preview of upcoming attractions regarding the ABLE act in Maine. Thank you for being here today, Rachel!
Rachel Dyer: Thank you for having me today! My plan is to talk about the DD Council and let the group know what it is, and then provide the other two updates.
Begin Presentation (Click here for the presentation)
Rachel: The Maine DDC is required to work within a State Plan. The goal is to make the goals, objectives, and strategies within the plan concrete and doable, but flexible because the State Plan spans over a five-year timeframe.
Goal 1: People with developmental disabilities, families, and communities will have increased opportunities for choice, self-determination, and community membership.
Goal 2: Improve systems of support for people with Developmental Disabilities and their Families
(Just a note that the presentation was paused at this point in the meeting because our other presenters had time constraints. The presentation continued after the conclusion of Lisa and Sharon’s presentation. For ease of reading, these minutes will capture this as two intact presentations, with Lisa and Sharon’s beginning on page 3.)
COVID-19:
National Core Indicators (NCI):
Coming Attractions:
Cullen: Thank you for this in-depth presentation, Rachel!
Discussion:
-A provider stated that they support someone who just spent a few days in the emergency room who was sedated and secluded for mental health issues. She asked how they’re looking at people with ID/DD with dual diagnoses.
Rachel: This has been such a long-term problem. I know that the Department has been working on reestablishing some of the capacity around this that has diminished over the years. But this doesn’t get at the psychiatric and strong clinical component. We’ve done individual education for staff and clinicians around this in the past. I don’t know if there’s anyone here that has more information on this, but that service just does not exist here, and in the states where it does it appears to be very institutionally based. Part of the issue is that Medicaid does not pay for psychiatric hospitalization for people with ID/DD.
-A self-advocate thanked Rachel for her presentation and all of the work that went into it. She stated that about ten (10) years ago University of New England students working towards becoming physicians had zero training on providing health care for people with ID/DD. They thought people with ID/DD “went to someone else.” It was asked if curriculum today includes training for people with disabilities.
Rachel: As far as I know this continues to be absent from the standard medical school curriculum. There are certain schools and programs that address it. The American Academy of Medicine and Dentistry has made efforts to get that type of information more broadly shared, but this is a prime example of how systems change efforts take a very long time, and work on many different areas/levels.
-It was asked how the NCI data was collected.
Rachel: The State of Maine data is from in-person interviews, which has different sections: A portion is background information collected by case managers, a portion is self-reported, and a portion can be done by proxy. It’s designed to be a valid tool across the board, even when every single person who responds is perhaps not able to answer every single question.
-It was stated that it appears not everyone who utilizes services is included in the survey process.
Rachel: A sample of people who receive case management and one other service were selected randomly. It’s completely randomly generated. It’s generally people who were receiving case management and either Section 21 or 29.
Laura Cordes: My questions are about the timing of the NCI data collection. If Maine were to participate in next year’s NCI survey, when would the sample interviews take place? When would the work be published?
Rachel: I don’t know whether Maine will participate in the next interview process. It generally goes from September to September. The data collection can begin in October, but Maine has generally started in January. There is a time lag. Interviews and data have to be submitted by the end of June, and the report is typically released about a year later.
Laura: Have other states released survey results for the years in which Maine didn’t participate?
Rachel: I haven’t seen anything since 2019, but I can look further into this.
Laura: Clearly you can’t get everyone to respond to every survey, but I’m curious what Maine’s sample size benchmark is and how it compares to other states.
Rachel: The benchmark is provided by HSRI (Human Services Research Institute) and it’s based on what they need in order to complete a statistically reliable analysis. I know that the sample size varies significantly from state to state, but in Maine it’s 400 participants.
-A parent asked if data is available to compare other states with Maine. She stated that the data point regarding Maine having a higher rate of state guardianship was interesting, and she wondered if age had been considered.
Rachel: Yes. It depends on how deeply you want to do the comparison. That’s something about which we could certainly inquire.
Cullen: Thank you very much, Rachel, for taking the time to talk with us today and for putting together such a comprehensive presentation!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
Featured Speakers: Lisa M. Letourneau MD, MPH, Senior Advisor, Delivery System Change, DHHS Commissioner’s Office, and Sharon McDonnell, MD, MPH, Director, COVID-19 Social Services, DHHS. www.maine.gov/dhhs Topic: COVID-19 Continued Basics including the importance of masking, social distancing, the now more-than-ever importance of testing & vaccination, and updates on treatment options, as well as ongoing social service supports.
Cullen: I am very pleased to welcome Lisa M. Letourneau MD, MPH, Senior Advisor, Delivery System Change, DHHS Commissioner’s Office, and Sharon McDonnell MD, MPH, Director, COVID-19 Social Services, who will be presenting on COVID-19 continued basics including the importance of masking, social distancing, testing, and vaccination, and updates on treatment options, as well as ongoing social service supports. Lisa and Sharon, thank you both very much for presenting today, it’s wonderful to have you!
Sharon McDonnell: Lisa and I both work with the Department in the Commissioner’s Office in response to the COVID-19 pandemic.
Lisa Letourneau: I’m an internist by background and as Sharon stated I currently work in the DHHS Commissioner’s office along with her. I’m going to go through some of the clinical issues, and Sharon will cover the social services aspect. Some of these slides are very clinical in nature so I’ll keep it higher level and focus on what’s new.
Begin Presentation (Click here for the presentation)
Lisa: Boosters: The largest change with vaccines is that we’re recommending boosters for everyone. There are some walk-in vaccine clinics setup in the State – in Augusta, Auburn, and Sanford – in hopes of getting as many people boosters as possible who want them. You’ll hear people asking if it’s worth it to get a booster or not if you’re going to potentially contract COVID anyway. The answer is absolutely yes, because people with boosters are substantially less likely to get seriously ill.
Implications of Omicron: We still don’t know a lot about the Omicron variant, but we know there are multiple mutations in it and the overall implications are unknown. The rate of spread in other countries suggests that it has a higher rate of transmissibility. We haven’t detected a case of Omicron in Maine yet, but it’s likely here we just haven’t detected it. Reports from other countries have shown that Omicron may cause milder disease, but that is still a large unknown. Protections against Omicron are the same: masking and social distancing, vaccination, and boosters.
Treatment options: COVID-19 Monoclonal antibodies are indicated for people at high risk for developing severe COVID-19 disease. There is a limited federal supply and increased demand has created shortages. There are also some brand new long-acting antibodies, for people who are severely immunosuppressed. Oral anti-viral drugs are on the horizon, but monoclonal antibodies are far more effective at preventing/treating severe disease. It’s anticipated that the initial supply of the oral anti-viral drugs will be very constrained.
Sharon: Maine DHHS COVID-19 Community Care & Social Support: Referrals to us can be made via an online form, via email, on our website, or simply Google “Maine DHHS COVID Social Support” and the referral form will come up among the top search results. Our core services are available to all Mainers who are cases or contacts. When you make a referral, the more information you provide the better. We use geography, preferred language, culture, etc., to coordinate referrals to funded partners statewide. We have received 6,406 referrals for a total of approximately 19,340 Mainers in households, shelters, or outbreaks since the program began in June of 2020.
Cullen: I know that many people here may be associated with people living in group homes or shared living arrangements, and some people remain home with family. There are a variety of different living situations for people with ID/DD.
Sharon: We’ve worked with many group homes on providing information and services.
Discussion:
-It was asked if the monoclonal antibodies can be used as a preventative measure.
Lisa: That’s a great question. They could be used for preventative measures; however, due to the supply constraint we’ve reserved use for people with COVID-19. But if you know of a case where someone tested positive and exposed a group of people at very high risk you could reach out.
Sharon: We could get someone out there to do testing very quickly. Then, you could get results within a day and get the referral process started.
-A parent asked if they provide one-on-one education for people who are vaccine hesitant, specifically direct support providers. She stated she’s found that conversations about vaccines among people with established relationships and shared trust have been helpful.
Sharon: There are vaccine promoters at agencies all across the state. There are groups specifically working on that currently, including groups in the Lewiston/Auburn area. In the more rural areas, there are campaigns specific to social profiles such as hunters, etc. The community vaccine line staff are very willing to do outreach calls to folks, but that likely wouldn’t have the same affect. There is a group of physicians giving talks to folks about how to talk to people who are vaccine hesitant, because generally it’s much more important to listen versus talk, to ask questions versus give information.
Cullen: Thank you both again, for taking time out of your very busy schedules to give this very informative presentation. Well done!
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: Really quick I’ll provide some information:
-A provider thanked Betsy and the Department for extending the Appendix K waiver provisions. He asked if there’s been any follow-up with CMS (Centers for Medicare and Medicaid Services) regarding the K waiver retainer payments and modifying the language to allow a larger group of providers to access those funds.
Betsy: Yes, we have had those conversations, though I don’t have the exact details handy. I’ll try to have updates on that for tomorrow’s Stakeholders’ call.
-A parent stated that the K waiver and the CMS approval are both great news. However, she stated that her son’s group home had to close, and he was lucky to have been able to move to a different one. She stated that these changes are happening far too slowly. She asked if they are tracking the closures that have already occurred while waiting for these additional federal funds.
Betsy: We are keeping track of that through our Licensing Department. We agree with you that the workforce shortage, the closing of homes, and the challenges agencies are having with finding staff are very significant and we’re very aware of that. We’re working with some individual agencies to support them as much as we can. I will look into this and share any updated information we have (see below).
-A parent stated that in the last Legislative Session the rates were increased so that DSPs could earn 125% of minimum wage, which is great. However, OMS (Office of MaineCare Services) opposed many of the rate increase initiatives in the last session. And, with the current workforce crisis worsening additional increases will be necessary, as what was put in place will likely not be enough to retain the current workforce let alone attract people to the field. She asked if OMS, the Commissioner of DHHS, and/or the Governor would support additional wage increases either through legislation or the supplemental budget process.
Betsy: We’ve been pretty clear that a lot of additional funding in a variety of different ways has been added to the support system. Our ability to further increase rates/wages relies heavily on the FMAP reimbursement. The Build Back Better Act, which I know Cullen has covered in these meetings and will cover in the Federal update, has a lot of measures that will greatly help the system of care if it passes.
Cullen: Thank you very much, Betsy, for being here today, this information, and all that you’re doing!
After the meeting Betsy provided the following follow-up information:
Implemented
Regarding home closures that we are tracking. For licensed homes, the information is below:
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows was unable to attend the meeting but sent an update via email: I will be working with Betsy to see if we can do a combined presentation with this group, possibly in February or March. I do not have any other updates other than the continuation of the transition work between Children’s Behavioral Health Services and the Office of Aging and Disability Services for an improved transition process.
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Libby Stone-Sterling: We’re very excited about partnering with OADS to do some co-location of OADS staff in Voc Rehab offices.
We’re getting ready for our third cohort of our Peer Social Services Curriculum. We’re working with the University of Maine and expect to start the third cohort in January. If people are interested please reach out to me, as we want to include as many people as possible who are interested across the state. (Email: [email protected])
Bureau of Rehabilitation Services (BRS) Stakeholder Meetings – ASL and CART will be available.
This is an opportunity to learn more about programs and services as well as offer your feedback! Meetings occur the 2nd Monday of each month from 9-10 am. The meeting schedule is as follows: Dec 13, 202, Jan 10, 2022, Feb 14, 2022, March 14, 2022, April 11, 2022, and May 9, 2022. Join Zoom Meeting:
https://mainestate.zoom.us/j/85030661047?pwd=dXpnRXhNREMwRy81bnhySVUramM0Zz09
-A self-advocate sked if they’ve looked into the Department of Labor funding for transportation.
Libby: We do have a team here working on transportation, so we’ll hopefully be able to share an update in the future.
Cullen: Thank you, Libby!
LD 924 Task Force Update:
Linda Lee: LD 924, Resolve, To Establish a Task Force To Study the Coordination of Services and Expansion of Educational Programs for Young Adults with Intellectual or Developmental Disabilities To Identify Barriers to Full Societal Integration, is the bill to establish a task force to look at the transition process. A few parents came together to work with legislators on this bill for the past three years, and it finally passed this year. The first meeting of the taskforce has occurred. We’re all looking to see how we can create systems that work better for people. We created a survey for parents to solicit input to bring as many voices as possible to the table. I’ve very grateful to everyone who helped put together the questions for the survey. We’ve also put together a one-minute survey, to have some data to bring back to the Task Force in January (see below for the One-minute Parent-to-Parent Survey announcement and link).
Maggie Hoffman: I wanted to add that survey responses are completely confidential.
Cullen: Thank you, Linda and Maggie, for this information and all your work! We will add this as a standing agenda item for next month’s meeting so we can cover this work in more detail.
Disability Rights Maine (DRM) Update:
Lauren Wille: The Employment First Coalition is now back in full swing. We’ll review the recommendations made last time the group met and go from there.
SMACT (Southern Maine Advisory Council on Transition)
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 ([email protected]). SMACT meetings occur the first Friday of each month throughout the school year. The 12/3 meeting was cancelled due to unforeseen circumstances. The January meeting will be on Friday, 1/7/2022, and will feature a presentation from the National Alliance on Mental Illness, Maine about their mission and services.
Federal & Housing Updates:
Cullen: Teague Morris from Senator King’s office is here today. Teague, thank you for being here and please extend our sincere thanks to Senator King for his support and advocacy on the Build Back Better Act.
State Legislature Update:
Laura Cordes – Executive Director, MACSP (Maine Association for Community Service Providers): We’re headed towards the Second Session of the 130th Legislature, known as the short session, which starts the first Wednesday of January, and is scheduled to end the second Wednesday in April. There were about 350 that were carried over from the First Session. The Legislative Council met to review approximately 300 emergency bills submitted by legislators; about 150 of those bills got through (click here for the final list of bills). I created a Google Doc for this Session that includes the LDs, LRs, and carry over bills as I know them, which I’ll update throughout the Session. (Click here for the Google Doc for the 2nd Session of the 130th Legislature that Laura will review more in-depth next month.)
Other Business:
Cullen: I want to express my great appreciation for all your hard work over this past year. Thank you! I wish you all a wonderful Holiday Season and a happy and healthy New Year!
The next meeting will be on Monday, January 10, 2022, 12-2pm, via Zoom*.
Featured Speaker & Topic TBD.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2022 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. Minutes from the last meeting were accepted. For the sake of time, Cullen read the names of participants.
Featured Speaker: Rachel Dyer, Associate Director, Maine Developmental Disabilities Council. www.maineddc.org Topic: The DD Council’s new State Plan, National Core Indicators outcomes, and a preview of upcoming attractions regarding the ABLE act.
Cullen: Today we have Rachel Dyer, Associate Director, with the Maine Developmental Disabilities Council, presenting on the DD Council’s new State Plan, National Core Indicators outcomes, and a preview of upcoming attractions regarding the ABLE act in Maine. Thank you for being here today, Rachel!
Rachel Dyer: Thank you for having me today! My plan is to talk about the DD Council and let the group know what it is, and then provide the other two updates.
Begin Presentation (Click here for the presentation)
Rachel: The Maine DDC is required to work within a State Plan. The goal is to make the goals, objectives, and strategies within the plan concrete and doable, but flexible because the State Plan spans over a five-year timeframe.
Goal 1: People with developmental disabilities, families, and communities will have increased opportunities for choice, self-determination, and community membership.
- 1.1: Promote Civil Rights:
- 1.2: Promote Advocacy
Goal 2: Improve systems of support for people with Developmental Disabilities and their Families
- 2.1: Decrease health and educational disparities experienced by people with developmental disabilities.
- 2.2: Improve access, quality, and integration of services & supports for individuals with developmental disabilities & families
- 2.3: Support efforts to expand access to information and services for underserved individuals with developmental disabilities and families.
(Just a note that the presentation was paused at this point in the meeting because our other presenters had time constraints. The presentation continued after the conclusion of Lisa and Sharon’s presentation. For ease of reading, these minutes will capture this as two intact presentations, with Lisa and Sharon’s beginning on page 3.)
COVID-19:
- The Maine DDC, Disability Rights Maine (DRM), University of Maine Center for Community Inclusion and Disability Studies, and Speaking Up For Us collaborated on a series of COVID-19 vaccination public service announcements to help increase the vaccination rate among individuals with disabilities and the people who support them. These are airing in Aroostook county now, but they’re also available online. This could be a great tool to assist people with the dialogue around vaccines.
National Core Indicators (NCI):
- Standard measures used across states to assess the outcomes of services provided to individuals and families. Indicators address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety.
- Through 2010 the “Quality of Life” Survey was administered to Section 21 Waiver recipients. Interviewers were primarily agency staff. This project was overseen by the (former) Office of Quality Improvement.
- OADS received a federal grant to resume participation in NCI in 2013. They contracted with Maine Developmental Disabilities Council to do the work. Interviews were completed in 2013/14, 2015/16, 2016/17, 2017/18, 2018/19 and 2019/20. However, 2019/20 ended early due to the pandemic and Maine did not participate in 2020/21 or 2021/22.
- Interviewer feedback:
- People do not seem to have many choices about where & how they spend their days.
- People who have had behavior problems in the past said that nobody lets them forget and rules just don’t relax, even when their behavior has improved.
- People often had a difficult time answering questions about living, working, doing something else or somewhere else, and about services needed- lack of awareness that there ARE other options.
- Key Survey Results:
- Maine was higher than the national average for people reporting that they voted in an election.
- Maine’s result was “N/A” for using a self-directed supports option because the state has yet to establish one. The national average was 12%.
- 60% of people receiving DD services in Maine were under full guardianship; the national average was 33%. And Maine was higher than the national average for people under State guardianship.
- 56% of women respondents age 21+ reported having a Pap test within the past three years, on par with the national average. However, 66% of all women age 18+ have reported having a Pap test within the past three years. This is an example of a possible inequity within the healthcare system for people with ID/DD.
Coming Attractions:
- Maine DDC Request for Proposals to Increase Capacity to Support Self Direction – For people/agencies who want to increase capacity of Maine’s developmental service system to provide support brokerage to adults using self-directed services. Available to anyone who is not a Section 21 or Section 29 provider.
- Able accounts are now available in Maine. Autism Society of Maine provided a webinar on this (click here for the webinar recording). A more in-depth training on Able Accounts will be held in January or February.
- Out of the Shadows – The Legacy of Pineland: This is DD history project that was developed, originally for the 25th anniversary of the closure of Pineland. It was moved to an online format documenting the history.
Cullen: Thank you for this in-depth presentation, Rachel!
Discussion:
-A provider stated that they support someone who just spent a few days in the emergency room who was sedated and secluded for mental health issues. She asked how they’re looking at people with ID/DD with dual diagnoses.
Rachel: This has been such a long-term problem. I know that the Department has been working on reestablishing some of the capacity around this that has diminished over the years. But this doesn’t get at the psychiatric and strong clinical component. We’ve done individual education for staff and clinicians around this in the past. I don’t know if there’s anyone here that has more information on this, but that service just does not exist here, and in the states where it does it appears to be very institutionally based. Part of the issue is that Medicaid does not pay for psychiatric hospitalization for people with ID/DD.
-A self-advocate thanked Rachel for her presentation and all of the work that went into it. She stated that about ten (10) years ago University of New England students working towards becoming physicians had zero training on providing health care for people with ID/DD. They thought people with ID/DD “went to someone else.” It was asked if curriculum today includes training for people with disabilities.
Rachel: As far as I know this continues to be absent from the standard medical school curriculum. There are certain schools and programs that address it. The American Academy of Medicine and Dentistry has made efforts to get that type of information more broadly shared, but this is a prime example of how systems change efforts take a very long time, and work on many different areas/levels.
-It was asked how the NCI data was collected.
Rachel: The State of Maine data is from in-person interviews, which has different sections: A portion is background information collected by case managers, a portion is self-reported, and a portion can be done by proxy. It’s designed to be a valid tool across the board, even when every single person who responds is perhaps not able to answer every single question.
-It was stated that it appears not everyone who utilizes services is included in the survey process.
Rachel: A sample of people who receive case management and one other service were selected randomly. It’s completely randomly generated. It’s generally people who were receiving case management and either Section 21 or 29.
Laura Cordes: My questions are about the timing of the NCI data collection. If Maine were to participate in next year’s NCI survey, when would the sample interviews take place? When would the work be published?
Rachel: I don’t know whether Maine will participate in the next interview process. It generally goes from September to September. The data collection can begin in October, but Maine has generally started in January. There is a time lag. Interviews and data have to be submitted by the end of June, and the report is typically released about a year later.
Laura: Have other states released survey results for the years in which Maine didn’t participate?
Rachel: I haven’t seen anything since 2019, but I can look further into this.
Laura: Clearly you can’t get everyone to respond to every survey, but I’m curious what Maine’s sample size benchmark is and how it compares to other states.
Rachel: The benchmark is provided by HSRI (Human Services Research Institute) and it’s based on what they need in order to complete a statistically reliable analysis. I know that the sample size varies significantly from state to state, but in Maine it’s 400 participants.
-A parent asked if data is available to compare other states with Maine. She stated that the data point regarding Maine having a higher rate of state guardianship was interesting, and she wondered if age had been considered.
Rachel: Yes. It depends on how deeply you want to do the comparison. That’s something about which we could certainly inquire.
Cullen: Thank you very much, Rachel, for taking the time to talk with us today and for putting together such a comprehensive presentation!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
Featured Speakers: Lisa M. Letourneau MD, MPH, Senior Advisor, Delivery System Change, DHHS Commissioner’s Office, and Sharon McDonnell, MD, MPH, Director, COVID-19 Social Services, DHHS. www.maine.gov/dhhs Topic: COVID-19 Continued Basics including the importance of masking, social distancing, the now more-than-ever importance of testing & vaccination, and updates on treatment options, as well as ongoing social service supports.
Cullen: I am very pleased to welcome Lisa M. Letourneau MD, MPH, Senior Advisor, Delivery System Change, DHHS Commissioner’s Office, and Sharon McDonnell MD, MPH, Director, COVID-19 Social Services, who will be presenting on COVID-19 continued basics including the importance of masking, social distancing, testing, and vaccination, and updates on treatment options, as well as ongoing social service supports. Lisa and Sharon, thank you both very much for presenting today, it’s wonderful to have you!
Sharon McDonnell: Lisa and I both work with the Department in the Commissioner’s Office in response to the COVID-19 pandemic.
Lisa Letourneau: I’m an internist by background and as Sharon stated I currently work in the DHHS Commissioner’s office along with her. I’m going to go through some of the clinical issues, and Sharon will cover the social services aspect. Some of these slides are very clinical in nature so I’ll keep it higher level and focus on what’s new.
Begin Presentation (Click here for the presentation)
Lisa: Boosters: The largest change with vaccines is that we’re recommending boosters for everyone. There are some walk-in vaccine clinics setup in the State – in Augusta, Auburn, and Sanford – in hopes of getting as many people boosters as possible who want them. You’ll hear people asking if it’s worth it to get a booster or not if you’re going to potentially contract COVID anyway. The answer is absolutely yes, because people with boosters are substantially less likely to get seriously ill.
Implications of Omicron: We still don’t know a lot about the Omicron variant, but we know there are multiple mutations in it and the overall implications are unknown. The rate of spread in other countries suggests that it has a higher rate of transmissibility. We haven’t detected a case of Omicron in Maine yet, but it’s likely here we just haven’t detected it. Reports from other countries have shown that Omicron may cause milder disease, but that is still a large unknown. Protections against Omicron are the same: masking and social distancing, vaccination, and boosters.
Treatment options: COVID-19 Monoclonal antibodies are indicated for people at high risk for developing severe COVID-19 disease. There is a limited federal supply and increased demand has created shortages. There are also some brand new long-acting antibodies, for people who are severely immunosuppressed. Oral anti-viral drugs are on the horizon, but monoclonal antibodies are far more effective at preventing/treating severe disease. It’s anticipated that the initial supply of the oral anti-viral drugs will be very constrained.
Sharon: Maine DHHS COVID-19 Community Care & Social Support: Referrals to us can be made via an online form, via email, on our website, or simply Google “Maine DHHS COVID Social Support” and the referral form will come up among the top search results. Our core services are available to all Mainers who are cases or contacts. When you make a referral, the more information you provide the better. We use geography, preferred language, culture, etc., to coordinate referrals to funded partners statewide. We have received 6,406 referrals for a total of approximately 19,340 Mainers in households, shelters, or outbreaks since the program began in June of 2020.
Cullen: I know that many people here may be associated with people living in group homes or shared living arrangements, and some people remain home with family. There are a variety of different living situations for people with ID/DD.
Sharon: We’ve worked with many group homes on providing information and services.
Discussion:
-It was asked if the monoclonal antibodies can be used as a preventative measure.
Lisa: That’s a great question. They could be used for preventative measures; however, due to the supply constraint we’ve reserved use for people with COVID-19. But if you know of a case where someone tested positive and exposed a group of people at very high risk you could reach out.
Sharon: We could get someone out there to do testing very quickly. Then, you could get results within a day and get the referral process started.
-A parent asked if they provide one-on-one education for people who are vaccine hesitant, specifically direct support providers. She stated she’s found that conversations about vaccines among people with established relationships and shared trust have been helpful.
Sharon: There are vaccine promoters at agencies all across the state. There are groups specifically working on that currently, including groups in the Lewiston/Auburn area. In the more rural areas, there are campaigns specific to social profiles such as hunters, etc. The community vaccine line staff are very willing to do outreach calls to folks, but that likely wouldn’t have the same affect. There is a group of physicians giving talks to folks about how to talk to people who are vaccine hesitant, because generally it’s much more important to listen versus talk, to ask questions versus give information.
Cullen: Thank you both again, for taking time out of your very busy schedules to give this very informative presentation. Well done!
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: Really quick I’ll provide some information:
- FMAP American Rescue Plan Act (ARPA) updates
- CMS has provided final approval of the spending plan. We continue to work with them on the claiming process (to actually receive the 10%) and must pursue waiver/state plan amendments for any projects where a Medicaid policy change is required. The bonus initiative continues to be our priority, and people will start to see evidence of other projects starting up in early 2022.
- FAQs for Home and Community Based Services (HCBS) Workforce Retention and Recruitment Initiative Supported Under Section 9817 of the American Rescue Plan Act (ARPA) outlines how agencies can submit information to receive bonuses for direct support workers and their supervisors who work in HCBS programs funded by MaineCare. These individuals are eligible to be paid bonuses under this initiative through their agencies, which must register to participate and that registration for providers has been extended to Friday, December 17th.
- Appendix K Provision Extensions through March 31, 2022 – Some of those provisions were particularly important to provider agencies to provide flexibility in the provision of services.
- Standardized Needs Assessment - Information of our selection process and initial plan for implementing the Supports Intensity Scale can be found here. There will be much more to come on that process, as it’s at the very beginning stages.
-A provider thanked Betsy and the Department for extending the Appendix K waiver provisions. He asked if there’s been any follow-up with CMS (Centers for Medicare and Medicaid Services) regarding the K waiver retainer payments and modifying the language to allow a larger group of providers to access those funds.
Betsy: Yes, we have had those conversations, though I don’t have the exact details handy. I’ll try to have updates on that for tomorrow’s Stakeholders’ call.
-A parent stated that the K waiver and the CMS approval are both great news. However, she stated that her son’s group home had to close, and he was lucky to have been able to move to a different one. She stated that these changes are happening far too slowly. She asked if they are tracking the closures that have already occurred while waiting for these additional federal funds.
Betsy: We are keeping track of that through our Licensing Department. We agree with you that the workforce shortage, the closing of homes, and the challenges agencies are having with finding staff are very significant and we’re very aware of that. We’re working with some individual agencies to support them as much as we can. I will look into this and share any updated information we have (see below).
-A parent stated that in the last Legislative Session the rates were increased so that DSPs could earn 125% of minimum wage, which is great. However, OMS (Office of MaineCare Services) opposed many of the rate increase initiatives in the last session. And, with the current workforce crisis worsening additional increases will be necessary, as what was put in place will likely not be enough to retain the current workforce let alone attract people to the field. She asked if OMS, the Commissioner of DHHS, and/or the Governor would support additional wage increases either through legislation or the supplemental budget process.
Betsy: We’ve been pretty clear that a lot of additional funding in a variety of different ways has been added to the support system. Our ability to further increase rates/wages relies heavily on the FMAP reimbursement. The Build Back Better Act, which I know Cullen has covered in these meetings and will cover in the Federal update, has a lot of measures that will greatly help the system of care if it passes.
Cullen: Thank you very much, Betsy, for being here today, this information, and all that you’re doing!
After the meeting Betsy provided the following follow-up information:
Implemented
- $65M in permanent rate increases over the biennium: effective 7/1/21
- Up to $18.9M in Retainer Payments for Community and Work Support: payments in process
- Up to $126M in bonuses for direct support workers and supervisors: payments planned to begin in January 2022
- Permanent increases effective January 2022 to implement Workforce Commission recommendation for MaineCare rates to support 125% of minimum wage
Regarding home closures that we are tracking. For licensed homes, the information is below:
- Closure information since May 2021 - updated through December 11, 2021
- 30 homes have closed temporarily or permanently, with a total capacity of 73 beds, average size just under 3
- A few closed for unique reasons, such as owner retirement, but nearly all cited staffing as the primary reason
- Most agencies were able to move individuals within their agencies, but some individuals had to move to a new provider
- The closures occurred in 11 counties in every region of the state, from Aroostook to York. Somerset and Cumberland Counties have the greatest number with 5 homes closing in each county.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows was unable to attend the meeting but sent an update via email: I will be working with Betsy to see if we can do a combined presentation with this group, possibly in February or March. I do not have any other updates other than the continuation of the transition work between Children’s Behavioral Health Services and the Office of Aging and Disability Services for an improved transition process.
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Libby Stone-Sterling: We’re very excited about partnering with OADS to do some co-location of OADS staff in Voc Rehab offices.
We’re getting ready for our third cohort of our Peer Social Services Curriculum. We’re working with the University of Maine and expect to start the third cohort in January. If people are interested please reach out to me, as we want to include as many people as possible who are interested across the state. (Email: [email protected])
Bureau of Rehabilitation Services (BRS) Stakeholder Meetings – ASL and CART will be available.
This is an opportunity to learn more about programs and services as well as offer your feedback! Meetings occur the 2nd Monday of each month from 9-10 am. The meeting schedule is as follows: Dec 13, 202, Jan 10, 2022, Feb 14, 2022, March 14, 2022, April 11, 2022, and May 9, 2022. Join Zoom Meeting:
https://mainestate.zoom.us/j/85030661047?pwd=dXpnRXhNREMwRy81bnhySVUramM0Zz09
-A self-advocate sked if they’ve looked into the Department of Labor funding for transportation.
Libby: We do have a team here working on transportation, so we’ll hopefully be able to share an update in the future.
Cullen: Thank you, Libby!
LD 924 Task Force Update:
Linda Lee: LD 924, Resolve, To Establish a Task Force To Study the Coordination of Services and Expansion of Educational Programs for Young Adults with Intellectual or Developmental Disabilities To Identify Barriers to Full Societal Integration, is the bill to establish a task force to look at the transition process. A few parents came together to work with legislators on this bill for the past three years, and it finally passed this year. The first meeting of the taskforce has occurred. We’re all looking to see how we can create systems that work better for people. We created a survey for parents to solicit input to bring as many voices as possible to the table. I’ve very grateful to everyone who helped put together the questions for the survey. We’ve also put together a one-minute survey, to have some data to bring back to the Task Force in January (see below for the One-minute Parent-to-Parent Survey announcement and link).
Maggie Hoffman: I wanted to add that survey responses are completely confidential.
- LD 924 Taskforce One Minute Parent-to-Parent Survey: We are contacting you as fellow parents of young adults with disabilities. The Maine State Legislature has given us all the wonderful opportunity through the newly formed L.D. 924 Task Force to dig in and examine how well current services are meeting our son or daughter’s needs. We are parents but also nominated members of this Task Force and are inviting you to participate in this one-minute survey because your responses can help improve the Adult Services, Employment, and Continuing Education systems for our sons or daughters with disabilities.
Please take ONE MINUTE NOW to answer the YES or NO questions. If you have a few extra minutes, please add your comments in the boxes below the questions. Your answers will be kept confidential within the Task Force members, and your name will not be shared (click here for the survey). Please feel free to contact us parents if you have any questions or concerns: Linda Lee: [email protected] and/or Maggie Hoffman: [email protected].
Cullen: Thank you, Linda and Maggie, for this information and all your work! We will add this as a standing agenda item for next month’s meeting so we can cover this work in more detail.
Disability Rights Maine (DRM) Update:
Lauren Wille: The Employment First Coalition is now back in full swing. We’ll review the recommendations made last time the group met and go from there.
SMACT (Southern Maine Advisory Council on Transition)
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 ([email protected]). SMACT meetings occur the first Friday of each month throughout the school year. The 12/3 meeting was cancelled due to unforeseen circumstances. The January meeting will be on Friday, 1/7/2022, and will feature a presentation from the National Alliance on Mental Illness, Maine about their mission and services.
Federal & Housing Updates:
Cullen: Teague Morris from Senator King’s office is here today. Teague, thank you for being here and please extend our sincere thanks to Senator King for his support and advocacy on the Build Back Better Act.
- Federal Budget: On 12/3 Congress passed and the President signed another short-term Continuing Resolution to keep the government open through 2/18/22. The CR maintains current federal funding levels. Advocates are working to ensure that the final FY 22 budget includes the highest possible funding for HUD programs, including Section 8.
- Senate FY 22 T-HUD Budget: On 10/19 the Senate Appropriations Committee released its FY 22 THUD bill. Overall, the bill increases funding for HUD programs in FY22, although at levels lower than those proposed in the House. The Senate bill funds HUD at $65.4 billion, or $5.7 billion above FY21 enacted levels. Unfortunately, the Senate bill does not include the major expansion of rental assistance proposed by both President Biden and the House.
- Congress’ Budget Resolution & “Build Back Better Act” Infrastructure Reconciliation Package: on 11/19 the House voted to approve the Build Back Better Act. The bill now goes to the Senate, where further changes to the bill are expected per NLIHC. As passed by the House, the Build Back Better Act is a $1.75 trillion package – negotiated down from $3.5 trillion – and includes $150 billion in affordable housing investments, including:
- $25 billion in rental assistance for hundreds of thousands of households.
- $65 billion to preserve our nation’s public housing infrastructure.
- $15 billion for the national Housing Trust Fund (HTF) to build and preserve over 150,000 homes affordable to extremely low-income households.
- $150 billion for Home and Community-Based Services.
- The Decent, Affordable, Safe Housing for All (DASH) Act: On 8/18 Senate Finance Committee Chair Ron Wyden (D-Ore.) announced the DASH Act, legislation to make a generational investment to which would tackle the housing affordability crisis, among various other important measures. Pertinent to this group, the legislation increases funding for low- and middle-income housing development and provides $10 billion in the Housing Trust Fund (HTF) for the next ten years to states to acquire, develop, or rehabilitate deeply affordable housing. In Maine, resources from the HTF are the primary funding mechanism for supportive housing development.
State Legislature Update:
Laura Cordes – Executive Director, MACSP (Maine Association for Community Service Providers): We’re headed towards the Second Session of the 130th Legislature, known as the short session, which starts the first Wednesday of January, and is scheduled to end the second Wednesday in April. There were about 350 that were carried over from the First Session. The Legislative Council met to review approximately 300 emergency bills submitted by legislators; about 150 of those bills got through (click here for the final list of bills). I created a Google Doc for this Session that includes the LDs, LRs, and carry over bills as I know them, which I’ll update throughout the Session. (Click here for the Google Doc for the 2nd Session of the 130th Legislature that Laura will review more in-depth next month.)
Other Business:
Cullen: I want to express my great appreciation for all your hard work over this past year. Thank you! I wish you all a wonderful Holiday Season and a happy and healthy New Year!
The next meeting will be on Monday, January 10, 2022, 12-2pm, via Zoom*.
Featured Speaker & Topic TBD.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2022 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].