February 13, 2023
Minutes
Minutes
Attendees via Zoom: Abby Stivers, Alexandria Twombly, Amanda Parker, Andy Taranko, Ann Bentley, Anne Marie Riley, Betsy Hopkins, Bonnie Robinson, Bryan Gordon, Carol Snyder, Darla Chafin, David Cowing, Debbie Dionne, Deborah Johnson, Diane Boas, J Richardson Collins, Jamie Whitehouse, Janet DiBiase, Jeff McFarren, Jen Greslick, Joyce Daggett, Julianne Zaharis, Kathy Rickards, Kim Humphrey, Lane Simsarian, Laura Cordes, Laurie Coldwell, Libby Stone-Sterling, Lily Lin, Linda Lee, Liz Hansen, Maggie Hoffman, Margaret Cardoza, Mark Kemmerle, Mary Chris Semrow, MaryBeth Briggs, Michaela York, Misty Marston, Monique Stairs, Nancy Peavy, Paul Saucier, Robin Levesque, Ryan Gallant, Samantha Hogan, Sammy-Ellie MacKinnon, Scott McKeough, Sarah Robinson, Shane Ashe, Shelley Zielinski, Staci Converse, Stacy Lamontagne, Steph Barrett, Suellen Doggett, Susan Farwell, Tina Riley, Tracy Williams, Vickey Merrill, Cullen Ryan, and a few people who didn’t identify themselves and/or left prior to the conclusion of the 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 Speakers: Paul Saucier, Director, DHHS Office of Aging and Disability Services (OADS). www.maine.gov/dhhs/oads Topic: Review of the Governor's Biennial Budget as it pertains to DHHS-OADS and an overview of two Department bills in the Legislature.
Cullen: Today I am very pleased to welcome Paul Saucier, Director of DHHS-OADS, who has graciously come back to present a review of the Governor's Biennial Budget as it pertains to DHHS-OADS and an overview of two Department bills in the Legislature. Thank you very much for taking the time to be with us today!
Paul Saucier: Thank you, I’m happy to be here to be able to present on OADS initiatives in the Biennial Budget. I’ll start with some historical information, that I also included in last month’s presentation, just to reground us.
Begin presentation (Click here for the presentation):
Paul: The Governor’s proposed Biennial Budget includes $84 million for access to Disability Services. This includes:
Lifespan Bill: LR 151, An Act to Promote Seamless and Flexible Home and Community Supports Across the Lifespan for Individuals with Intellectual and Developmental Disabilities or Autism. The bill is not yet printed, but will establish a waiver to provide services to people regardless of their level of need. It also:
-Establishes a stakeholder group to advise on design and implementation (which is already up and running). It also
-Establishes goals for the Lifespan waiver (for details on each goal please see Paul’s presentation):
-For more information, see our Lifespan webpage, including a plain language description.
When the Lifespan waiver opens in 2025, we will close applications for Sections 21 and 29; however, those that are currently receiving Sections 21 or 29 at that time will be able to remain on those waivers. After the Lifespan program has been up and running for two (2) years or so people on Sections 21 or 29 would be able to transition to the Lifespan waiver. The advisory committee is very interested in the timeline around this for a variety of reasons so more to follow on this.
Licensing and Autism Definition Bill: LD 449 An Act to Authorize the Department of Health and Human Services to License Home-based and Community-based Services for Persons with an Intellectual Disability, Autism Spectrum Disorder or a Related Condition or an Acquired Brain Injury and Define Autism Spectrum Disorder. This bill does two distinct things:
-Enables the Department to update the definition of autism spectrum disorder to align with the current version of the Diagnostic and Statistical Manual (DSM).
-Authorizes DHHS to modernize IDD and Brain Injury licensing.
-A self-advocate congratulated the Department on its Lifespan work. She stated that historically this group has advocated for this type of service provision and meeting people where they’re at. She asked if there’s any update on transportation.
Paul: There’s really nothing new to report on transportation. I think when we look at payment methods for the Lifespan waiver, we’ll be really clear about what’s included in the rate as far as transportation goes. There’s a lot of excitement more generally in Maine for the Maine Department of Transportation’s new community-based transportation approach. We’re certainly talking with them about what more can be done to improve transportation resources in Maine. I do know that the topic of rural versus urban communities and their unique needs/challenges, including transportation, is part of the on-going discussion for the Cabinet on Aging.
-A self-advocate stated that language is important and the term “group home” doesn’t convey that it truly is someone’s home.
Paul: Thank you for that. Having common, understandable language is important but I understand what you’re saying, and I will take that feedback back.
-A parent stated that she noticed that the Department is looking at licensing for community supports. She stated that she has been struggling to find support for her daughter, as she requires two-to-one support. She asked if this might open up additional options.
Paul: I have to be honest with you and say that licensing usually does not increase options, but it does clarify expectations. For such an important service we want to articulate clearly what the service is and what the expectations are. For Section-29 we have adopted self-direction, so that is an option as opposed to using an agency for the service.
Betsy: Definitely talk to your case manager about this and I can also provide a link with more information on this option. (Click here for information on self-direction from the Maine Developmental Disabilities Council.)
-A parent stated that continuity of case management has been a challenge as well.
Paul: We’re hoping that the new, increased rate for case managers will help, but we’re aware that there is a shortage of case managers.
-A parent stated that OADS believes that people on Section 21 and 29 will want to transition to the Lifespan waiver. She asked what they envision the incentives will be for this.
Paul: There will be a robust version of self-direction, which we’re hearing is a desire for a lot of people. We have 13 or 14 innovation projects that were just funded that will result, we hope, in a broader constellation of services as people figure out what services work well for their wants/needs. For example, we have grants for shared living providers who want to provide enhanced behavioral support, which would be a game-changer if it works well for people. We have an organization that offers remote support but wants to open it up to other agencies, which is another innovation project with which we’re involved. I don’t think remote supports ever replace people, but they sure can augment people and provide more overall supervision that otherwise would not be available. And finally, I tend to look at the Lifespan at a high level and reflecting back on the debates we’ve had about Sections 21 and 29, those debates have sometimes been divisive. Some people have been able to get into one program and not the other, which creates the perceived “haves and have nots”. To me, the Lifespan waiver offers a huge advantage as it would allow services to change as needs do without having to changes waivers. How do we plan for the long-term when we don’t know which service we’re going to be able to access? With the concept of Lifespan, someone can start working on their lifespan planning at age fourteen.
-A parent asked how the rate-setting process would be able to accommodate changes in services and supports.
Paul: There will still be rates associated with services. Fundamentally that process won’t change. What many providers are interested in is moving to a rate system that’s a true per diem system – a daily rate for a service. When you move to a system like that you have to be able to accommodate differences for individuals. We need to do something to ensure that the rates can be adjusted according to the needs of the individuals. That’s one of the important innovations we’re looking at.
-A parent thanked Paul for making the budget very easy to understand. She stated that her son, and her friend’s son, have Section 29 and a lot of the hours go unfilled. Both of their sons have been waiting for Section 21 for quite some time. They’re very eager to get into the Lifespan waiver because they believe it will be responsive to the person in the moment and grow and shrink in terms of services based on the person. She stated that for that to happen it sounds like it’s five to six years down the road. For aging parents this is a challenge; their children may quickly outgrow what Section 29 can provide when they can’t access Section 21 and can’t transition to the Lifespan.
Paul: We have proposed January of 2027 as the date when people receiving Sections 21 or 29 could begin to transition to the Lifespan waiver if they desire. As I mentioned, that timeline is a point of discussion that the Advisory Committee is very interested in, for all of the reasons you just mentioned. Between now and 2025 when Lifespan opens, we will continue to serve Section 21 Priority 1, which is no comfort for those waiting for the service. Once Lifespan opens our reserve capacity will shift to lifespan. So, for folks who have needs that change/increase that would be an option. We’re looking to make Section 29 self-direction more robust permanently and cover a broader array of services which might help as an interim strategy as well. Currently self-direction is included in Section 29 through our Appendix K waiver, granted under special authority. This lasts 6 months beyond the end of the public health emergency – which is November 11th. We are working on all of the changes that were made under the Appendix K waiver that we want to make permanent so that they’re in place prior to that date.
Cullen: Thank you both for being here and for providing all of this information. Thank you again, and well done!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
Featured Speakers: Steph Barrett, Manager of Quality Assurance and Training, DHHS-OADS. www.maine.gov/dhhs/oads Topic: Quality Assurance.
Cullen: I am also pleased to welcome Steph Barrett, Manager of Quality Assurance and Training with DHHS-OADS to present on Quality Assurance.
Steph Barrett: Thank you for having me. I’ve been at the Department for the better part of two decades. I started with the Department working with Children’s Services. I’ve been with OADS for a few years now. This is a very complex system, and even coming in with a high familiarity in rulemaking and MaineCare it’s still been a large learning curve.
Begin presentation (Click here for the presentation):
Steph: I’ve put together a few slides to guide the conversation, starting with where we’ve been and where we’re going. When I came on board we started looking at what OADS had been doing for quality assurance and what direction we needed to go to get where we wanted to be. We’re also in the process of developing procedures for all aspects of quality. This will provide structure for the variety of quality processes that we do. In conjunction with what we’re doing for quality there have been rather large initiatives going on, such as the HCBS implementation initiative, which ultimately will be integrated with our quality work. We started the quality assessment work with a gap analysis followed by stakeholder engagement for feedback on what quality looks like to a variety of stakeholders. Then we conducted an internal assessment of process, data, and job function. Now we’re starting to head towards the “planning for the future” stage. OADS’ Quality and Training Services is working on a variety of quality functions in partnership with providers to assure exceptional quality services for individuals with IDD and Autism in Maine (see slide 9 of the presentation for details on the quality functions). We’re also looking at the future of quality, including but not limited to full, complete HCBS integration into our quality work.
Discussion:
-Many parents stated that Steph’s background and approach appears to be perfectly suited to this work and this is exactly what parents/care givers want to hear. It was asked how agencies can be given tools and support around this, and how they can be publicly/socially thanked for their quality work.
Steph: Ensuring providers know that we’re here to ensure we’re all doing better is paramount to our work. The public-facing quality metric drives that recognition factor. My staff are regularly trained to look for the good along with the areas for improvement. I actively encourage staff to identify what’s going well and recognizing that directly with the provider to foster that encouragement.
-A self-advocate stated she would like to see more inclusion and greater diversity in terms of who’s involved in this quality improvement work. She stated that more oversight at the programmatic, systematic level would be advantageous. She stated that the recognition of innovative projects is very important as well.
Steph: Certainly, we are taking bigger picture looks at areas for improvement. There’s a Commissioner’s Office-led project related to workforce training, that’s one area with a very close relation to quality.
-A parent stated that his son’s agency has always had a keen eye towards quality assurance (QA); however, it wasn’t always clear what that meant. This presentation was very helpful for a QA 101. He stated that case managers are essential to a really good QA program but there’s a lot of turn over with case managers, and this is a very complicated system. This is a huge challenge. He added that it seems every time there’s a new and great idea in Augusta it seems case managers have another job to do and another piece of paper to complete. It’s important to remember the enormous weight on case managers’ shoulders.
Steph: You’re exactly right. Case managers play a critical role as they’re the drivers of the plan, and a good plan is the foundation of quality. Historically, the weight of quality was placed on the case managers. Due to changes, quality couldn’t live with case managers the way it had which is why we’re embarking on this new QA journey. Case managers remain a huge piece of this and drivers of QA overall. We are making changes that we hope will make it back to that level of attracting and retaining really high-quality staff. We have a laser focus on workforce training right now. We are trying to make it as easy as possible for people to do well, and we’re also trying to outline what quality really looks like.
Cullen: Thank you, Steph, for such a thorough, informative presentation!
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: We have a number of different positions open within OADS currently for which we’re looking to hire. Many of you know people and have connections that could be helpful in filling these positions so I wanted to share this information with you all. One position I’m really excited about is the Housing Specialist position, who will help get us back into connecting closely with MaineHousing, looking at different ways to provide rental subsidies to folks, as well as helping us with innovative housing supports. Please feel free to post and share the list of our current openings, which includes many other positions. As Paul mentioned, the Lifespan work is well underway. For more information, please see our Lifespan Project webpage. Additionally, our SIS-A Implementation Project is also underway; please see our Needs Assessment Implementation project webpage for more information. For information about our HCBS Innovation Pilot Grants please see our HCBS Innovation Pilot Grants webpage.
Cullen: That Housing Specialist position at OADS will be really important in working with MaineHousing, especially since MaineHousing has included a permanent supportive housing element to their Low-Income Housing Tax Credit (LIHTC) program.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows could not attend today’s meeting but sent the following update via email: OCFS is not able to be present Monday due to an all-day staff training. Here are some OCFS Updates:
DOL – Division of Vocational Rehabilitation (VR) - www.maine.gov/rehab/dvr
Libby Stone-Sterling: We’ve already started planning for the summer in hopes of getting as many people with disabilities as possible working who wish to do so. For people who aren’t interested in working over the summer, we have a lot of great programming including work-based learning. This year we’ll also be continuing our Step-Up program for people looking at going to college. There will be college bus tours again this year at the end of June. We are continuing with our PEERS social skills curriculum for young people ages 14-24 with ASD. The 16-week group is held over Zoom and teaches and reinforces many practical communication skills.
-A self-advocate praised VR and all their work. She asked how they were addressing transportation for all of these exciting programs.
Libby: We’re trying to think of a variety of options for summer employment options for people, including a broad array of creative transportation options. There’s a lot of things that can be done virtually, but that’s different from getting out into the community and that requires a means of transportation.
Office of Special Services and Inclusive Education (OSSIE) - www.maine.gov/doe/learning/specialed - No update
SMACT (Southern Maine Advisory Council on Transition):
Nancy Peavy: SMACT meetings are held quarterly. There are two meetings left this year. The next meeting is Friday, 3/3 and will feature National Alliance for the Mentally Ill Maine (NAMI Maine). The last meeting of the year is on Friday, 5/5 and will include Diane Luce with Maine Medical Center presenting on benefits counseling. 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]).
Disability Rights Maine (DRM) Update:
Staci Converse: As I’ve mentioned at the last couple of meetings, we conducted a survey on State Park access in hopes of making Maine’s state parks more accessible. The video on this, Accessible Outdoors, that I mentioned has been posted and available to watch online. Regarding the work we’re doing on ending sexual violence against people with disabilities, for which we collaborate with MECASA (Maine Coalition Against Sexual Assault), as you know DRM was awarded a grant from DOJ’s OVW - Training and Services to End Violence Against Women with Disabilities Grant Program. I’m excited to announce that we’ve hired our director for this work and you all know her, it’s Sammy-Ellie MacKinnon who had been in the meeting today but had to leave early.
LD 924 Task Force Update:
Linda Lee: The LD 924 final report-out presentation to the Legislature is tomorrow, 2/14 1:00 pm. Anyone watching via the Legislature’s streaming service can watch at the following link: https://legislature.maine.gov/Audio/#208. I want to thank everyone for being such a huge part of LD 924, including its coming into being. This process has been challenging but very eye-opening and rewarding. After months and months of searching we came up with very little data on people because we couldn’t find them. There needs to be a system through which people can be individually identified by a unique ID number and tracked. At next month’s meeting, after the report-out, I would be happy to share details of the report with the group.
Federal & Housing Updates:
Cullen:
State Legislature Update
Cullen: As this group knows, the First regular Session of the 131st Legislature convened on Wednesday, 12/7/22. Cloture (when bill titles must be submitted for consideration) occurred on 12/30/22. This being the First Session of the Legislature, any bill could be submitted for consideration. As such, the Legislature will be considering some 2,000+ bills this Session, in addition to the Supplemental Budget and the Biennial Budget.
Laura Cordes – Maine Association for Community Service Providers (MACSP): I created a Google doc using the format of the previous sessions to support the MCHQS' interest in monitoring and engaging in bills of interest in the 131st Legislature. The doc contains updated lists of key committees and their members, and a table for Coalition members to track bills (click here for more information). It is open to all members to edit and update. I will continue to add to and update the bill list and update this group as we move forward throughout the session. Committee assignments have been made and bills continue to make their way through the Revisor’s Office and are being posted on the Legislature’s website (click here for the new Bill Tracking site).
A few items to note:
Cullen: This is going to be a very busy Legislative Session. We will keep this group apprised as bills make their way through the Legislature, so please be on the lookout for action alerts. We’ll likely get called upon over the next couple of months for our expertise so please raise your voice when the opportunity arises. It’s still a good time to reach out and introduce yourself to your State Representatives and your State Senator. Tell your story, let them know the importance of resources and services for you and your family, and educate them about your needs. Our collective voice is very powerful.
Other Business:
Samantha Hogan: Thank you for having me at these meetings. I’m an investigative reporter with the Maine Monitor. I’m working on a project about the probate courts, specifically adult guardianship. If anyone is interested in speaking with me or sharing your story, please reach out: [email protected] or 860-575-5583.
Kim Humphrey – Community Connect: Next month is Disability Awareness Month. There will be a screening at Curtis Memorial Library of our digital stories, followed by discussion. The date is still to be determined but you can email me if you’d be interested in attending: [email protected]. We will be repeating the digital story workshop this spring as well; feel free to reach out if you’re interested.
The next meeting will be on Monday, March 13, 2023, 12-2pm, via Zoom*.
Featured Speakers: Dr. Todd Landry, Director, DHHS-OCFS, Dean Bugaj, Associate Director, Children's Behavioral Health Services, DHHS-OCFS, and Teresa Barrows, Children’s Behavioral Health Services Manager, DHHS-OCFS. Topic: Biennial Budget initiatives as they pertain to Children’s Behavioral Health Services (CBHS) and a review of the annual CBHS Report.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(In 2023 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].
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 Speakers: Paul Saucier, Director, DHHS Office of Aging and Disability Services (OADS). www.maine.gov/dhhs/oads Topic: Review of the Governor's Biennial Budget as it pertains to DHHS-OADS and an overview of two Department bills in the Legislature.
Cullen: Today I am very pleased to welcome Paul Saucier, Director of DHHS-OADS, who has graciously come back to present a review of the Governor's Biennial Budget as it pertains to DHHS-OADS and an overview of two Department bills in the Legislature. Thank you very much for taking the time to be with us today!
Paul Saucier: Thank you, I’m happy to be here to be able to present on OADS initiatives in the Biennial Budget. I’ll start with some historical information, that I also included in last month’s presentation, just to reground us.
Begin presentation (Click here for the presentation):
Paul: The Governor’s proposed Biennial Budget includes $84 million for access to Disability Services. This includes:
- $34M to add 900 individuals to Section 29 by 2025 (50 per month) – the goal is to eliminate the Section 29 waitlist in its entirety by 2025.
- $3M to continue reserve capacity in Section 21.
- $42M for future cost-of-living rate increases in Section 18, 20, 21, 29, Intermediate Care Facilities (Section 50), and PNMI-Fs (Section 97).
- The MaineCare rate-setting system has really taken hold. The biennium will go through the 3rd and 4th cycles of this rate-setting process. MaineCare put into statute the approach it would use to do rate setting going forward. Every year it will publish services that have not had rate reviews in a long time and do full cost studies. All the other services, if they’re not having a full cost study, will have a cost-of-living adjustment (COLA). The Budget anticipates there will be two additional rate adjustments, in January 2024 and January 2025.
- $5M to launch the Lifespan project and enroll 540 individuals in the Lifespan waiver in 2025 (in the last six months of the Biennium).
- For more details see the DHHS-OADS Budget Blog.
Lifespan Bill: LR 151, An Act to Promote Seamless and Flexible Home and Community Supports Across the Lifespan for Individuals with Intellectual and Developmental Disabilities or Autism. The bill is not yet printed, but will establish a waiver to provide services to people regardless of their level of need. It also:
-Establishes a stakeholder group to advise on design and implementation (which is already up and running). It also
-Establishes goals for the Lifespan waiver (for details on each goal please see Paul’s presentation):
- Flexibility across the lifespan
- Seamless transitions
- Early planning for independence
- Innovation
- Simplified and effective payment methods
-For more information, see our Lifespan webpage, including a plain language description.
When the Lifespan waiver opens in 2025, we will close applications for Sections 21 and 29; however, those that are currently receiving Sections 21 or 29 at that time will be able to remain on those waivers. After the Lifespan program has been up and running for two (2) years or so people on Sections 21 or 29 would be able to transition to the Lifespan waiver. The advisory committee is very interested in the timeline around this for a variety of reasons so more to follow on this.
Licensing and Autism Definition Bill: LD 449 An Act to Authorize the Department of Health and Human Services to License Home-based and Community-based Services for Persons with an Intellectual Disability, Autism Spectrum Disorder or a Related Condition or an Acquired Brain Injury and Define Autism Spectrum Disorder. This bill does two distinct things:
-Enables the Department to update the definition of autism spectrum disorder to align with the current version of the Diagnostic and Statistical Manual (DSM).
-Authorizes DHHS to modernize IDD and Brain Injury licensing.
- Consistency: Currently, the Department licenses group homes of all sizes. Authority to license homes with 3 or more beds is clear in statute, but licensing for one- and two-bed homes is not. The Department does not currently license other critical areas, such as community support services and work supports, where the same need for standards exist.
- Relevance to the people supported: Currently, these residential services are licensed under the Assisted Housing program. This means that a small group home for individuals with intellectual disability is treated similarly to a large memory care center for older adults or a PNMI-C for adults with significant medical needs. Disability services residential services are unique and ought to be treated as such and not lumped in with larger assisted housing licensing.
- Integration with the HCBS Global Rule: Any actual or perceived conflicts will be addressed in new licensing rules to ensure alignment of HCBS policy for clarity and effectiveness.
- Efficiency: Currently, a separate license must be issued for each residential site operated by an agency. Instead, the Department proposes to license agencies. An agency would have one license for its IDD services, for example, with multiple locations and/or services listed on the license.
-A self-advocate congratulated the Department on its Lifespan work. She stated that historically this group has advocated for this type of service provision and meeting people where they’re at. She asked if there’s any update on transportation.
Paul: There’s really nothing new to report on transportation. I think when we look at payment methods for the Lifespan waiver, we’ll be really clear about what’s included in the rate as far as transportation goes. There’s a lot of excitement more generally in Maine for the Maine Department of Transportation’s new community-based transportation approach. We’re certainly talking with them about what more can be done to improve transportation resources in Maine. I do know that the topic of rural versus urban communities and their unique needs/challenges, including transportation, is part of the on-going discussion for the Cabinet on Aging.
-A self-advocate stated that language is important and the term “group home” doesn’t convey that it truly is someone’s home.
Paul: Thank you for that. Having common, understandable language is important but I understand what you’re saying, and I will take that feedback back.
-A parent stated that she noticed that the Department is looking at licensing for community supports. She stated that she has been struggling to find support for her daughter, as she requires two-to-one support. She asked if this might open up additional options.
Paul: I have to be honest with you and say that licensing usually does not increase options, but it does clarify expectations. For such an important service we want to articulate clearly what the service is and what the expectations are. For Section-29 we have adopted self-direction, so that is an option as opposed to using an agency for the service.
Betsy: Definitely talk to your case manager about this and I can also provide a link with more information on this option. (Click here for information on self-direction from the Maine Developmental Disabilities Council.)
-A parent stated that continuity of case management has been a challenge as well.
Paul: We’re hoping that the new, increased rate for case managers will help, but we’re aware that there is a shortage of case managers.
-A parent stated that OADS believes that people on Section 21 and 29 will want to transition to the Lifespan waiver. She asked what they envision the incentives will be for this.
Paul: There will be a robust version of self-direction, which we’re hearing is a desire for a lot of people. We have 13 or 14 innovation projects that were just funded that will result, we hope, in a broader constellation of services as people figure out what services work well for their wants/needs. For example, we have grants for shared living providers who want to provide enhanced behavioral support, which would be a game-changer if it works well for people. We have an organization that offers remote support but wants to open it up to other agencies, which is another innovation project with which we’re involved. I don’t think remote supports ever replace people, but they sure can augment people and provide more overall supervision that otherwise would not be available. And finally, I tend to look at the Lifespan at a high level and reflecting back on the debates we’ve had about Sections 21 and 29, those debates have sometimes been divisive. Some people have been able to get into one program and not the other, which creates the perceived “haves and have nots”. To me, the Lifespan waiver offers a huge advantage as it would allow services to change as needs do without having to changes waivers. How do we plan for the long-term when we don’t know which service we’re going to be able to access? With the concept of Lifespan, someone can start working on their lifespan planning at age fourteen.
-A parent asked how the rate-setting process would be able to accommodate changes in services and supports.
Paul: There will still be rates associated with services. Fundamentally that process won’t change. What many providers are interested in is moving to a rate system that’s a true per diem system – a daily rate for a service. When you move to a system like that you have to be able to accommodate differences for individuals. We need to do something to ensure that the rates can be adjusted according to the needs of the individuals. That’s one of the important innovations we’re looking at.
-A parent thanked Paul for making the budget very easy to understand. She stated that her son, and her friend’s son, have Section 29 and a lot of the hours go unfilled. Both of their sons have been waiting for Section 21 for quite some time. They’re very eager to get into the Lifespan waiver because they believe it will be responsive to the person in the moment and grow and shrink in terms of services based on the person. She stated that for that to happen it sounds like it’s five to six years down the road. For aging parents this is a challenge; their children may quickly outgrow what Section 29 can provide when they can’t access Section 21 and can’t transition to the Lifespan.
Paul: We have proposed January of 2027 as the date when people receiving Sections 21 or 29 could begin to transition to the Lifespan waiver if they desire. As I mentioned, that timeline is a point of discussion that the Advisory Committee is very interested in, for all of the reasons you just mentioned. Between now and 2025 when Lifespan opens, we will continue to serve Section 21 Priority 1, which is no comfort for those waiting for the service. Once Lifespan opens our reserve capacity will shift to lifespan. So, for folks who have needs that change/increase that would be an option. We’re looking to make Section 29 self-direction more robust permanently and cover a broader array of services which might help as an interim strategy as well. Currently self-direction is included in Section 29 through our Appendix K waiver, granted under special authority. This lasts 6 months beyond the end of the public health emergency – which is November 11th. We are working on all of the changes that were made under the Appendix K waiver that we want to make permanent so that they’re in place prior to that date.
Cullen: Thank you both for being here and for providing all of this information. Thank you again, and well done!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
Featured Speakers: Steph Barrett, Manager of Quality Assurance and Training, DHHS-OADS. www.maine.gov/dhhs/oads Topic: Quality Assurance.
Cullen: I am also pleased to welcome Steph Barrett, Manager of Quality Assurance and Training with DHHS-OADS to present on Quality Assurance.
Steph Barrett: Thank you for having me. I’ve been at the Department for the better part of two decades. I started with the Department working with Children’s Services. I’ve been with OADS for a few years now. This is a very complex system, and even coming in with a high familiarity in rulemaking and MaineCare it’s still been a large learning curve.
Begin presentation (Click here for the presentation):
Steph: I’ve put together a few slides to guide the conversation, starting with where we’ve been and where we’re going. When I came on board we started looking at what OADS had been doing for quality assurance and what direction we needed to go to get where we wanted to be. We’re also in the process of developing procedures for all aspects of quality. This will provide structure for the variety of quality processes that we do. In conjunction with what we’re doing for quality there have been rather large initiatives going on, such as the HCBS implementation initiative, which ultimately will be integrated with our quality work. We started the quality assessment work with a gap analysis followed by stakeholder engagement for feedback on what quality looks like to a variety of stakeholders. Then we conducted an internal assessment of process, data, and job function. Now we’re starting to head towards the “planning for the future” stage. OADS’ Quality and Training Services is working on a variety of quality functions in partnership with providers to assure exceptional quality services for individuals with IDD and Autism in Maine (see slide 9 of the presentation for details on the quality functions). We’re also looking at the future of quality, including but not limited to full, complete HCBS integration into our quality work.
Discussion:
-Many parents stated that Steph’s background and approach appears to be perfectly suited to this work and this is exactly what parents/care givers want to hear. It was asked how agencies can be given tools and support around this, and how they can be publicly/socially thanked for their quality work.
Steph: Ensuring providers know that we’re here to ensure we’re all doing better is paramount to our work. The public-facing quality metric drives that recognition factor. My staff are regularly trained to look for the good along with the areas for improvement. I actively encourage staff to identify what’s going well and recognizing that directly with the provider to foster that encouragement.
-A self-advocate stated she would like to see more inclusion and greater diversity in terms of who’s involved in this quality improvement work. She stated that more oversight at the programmatic, systematic level would be advantageous. She stated that the recognition of innovative projects is very important as well.
Steph: Certainly, we are taking bigger picture looks at areas for improvement. There’s a Commissioner’s Office-led project related to workforce training, that’s one area with a very close relation to quality.
-A parent stated that his son’s agency has always had a keen eye towards quality assurance (QA); however, it wasn’t always clear what that meant. This presentation was very helpful for a QA 101. He stated that case managers are essential to a really good QA program but there’s a lot of turn over with case managers, and this is a very complicated system. This is a huge challenge. He added that it seems every time there’s a new and great idea in Augusta it seems case managers have another job to do and another piece of paper to complete. It’s important to remember the enormous weight on case managers’ shoulders.
Steph: You’re exactly right. Case managers play a critical role as they’re the drivers of the plan, and a good plan is the foundation of quality. Historically, the weight of quality was placed on the case managers. Due to changes, quality couldn’t live with case managers the way it had which is why we’re embarking on this new QA journey. Case managers remain a huge piece of this and drivers of QA overall. We are making changes that we hope will make it back to that level of attracting and retaining really high-quality staff. We have a laser focus on workforce training right now. We are trying to make it as easy as possible for people to do well, and we’re also trying to outline what quality really looks like.
Cullen: Thank you, Steph, for such a thorough, informative presentation!
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: We have a number of different positions open within OADS currently for which we’re looking to hire. Many of you know people and have connections that could be helpful in filling these positions so I wanted to share this information with you all. One position I’m really excited about is the Housing Specialist position, who will help get us back into connecting closely with MaineHousing, looking at different ways to provide rental subsidies to folks, as well as helping us with innovative housing supports. Please feel free to post and share the list of our current openings, which includes many other positions. As Paul mentioned, the Lifespan work is well underway. For more information, please see our Lifespan Project webpage. Additionally, our SIS-A Implementation Project is also underway; please see our Needs Assessment Implementation project webpage for more information. For information about our HCBS Innovation Pilot Grants please see our HCBS Innovation Pilot Grants webpage.
Cullen: That Housing Specialist position at OADS will be really important in working with MaineHousing, especially since MaineHousing has included a permanent supportive housing element to their Low-Income Housing Tax Credit (LIHTC) program.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows could not attend today’s meeting but sent the following update via email: OCFS is not able to be present Monday due to an all-day staff training. Here are some OCFS Updates:
- Transition Program Manager – Hired!
- One Transition Liaison – Hired!
- Interviews continue as we look to hire three more Transition Liaisons.
- OCFS will be presenting at the March Coalition meeting.
DOL – Division of Vocational Rehabilitation (VR) - www.maine.gov/rehab/dvr
Libby Stone-Sterling: We’ve already started planning for the summer in hopes of getting as many people with disabilities as possible working who wish to do so. For people who aren’t interested in working over the summer, we have a lot of great programming including work-based learning. This year we’ll also be continuing our Step-Up program for people looking at going to college. There will be college bus tours again this year at the end of June. We are continuing with our PEERS social skills curriculum for young people ages 14-24 with ASD. The 16-week group is held over Zoom and teaches and reinforces many practical communication skills.
-A self-advocate praised VR and all their work. She asked how they were addressing transportation for all of these exciting programs.
Libby: We’re trying to think of a variety of options for summer employment options for people, including a broad array of creative transportation options. There’s a lot of things that can be done virtually, but that’s different from getting out into the community and that requires a means of transportation.
Office of Special Services and Inclusive Education (OSSIE) - www.maine.gov/doe/learning/specialed - No update
SMACT (Southern Maine Advisory Council on Transition):
Nancy Peavy: SMACT meetings are held quarterly. There are two meetings left this year. The next meeting is Friday, 3/3 and will feature National Alliance for the Mentally Ill Maine (NAMI Maine). The last meeting of the year is on Friday, 5/5 and will include Diane Luce with Maine Medical Center presenting on benefits counseling. 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]).
Disability Rights Maine (DRM) Update:
Staci Converse: As I’ve mentioned at the last couple of meetings, we conducted a survey on State Park access in hopes of making Maine’s state parks more accessible. The video on this, Accessible Outdoors, that I mentioned has been posted and available to watch online. Regarding the work we’re doing on ending sexual violence against people with disabilities, for which we collaborate with MECASA (Maine Coalition Against Sexual Assault), as you know DRM was awarded a grant from DOJ’s OVW - Training and Services to End Violence Against Women with Disabilities Grant Program. I’m excited to announce that we’ve hired our director for this work and you all know her, it’s Sammy-Ellie MacKinnon who had been in the meeting today but had to leave early.
LD 924 Task Force Update:
Linda Lee: The LD 924 final report-out presentation to the Legislature is tomorrow, 2/14 1:00 pm. Anyone watching via the Legislature’s streaming service can watch at the following link: https://legislature.maine.gov/Audio/#208. I want to thank everyone for being such a huge part of LD 924, including its coming into being. This process has been challenging but very eye-opening and rewarding. After months and months of searching we came up with very little data on people because we couldn’t find them. There needs to be a system through which people can be individually identified by a unique ID number and tracked. At next month’s meeting, after the report-out, I would be happy to share details of the report with the group.
Federal & Housing Updates:
Cullen:
- Debt ceiling: Per the National Low Income Housing Coalition (NLIHC), On 1/19, U.S. Department of the Treasury Secretary Janet Yellen announced that the federal government had reached its statutory debt limit and that Treasury would begin implementing “extraordinary measures” to avoid a default. Negotiations about the raising of the debt limit that play out in Congress over the next year are likely to involve questions about federal funding for domestic programs, including housing. (Source: NLIHC).
- FY 24 Budget: Per NLIHC, there are reports suggesting that House Speaker Kevin McCarthy (R-CA) has committed to slashing federal spending by capping FY 24 appropriations at FY 22 levels. Speaker McCarthy and many of his Republican colleagues in the House have vowed that the roughly $130 billion in anticipated cuts will focus entirely on non-defense spending. In response to this Representative Rosa DeLauro (D-CT), ranking member of the House Committee on Appropriations, sent letters to several federal agencies on 1/19 requesting information about the impacts of budget cuts on crucial federal programs, including affordable housing and homelessness services programs managed by HUD and the U.S. Department of Agriculture (USDA).
State Legislature Update
Cullen: As this group knows, the First regular Session of the 131st Legislature convened on Wednesday, 12/7/22. Cloture (when bill titles must be submitted for consideration) occurred on 12/30/22. This being the First Session of the Legislature, any bill could be submitted for consideration. As such, the Legislature will be considering some 2,000+ bills this Session, in addition to the Supplemental Budget and the Biennial Budget.
Laura Cordes – Maine Association for Community Service Providers (MACSP): I created a Google doc using the format of the previous sessions to support the MCHQS' interest in monitoring and engaging in bills of interest in the 131st Legislature. The doc contains updated lists of key committees and their members, and a table for Coalition members to track bills (click here for more information). It is open to all members to edit and update. I will continue to add to and update the bill list and update this group as we move forward throughout the session. Committee assignments have been made and bills continue to make their way through the Revisor’s Office and are being posted on the Legislature’s website (click here for the new Bill Tracking site).
A few items to note:
- The HHS portion of the Biennial Budget will have a Public Hearing on Tuesday, 2/21 at 1pm in front of the AFA Committee (jointly with the HHS Committee). You can attend in-person to testify, sign up online to testify remotely, and/or submit written testimony.
- Click here to go to the Legislature’s Testimony Submission website. To sign up to testify via Zoom and/or submit written testimony:
- Select Public Hearing.
- Select the Committee holding the Public Hearing from the drop-down menu.
- Select the date the Public Hearing is being held from the drop-down menu.
- Select which bill for which you’re testifying.
- Check the box next to “I would like to testify electronically over Zoom” if you wish to do so.
- Click “Choose File” to upload written testimony or copy/paste it into the form.
- Fill out contact information; click Submit/Register.
- Click here to go to the Legislature’s Testimony Submission website. To sign up to testify via Zoom and/or submit written testimony:
- LD 393, Resolve, Regarding Legislative Review of Portions of Chapter 33: Rules Governing Physical Restraint and Seclusion, a Major Substantive Rule of the Department of Education: This bill will be of interest to many people in this group. This bill would amend Chapter 33: Rules Governing Physical Restraint and Seclusion, a major substantive rule of the Department of Education rules governing restrain and seclusion in schools.
- LD 35, An Act to Establish Adult Protective Services Training Requirements for Professionals Mandated to Report Suspected Abuse, Neglect or Exploitation to Enhance Protection of Incapacitated and Dependent Adults: This is a Department bill, which requires professionals mandated to make reports of abuse, neglect and exploitation of incapacitated and dependent adults pursuant to the Adult Protective Services Act to complete training on mandated reporter responsibilities once every 4 years.
- The google doc includes links for members to find their newly elected Representatives and Senators.
- Find your State Representative: https://legislature.maine.gov/house/house/MemberProfiles
- Find your State Senator: https://legislature.maine.gov/senate-home-page/find-your-state-senator
Cullen: This is going to be a very busy Legislative Session. We will keep this group apprised as bills make their way through the Legislature, so please be on the lookout for action alerts. We’ll likely get called upon over the next couple of months for our expertise so please raise your voice when the opportunity arises. It’s still a good time to reach out and introduce yourself to your State Representatives and your State Senator. Tell your story, let them know the importance of resources and services for you and your family, and educate them about your needs. Our collective voice is very powerful.
Other Business:
Samantha Hogan: Thank you for having me at these meetings. I’m an investigative reporter with the Maine Monitor. I’m working on a project about the probate courts, specifically adult guardianship. If anyone is interested in speaking with me or sharing your story, please reach out: [email protected] or 860-575-5583.
Kim Humphrey – Community Connect: Next month is Disability Awareness Month. There will be a screening at Curtis Memorial Library of our digital stories, followed by discussion. The date is still to be determined but you can email me if you’d be interested in attending: [email protected]. We will be repeating the digital story workshop this spring as well; feel free to reach out if you’re interested.
The next meeting will be on Monday, March 13, 2023, 12-2pm, via Zoom*.
Featured Speakers: Dr. Todd Landry, Director, DHHS-OCFS, Dean Bugaj, Associate Director, Children's Behavioral Health Services, DHHS-OCFS, and Teresa Barrows, Children’s Behavioral Health Services Manager, DHHS-OCFS. Topic: Biennial Budget initiatives as they pertain to Children’s Behavioral Health Services (CBHS) and a review of the annual CBHS Report.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(In 2023 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].