March 13, 2023
Minutes
Minutes
Attendees via Zoom: Abby Stivers, Alina Smith, Alli Vercoe, Amanda Parker, Betsy Hopkins, Bonnie-Jean Brooks, Brenda Charneski, Carol Snyder, Chris Call, Dean Bugaj, Heidi Mansir, J. Richardson Collins, Joyce Daggett, Julianne Zaharis, Lane Simsarian, Laura Cordes, Lily Lin, Linda Lee, Liz Hansen, LyAnn Grogan, Margaret Cardoza, Michaela York, Nancy Cronin, Paula Bush, Rachel Dyer, RJ Adler, Robin Levesque, Sammy-Ellie MacKinnon, Shelley Zielinski, Shelly King, Staci Converse, Stacy Lamontagne, Susan Farwell, Titus O’Rourke, Todd Landry, 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: Dr. Todd Landry, Director, DHHS-OCFS and Dean Bugaj, Associate Director, Children's Behavioral Health Services, DHHS-OCFS. www.maine.gov/dhhs/ocfs Topic: Biennial Budget initiatives as they pertain to Children’s Behavioral Health Services (CBHS) and a review of the annual CBHS Report.
Cullen: Today I am very pleased to welcome Dr. Todd Landry, Director of OCFS, and Dean Bugaj, Associate Director, Children's Behavioral Health Services, DHHS-OCFS, who will be covering the Governor's Biennial Budget as it pertains to Children’s Behavioral Health Services (CBHS) and a review of the annual CBHS report. Thank you very much for being with us today!
Dr. Todd Landry: Thank you for having us. Dean Bugaj, Associate Director of CHBS, joined us at the very end of last year. You may recall last session the Legislature authorized OCFS an additional Associate Director position. We split the previous position into two, with Dean’s position solely focusing on CBHS. Dean has prior experience with CHBS, and most recently was with the Office of MaineCare Services (OMS). His previous professional experience in these two areas is very helpful to everything we do. We’re going to talk a little bit about where we are now versus when we began a lot of our work under the current Administration in 2019, some high-level discussion on where we’re going, and what’s in store for CBHS in the Biennial Budget. I wanted to make sure the group had the links to the full CBHS Annual report, along with two blog posts – one pertaining to behavioral health efforts (both adult and children) from January 2023, and one pertaining to Governor Mills’ budget proposal investments in children and youth. It’s my pleasure to introduce Dean Bugaj, who will be going through our slides.
Dean Bugaj: Thank you for the warm introductions, I’m very happy to be here and to be in my role. I’m still in the learning stages, but I’ve learned a lot already and very much look forward to all the work underway and what’s to come.
Begin presentation (Click here for the presentation):
Dean: The CBHS Aspirational Service Array is a visual we use that illustrates the array of services from the foundational, lowest level of care to the highest acuity at the top of the pyramid. This is a good visual of the system and how funding interacts. When we really start to think about CBHS we think about the second level, which are services that tend to be feeders into the next level of care. The fourth level of care focuses mainly on the residential aspect. This is a snapshot of our CBHS delivery system as a whole. When we look at our work, we look at the pyramid and see where youth are within these tiers and see how we can support them.
CBHS developed 13 strategic priorities in 2019 and have been working on implementing those short-term and long-term initiatives in the years since. One of the initiatives we’ve been working on, for example, is creating a Psychiatric Residential Treatment Facility (PRTF) in Maine. A PRTF is a step down from a hospital and allows the delivery of more acute psychiatric treatment. It’s heavily federally regulated and intended to be short-term, with the goal of having youth stabilize and quickly return to their families. We’re still in the process of developing a PRTF in Maine, but this will build in another level of care as part of a full continuum of care.
New opportunities have included the System of Care Grant we received which allowed OCFS to rebuild the quality assurance team. It’s very important for CBHS and the Department as a whole to not only have youth be able to access care but to ensure it is quality care.
All of this has led to the budget initiatives including in the Biennial Budget – which includes $17 million towards CBHS.
Looking ahead, we have a number of priorities on which we’ll focus. There are three foundational principles supporting our work over the next four years:
These are pretty lofty goals, but we really believe that they are really important goals which we can work on over the next four years.
(Dean reviewed strategic priorities included within each of the three foundational principles/goals. See slide 5 of the PowerPoint Presentation for more info on what Dean reviewed.)
CBHS priorities in the Biennial Budget include the following (Specific budget initiatives related to each CBHS priority begin on slide 6 of the presentation):
Dr. Landry: The CBHS initiatives Dean discussed totals $16 million. This is significant from a budgetary perspective. We remain hopeful that the full Legislature will agree with the HHS Committee and endorse these as part of the Biennial Budget.
Discussion:
-It was asked how many children are served under CBHS. It was also asked if there are any particular areas of the state that are underserved or types of positions that are difficult to recruit.
Dr. Landry: Since 2019 we have published on our website a public-facing dashboard. One of the components of the dashboard is the Children’s Behavioral Health Data Dashboard. One of the data points on the dashboard is the total number of children authorized for CBHS; as of 12/2022 this number was 16,669 youth statewide. You can also look at this data by county.
Dean: The second question is an interesting one and I don’t believe it has an easy answer. We see pockets of need in some areas and then widespread needs. Widespread needs include licensed clinicians. The pandemic created an opportunity to leverage telehealth in ways that we weren’t really thinking about before. We’ve seen a huge shift in behavioral health services being accessed via telehealth. This has helped fill a large gap, especially for youth in rural areas. This was a pivot to support the need amidst workforce capacity issues. We’re looking at leveraging telehealth in other areas to increase access. We have a specific pilot geared towards assisting youth in schools to access services via telehealth. We contract with three agencies to cover five school systems. Youth are assisted to facilitate access to behavioral health support on site. This has been a very interesting pilot about which we’re very excited. With that I think we have a number of needs in other areas. I was at a community meeting last month in the mid-coast area where there is a great need for all services, but specifically access to psychiatry. We do have some programs that are available through primary-care providers for psychiatric consultations in partnership with the CDC. Unfortunately, not a lot of people know about this so we’re working on increasing awareness. We have a great need in Cumberland and York counties to support youth as well.
Cullen: I am very appreciative of CBHS working with OADS on the Lifespan project. I know it’s a big undertaking, but it will help actualize a real ID/DD continuum of care – as this Coalition and a broad array of stakeholders has envisioned for years.
-A self-advocate asked if CBHS covers youth from birth to age 21. She stated that CBHS can literally “make or break” someone. Early intervention, and the quality of that early intervention, gives the youth, their family, and the community the best chance for full community inclusion and integration. More clarity on the qualifications of receiving services and in what areas would be helpful.
Dean: OCFS-CHBS can serve youth up to age 21 for some programs; some programs have different age parameters due to federal requirements.
Dr. Landry: Part of the hope with the Lifespan project is a stronger and more robust CBHS system for all children in the state, including in that lowest, most foundational level. Youth who can receive early intervention and assistance at the earliest stages, at the lowest level of acuity, and have their needs met sufficiently are less likely to need as much at the highest level of care/acuity. We’ll never fully eliminate the highest acuity tier, but we can be proactive by addressing needs well as early as possible.
Cullen: We’re running into awareness of the limitations of targeted case management (TCM) in the homeless arena, with it being time-limited to 90 days. The next level of care for this population is Section 17 which is much more service intensive. It strikes me there may be a parallel here with the ID/DD system. Is it possible that TCM could be optimized by extending the length of time for which it can be utilized?
Dean: For youth and adults there are multiple avenues to care coordination, including the behavioral health home (BHH) model. The challenge with TCM is that there is federal law that states they can’t be reimbursed with federal dollars if there are similar services being delivered by other federal dollars such as in-patient care. Currently we have 30 days approved for allowable overlap between in-patient and TCM. The laws around TCM are more prohibitive than other models.
-It was stated that there are certain services that can’t be delivered with BHH due to perceived duplication of services.
Dean: If there are issues with Section 28 and BHH let me know, because that shouldn’t be an issue. With the care coordination between TCM and BHH, I don’t see that going away due to federal law for TCM. I know from my previous role with OMS that for certain programs there have been workarounds using pass-through payments. If someone is looking to shift to a BHH model from TCM, there’s an opportunity for the care coordinator to remain involved if they engage in a pass-through payment agreement for the care coordinator. That involves more paperwork, but I have seen it done.
Cullen: Thank you all for being here, for providing all of this information, and for working to optimize Maine’s continuum of care for CBHS. Thank you again, and 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: I’m pleased to introduce Shelly King to this group, who we’ve hired as the Transition Program Manager. She will help bridge the transition between OCFS and OADS for our transition and Lifespan projects.
The Department has put forward a bill, LD 449, most of which is about licensing programs for individuals with IDD, Autism and Brain Injury. The hearing for the bill is this Thursday, March 16, at 2:00 pm. (Information on this bill is included in last month’s meeting minutes.)
The Department has also put together a Lifespan Bill, LD 659 - Hearing for this bill is March 20th at 11:00 AM. For up to date information on the work that is going on regarding our Lifespan project, you can go to our website: HCBS Lifespan Project | Department of Health and Human Services (maine.gov)
For updates regarding OADS’ Innovation Pilots that are underway you can go to: HCBS Innovation Pilot Grants | Department of Health and Human Services (maine.gov). In particular, you can review a recent blog which provides information on the recent grants that were awarded and outlines of the proposed projects. We are completing a review of the second round of applicants and hope to make those awards later this week.
-Regarding LD 449, it was asked if agencies provide different types of services if all of those services would be covered under one license.
Betsy: Yes, exactly. When an agency receives a license approval it would cover their full array of services.
-It was asked if this would also cover Children’s Services, mental health services, and/or TCM.
Betsy: Children’s services and any mental health licenses would be separate from this. TCM is a different process entirely, as it’s certification/re-certification versus licensing.
-A self-advocate stated that one of her pet peeves is that people have to go to the physical agency for community-based services rather than the agency going to the individual and transporting them. She provided examples of the runaround that sometimes happens going from home, to the program, then to an activity in the community that is very close to the person’s home, then back to the agency only to have to travel all the way back home. It would seem this process could be simplified. She asked if that would be addressed in LD 449.
Betsy: There are several different ways to provide community supports for an individual. This could include an individual going from their home to the community-based program. There is a support called community membership that does start wherever the individual lives and then they go into the community. LD 449 doesn’t go into the details that you’re talking about – I think what you’re discussing would be included in Home and Community-Based Services (HCBS) and how they’re provided, and we’re looking at that through ongoing monitoring as part of the HCBS Global Rule.
Cullen: Thank you for this update and for being here today, Betsy!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs - No additional updates
DOL – Division of Vocational Rehabilitation (VR) - www.maine.gov/rehab/dvr - No updates
Office of Special Services and Inclusive Education (OSSIE) - www.maine.gov/doe/learning/specialed
Titus O’Rourke: We are happy to announce that we have secured a grant to develop regional transitional programs. We are developing and working on the call for proposals for this now and hope to send them out this week or next. We are also hoping to secure the State Transition Team that will support the regional teams on framework and support within those regions.
SMACT (Southern Maine Advisory Council on Transition):
SMACT meetings are held quarterly. There are two meetings left this year. The most recent meeting was on Friday, 3/3 and featured 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: DRM in partnership with SUFU (Speaking Up for Us) is working on a project to increase youth self-advocacy. One aspect of this project is by promoting self-advocacy focusing on youth by creating different chapters. Another aspect is the creation of a self-advocacy train-the-trainer project.
LD 924 Task Force Update:
Linda Lee: The LD 924 final report-out presentation to the Legislature was on 2/14. We’ve been working with legislators to see which recommendations would require formal bills and which could be implemented through rule changes, etc. They are are going to submit a bill which would establish an Office on Employment First, with actual staff, which would help see through various recommendations of the LD 924 Task Force as well as the recommendations from the Employment First Workgroup from years ago.
Federal & Housing Updates:
Cullen:
President Biden’s FY 24 Budget: President Biden unveiled a topline summary of his FY 24 budget request on Thursday, 3/9. The budget makes important investments in a range of areas, including in children, supports for workers, housing affordability, education, and core government functions. The President’s budget priorities, which sets the blueprint for the FY 24 appropriations and budget process. The President’s budget request calls for increased funding for affordable housing using two approaches:
-Regular Appropriations process proposal: Through the regular appropriations process, the president’s budget calls for:
Cullen: As Laura reported last month, the Legislature is considering some 2,000+ bills this Session, in addition to the Biennial Budget. It’s going to be a very busy session.
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. The google doc includes links for members to find their newly elected Representatives and Senators.
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). As of this morning there were only about 1,204 bills printed.
A few items to note:
-Most committees have reported out to the Appropriations and Financial Affairs (AFA) on the Biennial Budget. Many committees not only endorsed the Governor’s Budget, but also recommended adding in portions of bills that have not yet been heard.
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 bill has a public hearing on 3/15 at 1pm in front of the HHS Committee. 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.
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 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 has a public hearing on 3/16 at 2pm in front of the HHS Committee. Licensing and Autism Definition Bill. 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.
LD 659, An Act to Promote Seamless and Flexible Home and Community Supports Across the Lifespan for Individuals with Intellectual and Developmental Disabilities or Autism. This bill has a public hearing on Monday, 3/20 at 11am in front of the Health and Human Services Committee. Lifespan Bill. This bill 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.
LD 886, An Act to Allow Clerks to Issue Absentee Ballots After the 3rd Business Day Before Election Day to Voters Who Have a Nonphysical Disability and Voters Who Support a Person with a Disability – The bill had a public hearing on Monday, 3/13 at 10am in front of the Veteran and Legal Affairs Committee.
-A self-advocate stated that she is happy to go to the Legislature and tell her story in order to advance the education base of legislators/politicians. However, for many self-advocates this is extremely difficult, as the atmosphere in the hallways of the Legislature is abrasive to say the least. She stated that education for self-advocates on handling the behavior/comments of oppositional parties would be very beneficial. It’s very tough to be a self-advocate these days.
Cullen: Thank you very much for your bravery not only in illustrating this so clearly and thoughtfully but also for all your personal self-advocacy.
Betsy: I really do applaud when self-advocates get up in front of the legislature and tell their stories. The impact this has on legislators cannot be overstated.
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. Our collective voice is very powerful.
Other Business:
RJ Adler – WheelPad: My company is based in southern Vermont. We manufacture modular, accessible housing. Imagine a bedroom and bathroom on wheels, that’s accessible and can be quickly and easily attached to any home. Maine has one of the nations’ most generous home-modification loan programs, which allows up to $100,000 for home-modifications for accessibility at a very low-interest rates. WheelPad would qualify for this. I’ll have more to share at a future meeting as part of a presentation, but in the meantime please feel free to reach out with questions: [email protected]
Community Connect: Upcoming Community Connect events:
The next meeting will be on Monday, April 10, 2023, 12-2pm, via Zoom*.
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). Topic: Priorities and key bills related to the system of care for people with ID/DD in the First Regular Session of the 131st Legislature.
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: Dr. Todd Landry, Director, DHHS-OCFS and Dean Bugaj, Associate Director, Children's Behavioral Health Services, DHHS-OCFS. www.maine.gov/dhhs/ocfs Topic: Biennial Budget initiatives as they pertain to Children’s Behavioral Health Services (CBHS) and a review of the annual CBHS Report.
Cullen: Today I am very pleased to welcome Dr. Todd Landry, Director of OCFS, and Dean Bugaj, Associate Director, Children's Behavioral Health Services, DHHS-OCFS, who will be covering the Governor's Biennial Budget as it pertains to Children’s Behavioral Health Services (CBHS) and a review of the annual CBHS report. Thank you very much for being with us today!
Dr. Todd Landry: Thank you for having us. Dean Bugaj, Associate Director of CHBS, joined us at the very end of last year. You may recall last session the Legislature authorized OCFS an additional Associate Director position. We split the previous position into two, with Dean’s position solely focusing on CBHS. Dean has prior experience with CHBS, and most recently was with the Office of MaineCare Services (OMS). His previous professional experience in these two areas is very helpful to everything we do. We’re going to talk a little bit about where we are now versus when we began a lot of our work under the current Administration in 2019, some high-level discussion on where we’re going, and what’s in store for CBHS in the Biennial Budget. I wanted to make sure the group had the links to the full CBHS Annual report, along with two blog posts – one pertaining to behavioral health efforts (both adult and children) from January 2023, and one pertaining to Governor Mills’ budget proposal investments in children and youth. It’s my pleasure to introduce Dean Bugaj, who will be going through our slides.
Dean Bugaj: Thank you for the warm introductions, I’m very happy to be here and to be in my role. I’m still in the learning stages, but I’ve learned a lot already and very much look forward to all the work underway and what’s to come.
Begin presentation (Click here for the presentation):
Dean: The CBHS Aspirational Service Array is a visual we use that illustrates the array of services from the foundational, lowest level of care to the highest acuity at the top of the pyramid. This is a good visual of the system and how funding interacts. When we really start to think about CBHS we think about the second level, which are services that tend to be feeders into the next level of care. The fourth level of care focuses mainly on the residential aspect. This is a snapshot of our CBHS delivery system as a whole. When we look at our work, we look at the pyramid and see where youth are within these tiers and see how we can support them.
CBHS developed 13 strategic priorities in 2019 and have been working on implementing those short-term and long-term initiatives in the years since. One of the initiatives we’ve been working on, for example, is creating a Psychiatric Residential Treatment Facility (PRTF) in Maine. A PRTF is a step down from a hospital and allows the delivery of more acute psychiatric treatment. It’s heavily federally regulated and intended to be short-term, with the goal of having youth stabilize and quickly return to their families. We’re still in the process of developing a PRTF in Maine, but this will build in another level of care as part of a full continuum of care.
New opportunities have included the System of Care Grant we received which allowed OCFS to rebuild the quality assurance team. It’s very important for CBHS and the Department as a whole to not only have youth be able to access care but to ensure it is quality care.
All of this has led to the budget initiatives including in the Biennial Budget – which includes $17 million towards CBHS.
Looking ahead, we have a number of priorities on which we’ll focus. There are three foundational principles supporting our work over the next four years:
- Establish a single point of access for CBHS for youth: Improve accessibility for CBHS.
- Eliminate wait times for youth seeking CBHS: Improve availability of CBHS.
- Improve the quality and consistency of CBHS: Improve the quality and consistency of CBHS.
These are pretty lofty goals, but we really believe that they are really important goals which we can work on over the next four years.
(Dean reviewed strategic priorities included within each of the three foundational principles/goals. See slide 5 of the PowerPoint Presentation for more info on what Dean reviewed.)
CBHS priorities in the Biennial Budget include the following (Specific budget initiatives related to each CBHS priority begin on slide 6 of the presentation):
- Single Point of Access
- Improve Support for Providers and Families
- Target Service Expansion to Identified Needs
- Advance Therapeutic Foster Care
Dr. Landry: The CBHS initiatives Dean discussed totals $16 million. This is significant from a budgetary perspective. We remain hopeful that the full Legislature will agree with the HHS Committee and endorse these as part of the Biennial Budget.
Discussion:
-It was asked how many children are served under CBHS. It was also asked if there are any particular areas of the state that are underserved or types of positions that are difficult to recruit.
Dr. Landry: Since 2019 we have published on our website a public-facing dashboard. One of the components of the dashboard is the Children’s Behavioral Health Data Dashboard. One of the data points on the dashboard is the total number of children authorized for CBHS; as of 12/2022 this number was 16,669 youth statewide. You can also look at this data by county.
Dean: The second question is an interesting one and I don’t believe it has an easy answer. We see pockets of need in some areas and then widespread needs. Widespread needs include licensed clinicians. The pandemic created an opportunity to leverage telehealth in ways that we weren’t really thinking about before. We’ve seen a huge shift in behavioral health services being accessed via telehealth. This has helped fill a large gap, especially for youth in rural areas. This was a pivot to support the need amidst workforce capacity issues. We’re looking at leveraging telehealth in other areas to increase access. We have a specific pilot geared towards assisting youth in schools to access services via telehealth. We contract with three agencies to cover five school systems. Youth are assisted to facilitate access to behavioral health support on site. This has been a very interesting pilot about which we’re very excited. With that I think we have a number of needs in other areas. I was at a community meeting last month in the mid-coast area where there is a great need for all services, but specifically access to psychiatry. We do have some programs that are available through primary-care providers for psychiatric consultations in partnership with the CDC. Unfortunately, not a lot of people know about this so we’re working on increasing awareness. We have a great need in Cumberland and York counties to support youth as well.
Cullen: I am very appreciative of CBHS working with OADS on the Lifespan project. I know it’s a big undertaking, but it will help actualize a real ID/DD continuum of care – as this Coalition and a broad array of stakeholders has envisioned for years.
-A self-advocate asked if CBHS covers youth from birth to age 21. She stated that CBHS can literally “make or break” someone. Early intervention, and the quality of that early intervention, gives the youth, their family, and the community the best chance for full community inclusion and integration. More clarity on the qualifications of receiving services and in what areas would be helpful.
Dean: OCFS-CHBS can serve youth up to age 21 for some programs; some programs have different age parameters due to federal requirements.
Dr. Landry: Part of the hope with the Lifespan project is a stronger and more robust CBHS system for all children in the state, including in that lowest, most foundational level. Youth who can receive early intervention and assistance at the earliest stages, at the lowest level of acuity, and have their needs met sufficiently are less likely to need as much at the highest level of care/acuity. We’ll never fully eliminate the highest acuity tier, but we can be proactive by addressing needs well as early as possible.
Cullen: We’re running into awareness of the limitations of targeted case management (TCM) in the homeless arena, with it being time-limited to 90 days. The next level of care for this population is Section 17 which is much more service intensive. It strikes me there may be a parallel here with the ID/DD system. Is it possible that TCM could be optimized by extending the length of time for which it can be utilized?
Dean: For youth and adults there are multiple avenues to care coordination, including the behavioral health home (BHH) model. The challenge with TCM is that there is federal law that states they can’t be reimbursed with federal dollars if there are similar services being delivered by other federal dollars such as in-patient care. Currently we have 30 days approved for allowable overlap between in-patient and TCM. The laws around TCM are more prohibitive than other models.
-It was stated that there are certain services that can’t be delivered with BHH due to perceived duplication of services.
Dean: If there are issues with Section 28 and BHH let me know, because that shouldn’t be an issue. With the care coordination between TCM and BHH, I don’t see that going away due to federal law for TCM. I know from my previous role with OMS that for certain programs there have been workarounds using pass-through payments. If someone is looking to shift to a BHH model from TCM, there’s an opportunity for the care coordinator to remain involved if they engage in a pass-through payment agreement for the care coordinator. That involves more paperwork, but I have seen it done.
Cullen: Thank you all for being here, for providing all of this information, and for working to optimize Maine’s continuum of care for CBHS. Thank you again, and 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: I’m pleased to introduce Shelly King to this group, who we’ve hired as the Transition Program Manager. She will help bridge the transition between OCFS and OADS for our transition and Lifespan projects.
The Department has put forward a bill, LD 449, most of which is about licensing programs for individuals with IDD, Autism and Brain Injury. The hearing for the bill is this Thursday, March 16, at 2:00 pm. (Information on this bill is included in last month’s meeting minutes.)
The Department has also put together a Lifespan Bill, LD 659 - Hearing for this bill is March 20th at 11:00 AM. For up to date information on the work that is going on regarding our Lifespan project, you can go to our website: HCBS Lifespan Project | Department of Health and Human Services (maine.gov)
For updates regarding OADS’ Innovation Pilots that are underway you can go to: HCBS Innovation Pilot Grants | Department of Health and Human Services (maine.gov). In particular, you can review a recent blog which provides information on the recent grants that were awarded and outlines of the proposed projects. We are completing a review of the second round of applicants and hope to make those awards later this week.
-Regarding LD 449, it was asked if agencies provide different types of services if all of those services would be covered under one license.
Betsy: Yes, exactly. When an agency receives a license approval it would cover their full array of services.
-It was asked if this would also cover Children’s Services, mental health services, and/or TCM.
Betsy: Children’s services and any mental health licenses would be separate from this. TCM is a different process entirely, as it’s certification/re-certification versus licensing.
-A self-advocate stated that one of her pet peeves is that people have to go to the physical agency for community-based services rather than the agency going to the individual and transporting them. She provided examples of the runaround that sometimes happens going from home, to the program, then to an activity in the community that is very close to the person’s home, then back to the agency only to have to travel all the way back home. It would seem this process could be simplified. She asked if that would be addressed in LD 449.
Betsy: There are several different ways to provide community supports for an individual. This could include an individual going from their home to the community-based program. There is a support called community membership that does start wherever the individual lives and then they go into the community. LD 449 doesn’t go into the details that you’re talking about – I think what you’re discussing would be included in Home and Community-Based Services (HCBS) and how they’re provided, and we’re looking at that through ongoing monitoring as part of the HCBS Global Rule.
Cullen: Thank you for this update and for being here today, Betsy!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs - No additional updates
DOL – Division of Vocational Rehabilitation (VR) - www.maine.gov/rehab/dvr - No updates
Office of Special Services and Inclusive Education (OSSIE) - www.maine.gov/doe/learning/specialed
Titus O’Rourke: We are happy to announce that we have secured a grant to develop regional transitional programs. We are developing and working on the call for proposals for this now and hope to send them out this week or next. We are also hoping to secure the State Transition Team that will support the regional teams on framework and support within those regions.
SMACT (Southern Maine Advisory Council on Transition):
SMACT meetings are held quarterly. There are two meetings left this year. The most recent meeting was on Friday, 3/3 and featured 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: DRM in partnership with SUFU (Speaking Up for Us) is working on a project to increase youth self-advocacy. One aspect of this project is by promoting self-advocacy focusing on youth by creating different chapters. Another aspect is the creation of a self-advocacy train-the-trainer project.
LD 924 Task Force Update:
Linda Lee: The LD 924 final report-out presentation to the Legislature was on 2/14. We’ve been working with legislators to see which recommendations would require formal bills and which could be implemented through rule changes, etc. They are are going to submit a bill which would establish an Office on Employment First, with actual staff, which would help see through various recommendations of the LD 924 Task Force as well as the recommendations from the Employment First Workgroup from years ago.
Federal & Housing Updates:
Cullen:
President Biden’s FY 24 Budget: President Biden unveiled a topline summary of his FY 24 budget request on Thursday, 3/9. The budget makes important investments in a range of areas, including in children, supports for workers, housing affordability, education, and core government functions. The President’s budget priorities, which sets the blueprint for the FY 24 appropriations and budget process. The President’s budget request calls for increased funding for affordable housing using two approaches:
-Regular Appropriations process proposal: Through the regular appropriations process, the president’s budget calls for:
- Funding HUD programs at $73.3 billion, or approximately $1.1 billion – or 1.6% – more than the FY23-enacted level.
- $32.7 billion to renew all existing housing vouchers and to expand assistance to an additional 50,000 households through increased funding and another 130,000 households through program reserves, among other things.
- Senate Appropriations Committee Begins work on FY 24 budget process: The Senate Committee on Appropriations, led by Chair Patty Murray (D-WA) and Ranking Member Susan Collins (R-ME), held its first full committee meeting on 3/2 to begin planning a path towards a fiscal year (FY) 2024 budget agreement.
- 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. 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.
Cullen: As Laura reported last month, the Legislature is considering some 2,000+ bills this Session, in addition to the Biennial Budget. It’s going to be a very busy session.
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. 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
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). As of this morning there were only about 1,204 bills printed.
A few items to note:
-Most committees have reported out to the Appropriations and Financial Affairs (AFA) on the Biennial Budget. Many committees not only endorsed the Governor’s Budget, but also recommended adding in portions of bills that have not yet been heard.
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 bill has a public hearing on 3/15 at 1pm in front of the HHS Committee. 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.
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 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 has a public hearing on 3/16 at 2pm in front of the HHS Committee. Licensing and Autism Definition Bill. 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.
LD 659, An Act to Promote Seamless and Flexible Home and Community Supports Across the Lifespan for Individuals with Intellectual and Developmental Disabilities or Autism. This bill has a public hearing on Monday, 3/20 at 11am in front of the Health and Human Services Committee. Lifespan Bill. This bill 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.
LD 886, An Act to Allow Clerks to Issue Absentee Ballots After the 3rd Business Day Before Election Day to Voters Who Have a Nonphysical Disability and Voters Who Support a Person with a Disability – The bill had a public hearing on Monday, 3/13 at 10am in front of the Veteran and Legal Affairs Committee.
-A self-advocate stated that she is happy to go to the Legislature and tell her story in order to advance the education base of legislators/politicians. However, for many self-advocates this is extremely difficult, as the atmosphere in the hallways of the Legislature is abrasive to say the least. She stated that education for self-advocates on handling the behavior/comments of oppositional parties would be very beneficial. It’s very tough to be a self-advocate these days.
Cullen: Thank you very much for your bravery not only in illustrating this so clearly and thoughtfully but also for all your personal self-advocacy.
Betsy: I really do applaud when self-advocates get up in front of the legislature and tell their stories. The impact this has on legislators cannot be overstated.
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. Our collective voice is very powerful.
Other Business:
RJ Adler – WheelPad: My company is based in southern Vermont. We manufacture modular, accessible housing. Imagine a bedroom and bathroom on wheels, that’s accessible and can be quickly and easily attached to any home. Maine has one of the nations’ most generous home-modification loan programs, which allows up to $100,000 for home-modifications for accessibility at a very low-interest rates. WheelPad would qualify for this. I’ll have more to share at a future meeting as part of a presentation, but in the meantime please feel free to reach out with questions: [email protected]
Community Connect: Upcoming Community Connect events:
- Community Connect is holding a screening event on 3/23 in Brunswick for ‘Invisible’ Personal stories from the front lines of disability. This is a screening of short videos by and about people living with disability in Maine, followed by a conversation with the filmmakers. Click here for more information. Everyone has a story to tell, and stories are meant to be heard. The goal is to take this on the road to all libraries across the state.
- Community Connect is offering an online training: Digital Storytelling Workshop with Anne Aronson. The workshop will be held over four Sunday mornings from 8:30am-12:30pm on 4/16, 4/23, 4/30 and 5/14. Click here for more information.
The next meeting will be on Monday, April 10, 2023, 12-2pm, via Zoom*.
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). Topic: Priorities and key bills related to the system of care for people with ID/DD in the First Regular Session of the 131st Legislature.
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].