May 11, 2020
Minutes
Minutes
Attendees via Zoom: Betsy Hopkins, Teresa Barrows, Emily Kalafarski, Elizabeth Hardink, Alli Vercoe, Mary Chris Semrow, Janet Hamel, Lucas, Sierra Hillebrand, Bethany Morse, Bryan Gordon, Luc Nya, Julie Brennan, Laura Cordes, Ray Nagel, Abbie Tanguay, Derek Fales, Jenny Claire, Robin Levesque, Kristin McPherson, Linda Lee, David Cowing, Frances Ryan, Lorraine Defraides, Helen Hemminger, Debbie Dionne, Darla Chafin, Craig Patterson, Kim Humphrey, Christopher Call, J Richardson Collins, M Allen, Andy Taranko, Jodi Benvie, Natalie Childs, Jeff Hooke, Lauren Wille, Maggie Hoffman, Steve McKenna, Alan Cobo-Lewis, Cullen Ryan, and Vickey Rand.
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speaker: Betsy Hopkins, Associate Director, Developmental Disability and Brain Injury Services, DHHS-OADS. www.maine.gov/dhhs/oads Topic: Overview of OADS’ submitted K Waiver to CMS, what this means for service provision for people with ID/DD, and next steps. Discussion to follow.
Cullen: Today our featured speaker is Betsy Hopkins, Associate Director, Developmental Disability and Brain Injury Services, DHHS-OADS, presenting an overview of OADS’ Appendix K Waiver, including what this means for service provision for people with ID/DD and next steps. Thank you for being here today, Betsy, on short notice at that, and for providing this important information. OADS had a Zoom meeting detailing its K Waiver submission to CMS (Centers for Medicare and Medicaid Services) that was attended mainly by providers, and I thought that this group would be very interested in its content, specifically parents and family members of people with ID/DD. So, thank you again, Betsy, for your quick work on this and for being here today!
Betsy Hopkins - Associate Director, Developmental Disability and Brain Injury Services: Thank you for having me! I would like to say that we’re happy to announce that we received final approval for the K Waiver from CMS on Friday late in the day (click here for the approved Appendix K Waiver). We’re pleased that it was approved. Implementing this work has been in process since we first developed the draft application. We’re still working with OMS (Office of MaineCare Services) and others to discuss the billing process and what it will look like for providers – that’s still underway. As soon as we have more of those details, we’ll certainly share them. I also have Derek Fales and Elizabeth Hardink with me to answer questions, as there are some pieces that are more complex. As you know, many states around the country have submitted K Waivers, and we were fortunate to use this as guidance, as well as receiving feedback ahead of time, before we put forth the K Waiver for CMS approval. We were happy in many ways with what we got but wish we could have gotten more. The effective date goes back to 3/1/20, because we’re aware that providers have been dealing with this crisis since then and we wanted the funding to coincide with that. I’m going to do a more high-level review and Derek will go into more detail.
Begin Presentation (click here for the presentation)
Derek Fales: With the Appendix K Waiver, we wanted to ensure members who need to utilize telehealth or remote technology to communicate with staff have the availability to do so. As such, they’ll be able to use the full assistive technology (AT) benefit up to $6,000, and we will approve those requests with some flexibility. This will help ensure that people who need to have remote services can remain safe. We also have a shared living rate increase, an additional increase for shared living arrangements with more than one member, and this now allows for up to three members in the shared living home. All of this requires prior authorization and is currently in effect from 3/1 through 5/31/2020. We’re also providing a 10% rate increase on specified direct care and related services. The guidance, which we’re in the process of finalizing, will detail the services to which this increased rate applies.
Betsy: We also have temporary services for the care of people who test positive for COVID-19. We’re implementing an emergency transitional housing rate to assist with the increased costs of quarantining. Also, if needed, asked for, and approved through the hospital, there is the ability for paid staffing to be provided while someone is in the hospital. We wanted to expand where services could be provided for people depending upon need. Some providers have already utilized hotels, either to quarantine someone with COVID-19 or for someone who has tested negative but lives in a home with people who have tested positive. We worked with licensing to have some requirements waived to expedite these temporary settings. We’ve specified that community support can be provided in participants’ homes (or other settings). We wanted to provide some flexibility on provider qualifications, with the caveat that they’re working alongside others who do have the qualifications especially in the beginning, so that health and safety is assured through agency oversight. We’ve also included temporary permission for payment for services provided by family caregivers. The family member must be hired or contracted with an agency, and the provider agency must ensure services are provided as authorized in the PCP (person-centered plan). Almost right at implementation we’ll have to talk about what the plan looks like for the transition to pre-emergency services, since this is scheduled to end on 5/31; though K Waivers can be extended if necessary.
Discussion:
-It was asked how one would get prior authorization now, in May, for things that occurred in March,
Derek: The Department needs to receive a request; we will approve those requests, as long as they meet the expectations as outlined in the K Waiver. The provider will document the changes that occurred on or about March 1st. For some services, providers will submit billing for services, and it’s reviewed and approved. The Department still has to review and approve that change, even if it occurred in March and you’re submitting now.
-It was asked if there are any specifics on the increased rate for shared living.
Derek: We start with a 10% increase for the base rate for a single person in the shared living home, and that rate is implemented for the second and third people; so that second person receives a higher percentage for the rate, and the same for the third person. Let’s say, if the shared living reimbursement is $100 per day for one person, the second person would receive a higher percentage versus just splitting the $100 between the two. This shared living rate will continue past 5/31, until the end of this emergency. So, in general, one shared living provider can serve up to three individuals in that provider’s home, and the second and third person will have a higher rate percentage.
Laura Cordes – MACSP (Maine Association for Community Service Providers): We’ve had a lot of questions throughout the process of creating the Appendix K Waiver application, and I want to thank you for the flexibility that this waiver provides. We’ve shared our disappointment that the Appendix K Waiver application did not include retainer payments for community and work support providers. I wanted to see where the State was in terms of keeping the door open for this so that agencies can remain viable during and after the pandemic.
Betsy: I know, and I hear the disappointment and concern for sure. I think we focused our energy for this first K Waiver on emergency services for people who are in residential settings, home and family support, and emergency quarantining, all of which was essential. As far as community and work supports, we’re happy to see there are a number of agencies providing those services through telehealth and we hope to see more of that. What I can tell you is that we’re continuing to evaluate the need for financial relief for all MaineCare providers, including ID/DD providers, in terms of what’s happening in general and the broader economic outlook for the state. We’re having ongoing conversations about all of this; we’re trying to get this implemented and examine what else might be needed.
Laura: I’m sure a lot of folks in this meeting and others are thinking about the transition period, understanding there could be a reemergence of COVID-19, and the challenges faced with COVID-19 and working with a population that is more vulnerable. Right now, we’re looking at one-on-one services and wondering if OADS will be working with the CDC, or seeking support from providers, to think about particular guidance in transitioning to smaller group services.
Betsy: We have a lot of guidance we’re trying to get vetted regarding telehealth. We’re also putting together guidance regarding what it would look like to do community supports in person, and in a variety of different ways. One of the things we’re hoping for is rather than center-based services, is people being in their communities as much as possible. Right now, being in one’s community looks very different. We will be putting together guidance for people if they’re going to bring small groups together, and that has to be vetted by the CDC. We’re happy to bring that to this group.
-It was asked how many adults are served in community support day programs currently, as it’s one of the services that’s highly utilized through Section 29. It was stated that there are general concerns about the viability of provider agencies.
Betsy: I don’t have those specific numbers. I think the concern is what will happen with community programs after this emergency. We’re aware of those concerns and we’re having discussions. If people can provide community and work supports through telehealth, then we encourage providers to do that as much as possible right now. We’re hearing that having that contact and having that support from community case managers and community programs, has been very helpful for people who haven’t been able to do much outside of their homes.
Cullen: I want to thank everyone who worked on this Appendix K Waiver to get it submitted as quickly as possible. I think it’s great that we’re examining the challenges now as posed by COVID-19, as well as when this emergency ends. There is a need to have a highly professional workforce to meet the needs of this population. Hopefully, some of the short-term gains with this waiver will persist after this emergency. Often, times of crisis create groundswell for opportunities for lasting positive change; I hope that is the case now. I want to thank you, Betsy, for putting together this presentation, and for the care and thought that went into its creation!
End Presentation (round of applause)
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Cullen: I’m also pleased that today we’re joined by Teresa Barrows, Children’s Behavioral Health (CBH) Manager, who also agreed to present to this group on very short notice. Thank you, Teresa, for being here!
Teresa Barrows, Children’s Behavioral Health Services (CBHS) Manager: I’m very happy to be here, and I look forward to attending these meetings regularly. I’m one of three Children’s Behavioral Health Managers. I manage coordinators across the state to help people navigate the system of care, and part of that work is transition.
(Click here for the OCFS Update which Teresa reviewed in detail.)
Teresa: I started with the Department about 20 years ago, and at that time we always met with OADS to track children who might be able to get an adult waiver, so OADS could plan for children’s need when they transition to adult services. Our work together has changed over time with the waivers and the waitlists, but we continue to work collaboratively on a regular basis, specifically on transition. We realize there will be youth about whom we won’t know, for a variety of reasons, and for these situations there is an early referral form (click here for the Early Notification Form). Information from this form is then entered into EIS to begin the process on transition. We’ve always wanted to focus on that transition to adulthood; not everyone will need services when they’re an adult, but we want to make sure that we identify the youth who will need services in adulthood, so they don’t fall through the cracks and begin work with them as soon as possible. There aren’t enough services, but we want to at least identify all of the needs. I also wanted to provide a guide to our staff so that people can reach out with any questions etc., (click here for the State of Maine CHBS Staff Guide) as well as a map that details transition by county, which includes staff information and contact information for both OADS and OCFS (click here for the Transition County and Map document). Additionally, an OCFS listserv announcement recently was distributed with information on entering transition information in the EIS database for youth ages 16-20 with ID/DD (click here for the OCFS listserv email).
Discussion:
-It was stated that EIS access has always been difficult. Agencies are limited in the number of staff who can access EIS. It was stated that children’s services, specifically case managers, ought to have access to EIS and the new Evergreen system when it comes out. It was asked if EIS or Evergreen will be used, why not make that be the electronic health record.
Teresa: We share a similar thought, that it would be easier if we could have one system. The reality at the moment is that we don’t, but I will certainly bring your concerns back, because it has been frustrating. I definitely hear you. One of the reasons we’re having case managers enter information into EIS is we were trying to manage all of this information ourselves, and it was backlogged. Having case managers enter the information allows us to have access to the information and ensure children are getting the services they need. Not having access to all of the information, with OADS’ new system, has been frustrating for all.
Betsy: I know enough about the new system to be dangerous. Everyone is excited about the way that it talks across systems much more efficiently. I’ve written down this concern as well. My guess is that they’ve heard it before, but I’ll make sure this feedback is brought back.
-A parent and former special educator stated that he was always concerned that the information that special education and schools had was not effectively leveraged in the transition process. Families, especially those with children with more challenges, benefitted from schools communicating with Voc Rehab, transition specialists, summaries of skills and needs upon graduation, etc. It was asked how OCFS is working to interface with DOE and Special Education to make the process easier for families.
Teresa: We had been working closely with them, then that staff person left, so we need to pick that back up. There is a lot of work to do on transition, and there are a lot of gaps. We’re in the process of working on particular strategies, one of which is transition to adulthood. I think once we get to that point, we’d create a stakeholder group to examine this. In my experience no matter how we do this we never quite get there, and I’m not sure why it has been so difficult. Transition is such an important piece on which we need to be working. Meetings with school superintendents etc., need to resume so this work can move forward effectively.
Cullen: First, thank you for making transition a focal point of what you’re doing – it’s welcome and long awaited. It seemed like there was a system in place for transition and then it eroded, or perhaps was dismantled, over time. I want to point to the Blueprint for Effective Transition that looks at the major transition from children’s to adult services, as well as all of the other smaller transitions that occur throughout a person’s life. There’s a lot of room to better the transition to adulthood, beginning early on and building on that as the person evolves into early adulthood and beyond. I urge you to take a look at that in conjunction with this group. It’s a great place to start as a lot of work went into it right when transition seemed to fall by the wayside.
Teresa: Yes, you are right. Things change with administration changes, but I think that transition will be a focus, in which I will be actively involved. Attending these meetings on a regular basis will allow us to work together and move this work forward.
Cullen: That is fantastic. There is a tremendous amount of expertise around the table, from which the system would benefit.
-It was stated that the idea of one system, versus a children’s and an adult system, would be advantageous and eliminate the “cliff of no services” many people face upon graduation.
Teresa: Thank you for allowing me to share information with you today, and please reach out! Elissa Wynne, Associate Director of Children's Development & Behavioral Health, who presented to this group in February, is also willing to attend periodically to provide updates on the larger OCFS picture as well.
Cullen: Thank you for being here today, and for your willingness to attend moving forward, as we will all be better for having OCFS consistently at the table!
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy: The OADS Quarterly Update was posted to the website on Friday, and includes waitlist information (click here for the OADS Quarterly Update). Waitlist information as of 4/1/20: Section 21: 1,694; Section 29: 369
Betsy: In general, we’ve seen an increase in applications for Section 29. We have been making a number of Section 29 offers, and we’ll be making more starting 7/1, with the inclusion of funding for additional offers in the budget. There are some agencies who are not accepting new offers for whatever reason, so this has affected people being able to begin receiving services. So, the time-limit for people to find a service provider has been suspended so as not to be a barrier.
Disability Rights Maine (DRM) Update:
Laura Wille: I want to share a brief update on what we’ve been working on since the COVID-19 crisis emerged. We’ve been working hard on outreach to providers and clients. Initially we began with agencies serving a certain number of clients, checking in, seeing if they had what they needed, how they were supporting clients, etc. We’ve chosen a random selection of individuals across the state to see how they’re doing, to ensure their needs are being met, that they’re receiving ample communication regarding everything that’s going on, and so on. We’re hearing some concerns about communication and privacy. We want to ensure that the technology is there so that people can stay in touch with friends, family, and community access. Like many of us, most feel that life is on hold and there’s uncertainty about when things will begin to return to normal. There have also been a lot of questions about the stimulus checks, which we’re trying to answer.
-It was stated that the DRM emails have been extremely helpful, and people were encouraged to sign up for the email distribution list.
Laura: You should be able to sign up for DRM updates by going to our website, which is also updated frequently.
Betsy: I wanted to add that I saw the work you recently did with SUFU, which was great! We have posted plain language information on the stimulus checks on our website, so feel free to share that as well.
Federal & Housing Updates:
Cullen: Congress and the Administration have taken measures regarding the COVID-19 pandemic. Three stimulus packages have been signed into law, with Congress currently in negotiations on a fourth stimulus package, the timing of which is up in the air. The President signed the third stimulus package, the nearly $2 trillion CARES Act, to combat the economic fallout of the coronavirus outbreak, including direct payments to most Americans and a half-trillion-dollar fund to shore up struggling companies. Also included within the CARES act was additional funding for HUD, stressing the importance of Section 8 especially at this time. Maine received $1.25 billion for the small-state minimum. There’s funding coming in to meet the emergency needs of people, but it’s opening the door for a most lasting effect, such as rental assistance and the creation of supportive housing. There is a push from advocates across the country for the fourth stimulus package to include robust funding for $100B of rental assistance, and a large investment in sorely needed affordable housing through the passage of the Affordable Housing Credit Improvement Act of 2019 (S 1703/HR 3077). We’ve been in contact with Maine’s Delegation advocating for these critical resources, which would have a substantial positive effect on Maine’s affordable housing capacity. I also want to thank Maine’s entire Delegation because they have truly been champions for what Maine needs amid the COVID-19 pandemic.
State Legislature Update:
Cullen: As you know, the 129th Legislative Session ended early due to the COVID-19 crisis. A special session may be held, though it’s too early to know when. All bills with the exception of those that had already died in committee have been carried over to the special session, but only a few will likely be considered.
Laura Cordes – MACSP (Maine Association for Community Service Providers): There is a growing deficit, so the Legislature will have to reconvene, possibly in September, but the timing is still to be determined. MACSP’s advocacy has been around securing supports for people with ID/DD so that they can stay healthy and safe. We’re also working on ensuring that services will be intact on the other side of this crisis as well. On the federal side, we’re working on determining if the larger dollars set aside for healthcare providers, which is defined rather broadly, could be used as financial support for Medicaid providers in the State.
-It was stated that there hasn’t been a lot of discussion in the media about how COVID-19 is affecting this population, including outbreaks at residential facilities. It was asked if there has been discussion regarding how to publicize the needs without insinuating that the crisis isn’t being well-managed.
Laura: I can’t say enough about the providers and DSPs trying to secure PPE (personal protective equipment) and cleaning supplies amidst a shortage of both. On the weekly OADS calls people have elevated those needs, and we’ve spoken to many reporters about the needs of this population amidst the pandemic. There has been a lot of talk about “congregate settings”, but what hasn’t been discussed or contemplated, specifically in the media, are the challenges of DSPs working in several settings, or the vulnerabilities of the population we’re supporting. I think there’s been some headway with the CDC to get the word out, but there’s definitely room for more advocacy and education.
Other business:
Cullen: The Coalition is both a gathering place and an information clearinghouse. We seem to be good at accomplishing the latter through Zoom, less so with the former which has historically occurred at the beginning of these meetings through conversations over food. I want to acknowledge that it’s not the same having everyone on a computer screen. I want to encourage everyone here to reach out through the connections they have and connect with one another. This Coalition has a website that is updated regularly. The Coalition website has two forums, one on the Section 21 & 29 page (scroll down), and a general parent forum where people can communicate with one another – feel free to use that. Community Connect also has a robust Facebook group into which I would encourage you to look. It’s lonely out there trying to understand how the system works and figuring out what to do with your loved ones. We have some work to do to fill that void. Let people know about the Coalition, that there’s a place to which they can turn for support. Thank you for all you do and please continue to keep yourselves and each other safe.
The next meeting will be on Monday, June 8, 2020, 12-2pm, via Zoom.
Featured Speaker: Mark Kemmerle, Executive Director, Maine Developmental Services Oversight and Advisory Board (MDSOAB). Topic: MDSOAB Annual Forum – feedback for DHHS.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
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. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speaker: Betsy Hopkins, Associate Director, Developmental Disability and Brain Injury Services, DHHS-OADS. www.maine.gov/dhhs/oads Topic: Overview of OADS’ submitted K Waiver to CMS, what this means for service provision for people with ID/DD, and next steps. Discussion to follow.
Cullen: Today our featured speaker is Betsy Hopkins, Associate Director, Developmental Disability and Brain Injury Services, DHHS-OADS, presenting an overview of OADS’ Appendix K Waiver, including what this means for service provision for people with ID/DD and next steps. Thank you for being here today, Betsy, on short notice at that, and for providing this important information. OADS had a Zoom meeting detailing its K Waiver submission to CMS (Centers for Medicare and Medicaid Services) that was attended mainly by providers, and I thought that this group would be very interested in its content, specifically parents and family members of people with ID/DD. So, thank you again, Betsy, for your quick work on this and for being here today!
Betsy Hopkins - Associate Director, Developmental Disability and Brain Injury Services: Thank you for having me! I would like to say that we’re happy to announce that we received final approval for the K Waiver from CMS on Friday late in the day (click here for the approved Appendix K Waiver). We’re pleased that it was approved. Implementing this work has been in process since we first developed the draft application. We’re still working with OMS (Office of MaineCare Services) and others to discuss the billing process and what it will look like for providers – that’s still underway. As soon as we have more of those details, we’ll certainly share them. I also have Derek Fales and Elizabeth Hardink with me to answer questions, as there are some pieces that are more complex. As you know, many states around the country have submitted K Waivers, and we were fortunate to use this as guidance, as well as receiving feedback ahead of time, before we put forth the K Waiver for CMS approval. We were happy in many ways with what we got but wish we could have gotten more. The effective date goes back to 3/1/20, because we’re aware that providers have been dealing with this crisis since then and we wanted the funding to coincide with that. I’m going to do a more high-level review and Derek will go into more detail.
Begin Presentation (click here for the presentation)
Derek Fales: With the Appendix K Waiver, we wanted to ensure members who need to utilize telehealth or remote technology to communicate with staff have the availability to do so. As such, they’ll be able to use the full assistive technology (AT) benefit up to $6,000, and we will approve those requests with some flexibility. This will help ensure that people who need to have remote services can remain safe. We also have a shared living rate increase, an additional increase for shared living arrangements with more than one member, and this now allows for up to three members in the shared living home. All of this requires prior authorization and is currently in effect from 3/1 through 5/31/2020. We’re also providing a 10% rate increase on specified direct care and related services. The guidance, which we’re in the process of finalizing, will detail the services to which this increased rate applies.
Betsy: We also have temporary services for the care of people who test positive for COVID-19. We’re implementing an emergency transitional housing rate to assist with the increased costs of quarantining. Also, if needed, asked for, and approved through the hospital, there is the ability for paid staffing to be provided while someone is in the hospital. We wanted to expand where services could be provided for people depending upon need. Some providers have already utilized hotels, either to quarantine someone with COVID-19 or for someone who has tested negative but lives in a home with people who have tested positive. We worked with licensing to have some requirements waived to expedite these temporary settings. We’ve specified that community support can be provided in participants’ homes (or other settings). We wanted to provide some flexibility on provider qualifications, with the caveat that they’re working alongside others who do have the qualifications especially in the beginning, so that health and safety is assured through agency oversight. We’ve also included temporary permission for payment for services provided by family caregivers. The family member must be hired or contracted with an agency, and the provider agency must ensure services are provided as authorized in the PCP (person-centered plan). Almost right at implementation we’ll have to talk about what the plan looks like for the transition to pre-emergency services, since this is scheduled to end on 5/31; though K Waivers can be extended if necessary.
Discussion:
-It was asked how one would get prior authorization now, in May, for things that occurred in March,
Derek: The Department needs to receive a request; we will approve those requests, as long as they meet the expectations as outlined in the K Waiver. The provider will document the changes that occurred on or about March 1st. For some services, providers will submit billing for services, and it’s reviewed and approved. The Department still has to review and approve that change, even if it occurred in March and you’re submitting now.
-It was asked if there are any specifics on the increased rate for shared living.
Derek: We start with a 10% increase for the base rate for a single person in the shared living home, and that rate is implemented for the second and third people; so that second person receives a higher percentage for the rate, and the same for the third person. Let’s say, if the shared living reimbursement is $100 per day for one person, the second person would receive a higher percentage versus just splitting the $100 between the two. This shared living rate will continue past 5/31, until the end of this emergency. So, in general, one shared living provider can serve up to three individuals in that provider’s home, and the second and third person will have a higher rate percentage.
Laura Cordes – MACSP (Maine Association for Community Service Providers): We’ve had a lot of questions throughout the process of creating the Appendix K Waiver application, and I want to thank you for the flexibility that this waiver provides. We’ve shared our disappointment that the Appendix K Waiver application did not include retainer payments for community and work support providers. I wanted to see where the State was in terms of keeping the door open for this so that agencies can remain viable during and after the pandemic.
Betsy: I know, and I hear the disappointment and concern for sure. I think we focused our energy for this first K Waiver on emergency services for people who are in residential settings, home and family support, and emergency quarantining, all of which was essential. As far as community and work supports, we’re happy to see there are a number of agencies providing those services through telehealth and we hope to see more of that. What I can tell you is that we’re continuing to evaluate the need for financial relief for all MaineCare providers, including ID/DD providers, in terms of what’s happening in general and the broader economic outlook for the state. We’re having ongoing conversations about all of this; we’re trying to get this implemented and examine what else might be needed.
Laura: I’m sure a lot of folks in this meeting and others are thinking about the transition period, understanding there could be a reemergence of COVID-19, and the challenges faced with COVID-19 and working with a population that is more vulnerable. Right now, we’re looking at one-on-one services and wondering if OADS will be working with the CDC, or seeking support from providers, to think about particular guidance in transitioning to smaller group services.
Betsy: We have a lot of guidance we’re trying to get vetted regarding telehealth. We’re also putting together guidance regarding what it would look like to do community supports in person, and in a variety of different ways. One of the things we’re hoping for is rather than center-based services, is people being in their communities as much as possible. Right now, being in one’s community looks very different. We will be putting together guidance for people if they’re going to bring small groups together, and that has to be vetted by the CDC. We’re happy to bring that to this group.
-It was asked how many adults are served in community support day programs currently, as it’s one of the services that’s highly utilized through Section 29. It was stated that there are general concerns about the viability of provider agencies.
Betsy: I don’t have those specific numbers. I think the concern is what will happen with community programs after this emergency. We’re aware of those concerns and we’re having discussions. If people can provide community and work supports through telehealth, then we encourage providers to do that as much as possible right now. We’re hearing that having that contact and having that support from community case managers and community programs, has been very helpful for people who haven’t been able to do much outside of their homes.
Cullen: I want to thank everyone who worked on this Appendix K Waiver to get it submitted as quickly as possible. I think it’s great that we’re examining the challenges now as posed by COVID-19, as well as when this emergency ends. There is a need to have a highly professional workforce to meet the needs of this population. Hopefully, some of the short-term gains with this waiver will persist after this emergency. Often, times of crisis create groundswell for opportunities for lasting positive change; I hope that is the case now. I want to thank you, Betsy, for putting together this presentation, and for the care and thought that went into its creation!
End Presentation (round of applause)
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Cullen: I’m also pleased that today we’re joined by Teresa Barrows, Children’s Behavioral Health (CBH) Manager, who also agreed to present to this group on very short notice. Thank you, Teresa, for being here!
Teresa Barrows, Children’s Behavioral Health Services (CBHS) Manager: I’m very happy to be here, and I look forward to attending these meetings regularly. I’m one of three Children’s Behavioral Health Managers. I manage coordinators across the state to help people navigate the system of care, and part of that work is transition.
(Click here for the OCFS Update which Teresa reviewed in detail.)
Teresa: I started with the Department about 20 years ago, and at that time we always met with OADS to track children who might be able to get an adult waiver, so OADS could plan for children’s need when they transition to adult services. Our work together has changed over time with the waivers and the waitlists, but we continue to work collaboratively on a regular basis, specifically on transition. We realize there will be youth about whom we won’t know, for a variety of reasons, and for these situations there is an early referral form (click here for the Early Notification Form). Information from this form is then entered into EIS to begin the process on transition. We’ve always wanted to focus on that transition to adulthood; not everyone will need services when they’re an adult, but we want to make sure that we identify the youth who will need services in adulthood, so they don’t fall through the cracks and begin work with them as soon as possible. There aren’t enough services, but we want to at least identify all of the needs. I also wanted to provide a guide to our staff so that people can reach out with any questions etc., (click here for the State of Maine CHBS Staff Guide) as well as a map that details transition by county, which includes staff information and contact information for both OADS and OCFS (click here for the Transition County and Map document). Additionally, an OCFS listserv announcement recently was distributed with information on entering transition information in the EIS database for youth ages 16-20 with ID/DD (click here for the OCFS listserv email).
Discussion:
-It was stated that EIS access has always been difficult. Agencies are limited in the number of staff who can access EIS. It was stated that children’s services, specifically case managers, ought to have access to EIS and the new Evergreen system when it comes out. It was asked if EIS or Evergreen will be used, why not make that be the electronic health record.
Teresa: We share a similar thought, that it would be easier if we could have one system. The reality at the moment is that we don’t, but I will certainly bring your concerns back, because it has been frustrating. I definitely hear you. One of the reasons we’re having case managers enter information into EIS is we were trying to manage all of this information ourselves, and it was backlogged. Having case managers enter the information allows us to have access to the information and ensure children are getting the services they need. Not having access to all of the information, with OADS’ new system, has been frustrating for all.
Betsy: I know enough about the new system to be dangerous. Everyone is excited about the way that it talks across systems much more efficiently. I’ve written down this concern as well. My guess is that they’ve heard it before, but I’ll make sure this feedback is brought back.
-A parent and former special educator stated that he was always concerned that the information that special education and schools had was not effectively leveraged in the transition process. Families, especially those with children with more challenges, benefitted from schools communicating with Voc Rehab, transition specialists, summaries of skills and needs upon graduation, etc. It was asked how OCFS is working to interface with DOE and Special Education to make the process easier for families.
Teresa: We had been working closely with them, then that staff person left, so we need to pick that back up. There is a lot of work to do on transition, and there are a lot of gaps. We’re in the process of working on particular strategies, one of which is transition to adulthood. I think once we get to that point, we’d create a stakeholder group to examine this. In my experience no matter how we do this we never quite get there, and I’m not sure why it has been so difficult. Transition is such an important piece on which we need to be working. Meetings with school superintendents etc., need to resume so this work can move forward effectively.
Cullen: First, thank you for making transition a focal point of what you’re doing – it’s welcome and long awaited. It seemed like there was a system in place for transition and then it eroded, or perhaps was dismantled, over time. I want to point to the Blueprint for Effective Transition that looks at the major transition from children’s to adult services, as well as all of the other smaller transitions that occur throughout a person’s life. There’s a lot of room to better the transition to adulthood, beginning early on and building on that as the person evolves into early adulthood and beyond. I urge you to take a look at that in conjunction with this group. It’s a great place to start as a lot of work went into it right when transition seemed to fall by the wayside.
Teresa: Yes, you are right. Things change with administration changes, but I think that transition will be a focus, in which I will be actively involved. Attending these meetings on a regular basis will allow us to work together and move this work forward.
Cullen: That is fantastic. There is a tremendous amount of expertise around the table, from which the system would benefit.
-It was stated that the idea of one system, versus a children’s and an adult system, would be advantageous and eliminate the “cliff of no services” many people face upon graduation.
Teresa: Thank you for allowing me to share information with you today, and please reach out! Elissa Wynne, Associate Director of Children's Development & Behavioral Health, who presented to this group in February, is also willing to attend periodically to provide updates on the larger OCFS picture as well.
Cullen: Thank you for being here today, and for your willingness to attend moving forward, as we will all be better for having OCFS consistently at the table!
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy: The OADS Quarterly Update was posted to the website on Friday, and includes waitlist information (click here for the OADS Quarterly Update). Waitlist information as of 4/1/20: Section 21: 1,694; Section 29: 369
Betsy: In general, we’ve seen an increase in applications for Section 29. We have been making a number of Section 29 offers, and we’ll be making more starting 7/1, with the inclusion of funding for additional offers in the budget. There are some agencies who are not accepting new offers for whatever reason, so this has affected people being able to begin receiving services. So, the time-limit for people to find a service provider has been suspended so as not to be a barrier.
Disability Rights Maine (DRM) Update:
Laura Wille: I want to share a brief update on what we’ve been working on since the COVID-19 crisis emerged. We’ve been working hard on outreach to providers and clients. Initially we began with agencies serving a certain number of clients, checking in, seeing if they had what they needed, how they were supporting clients, etc. We’ve chosen a random selection of individuals across the state to see how they’re doing, to ensure their needs are being met, that they’re receiving ample communication regarding everything that’s going on, and so on. We’re hearing some concerns about communication and privacy. We want to ensure that the technology is there so that people can stay in touch with friends, family, and community access. Like many of us, most feel that life is on hold and there’s uncertainty about when things will begin to return to normal. There have also been a lot of questions about the stimulus checks, which we’re trying to answer.
-It was stated that the DRM emails have been extremely helpful, and people were encouraged to sign up for the email distribution list.
Laura: You should be able to sign up for DRM updates by going to our website, which is also updated frequently.
Betsy: I wanted to add that I saw the work you recently did with SUFU, which was great! We have posted plain language information on the stimulus checks on our website, so feel free to share that as well.
Federal & Housing Updates:
Cullen: Congress and the Administration have taken measures regarding the COVID-19 pandemic. Three stimulus packages have been signed into law, with Congress currently in negotiations on a fourth stimulus package, the timing of which is up in the air. The President signed the third stimulus package, the nearly $2 trillion CARES Act, to combat the economic fallout of the coronavirus outbreak, including direct payments to most Americans and a half-trillion-dollar fund to shore up struggling companies. Also included within the CARES act was additional funding for HUD, stressing the importance of Section 8 especially at this time. Maine received $1.25 billion for the small-state minimum. There’s funding coming in to meet the emergency needs of people, but it’s opening the door for a most lasting effect, such as rental assistance and the creation of supportive housing. There is a push from advocates across the country for the fourth stimulus package to include robust funding for $100B of rental assistance, and a large investment in sorely needed affordable housing through the passage of the Affordable Housing Credit Improvement Act of 2019 (S 1703/HR 3077). We’ve been in contact with Maine’s Delegation advocating for these critical resources, which would have a substantial positive effect on Maine’s affordable housing capacity. I also want to thank Maine’s entire Delegation because they have truly been champions for what Maine needs amid the COVID-19 pandemic.
State Legislature Update:
Cullen: As you know, the 129th Legislative Session ended early due to the COVID-19 crisis. A special session may be held, though it’s too early to know when. All bills with the exception of those that had already died in committee have been carried over to the special session, but only a few will likely be considered.
Laura Cordes – MACSP (Maine Association for Community Service Providers): There is a growing deficit, so the Legislature will have to reconvene, possibly in September, but the timing is still to be determined. MACSP’s advocacy has been around securing supports for people with ID/DD so that they can stay healthy and safe. We’re also working on ensuring that services will be intact on the other side of this crisis as well. On the federal side, we’re working on determining if the larger dollars set aside for healthcare providers, which is defined rather broadly, could be used as financial support for Medicaid providers in the State.
-It was stated that there hasn’t been a lot of discussion in the media about how COVID-19 is affecting this population, including outbreaks at residential facilities. It was asked if there has been discussion regarding how to publicize the needs without insinuating that the crisis isn’t being well-managed.
Laura: I can’t say enough about the providers and DSPs trying to secure PPE (personal protective equipment) and cleaning supplies amidst a shortage of both. On the weekly OADS calls people have elevated those needs, and we’ve spoken to many reporters about the needs of this population amidst the pandemic. There has been a lot of talk about “congregate settings”, but what hasn’t been discussed or contemplated, specifically in the media, are the challenges of DSPs working in several settings, or the vulnerabilities of the population we’re supporting. I think there’s been some headway with the CDC to get the word out, but there’s definitely room for more advocacy and education.
Other business:
Cullen: The Coalition is both a gathering place and an information clearinghouse. We seem to be good at accomplishing the latter through Zoom, less so with the former which has historically occurred at the beginning of these meetings through conversations over food. I want to acknowledge that it’s not the same having everyone on a computer screen. I want to encourage everyone here to reach out through the connections they have and connect with one another. This Coalition has a website that is updated regularly. The Coalition website has two forums, one on the Section 21 & 29 page (scroll down), and a general parent forum where people can communicate with one another – feel free to use that. Community Connect also has a robust Facebook group into which I would encourage you to look. It’s lonely out there trying to understand how the system works and figuring out what to do with your loved ones. We have some work to do to fill that void. Let people know about the Coalition, that there’s a place to which they can turn for support. Thank you for all you do and please continue to keep yourselves and each other safe.
The next meeting will be on Monday, June 8, 2020, 12-2pm, via Zoom.
Featured Speaker: Mark Kemmerle, Executive Director, Maine Developmental Services Oversight and Advisory Board (MDSOAB). Topic: MDSOAB Annual Forum – feedback for DHHS.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
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].