October 21, 2019
Minutes
Minutes
Present: Todd Landry, Karen Tompkins, Mark Kemmerle, David Cowing, Debbie Dionne, Kim Humphrey, Jennifer Putnam, Betsy Mahoney, Margaret Cardoza, Foxfire Buck, Jenn Brooking, Ryan Gallant, Geoffrey Slack, Tracey Webb, Julie Brennan, Deb Dunlap, John Regan, Ariel Linet, Cullen Ryan, and Vickey Rand. Via Zoom – (Bangor): Bonnie-Jean Brooks. (Brunswick): Ray Nagel. (Winthrop): Cathy Dionne. (Sanford): Emily Spencer. (Orono): Maria Cameron. (Belfast): Linda Lee. Misc. sites: Lydia Dawson, Paul Saucier, Betsy Hopkins, Craig Patterson, Bonnie-Jean Brooks, and Helen Hemminger.
Cullen Ryan introduced himself and welcomed the group. Participants introduced themselves. Minutes from the last meeting were accepted.
Disability Rights Maine (DRM) Update:
Foxfire Buck: We continue to do systemic monitoring activities statewide, which usually take place in residential group homes for adults to see how they feel about their services and provide advocacy around that. We’re updating some of our trainings to make them more informative. We’ve added more rights trainings which occur all throughout the state.
State Legislature Update:
Lydia Dawson – Maine Association for Community Service Providers (MACSP): MACSP has hired a new Executive Director, who starts on Monday. She has a long history of working with coalitions to further important causes; I feel confident she will represent MACSP well around this table.
Jennifer Putnam: Cloture occurred at the end of September; the Legislative Council will be deciding upon which bills will be considered as emergency legislation in the Second Session of the Legislature. They will be reviewing around 400 bills that have been submitted. I’ve heard that they will only likely consider 15% of the bills, and I’ve also heard that they will consider a lot more, so we’ll have to wait and see. There are two bills that we submitted which will be presented to the Legislative Council on Wednesday. One bill is LR 2894, An Act Regarding the Implementation of Federal Requirements for Electronic Visit Verification of Personal Care and Home Health Assistance. For any in-home service there’s a Federal requirement for states, and as such providers, to have parents’ signatures at arrival and departure times in the home to prevent fraud. That’s created a lot of snafus in Maine. We just got a one-year extension to provide a structure to advocate for providers and workers to ensure that they are part of this process moving forward. The second bill submitted is LR 2895, Resolve, Directing the Department of Health and Human Services To Increase MaineCare Reimbursement Rates for Targeted Case Management To Reflect Inflation. There hasn’t been a rate increase in Targeted Case Management (TCM) for more than a decade. TCM services were left out of the Section 21 and Section 29 rate increases that were passed in the Legislature a couple years ago. We’re hoping that these bills will be heard in the upcoming Legislative session. There are a couple bills that this group has been following which were carried over. One of these bills was the bill which would set DSP rates at 120% of minimum wage, up to $15 per hour after January. However, the fiscal note looks quite low to us, so we’re working with people to identify why it looks so low. This bill passed the Legislature but is sitting on the Special Appropriations Table awaiting funding. LD 1377, An Act To Enhance and Improve the Maine Developmental Services Oversight and Advisory Board and To Establish the Aging and Disability Mortality Review Panel, is the MDSOAB bill looking at a mortality and independent review panel, examining at deaths and serious injuries of people with ID/DD and Autism. This bill, which had Department support, would provide a framework for an independent panel with a nurse housed in the Maine CDC to vet all of those reports and be a facilitator/chair of this panel. This bill is also on the Special Appropriations Table.
-There was a question regarding the status of the dental care bill for people with ID/DD (LD 373, An Act To Provide MaineCare Coverage for Dental Services to Adults with Intellectual Disabilities or Autism Spectrum Disorder, Brain Injuries and Other Related Conditions.)
Lydia: The bill specific to people with ID/DD didn’t move forward because of the bill that encompasses the broader group of MaineCare recipients (LD 519, An Act To Expand Adult Dental Health Insurance Coverage). This bill is also on the Special Appropriations Table. (LD 373 was carried over into the next Legislative Session.)
Jennifer: LD 1178, An Act To Address the Needs of Children with Intellectual Disabilities and Pervasive Developmental Disorders, would create a waiver program specifically for children with ID/DD and Autism. The Department wanted more latitude to make this a State Plan amendment rather than the requirement to create a waiver. Nothing has happened with this thus far. There are currently hundreds of children waiting for services, and then when they do receive service offers, they are pushed into a behavioral health system.
-There was a discussion regarding credentials for who would be eligible for the rate increase.
Jennifer: The rate increases would be for DSPs not all employees. The previous rate increases brought the rates to minimum wage, so there wasn’t a discrepancy; however, this time it will be a little different because the rate would exceed minimum wage so what other employees make relative to minimum wage will be up to individual providers.
Federal & Housing Updates:
Cullen: On 9/27 the President signed a short-term CR to fund the government through November 21. Congress is working on the FY 20 allocations and budget, including working on reconciling House and Senate appropriations bills, including the T-HUD budget. The House and Senate T-HUD budgets look very favorable and aren’t far off. More information to follow next month.
Developmental Services Stakeholders Continuum of Care
Cullen: The Developmental Services Stakeholders Continuum of Care group is moving forward on creating a more user friendly diagram for the Developmental Services Lifelong CoC (DD CoC), which will hopefully be an effective tool for the Legislature. The layout is much more linear and illustrates the entire lifespan. This group will also be reviewing the Blueprint for Effective Transition, and the Charting the LifeCourse Toolkit.
David Cowing: OADS contracted with Jane Gallivan for a whole developmental services system review. Jane introduced the Charting the LifeCourse work done at the University of Missouri, as a way to contemplate service needs throughout the entire lifespan (Click here for the Charting the LifeCourse Experiences and Questions Booklet). The DD CoC group will be reviewing this work to help us be more effective in our advocacy efforts. Charting the LifeCourse includes eight domains, and then it examines what these domains look like at different stages of the lifespan.
Cullen: The DD CoC contemplates a system view of a person’s entire life and includes an overview of principles upon which the system ought to be built. Charting the LifeCourse appears to take these principles and apply them where the rubber meets the road.
Featured Speaker: Todd Landry, Director, DHHS Office of Child and Family Services (OCFS). www.maine.gov/dhhs/ocfs Topic: Update on Children’s Services, and discussion of Blueprint for Effective Transition.
Cullen: Today our featured speaker is Todd Landry, Director of the Office of Child and Family Services (OCFS). Todd, thank you for joining us today. OCFS played a very active role under Jim Martin’s leadership, after which we have experienced only sporadic attendance. Thank you for being here, we look forward to hearing updates from OCFS, and the opportunity to discuss this Coalition’s Blueprint for Effective Transition.
Todd Landry: I’ll run through these slides fairly quickly; some of this might be familiar to you as I’ve shared them in various venues recently. I thought it might be beneficial to know a little more about where OCFS is heading. I’ve been here for about five months and have enjoyed the opportunity to meet with some of you in other forums. One of the first things I did when I came to Maine was, I intentionally set goals. For instance, I wanted to visit every district office to engage with staff within my first four weeks. It took me five weeks instead of four, but I visited every office and began the intentional process of rebuilding trust with staff. These visits were also about taking the opportunity to meet and engage with some of our stakeholders. During this we did a word cloud exercise, and the question I posed was for them to tell me what they wanted for children and families in Maine, not from OCFS, but generally speaking. A few things came up repeatedly, which led us to build a North Star – something everyone in the office can point to as what guides us: All Maine children and families are safe, stable, happy, and healthy. This North Star is aspirational in nature for all of the aspects within OCFS. This is what’s grounding our work moving forward. I’ve asked staff every day, before you leave, take a pause and ask yourself: “Did you do something, even small, to help create some safety, stability, happiness, or health?” If the answer is yes, then we’re on the right track.
Begin Presentation (Click here for the presentation)
Todd: Until I came to Maine, I didn’t realize that State and Federal mandates were optional, but apparently that was the case for years here. One example is around the child care subsidy. Almost all of the dollars we provide to families who qualify come from the Federal government. Federal dollars come with requirements, rules etc. In the past several years the State had decided to promulgate some different rules about subsidy and licensing requirements. The Federal government sent some emails to the effect of “if you do this, you’ll be out of compliance with Federal regulations.” The State went ahead and promulgated the rules anyway, and then received a formal letter from the Federal government stating that Maine was out of compliance and unless substantive changes were made to come into compliance Maine will be fined $800,000 per year. We’re working hard to promulgate new rules to bring us back into compliance with Federal rules and regulations. This is one example.
To further increase transparency, a few weeks ago we released the OCFS Data Dashboard. It’s a very user-friendly interface and you can drill down into the data. This is a commitment to sharing our data more widely. I’ll be honest with you, some data points are positive, but there are some that are not. I encourage you to take a look at that. (Click here for the Children’s Behavioral Health Data Dashboard.) This is a new endeavor for us, and on each page of the data dashboard there’s an option to provide feedback.
The Governor reconvened the Children’s Cabinet after an eight-year hiatus. Early childhood education is one of the key areas on which it focuses. The Children’s Cabinet meets every six weeks.
In the child welfare area in particular, when I was back in Texas numerous reports were sent to me when I accepted this position. I added up all of the recommendations included within all of these reports and there were around 150 of them. There was no way we could implement 150 recommendations all at once; we certainly wouldn’t be able to do them well. I began to hear, including from our own staff, that people were randomly pulling things off the table from those 150 recommendations; this didn’t seem like the best approach either. When I came on board in May, I slowed things down a little, and instead of picking things out randomly I wanted to look at what we should do to prioritize things. We have re-engaged with a number of our national partners, specifically Casey Family Programs. We asked them to come in and work with staff and stakeholders to rationalize these recommendations and priorities. We prioritized all of those recommendations and mapped what’s going on in the childhood arena. We ended up with a map of 12 strategies on which we’re going to focus in order to move the needle and improve the system for children and families. We’ve already started work on nine of these 12 strategies. These are the areas we’re going to build out specific implementation plans so we can stay focused. We didn’t do this in a vacuum – we did this with staff at every office in the state, along with stakeholder groups across the state and our national partners.
In the Children’s Behavioral Health Services arena, we approached it similarly; however, it’s a little different from child welfare or early childhood education. Looking at the array of services within Children’s Behavioral Health, this was not an exercise about reforming but around rebuilding the system. We chose to frame this around the Children’s Behavioral Health Services Array, which is structured as a pyramid. At the bottom of the pyramid is the least-intensive, most community-based services, serving the largest number of children and families. As you move up the pyramid you get into more intense levels of care, and hopefully fewer children and families in need of those services. As you move up the pyramid the costs also increase. I want to point out that at the top of this it doesn’t say this is Maine’s service array – that’s very intentional. There are pieces on this chart we don’t even have in the state of Maine. We would certainly have strong agreement even where we have them, we don’t have them in the quantity we need, nor do we have them spread out geographically. This is the theoretical direction in which we’re going. We do have a version of this where we’ve begun to try to quantify with numbers but that’s in draft form. The next public version of this will be color coded, based on provider, family, State-funded services, non-State-funded services, etc. This is conceptually where we’d like to go. How do we get there? Over the course of the summer we developed the Children’s Behavioral Health Services Visioning. We started with the PCG (Public Consulting Group) reports that came out, with national experts, staff, and stakeholders, and we began to rationalize the list of strategies. We divided the strategies up between short- and long-term. Short-term strategies are ones we can accomplish within the next two to three years. The long-term strategies will take longer to see measurable progress because there’s more involved. For example, with the workforce issue it will take longer to see major improvements, but this doesn’t mean we won’t begin to make improvements. For the short-term strategies, we think we can make changes to the waitlist process to improve this for children and families. We’ve nearly completed the drafting of the first four of these strategies and implementation plans, and we’re about to start tackling the second four, with their implementation plans to follow. The implementation plans will change as we learn, and on an annual basis we intend to provide a report on where we are on the implementation of these strategies. Another of our short-term strategies is to improve coordination for transition-age youth for children’s behavioral health services. We’ll be partnering with OADS on this. The waitlist process is obviously important. Section 28 is specifically called out here for us to explore options for how we can amend that. Some of these are internally focused, such as being clearer about our own staff roles and responsibilities, etc., while others are much more externally focused.
Discussion:
-It was stated that this is terrific and well done.
Todd: The intent is that we’re focusing on this whole array, but a lot of what you’re seeing in the Children’s Behavioral Health Services plan is in the HCBS section of the service array – the middle section of the pyramid. We need to improve this and ensure we’re using evidence-based models. It doesn’t mean everything we’re going to do is a gold-standard program. However, this middle section of the pyramid is where we recognize there’s a logjam. When kids at the bottom of the pyramid need a slightly higher level of services, they’re bumping up against a large barrier to access it and access it in a timely fashion. Kids in residential treatment settings, at the top of the pyramid, bump up against the same barrier when titrating down services. We’d love to see them in the least restrictive setting but that’s incumbent upon getting the middle section of the pyramid right.
Jennifer Putnam: I wanted to ask a few questions about exploring amending Section 28. Section 28 in-home services are not necessarily evidence-based. Can you talk a little further about your thoughts on this?
Todd: This is something we’re doing in conjunction with the Office of MaineCare Services (OMS). One of the things we heard very clearly from providers and family members was that they felt the current waitlist process wasn’t enabling them to be as specialized as they wanted it to be around ID/DD. We have also heard that we need to be careful not to restrict Section 28 too much, to ensure people can still access the service. We’re approaching this very carefully. We’re recognizing that the way the system has developed Section 28 has become a little bit of a catch-all. We don’t want to overly restrict Section 28 and create an unintended consequence of having people not eligible for other services. I’ve asked staff to be very thoughtful and careful regarding this. As for the waitlist, we can move a little more quickly with changes. The question is how far of a swing do we want in terms of the waitlist? It appears that the way the waitlist has been working lately has been through this very significant pendulum swing – a rigid first come, first served waiting list versus a more flexible approach. With any changes we need to not swing the pendulum all the way back, we need to be in the middle – to serve children and families in an appropriate manner.
Jennifer: There was a bill, LD 1178, modeled after the old MaineCare Section 32, specifically for children with ID/DD and Autism. In working with the Department, we came to broader agreement that this didn’t need to be a waiver and that it could be a State Plan amendment allowing for services for children with ID/DD and Autism that mirrors Sections 21 and 29.
Todd: I believe Office of MaineCare Services has the responsibility to take the lead on LD 1178, but we are also involved.
-A parent stated that her son ended up on the waitlists for Section 65, Section 28 specialized, and Section 28 non-specialized because his case manager didn’t know the differences between the waivers. She stated that her son has received all of these services at one point in time and did not need Section 65 services. This was a waste of time and money. Additionally, she stated that despite her son having a diagnosis of Autism, which he will always have, he had to be found eligible for services every so many years which is neither efficient nor effective.
Todd: What tends to happen when there’s a real or perceived lack of access to services, is you end up throwing a bunch of spaghetti at the walls to see what sticks. This is what’s happening now. If there’s a long waitlist for the ideal service people think that something is better than nothing, so they get on all of the waitlists. With this, children and families end up not getting the services from which they would most benefit. You also end up with a bunch of waitlist data with which you can’t make decisions.
-A provider stated that the hardest families they serve are the families that when they transitioned out of high school, they didn’t get the services they needed. Parents who have ID/DD or Autism then end up in child protective cases.
Todd: I appreciate you highlighting that. This is a challenge, and one of the reasons we have more effective transitions as a short-term goal. We’re working with OADS and the Office of Behavioral Health because it will take all of us working together on this.
-It was stated that these appear to be medium-term rather than short-term goals. It was asked what can be done in the next twelve months for these children on the waitlists, and for children who are out of state.
Todd: We have about a two to three-year timeframe for our short-term goals, but this doesn’t mean we’re waiting to start on them. I think as we roll these out, we’ll be making some changes within the first 12 months. Immediate changes in the near term would be around the waitlist; we can make some significant changes around the waitlist process that would help everyone. You’ll begin to see some of these pieces within the next 12 months. This isn’t to say we couldn’t make some improvements in the lone-term goals in the next 12 months as well. As it relates to the kids out of state, many of the changes will affect them. There are around 70 kids out of state currently, the vast majority of whom are not in state custody. We’re working and building plans for how they can return to the state (for those in state custody) and engaging with families for those that are in parental/familial care.
Bonnie-Jean Brooks: I’m thinking about children who are on your caseload who are victims of the opioid crisis. I’m wondering if you’ve had time to think about this or developing strategic initiatives around this.
Todd: The issue of drug-affected or substance-exposed infants is something of which we’re very aware and cognizant. We continue to see, if not a decline, a flattening of substance-exposed infants in Maine. The way we have been approaching much of that work is in partnership with the Governor’s Office. Within DHHS, there is an opioid coordinated council and part of that is looking at the multigenerational aspect of Substance Use Disorder (SUD), and how all of the different offices within the Department can link our strategies together. This council is in the process of formalizing a very specific response, which contemplates it from the full continuum of prevention, treatment, and recovery. I’m hoping you’ll see emphasis on all three of those areas. I have some concerns about the legalization of marijuana, how it will affect children and youth, and am interested to see what other states have done regarding this.
Cullen: Todd, thank you very much for being here. This was very informative, and it’s great to see where you’re going with OCFS, how you’re coordinating with other offices within DHHS, as well as intentionally soliciting stakeholder feedback. I hope we can have you attend more often. We’re looking to modify the DD CoC, which covers the entire lifespan, and the Blueprint for Effective Transition, which includes principles, goals, and strategies for all forms of transition within the system of care for persons with ID/DD. It would be great to work with both you and Paul Saucier over the coming months to see where we can all work together to implement strategies around effective transitions.
Todd: Just last week I sat down with Paul to see how we can best work together. I’ve been pleased with the openness of our staff to re-engage with other offices, national partners, and other stakeholders. There are a lot of things we can learn from other states that can be modified so it works for Maine. Editing something is a lot easier than starting from scratch.
Paul Saucier: We are excited to work with OCFS on transition. Todd has embraced the idea of working strategically together on planning tools that chart the life course from childhood to adulthood; we’re looking at the Charting the LifeCourse materials and tools from the University of Missouri. Give us a little more time to figure out which way we want to go, and we’d be happy to come back to engage and discuss this with all of you.
Todd: I’m happy to engage with this group where those linkages occur, likely with it making the most sense to do so in conjunction with Paul.
Cullen: It’s exciting to have everyone engaged and around the table. Thank you again, Todd, well done, and we’d love to have you back!
End Presentation (round of applause)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads - Click here for the most recent waitlist update provided by OADS staff.
Paul Saucier: I’m happy to be here today. I also have with me Betsy Hopkins, our new Associate Director of Developmental Disabilities and Brain Injury Services. Unfortunately, I have to start with some difficult news – today the Department issued a press release detailing our move to terminate our MaineCare provider agreement with RCSS (Residential and Community Support Services), a sizeable residential provider in southern Maine. We had to do this to protect and ensure the health and safety of individuals served by RCSS. It will be challenging to find new homes for the 65 people who live in residential homes run by RCSS, but we had to ensure the health and safety of those individuals. DHHS also terminated RCSS' separate state contract to provide emergency transitional housing services. These will take effect immediately, but we will continue to work with and pay RCSS to ensure a smooth transition, which we expect will take about 30 days. More information is included in the press release. We’ve been working closely with RCSS since late August, after a resident's death. Despite our work with them they did not make sufficient progress and improvement to ensure the health and safety of the people who live there. We have a rapid response team meeting daily and will be ready to engage to find new homes for people. If any of the providers in this group are in the position to offer homes, please let us know. Derek Fales is our point-of-contact for this (Derek’s contact information – email: [email protected] phone: (207) 287-6656). This includes a legal matter, so I won’t be able to say too much but I’m happy to try to answer any questions you have.
-A parent stated that her son happens to live in an RCSS home. It was asked if residents will have to vacate immediately.
Paul: We will continue to pay RCSS and continue to work with them. We expect that it will take up to 30 days to find homes for the residents. No one will be on the street today.
Bonnie-Jean Brooks: Obviously this is sad news for the people who live there and their family members. I’m wondering if the people supported by RCSS come from all over the state or just in southern Maine, as it may be easier to relocate to other areas in Maine if that’s where they’re from and want to live.
Paul: Residents and guardians will have a say regarding location. We do have adequate capacity in our system but that is statewide – we may have a few beds in Aroostook county but if no one wants them it won’t be helpful. These will be individualized conversations with residents and guardians. If it becomes evident we need more resources in southern Maine, we’ll work to find them.
Mark Kemmerle: Whatever you learn from potentially expediting the process to bring new homes online, keep it going because it’s a big drag on the system universally.
Paul: This is a good point. We are working closely with the Office of MaineCare Services, and they are prepared to expedite applications.
Lydia: You mentioned emergency transitional housing in addition to waiver housing and residents not being appropriately supported. Were they waiver clients or emergency transitional housing clients?
Paul: We have generalized concerns about the agency’s ability to implement a quality management system and ensure the health and safety of residents. They do have both types of housing, but mostly for Section 21.
Lydia: Was the client who died in emergency transitional housing?
Paul: I’m not 100% certain so I can’t answer that.
Lydia: If there were any concerns about something as severe as a death, abuse, neglect, or exploitation, we would hope crisis services or APS (Adult Protective Services) were notified. Are you looking at these systems to see if there were gaps there as well?
Paul: Yes, of course. We are looking at our own processes and offices internally. APS opened a case immediately upon learning of the death in late August. Law enforcement was called and asked the Department to hold its APS case pending the conclusion of their investigation. We have complied with that request and have cooperated fully with law enforcement in its investigation.
-A provider asked if an agency could take over an entire house as is.
Paul: I recommend connecting with Derek regarding your interest. Houses owned or leased by RCSS will continue to be in their control. However, my understanding is at least one home is owned by guardians, who will be looking to retain the location and bring a new provider in for services.
-It was asked if there was any news on self-advocacy.
Paul: We’re behind the schedule we set for issuing the self-advocacy RFP. We will continue our current self-advocacy arrangement for as long as needed until we can award a new contract.
Paul: On a brighter note, the happy news is Betsy’s arrival, so I’d like to turn it over to her.
Betsy Hopkins: Hello everyone, I’m happy to be here. I’ve joined your meeting in the past when I was in the role of Voc Rehab Director a few years ago. I’m excited to be here at OADS and I’m excited for the collaboration between OADS and OCFS around transition. I’m on week three of my job, but I’ve jumped in on the HCBS Settings Rule. A number of pieces of information have been shared on the HCBS website. There are going to be some town halls around the state and I wanted to mention those here (Click here for more information). The purpose of those is for us to give a brief overview of the HCBS Settings Rule and the changes coming, inviting any and all interested parties to ask questions, which we’ll try to answer or gather them to add them to our HCBS Settings FAQ. I look forward to joining you in person soon.
Cullen: It’s great to have you back around the table, Betsy.
-It was asked when the provider site self-assessment will be finalized so providers can begin working on this task.
Betsy: Those will be sent out to providers on November 1st.
Ray Nagel: At first, I thought that the assessment would be available today, though it’s understandable why it’s not. Having the assessments in our hands on 11/1 and giving us until the end of November to complete theme is a task that likely cannot be done, definitely not done well. I would urge OADS to reconsider that and consider giving us a 90-day period. We know you’re behind schedule, through no fault of your own, but we feel we won’t have quality self-assessments without more time dedicated to the matter.
Paul: I appreciate that Ray. The reason you’re not getting the assessment today is because we got some really good feedback on the tool from stakeholders, so the tool has been modified. We will certainly take your request for more time back to Derek and the team, but any extension wouldn’t be an extension of that magnitude.
-A parent and former special educator stated that he hopes the Department of Education and Special Education are both around the table with OADS and OCFS in discussions around transition.
Paul: That’s why I was asking for a little more time to ensure we have the right people on our end engaged in the process before we bring this to you.
Cullen: I want to echo that, I think it’s wonderful that everyone wants to be around the table, and time is something that has to be put in it to get it right.
-A self-advocate stated that the mental health arena has a Quality Improvement Council, but one doesn’t exist for the ID/DD arena. It was asked how we can ensure that all stakeholders are working together and have equal input.
Paul: I think this Coalition is the most broadly representative meeting in which I participate. We have the HCBS Stakeholders group as well. We’re open to thinking about other stakeholder processes if there’s a need, but we don’t want to create more stakeholder groups just for the sake of creating them.
Cullen: Thank you, Paul and Betsy, for being here. It is great to consistently have OADS around the table.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs - Click here for the 10/21 OCFS System Improvements Update.
The next meeting will be on ***Monday, November 18, 2019***, 12-2pm, Burton Fisher Community Meeting Room, located on the First Floor of One City Center (food court area, next to City Deli), Portland.
***Please note that this is the third Monday of the month due to the holiday on the regular meeting date***
Featured Speaker: Derek Fales, Waiver Services Director, Developmental Disabilities and Brain Injury Services, DHHS-OADS. Topic: An update on Maine’s Home and Community-Based Services (HCBS), including discussion on the provider self-assessment, FAQs, and OADS’ continued path forward to compliance.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
Burton Fisher Community Meeting Room, 1st Floor of One City Center in Portland (off of the food court).
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 introduced themselves. Minutes from the last meeting were accepted.
Disability Rights Maine (DRM) Update:
Foxfire Buck: We continue to do systemic monitoring activities statewide, which usually take place in residential group homes for adults to see how they feel about their services and provide advocacy around that. We’re updating some of our trainings to make them more informative. We’ve added more rights trainings which occur all throughout the state.
State Legislature Update:
Lydia Dawson – Maine Association for Community Service Providers (MACSP): MACSP has hired a new Executive Director, who starts on Monday. She has a long history of working with coalitions to further important causes; I feel confident she will represent MACSP well around this table.
Jennifer Putnam: Cloture occurred at the end of September; the Legislative Council will be deciding upon which bills will be considered as emergency legislation in the Second Session of the Legislature. They will be reviewing around 400 bills that have been submitted. I’ve heard that they will only likely consider 15% of the bills, and I’ve also heard that they will consider a lot more, so we’ll have to wait and see. There are two bills that we submitted which will be presented to the Legislative Council on Wednesday. One bill is LR 2894, An Act Regarding the Implementation of Federal Requirements for Electronic Visit Verification of Personal Care and Home Health Assistance. For any in-home service there’s a Federal requirement for states, and as such providers, to have parents’ signatures at arrival and departure times in the home to prevent fraud. That’s created a lot of snafus in Maine. We just got a one-year extension to provide a structure to advocate for providers and workers to ensure that they are part of this process moving forward. The second bill submitted is LR 2895, Resolve, Directing the Department of Health and Human Services To Increase MaineCare Reimbursement Rates for Targeted Case Management To Reflect Inflation. There hasn’t been a rate increase in Targeted Case Management (TCM) for more than a decade. TCM services were left out of the Section 21 and Section 29 rate increases that were passed in the Legislature a couple years ago. We’re hoping that these bills will be heard in the upcoming Legislative session. There are a couple bills that this group has been following which were carried over. One of these bills was the bill which would set DSP rates at 120% of minimum wage, up to $15 per hour after January. However, the fiscal note looks quite low to us, so we’re working with people to identify why it looks so low. This bill passed the Legislature but is sitting on the Special Appropriations Table awaiting funding. LD 1377, An Act To Enhance and Improve the Maine Developmental Services Oversight and Advisory Board and To Establish the Aging and Disability Mortality Review Panel, is the MDSOAB bill looking at a mortality and independent review panel, examining at deaths and serious injuries of people with ID/DD and Autism. This bill, which had Department support, would provide a framework for an independent panel with a nurse housed in the Maine CDC to vet all of those reports and be a facilitator/chair of this panel. This bill is also on the Special Appropriations Table.
-There was a question regarding the status of the dental care bill for people with ID/DD (LD 373, An Act To Provide MaineCare Coverage for Dental Services to Adults with Intellectual Disabilities or Autism Spectrum Disorder, Brain Injuries and Other Related Conditions.)
Lydia: The bill specific to people with ID/DD didn’t move forward because of the bill that encompasses the broader group of MaineCare recipients (LD 519, An Act To Expand Adult Dental Health Insurance Coverage). This bill is also on the Special Appropriations Table. (LD 373 was carried over into the next Legislative Session.)
Jennifer: LD 1178, An Act To Address the Needs of Children with Intellectual Disabilities and Pervasive Developmental Disorders, would create a waiver program specifically for children with ID/DD and Autism. The Department wanted more latitude to make this a State Plan amendment rather than the requirement to create a waiver. Nothing has happened with this thus far. There are currently hundreds of children waiting for services, and then when they do receive service offers, they are pushed into a behavioral health system.
-There was a discussion regarding credentials for who would be eligible for the rate increase.
Jennifer: The rate increases would be for DSPs not all employees. The previous rate increases brought the rates to minimum wage, so there wasn’t a discrepancy; however, this time it will be a little different because the rate would exceed minimum wage so what other employees make relative to minimum wage will be up to individual providers.
Federal & Housing Updates:
Cullen: On 9/27 the President signed a short-term CR to fund the government through November 21. Congress is working on the FY 20 allocations and budget, including working on reconciling House and Senate appropriations bills, including the T-HUD budget. The House and Senate T-HUD budgets look very favorable and aren’t far off. More information to follow next month.
Developmental Services Stakeholders Continuum of Care
Cullen: The Developmental Services Stakeholders Continuum of Care group is moving forward on creating a more user friendly diagram for the Developmental Services Lifelong CoC (DD CoC), which will hopefully be an effective tool for the Legislature. The layout is much more linear and illustrates the entire lifespan. This group will also be reviewing the Blueprint for Effective Transition, and the Charting the LifeCourse Toolkit.
David Cowing: OADS contracted with Jane Gallivan for a whole developmental services system review. Jane introduced the Charting the LifeCourse work done at the University of Missouri, as a way to contemplate service needs throughout the entire lifespan (Click here for the Charting the LifeCourse Experiences and Questions Booklet). The DD CoC group will be reviewing this work to help us be more effective in our advocacy efforts. Charting the LifeCourse includes eight domains, and then it examines what these domains look like at different stages of the lifespan.
Cullen: The DD CoC contemplates a system view of a person’s entire life and includes an overview of principles upon which the system ought to be built. Charting the LifeCourse appears to take these principles and apply them where the rubber meets the road.
Featured Speaker: Todd Landry, Director, DHHS Office of Child and Family Services (OCFS). www.maine.gov/dhhs/ocfs Topic: Update on Children’s Services, and discussion of Blueprint for Effective Transition.
Cullen: Today our featured speaker is Todd Landry, Director of the Office of Child and Family Services (OCFS). Todd, thank you for joining us today. OCFS played a very active role under Jim Martin’s leadership, after which we have experienced only sporadic attendance. Thank you for being here, we look forward to hearing updates from OCFS, and the opportunity to discuss this Coalition’s Blueprint for Effective Transition.
Todd Landry: I’ll run through these slides fairly quickly; some of this might be familiar to you as I’ve shared them in various venues recently. I thought it might be beneficial to know a little more about where OCFS is heading. I’ve been here for about five months and have enjoyed the opportunity to meet with some of you in other forums. One of the first things I did when I came to Maine was, I intentionally set goals. For instance, I wanted to visit every district office to engage with staff within my first four weeks. It took me five weeks instead of four, but I visited every office and began the intentional process of rebuilding trust with staff. These visits were also about taking the opportunity to meet and engage with some of our stakeholders. During this we did a word cloud exercise, and the question I posed was for them to tell me what they wanted for children and families in Maine, not from OCFS, but generally speaking. A few things came up repeatedly, which led us to build a North Star – something everyone in the office can point to as what guides us: All Maine children and families are safe, stable, happy, and healthy. This North Star is aspirational in nature for all of the aspects within OCFS. This is what’s grounding our work moving forward. I’ve asked staff every day, before you leave, take a pause and ask yourself: “Did you do something, even small, to help create some safety, stability, happiness, or health?” If the answer is yes, then we’re on the right track.
Begin Presentation (Click here for the presentation)
Todd: Until I came to Maine, I didn’t realize that State and Federal mandates were optional, but apparently that was the case for years here. One example is around the child care subsidy. Almost all of the dollars we provide to families who qualify come from the Federal government. Federal dollars come with requirements, rules etc. In the past several years the State had decided to promulgate some different rules about subsidy and licensing requirements. The Federal government sent some emails to the effect of “if you do this, you’ll be out of compliance with Federal regulations.” The State went ahead and promulgated the rules anyway, and then received a formal letter from the Federal government stating that Maine was out of compliance and unless substantive changes were made to come into compliance Maine will be fined $800,000 per year. We’re working hard to promulgate new rules to bring us back into compliance with Federal rules and regulations. This is one example.
To further increase transparency, a few weeks ago we released the OCFS Data Dashboard. It’s a very user-friendly interface and you can drill down into the data. This is a commitment to sharing our data more widely. I’ll be honest with you, some data points are positive, but there are some that are not. I encourage you to take a look at that. (Click here for the Children’s Behavioral Health Data Dashboard.) This is a new endeavor for us, and on each page of the data dashboard there’s an option to provide feedback.
The Governor reconvened the Children’s Cabinet after an eight-year hiatus. Early childhood education is one of the key areas on which it focuses. The Children’s Cabinet meets every six weeks.
In the child welfare area in particular, when I was back in Texas numerous reports were sent to me when I accepted this position. I added up all of the recommendations included within all of these reports and there were around 150 of them. There was no way we could implement 150 recommendations all at once; we certainly wouldn’t be able to do them well. I began to hear, including from our own staff, that people were randomly pulling things off the table from those 150 recommendations; this didn’t seem like the best approach either. When I came on board in May, I slowed things down a little, and instead of picking things out randomly I wanted to look at what we should do to prioritize things. We have re-engaged with a number of our national partners, specifically Casey Family Programs. We asked them to come in and work with staff and stakeholders to rationalize these recommendations and priorities. We prioritized all of those recommendations and mapped what’s going on in the childhood arena. We ended up with a map of 12 strategies on which we’re going to focus in order to move the needle and improve the system for children and families. We’ve already started work on nine of these 12 strategies. These are the areas we’re going to build out specific implementation plans so we can stay focused. We didn’t do this in a vacuum – we did this with staff at every office in the state, along with stakeholder groups across the state and our national partners.
In the Children’s Behavioral Health Services arena, we approached it similarly; however, it’s a little different from child welfare or early childhood education. Looking at the array of services within Children’s Behavioral Health, this was not an exercise about reforming but around rebuilding the system. We chose to frame this around the Children’s Behavioral Health Services Array, which is structured as a pyramid. At the bottom of the pyramid is the least-intensive, most community-based services, serving the largest number of children and families. As you move up the pyramid you get into more intense levels of care, and hopefully fewer children and families in need of those services. As you move up the pyramid the costs also increase. I want to point out that at the top of this it doesn’t say this is Maine’s service array – that’s very intentional. There are pieces on this chart we don’t even have in the state of Maine. We would certainly have strong agreement even where we have them, we don’t have them in the quantity we need, nor do we have them spread out geographically. This is the theoretical direction in which we’re going. We do have a version of this where we’ve begun to try to quantify with numbers but that’s in draft form. The next public version of this will be color coded, based on provider, family, State-funded services, non-State-funded services, etc. This is conceptually where we’d like to go. How do we get there? Over the course of the summer we developed the Children’s Behavioral Health Services Visioning. We started with the PCG (Public Consulting Group) reports that came out, with national experts, staff, and stakeholders, and we began to rationalize the list of strategies. We divided the strategies up between short- and long-term. Short-term strategies are ones we can accomplish within the next two to three years. The long-term strategies will take longer to see measurable progress because there’s more involved. For example, with the workforce issue it will take longer to see major improvements, but this doesn’t mean we won’t begin to make improvements. For the short-term strategies, we think we can make changes to the waitlist process to improve this for children and families. We’ve nearly completed the drafting of the first four of these strategies and implementation plans, and we’re about to start tackling the second four, with their implementation plans to follow. The implementation plans will change as we learn, and on an annual basis we intend to provide a report on where we are on the implementation of these strategies. Another of our short-term strategies is to improve coordination for transition-age youth for children’s behavioral health services. We’ll be partnering with OADS on this. The waitlist process is obviously important. Section 28 is specifically called out here for us to explore options for how we can amend that. Some of these are internally focused, such as being clearer about our own staff roles and responsibilities, etc., while others are much more externally focused.
Discussion:
-It was stated that this is terrific and well done.
Todd: The intent is that we’re focusing on this whole array, but a lot of what you’re seeing in the Children’s Behavioral Health Services plan is in the HCBS section of the service array – the middle section of the pyramid. We need to improve this and ensure we’re using evidence-based models. It doesn’t mean everything we’re going to do is a gold-standard program. However, this middle section of the pyramid is where we recognize there’s a logjam. When kids at the bottom of the pyramid need a slightly higher level of services, they’re bumping up against a large barrier to access it and access it in a timely fashion. Kids in residential treatment settings, at the top of the pyramid, bump up against the same barrier when titrating down services. We’d love to see them in the least restrictive setting but that’s incumbent upon getting the middle section of the pyramid right.
Jennifer Putnam: I wanted to ask a few questions about exploring amending Section 28. Section 28 in-home services are not necessarily evidence-based. Can you talk a little further about your thoughts on this?
Todd: This is something we’re doing in conjunction with the Office of MaineCare Services (OMS). One of the things we heard very clearly from providers and family members was that they felt the current waitlist process wasn’t enabling them to be as specialized as they wanted it to be around ID/DD. We have also heard that we need to be careful not to restrict Section 28 too much, to ensure people can still access the service. We’re approaching this very carefully. We’re recognizing that the way the system has developed Section 28 has become a little bit of a catch-all. We don’t want to overly restrict Section 28 and create an unintended consequence of having people not eligible for other services. I’ve asked staff to be very thoughtful and careful regarding this. As for the waitlist, we can move a little more quickly with changes. The question is how far of a swing do we want in terms of the waitlist? It appears that the way the waitlist has been working lately has been through this very significant pendulum swing – a rigid first come, first served waiting list versus a more flexible approach. With any changes we need to not swing the pendulum all the way back, we need to be in the middle – to serve children and families in an appropriate manner.
Jennifer: There was a bill, LD 1178, modeled after the old MaineCare Section 32, specifically for children with ID/DD and Autism. In working with the Department, we came to broader agreement that this didn’t need to be a waiver and that it could be a State Plan amendment allowing for services for children with ID/DD and Autism that mirrors Sections 21 and 29.
Todd: I believe Office of MaineCare Services has the responsibility to take the lead on LD 1178, but we are also involved.
-A parent stated that her son ended up on the waitlists for Section 65, Section 28 specialized, and Section 28 non-specialized because his case manager didn’t know the differences between the waivers. She stated that her son has received all of these services at one point in time and did not need Section 65 services. This was a waste of time and money. Additionally, she stated that despite her son having a diagnosis of Autism, which he will always have, he had to be found eligible for services every so many years which is neither efficient nor effective.
Todd: What tends to happen when there’s a real or perceived lack of access to services, is you end up throwing a bunch of spaghetti at the walls to see what sticks. This is what’s happening now. If there’s a long waitlist for the ideal service people think that something is better than nothing, so they get on all of the waitlists. With this, children and families end up not getting the services from which they would most benefit. You also end up with a bunch of waitlist data with which you can’t make decisions.
-A provider stated that the hardest families they serve are the families that when they transitioned out of high school, they didn’t get the services they needed. Parents who have ID/DD or Autism then end up in child protective cases.
Todd: I appreciate you highlighting that. This is a challenge, and one of the reasons we have more effective transitions as a short-term goal. We’re working with OADS and the Office of Behavioral Health because it will take all of us working together on this.
-It was stated that these appear to be medium-term rather than short-term goals. It was asked what can be done in the next twelve months for these children on the waitlists, and for children who are out of state.
Todd: We have about a two to three-year timeframe for our short-term goals, but this doesn’t mean we’re waiting to start on them. I think as we roll these out, we’ll be making some changes within the first 12 months. Immediate changes in the near term would be around the waitlist; we can make some significant changes around the waitlist process that would help everyone. You’ll begin to see some of these pieces within the next 12 months. This isn’t to say we couldn’t make some improvements in the lone-term goals in the next 12 months as well. As it relates to the kids out of state, many of the changes will affect them. There are around 70 kids out of state currently, the vast majority of whom are not in state custody. We’re working and building plans for how they can return to the state (for those in state custody) and engaging with families for those that are in parental/familial care.
Bonnie-Jean Brooks: I’m thinking about children who are on your caseload who are victims of the opioid crisis. I’m wondering if you’ve had time to think about this or developing strategic initiatives around this.
Todd: The issue of drug-affected or substance-exposed infants is something of which we’re very aware and cognizant. We continue to see, if not a decline, a flattening of substance-exposed infants in Maine. The way we have been approaching much of that work is in partnership with the Governor’s Office. Within DHHS, there is an opioid coordinated council and part of that is looking at the multigenerational aspect of Substance Use Disorder (SUD), and how all of the different offices within the Department can link our strategies together. This council is in the process of formalizing a very specific response, which contemplates it from the full continuum of prevention, treatment, and recovery. I’m hoping you’ll see emphasis on all three of those areas. I have some concerns about the legalization of marijuana, how it will affect children and youth, and am interested to see what other states have done regarding this.
Cullen: Todd, thank you very much for being here. This was very informative, and it’s great to see where you’re going with OCFS, how you’re coordinating with other offices within DHHS, as well as intentionally soliciting stakeholder feedback. I hope we can have you attend more often. We’re looking to modify the DD CoC, which covers the entire lifespan, and the Blueprint for Effective Transition, which includes principles, goals, and strategies for all forms of transition within the system of care for persons with ID/DD. It would be great to work with both you and Paul Saucier over the coming months to see where we can all work together to implement strategies around effective transitions.
Todd: Just last week I sat down with Paul to see how we can best work together. I’ve been pleased with the openness of our staff to re-engage with other offices, national partners, and other stakeholders. There are a lot of things we can learn from other states that can be modified so it works for Maine. Editing something is a lot easier than starting from scratch.
Paul Saucier: We are excited to work with OCFS on transition. Todd has embraced the idea of working strategically together on planning tools that chart the life course from childhood to adulthood; we’re looking at the Charting the LifeCourse materials and tools from the University of Missouri. Give us a little more time to figure out which way we want to go, and we’d be happy to come back to engage and discuss this with all of you.
Todd: I’m happy to engage with this group where those linkages occur, likely with it making the most sense to do so in conjunction with Paul.
Cullen: It’s exciting to have everyone engaged and around the table. Thank you again, Todd, well done, and we’d love to have you back!
End Presentation (round of applause)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads - Click here for the most recent waitlist update provided by OADS staff.
Paul Saucier: I’m happy to be here today. I also have with me Betsy Hopkins, our new Associate Director of Developmental Disabilities and Brain Injury Services. Unfortunately, I have to start with some difficult news – today the Department issued a press release detailing our move to terminate our MaineCare provider agreement with RCSS (Residential and Community Support Services), a sizeable residential provider in southern Maine. We had to do this to protect and ensure the health and safety of individuals served by RCSS. It will be challenging to find new homes for the 65 people who live in residential homes run by RCSS, but we had to ensure the health and safety of those individuals. DHHS also terminated RCSS' separate state contract to provide emergency transitional housing services. These will take effect immediately, but we will continue to work with and pay RCSS to ensure a smooth transition, which we expect will take about 30 days. More information is included in the press release. We’ve been working closely with RCSS since late August, after a resident's death. Despite our work with them they did not make sufficient progress and improvement to ensure the health and safety of the people who live there. We have a rapid response team meeting daily and will be ready to engage to find new homes for people. If any of the providers in this group are in the position to offer homes, please let us know. Derek Fales is our point-of-contact for this (Derek’s contact information – email: [email protected] phone: (207) 287-6656). This includes a legal matter, so I won’t be able to say too much but I’m happy to try to answer any questions you have.
-A parent stated that her son happens to live in an RCSS home. It was asked if residents will have to vacate immediately.
Paul: We will continue to pay RCSS and continue to work with them. We expect that it will take up to 30 days to find homes for the residents. No one will be on the street today.
Bonnie-Jean Brooks: Obviously this is sad news for the people who live there and their family members. I’m wondering if the people supported by RCSS come from all over the state or just in southern Maine, as it may be easier to relocate to other areas in Maine if that’s where they’re from and want to live.
Paul: Residents and guardians will have a say regarding location. We do have adequate capacity in our system but that is statewide – we may have a few beds in Aroostook county but if no one wants them it won’t be helpful. These will be individualized conversations with residents and guardians. If it becomes evident we need more resources in southern Maine, we’ll work to find them.
Mark Kemmerle: Whatever you learn from potentially expediting the process to bring new homes online, keep it going because it’s a big drag on the system universally.
Paul: This is a good point. We are working closely with the Office of MaineCare Services, and they are prepared to expedite applications.
Lydia: You mentioned emergency transitional housing in addition to waiver housing and residents not being appropriately supported. Were they waiver clients or emergency transitional housing clients?
Paul: We have generalized concerns about the agency’s ability to implement a quality management system and ensure the health and safety of residents. They do have both types of housing, but mostly for Section 21.
Lydia: Was the client who died in emergency transitional housing?
Paul: I’m not 100% certain so I can’t answer that.
Lydia: If there were any concerns about something as severe as a death, abuse, neglect, or exploitation, we would hope crisis services or APS (Adult Protective Services) were notified. Are you looking at these systems to see if there were gaps there as well?
Paul: Yes, of course. We are looking at our own processes and offices internally. APS opened a case immediately upon learning of the death in late August. Law enforcement was called and asked the Department to hold its APS case pending the conclusion of their investigation. We have complied with that request and have cooperated fully with law enforcement in its investigation.
-A provider asked if an agency could take over an entire house as is.
Paul: I recommend connecting with Derek regarding your interest. Houses owned or leased by RCSS will continue to be in their control. However, my understanding is at least one home is owned by guardians, who will be looking to retain the location and bring a new provider in for services.
-It was asked if there was any news on self-advocacy.
Paul: We’re behind the schedule we set for issuing the self-advocacy RFP. We will continue our current self-advocacy arrangement for as long as needed until we can award a new contract.
Paul: On a brighter note, the happy news is Betsy’s arrival, so I’d like to turn it over to her.
Betsy Hopkins: Hello everyone, I’m happy to be here. I’ve joined your meeting in the past when I was in the role of Voc Rehab Director a few years ago. I’m excited to be here at OADS and I’m excited for the collaboration between OADS and OCFS around transition. I’m on week three of my job, but I’ve jumped in on the HCBS Settings Rule. A number of pieces of information have been shared on the HCBS website. There are going to be some town halls around the state and I wanted to mention those here (Click here for more information). The purpose of those is for us to give a brief overview of the HCBS Settings Rule and the changes coming, inviting any and all interested parties to ask questions, which we’ll try to answer or gather them to add them to our HCBS Settings FAQ. I look forward to joining you in person soon.
Cullen: It’s great to have you back around the table, Betsy.
-It was asked when the provider site self-assessment will be finalized so providers can begin working on this task.
Betsy: Those will be sent out to providers on November 1st.
Ray Nagel: At first, I thought that the assessment would be available today, though it’s understandable why it’s not. Having the assessments in our hands on 11/1 and giving us until the end of November to complete theme is a task that likely cannot be done, definitely not done well. I would urge OADS to reconsider that and consider giving us a 90-day period. We know you’re behind schedule, through no fault of your own, but we feel we won’t have quality self-assessments without more time dedicated to the matter.
Paul: I appreciate that Ray. The reason you’re not getting the assessment today is because we got some really good feedback on the tool from stakeholders, so the tool has been modified. We will certainly take your request for more time back to Derek and the team, but any extension wouldn’t be an extension of that magnitude.
-A parent and former special educator stated that he hopes the Department of Education and Special Education are both around the table with OADS and OCFS in discussions around transition.
Paul: That’s why I was asking for a little more time to ensure we have the right people on our end engaged in the process before we bring this to you.
Cullen: I want to echo that, I think it’s wonderful that everyone wants to be around the table, and time is something that has to be put in it to get it right.
-A self-advocate stated that the mental health arena has a Quality Improvement Council, but one doesn’t exist for the ID/DD arena. It was asked how we can ensure that all stakeholders are working together and have equal input.
Paul: I think this Coalition is the most broadly representative meeting in which I participate. We have the HCBS Stakeholders group as well. We’re open to thinking about other stakeholder processes if there’s a need, but we don’t want to create more stakeholder groups just for the sake of creating them.
Cullen: Thank you, Paul and Betsy, for being here. It is great to consistently have OADS around the table.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs - Click here for the 10/21 OCFS System Improvements Update.
The next meeting will be on ***Monday, November 18, 2019***, 12-2pm, Burton Fisher Community Meeting Room, located on the First Floor of One City Center (food court area, next to City Deli), Portland.
***Please note that this is the third Monday of the month due to the holiday on the regular meeting date***
Featured Speaker: Derek Fales, Waiver Services Director, Developmental Disabilities and Brain Injury Services, DHHS-OADS. Topic: An update on Maine’s Home and Community-Based Services (HCBS), including discussion on the provider self-assessment, FAQs, and OADS’ continued path forward to compliance.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
Burton Fisher Community Meeting Room, 1st Floor of One City Center in Portland (off of the food court).
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].