October 18, 2021
Minutes
Minutes
Attendees via Zoom: Alli Vercoe, Amy Moller, Andrea Liming, Ann-Marie Mayberry, Betsy Hopkins, Betsy Mahoney, Brenda Smith, Brett Bulmer, Carol Snyder, Chris Call, Darla Chafin, David Cowing, Debbie Dionne, Heidi Bechard, Heidi Mansir, J. Richardson Collins, Janet DiBiase, Janet Hamel, Jennifer Putnam, Julie Brennan, Kim Humphrey, Kristen McPherson, Laura Cordes, Libby Stone-Sterling, Linda Lee, Lisa Wesel, Lorraine DeFreitas, LyAnn Grogan, Maggie Hoffman, Mark Kemmerle, Mary Chris Semrow, Nancy Peavy, Paul Saucier, Rachel Dyer, Ray Nagel, Robin Levesque, Ryan Jackson, Staci Converse, Stephanie Johnson, Susan Farwell, Teague Morris, Teresa Barrows, Trena Jackson, Spring, Vickey Rand, Cullen Ryan, and about ten people who joined the meeting in progress and/or left prior to its conclusion.
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Minutes from the last meeting were accepted. For the sake of time, Cullen read the names of participants.
Featured Speaker: Paul Saucier, Director, DHHS-OADS. www.maine.gov/dhhs/oads Topic: What’s going on at OADS – an overview of OADS initiatives, goals and objectives, and its vision for the future.
Cullen: Today we have Paul Saucier, Director, DHHS-OADS giving a presentation on an overview of OADS initiatives, its goals and objectives, and its vision for the future. Paul, I appreciate you taking the time to update us on what’s going on and have a dialogue about it. Welcome, it’s wonderful to have you!
Paul Saucier: Thank you all for the invitation. I haven’t been able to attend these meetings regularly but it’s great to be back with you all. This is a core group that’s involved with all of our work and we appreciate that and appreciate being here today. We’re going to tell you a little bit about what we have all managed to achieve in the past year, despite the incredible challenges we’ve all faced together. We’d also like to let you know what will be going on over the next biennium. In many ways, these things are far more possible to accomplish due to federal funding we’ve been able to put towards our priorities. This particular time has caused a lot of anxiety for many of us. Without a doubt the first and most significant issue that everyone is coping with currently is staffing challenges, that really is unprecedented. Those of you who’ve been around for a while know that staffing has been a challenge for years now, but COVID has really accentuated that issue. And, with some impending deadlines coming up around vaccinations, there’s concern about what the next couple of weeks will bring. We’ve worked with agencies on this issue. There has been a lot of concerns. A lot of the work has been around making temporary arrangements, such as combining homes to stretch staffing, etc. Earlier this year we worked with a few agencies about permanent closures of homes – which was workforce related. We will continue to work with any agency that needs our assistance, and we’ll continue to respond to notices of closure, notices of discharge and so on, and work with agencies to make sure that goes as smoothly as possible. Another issues, I know many of you attended the public hearing for the Home and Community-Based (HCBS) proposed rule to reflect the federal HCBS Settings Final Rule. It was a tough hearing for all involved. We believe that a lot of the emotion at that hearing was prompted by misinformation about that rule. We unfortunately won’t be able to address that misinformation because we’re in the process of responding to the many, many comments/questions we received. Though, we will be able to provide you with a good update on the HCBS Settings implementation thus far.
Begin presentation (Click here for the presentation):
Paul provided information on OADS’ Vision:
More Stability and sustainability: There are parts of our system that are not sustainable the way they’re currently configured. I’m not talking fiscally – even if we had all the money in the world it wouldn’t be sustainable. I’m talking logistically such as staffing group homes etc. There are things we need to do in terms of the workforce to ensure we continue to have people coming into this field. However, we also really have to be innovative and think differently about the way we discuss the work with folks and develop a system that has a lot of choices for people.
More equity: We need to ensure that people with similar needs receive similar levels of support across Maine.
More balance: We need more balance in the system as shared living and innovative living arrangements grow. We’re not looking to reduce group homes – we’re looking to grow other parts of the system for better balance. More people have turned to shared living. We’re doing an analysis about the living arrangements people have, which we’ll share later. We’re looking at more balance so that over time there’s a larger array of options so people can choose something that fits with their life plan, vs. choosing something because it’s all that’s available.
More Integration: We need more integration in the community. This is what Community 2.0 was all about. The concept is that many years ago Maine successfully closed its only large-scale institution. That was a significant accomplishment, but now we want to take the next step to ensure that in whatever town people live in they can have relationships with their communities.
More individualized options: We’re working hard to expand more individualized options, such as self-direction. It’s not for everyone, but for many families it will be a good solution. We’re also looking at renewing the Person-Centered Planning (PCP) process. PCP doesn’t mean just going through two or three things in a very remote kind of way, it means really looking at what people want and need, in a new way every time that planning process is approached.
More continuity: We’re working on lifespan transitions, from childhood to adulthood but also through all the phases of adulthood so people’s lives maintain a good rhythm as plans and needs and desires change. Change ought to be based on the individual’s changing wants and needs versus artificial change because someone is moving from one part of the system to another.
More emphasis on quality: We’re made a lot of progress on safety and basic assurances. Now, we need to get to the next level of program improvement, how we can measure that, how we can incorporate those measures in how we pay for services.
Paul provided information on where OADS has been:
IDD/BI Programs Grew During the Pandemic: Even with significant staffing shortages, we managed to increase the number of people served by about 5%. There are still waitlists, and the system needs to grow better to address that, but progress has been made. The system has been growing despite the challenges faced by all.
Recent and Upcoming Funding Increases: There was a $65 million permanent rate increase over the biennium, which has taken effect. At the end of the session, $18.9 million in retainer payments were authorized by the Legislature, and those payments are in process now. What’s scheduled is even more significant. We’ve allocated up to $126 million in bonuses for direct support professionals (DSPs) and supervisors, pending CMS (Centers for Medicare and Medicaid Services) approval. We’d like these payments to begin in November because we know they’re sorely needed. Permanent increases are scheduled for January 2022 to implement the Workforce Commission recommendation for MaineCare rates to be at 125% of minimum wage.
Emergency Provisions Implemented: We implemented temporary MaineCare HCBS waiver benefits and flexibilities under the Appendix K waiver (see page 7 of the presentation for more details).
Member Vaccinations Exceeds that of the General Population: Thanks to everyone’s immense efforts, Member vaccination rates exceed the general population’s – only 15.2% of our client population has not been vaccinated – some of which might be due to medical conditions etc. However, I suspect there are some among that 15.2% that could benefit from more information and encouragement. There have been a few outbreaks in group homes with the resurgence of the Delta variant – we now have about four outbreaks, compared to dozens earlier in the pandemic.
Betsy Hopkins, Associate Director, DHHS-OADS Disability Services, continued the presentation on where OADS has been:
Stakeholder Work Groups: It seems like forever ago when we discussed Community 2.0. We’ve had two work groups – Community Membership and Innovation, that have been meeting since 2020. These two groups are wrapping up in the next couple of months, and we’ll be developing recommendations based on their work. The Quality work group started earlier in 2021. The Communication work group will start in December of 2021. We’ve heard that communication is so important, especially now. We really want to come together as a work group and determine the best ways in which we can communicate effectively.
HCBS Compliance & Implementation in Maine: The goal of the HCBS Settings Rule and the work we’re doing is to focus on choices for people. It applies to all settings and all individuals in the same way. We want to have someone living in shared living in a rural part of the Maine to have all of the same access and choices as someone living in southern Maine. The way people access their communities on the mid coast might look very different than in southern Maine, but we want everyone to have the same ability to access their communities. One of the great opportunities we had in visiting the settings and talking with providers is that we continue to see all the great work going on in Maine. There are some providers that are really doing some wonderful work with the people they serve, having them access their communities, and access employment. Our goal is really to improve that so that’s happening for everyone across the state.
We had 1,725 total settings with Findings Reports issued. Of those, 90% were found to be non-isolating settings. The other 10% were found to have isolating components; the Federal HCBS Settings Rule refers to this group as “Heightened Scrutiny Settings” (HS Settings). Only 170 (10%) were determined to be HS Settings. 1,631 settings have approved Transition to Compliance Plans (TTCPs), of which 1,553 approved TTCPs have been accepted by the providers. Geographically, the HS Settings reflect population.
Progress on Quality and Access: In late 2019, we made some Quality Assurance positions available in our districts. Throughout the pandemic these positions were point-people for information and resources. Once the pandemic subsides, these positions will transition to quality assurance work.
Betsy provided information on where OADS is headed:
Person-Centered Planning: We really recognize that the PCP process should be at the heart of all of the work people are doing. We’re excited that we’ve been able to work on implementing the Charting the LifeCourse tools in the PCP process. In early 2022 when we’re closer to having the PCP Guide based on this, we’ll share that with this group.
Paul continued the presentation on where OADS is headed:
Workforce Initiatives:
Additional Biennial Initiatives:
Paul: That was a lot to cover, and I appreciate everyone’s patience. We would be happy to hear feedback.
Discussion:
-It was asked if the Department has gathered any data on the High Scrutiny (HS) Settings and if there are any commonalities.
Betsy: We do have that information. I didn’t delve that deeply into it here because it’s fairly detailed. There are four core areas when we talk about HS that we’re seeing that are somewhat similar across the entities.
Heidi Bechard: There were definite themes, for instance in the residential settings we discovered 15 top areas where settings were identified as HS, involving: Individual’s lack of ability to access personal resources; the lack of exploration of competitive, integrated employment; staff’s lack of training in exploring and having conversations about competitive, integrated employment; individuals not having locks to either the entry door or their personal room door in their residential setting; and not having the ability to have visitors at any time in a residential setting, keeping in mind everyone who resides in that setting and not interfering with people’s schedules etc. Non-residential settings had some themes/patterns which indicated isolating qualities as well, such as individuals in community support settings who didn’t have meaningful opportunities and interactions in their communities. Transportation was another finding across both residential and non-residential settings.
Paul: We’re talking about 10% of 1700 settings in Maine. The HS Settings are important, and we want to work with all of them to get them to where they need to be and most of them are well on their way. But let’s not lose sight. One would think given some statements made that the entire system is about to shut down based on HS Settings, and nothing could be further from the truth.
-It was pointed out that Paul stated that the system expanded during the pandemic, versus it shrinking. It was stated that is based off of a specific set of raw numbers that doesn’t paint the full picture. That data doesn’t consider the number of people coming into the system. That doesn’t consider the hours of services needed vs. the hours provided. It doesn’t paint the full picture of the extent to which the system is adequately serving people. It was also stated that not having the Communication work group in effect while the other work groups were doing their work was disappointing as there was no way to communicate what was going on in those groups to a broader audience. The extent to which this affected feedback which would have been helpful cannot be overstated.
Paul: I appreciate that feedback. We hear you on communication and we want to have a more formalized way to get information out. Meeting with groups like this is not the same as having a systemized way of getting information out to people. I also appreciate your point about hours authorized. Point well taken. One of the ways we’ve been able to get through the pandemic is providers have been providing fewer hours. We have been serving more people, though the waitlist does continue to grow. We have been able to add folks more quickly compared to the numbers being added to the waitlist. We’re looking forward to our new case management system being implemented and being able to produce information such as hours of services provided on a regular basis.
-A provider stated that the 10% HS Settings seems very low, perhaps because the overall number of settings includes shared living providers. It was stated that when you exclude shared living providers the HS Settings percentage is likely far higher. She also asked if it was known how many of the HS Settings were community-based programs.
Betsy: I’m not sure about what the percentage would look like if we excluded shared living. About the community support programs, our goal is to work with all of them and we are. We’re providing a lot of technical assistance so that they can come into compliance. We’re looking forward to that work with them and doing trainings with them. Over the next year our goal is to continue working with these agencies as we have been so they can come into compliance.
Heidi: When I looked back on some of the other data, we’ve only identified 27 shared living settings as being HS Settings. Another piece of information you didn’t see today, as it looks at all the residential settings, 31% of all of the residential settings factors were found in compliance, meaning 69% were not. However, there were 15 primary factors of non-compliance. Many of those 15 indicators are duplicative – meaning there are about 10 remediation steps that cover those 15 indicators. With the Federal HCBS Settings requirements, it required more opportunities for greater inclusion in their communities.
Paul: One of the advantages of being so late to the game in Maine, is there’s lots of experience in other states. Maine is not at all an outlier for the number of HS Settings nor the types of settings subject to HS.
Laura Cordes, Executive Director, MACSP (Maine Association for Community Service Providers): My question is about the HS Settings. My recollection was that there were a number of settings that were included as HS Settings that did not have isolating qualities, but the time ran out and they were not given the amount of time to demonstrate they wouldn’t be a HS Setting. Am I recalling that correctly?
Paul: That is true, some of the sites got caught up in the timeline which would suggest we have even fewer HS Settings.
Heidi: 7/1/21 was a CMS deadline. This was the date by which settings identified as HS Settings had to come into full compliance to avoid completing an evidentiary package. We had 7 settings come into compliance before this deadline. We got started late through this journey, then COVID came into play. This resulted in a more compressed timeline for settings to come into full compliance.
Laura: But we don’t know the number that were not given the originally indicated time to come into compliance?
Heidi: I don’t have that number off the top of my head. Due to COVID, we weren’t able to visit all settings prior to the deadline because not all settings were fully up and running. I can look into the number of settings that fall into the category to which you refer.
Laura: I would suggest when you provide this data to carve those settings out as it would be helpful for people to understand that the HS Settings percentage includes a smaller percentage that otherwise would not have been included.
-A parent stated that having 10% of settings be considered HS Settings in a system that is already static is very troubling. She stated that in her area it’s 18% - losing 18% of resources is a terrible loss. Perhaps this is a communication issue and there’s a plan in place for that 18%. Across the spectrum of people with disabilities, there’s a difference in the number of choices there are for people. It was asked if the 10% is equal across the board or if it’s hitting certain placements more than others. It was also asked what consumer-based transportation means.
Paul: To clarify the statistics, 18% in western Maine does not refer to 18% of your settings, it means 18% of the 170 HS Settings are in that area. From our perspective it does not indicate that those services are coming offline – we want to work with all of them to keep them online. HS does not equate to coming offline or closure – it means there’s extra work to be done with those settings. In terms of choices, it’s our view that everyone ought to have choices. How someone executes those choices will be different for everyone. But across the board everyone should have choices. The Federal HCBS Settings Rule impacts everyone, we think in a positive way, but at the end of the day those choices reside with the individual. Regarding consumer-directed transportation – we want help to look at a range of options for transportation. There’s a distinction between medical transportation versus transportation that’s used to access a waiver service. The latter category is what’s been in contention forever and has been challenging forever. We’d like to look at models where part of the PCP includes consumers having choices about how they use their transportation budget that better fit what they want need. I don’t know where this will land because we haven’t started yet.
-A parent stated that the 18% in western Maine, or 30 programs seems like a lot, but it’s good to hear that HS doesn’t mean closure.
Paul: If providers will engage with us, we’re willing to put as much time and energy in as is needed to get them to where they need to be. We would love to engage with everyone around this.
-A provider stated that he hears quite a bit that the Administration started this at the last moment. Maine was given a two-year extended timeframe to demonstrate compliance. While we’ve had the continued timeline, it doesn’t appear the extension was passed on to providers. And there appears to be an extended wait time for EconSys to respond to providers of HS Settings. Maine is already substantially in compliance with the CMS rules. The provider stated that he doesn’t understand why there is this extremely onerous, administratively burdensome work to report to EconSys when Maine is already substantially compliant. Additionally, he stated that he’s confused about community membership rolled out as part of the Appendix K waiver. He stated that it’s very limiting, as schedules have to be done a week in advance – this doesn’t seem to be driven by consumer choice.
Paul: What you’re pointing out is that we have a significant number of providers that are already in compliance. We have a sizeable group that has work to do. The reality is many providers are already in compliance in Maine. As far as the timeframe to get the rest of the group into compliance, this was raised several times at the public hearing, and we’ll address that in our response to comments. In terms of choice, having a community membership benefit is a huge advancement versus not having one. As we implement it together, we’ll want feedback on how it can be improved over time. I would guess that no agency could implement this spontaneously on an hour-to-hour basis, for staff scheduling etc. So there has to be some kind of balance.
-A parent stated that she’s glad that sustainability was included in the presentation. She stated that she’s had to be home to provide home supports and access trainings etc. She asked what’s out there for parents. The training she had to take to become a DSP for her son was eye-opening. Parents having access to information that DSPs do would be advantageous. She asked if the thought is that there will always be a waitlist for services.
Paul: The waitlist is not something we have to live with indefinitely. In previous legislative sessions completely addressing the waitlists was priced out, it’s not an insignificant amount of money. However, waitlists are one of the issues that’s slated to be addressed in the federal reconciliation bill later this fall. If we get a significant infusion of longer-term federal money, we’d have more to put towards the waitlist, and we could do it with confidence that the money will continue to be there. That’s the sustainability balance we need to find. In terms of the training, my gut reaction is if parents want to take DSP training, we ought to make it available to them. And/or have some other type of training.
Betsy: Parents can access the College of Direct Support, what we use for DSP training. I’ll get more information on this for the minutes.
-A parent stated that transportation has become an immense issue for her personally, including times when it’s simply not safe. As such she decided to provide her son’s transportation herself. She stated that she’s glad they’re looking at options.
-It was stated there was mention of the creation of a PCP Guide. In the past when guides have been put together, the guide through its use, not through intent, became a manual instead. It was asked what thought has gone into the content of the guide, and the training for it, so that it’s truly used as a guide versus a manual. It was also asked how self-advocates have been/will be part of the development process. He stated he would like to hear how self-advocates have been included as part of all the design work.
Betsy: You bring up some excellent points. We’ve had some conversations around the initial draft of the Guide with Disability Rights Maine (DRM) and Speaking Up For Us (SUFU). We don’t want the guide to become a technical manual. That’s part of the work we’ve been doing with the Charting the LifeCourse work with University of Missouri. As we develop training, we will definitely be seeking input. We also have a contract we’re putting together with the University of Minnesota, as they’ve taken the PCP Guide and put it into plain language. I think the way we’ve talked about doing that is to open it up to stakeholders’ meetings around the Guide and how we’re going to roll it out.
Paul: We’ve also had waiver participants in our reform efforts, including as part of the work groups.
Betsy: Yes. We sent out invitations across the board for stakeholders to join the four groups. We have several self-advocates, disability advocates, family members, etc.
-A self-advocate asked if they will be adding the phrases accommodations and accessibility to their vision. The ID/DD community has similar challenges as other disability communities, by needing accommodations for reading, transportation, assistive technology, etc. Incorporating that language would be helpful. She stated that the ability to offer support so that people can have financial control is essential, so people have ways in which they can manage their finances, income, etc. She added that addressing transportation, actually implementing change, is critical. She stated that she hopes this happens during the current Administration so that progress isn’t lost in future Administrations as often happens. She asked if the Department has data regarding the number of people who have passed away while on the waitlists.
Paul: Thank you for the suggestion on accommodation and accessibility. The financial control comment – we have many people who are interested in the self-direction programs we’re establishing, including people would like to have budget authority. It will take us a bit to get to people having budget authority, but it’s the direction in which we’re going. In terms of the Mortality Review Panel, I hadn’t considered including the data for people on the waitlist but the rule making process for this is upcoming and that would be a good opportunity to include this. I like that idea.
-A parent stated that having support to assist parents with the technology aspect of being able to participate in stakeholder opportunities would be very helpful.
-A parent stated that he’s very interested in continuing education for the ID/DD population. He stated that he’s curious to see what the State is doing to expand online learning and continuing education opportunities. He stated that rural life is difficult and Zoom programs can be very useful in integrating people in a number of different ways, but more attention to this is needed. He stated that as a result of LD 924, there’s a taskforce staring on 11/9, for post-secondary young adults, about which people in this group might be interested.
Paul: We promoted telehealth during the pandemic and will continue to, and you can think of online education as a form of that.
-A parent stated that transportation has consistently been identified as a huge challenge. It was stated that a presentation on the transportation final report to the Coalition would be extremely helpful. She added that in Connecticut they had a level of needs assessment tool. She stated that she’s interested in hearing about their progress on a need’s assessment.
Paul: I think transportation would be a good topic when the evaluation report is ready. OMS (Office of MaineCare Services) is taking the lead on that. We’ll let Cullen know when that’s available to schedule a presentation for this group.
Cullen: Before we conclude I wanted to go back to a statement made earlier and the use of the term “misinformation.” This could imply that there’s something disparaging going on, and it could also sow the seeds of an “us against them” mentality. I believe that everyone here is “us.” We’re on the same team and working together towards the same goal of making the world a better place for people with intellectual and developmental disabilities. There’s room for more communication. There’s a lot of stress and anxiety involved for everyone. I think with the stakes so high understanding can take time, and it’s very important to have dialogues like this. A lot of worries and misunderstandings could easily be cured with more open and transparent communication such as this discussion. Paul, I would like to invite you back to continue this discussion at next month’s meeting. It’s very apparent that this discussion would have continued far longer if we had more time. It is important people have a clear and accurate picture of what’s going on. This is what will bring us together, so we can work together towards systems change and improvement.
Paul: Thank you for the invitation. Betsy and I attend these meetings when we can. There are many different venues in which conversations are being had. I really appreciate you dedicating all of this time today. Thank you all.
Cullen: Thank you very much for this presentation, Paul and Betsy, and for the robust dialogue it generated. Please keep coming!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads - No additional updates
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs - No updates
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Libby Stone-Sterling: I wanted to take a minute to say that October is National Disability Employment Awareness month. We’ve put together a calendar of events online. Please feel free to reach out to me with any questions or recordings of past events: [email protected]
Cullen: Thank you, Libby!
SMACT (Southern Maine Advisory Council on Transition)
The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy ([email protected]). SMACT meetings occur the first Friday of each month throughout the school year. The first SMACT meeting was on 10/1 and featured Betsy Morrison, Transitional Services Manager at PSL/STRIVE in South Portland sharing information about TOPS (Transition Outcomes Program for Students) and Anne Ryan, STRIVE Online Program Director, sharing information about STRIVE Worldwide. (Click here for a link to these presentations.)
Disability Rights Maine (DRM) Update:
Staci Converse sent the following update after the meeting for inclusion in the minutes: I wanted to share Employment 1st information with group and particularly the upcoming forum DRM is hosting. (Click here for more information on the forum.)
Federal & Housing Updates:
Cullen: Due to time the federal and housing update will simply be in the minutes. However, I wanted to take a moment to specifically thank Senator King for being one of 36 senators to sign on to a Dear Colleague letter to the President, Speaker Pelosi, and majority Leader Schumer urging them to preserve the housing investments included in the Build back Better Act. Teague, please express our thanks to Senator King!
State Legislature Update: No additional Updates
Updates/Other Business: No additional Updates
The next meeting will be on Monday, November 8, 2021, 12-2pm, via Zoom*.
Featured Speaker & Topic TBD.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2022 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Minutes from the last meeting were accepted. For the sake of time, Cullen read the names of participants.
Featured Speaker: Paul Saucier, Director, DHHS-OADS. www.maine.gov/dhhs/oads Topic: What’s going on at OADS – an overview of OADS initiatives, goals and objectives, and its vision for the future.
Cullen: Today we have Paul Saucier, Director, DHHS-OADS giving a presentation on an overview of OADS initiatives, its goals and objectives, and its vision for the future. Paul, I appreciate you taking the time to update us on what’s going on and have a dialogue about it. Welcome, it’s wonderful to have you!
Paul Saucier: Thank you all for the invitation. I haven’t been able to attend these meetings regularly but it’s great to be back with you all. This is a core group that’s involved with all of our work and we appreciate that and appreciate being here today. We’re going to tell you a little bit about what we have all managed to achieve in the past year, despite the incredible challenges we’ve all faced together. We’d also like to let you know what will be going on over the next biennium. In many ways, these things are far more possible to accomplish due to federal funding we’ve been able to put towards our priorities. This particular time has caused a lot of anxiety for many of us. Without a doubt the first and most significant issue that everyone is coping with currently is staffing challenges, that really is unprecedented. Those of you who’ve been around for a while know that staffing has been a challenge for years now, but COVID has really accentuated that issue. And, with some impending deadlines coming up around vaccinations, there’s concern about what the next couple of weeks will bring. We’ve worked with agencies on this issue. There has been a lot of concerns. A lot of the work has been around making temporary arrangements, such as combining homes to stretch staffing, etc. Earlier this year we worked with a few agencies about permanent closures of homes – which was workforce related. We will continue to work with any agency that needs our assistance, and we’ll continue to respond to notices of closure, notices of discharge and so on, and work with agencies to make sure that goes as smoothly as possible. Another issues, I know many of you attended the public hearing for the Home and Community-Based (HCBS) proposed rule to reflect the federal HCBS Settings Final Rule. It was a tough hearing for all involved. We believe that a lot of the emotion at that hearing was prompted by misinformation about that rule. We unfortunately won’t be able to address that misinformation because we’re in the process of responding to the many, many comments/questions we received. Though, we will be able to provide you with a good update on the HCBS Settings implementation thus far.
Begin presentation (Click here for the presentation):
Paul provided information on OADS’ Vision:
More Stability and sustainability: There are parts of our system that are not sustainable the way they’re currently configured. I’m not talking fiscally – even if we had all the money in the world it wouldn’t be sustainable. I’m talking logistically such as staffing group homes etc. There are things we need to do in terms of the workforce to ensure we continue to have people coming into this field. However, we also really have to be innovative and think differently about the way we discuss the work with folks and develop a system that has a lot of choices for people.
More equity: We need to ensure that people with similar needs receive similar levels of support across Maine.
More balance: We need more balance in the system as shared living and innovative living arrangements grow. We’re not looking to reduce group homes – we’re looking to grow other parts of the system for better balance. More people have turned to shared living. We’re doing an analysis about the living arrangements people have, which we’ll share later. We’re looking at more balance so that over time there’s a larger array of options so people can choose something that fits with their life plan, vs. choosing something because it’s all that’s available.
More Integration: We need more integration in the community. This is what Community 2.0 was all about. The concept is that many years ago Maine successfully closed its only large-scale institution. That was a significant accomplishment, but now we want to take the next step to ensure that in whatever town people live in they can have relationships with their communities.
More individualized options: We’re working hard to expand more individualized options, such as self-direction. It’s not for everyone, but for many families it will be a good solution. We’re also looking at renewing the Person-Centered Planning (PCP) process. PCP doesn’t mean just going through two or three things in a very remote kind of way, it means really looking at what people want and need, in a new way every time that planning process is approached.
More continuity: We’re working on lifespan transitions, from childhood to adulthood but also through all the phases of adulthood so people’s lives maintain a good rhythm as plans and needs and desires change. Change ought to be based on the individual’s changing wants and needs versus artificial change because someone is moving from one part of the system to another.
More emphasis on quality: We’re made a lot of progress on safety and basic assurances. Now, we need to get to the next level of program improvement, how we can measure that, how we can incorporate those measures in how we pay for services.
Paul provided information on where OADS has been:
IDD/BI Programs Grew During the Pandemic: Even with significant staffing shortages, we managed to increase the number of people served by about 5%. There are still waitlists, and the system needs to grow better to address that, but progress has been made. The system has been growing despite the challenges faced by all.
Recent and Upcoming Funding Increases: There was a $65 million permanent rate increase over the biennium, which has taken effect. At the end of the session, $18.9 million in retainer payments were authorized by the Legislature, and those payments are in process now. What’s scheduled is even more significant. We’ve allocated up to $126 million in bonuses for direct support professionals (DSPs) and supervisors, pending CMS (Centers for Medicare and Medicaid Services) approval. We’d like these payments to begin in November because we know they’re sorely needed. Permanent increases are scheduled for January 2022 to implement the Workforce Commission recommendation for MaineCare rates to be at 125% of minimum wage.
Emergency Provisions Implemented: We implemented temporary MaineCare HCBS waiver benefits and flexibilities under the Appendix K waiver (see page 7 of the presentation for more details).
Member Vaccinations Exceeds that of the General Population: Thanks to everyone’s immense efforts, Member vaccination rates exceed the general population’s – only 15.2% of our client population has not been vaccinated – some of which might be due to medical conditions etc. However, I suspect there are some among that 15.2% that could benefit from more information and encouragement. There have been a few outbreaks in group homes with the resurgence of the Delta variant – we now have about four outbreaks, compared to dozens earlier in the pandemic.
Betsy Hopkins, Associate Director, DHHS-OADS Disability Services, continued the presentation on where OADS has been:
Stakeholder Work Groups: It seems like forever ago when we discussed Community 2.0. We’ve had two work groups – Community Membership and Innovation, that have been meeting since 2020. These two groups are wrapping up in the next couple of months, and we’ll be developing recommendations based on their work. The Quality work group started earlier in 2021. The Communication work group will start in December of 2021. We’ve heard that communication is so important, especially now. We really want to come together as a work group and determine the best ways in which we can communicate effectively.
HCBS Compliance & Implementation in Maine: The goal of the HCBS Settings Rule and the work we’re doing is to focus on choices for people. It applies to all settings and all individuals in the same way. We want to have someone living in shared living in a rural part of the Maine to have all of the same access and choices as someone living in southern Maine. The way people access their communities on the mid coast might look very different than in southern Maine, but we want everyone to have the same ability to access their communities. One of the great opportunities we had in visiting the settings and talking with providers is that we continue to see all the great work going on in Maine. There are some providers that are really doing some wonderful work with the people they serve, having them access their communities, and access employment. Our goal is really to improve that so that’s happening for everyone across the state.
We had 1,725 total settings with Findings Reports issued. Of those, 90% were found to be non-isolating settings. The other 10% were found to have isolating components; the Federal HCBS Settings Rule refers to this group as “Heightened Scrutiny Settings” (HS Settings). Only 170 (10%) were determined to be HS Settings. 1,631 settings have approved Transition to Compliance Plans (TTCPs), of which 1,553 approved TTCPs have been accepted by the providers. Geographically, the HS Settings reflect population.
Progress on Quality and Access: In late 2019, we made some Quality Assurance positions available in our districts. Throughout the pandemic these positions were point-people for information and resources. Once the pandemic subsides, these positions will transition to quality assurance work.
Betsy provided information on where OADS is headed:
Person-Centered Planning: We really recognize that the PCP process should be at the heart of all of the work people are doing. We’re excited that we’ve been able to work on implementing the Charting the LifeCourse tools in the PCP process. In early 2022 when we’re closer to having the PCP Guide based on this, we’ll share that with this group.
Paul continued the presentation on where OADS is headed:
Workforce Initiatives:
- Portability and Advancement Initiative – We’re looking to create a universal base credential that applies across all populations for consistency and mobility. We hope this will help attract people to the field. Currently, depending on the population group it’s difficult to explain to people the credentials needed. We’d like to be able to say to people they can get a base credential for a solid foundation. Then, when people develop an interest they can specialize. Then, if people want to better understand how to work with people with autism, they can become specialized in that, or behavior, or people with dementia, etc. This will add advancement opportunities and build needed expertise in the system. The plan is to start with DSPs.
- Labor Market Analysis – We want to talk with employers and workers to better understand what’s happening in the labor market so we can better understand what efforts would make the biggest difference in retaining and attaining staff.
- Pathways & Tuition Remission – DSPs might get into the field as a pathway to another career path. We want to look into how to foster this, along with tuition remission, both of which were funded as part of LD 1733 at the end of the legislative sessions.
- Learning Management System – We want to create an interface with the State that’s a one-stop-shop through a single learning management system, where workers can maintain their credentials, take online trainings, etc.
- Nurse Delegation – There’s a nursing shortage, and nurse delegation is part of the solution to overcoming that challenge.
Additional Biennial Initiatives:
- Innovation Pilots – We need to firm up our foundation in order to be able to grow the HCBS system, as much and as rapidly as possible should more, sustainable federal funds materialize. This is where innovation is key.
- Transition from Children’s to Adult Services – We are working on a transition from children’s to adult services. LD 924, which many of you worked very hard to get passed, established a task force that has been created and will meet soon. I know that some of you will be serving on it. Our colleagues with the DOE (Department of Education) will be overseeing that and we will be participating. We’re also working with OCFS on transition issues and our hope is that OADS and OCFS can come back later this fall to provide an update on that work.
Paul: That was a lot to cover, and I appreciate everyone’s patience. We would be happy to hear feedback.
Discussion:
-It was asked if the Department has gathered any data on the High Scrutiny (HS) Settings and if there are any commonalities.
Betsy: We do have that information. I didn’t delve that deeply into it here because it’s fairly detailed. There are four core areas when we talk about HS that we’re seeing that are somewhat similar across the entities.
Heidi Bechard: There were definite themes, for instance in the residential settings we discovered 15 top areas where settings were identified as HS, involving: Individual’s lack of ability to access personal resources; the lack of exploration of competitive, integrated employment; staff’s lack of training in exploring and having conversations about competitive, integrated employment; individuals not having locks to either the entry door or their personal room door in their residential setting; and not having the ability to have visitors at any time in a residential setting, keeping in mind everyone who resides in that setting and not interfering with people’s schedules etc. Non-residential settings had some themes/patterns which indicated isolating qualities as well, such as individuals in community support settings who didn’t have meaningful opportunities and interactions in their communities. Transportation was another finding across both residential and non-residential settings.
Paul: We’re talking about 10% of 1700 settings in Maine. The HS Settings are important, and we want to work with all of them to get them to where they need to be and most of them are well on their way. But let’s not lose sight. One would think given some statements made that the entire system is about to shut down based on HS Settings, and nothing could be further from the truth.
-It was pointed out that Paul stated that the system expanded during the pandemic, versus it shrinking. It was stated that is based off of a specific set of raw numbers that doesn’t paint the full picture. That data doesn’t consider the number of people coming into the system. That doesn’t consider the hours of services needed vs. the hours provided. It doesn’t paint the full picture of the extent to which the system is adequately serving people. It was also stated that not having the Communication work group in effect while the other work groups were doing their work was disappointing as there was no way to communicate what was going on in those groups to a broader audience. The extent to which this affected feedback which would have been helpful cannot be overstated.
Paul: I appreciate that feedback. We hear you on communication and we want to have a more formalized way to get information out. Meeting with groups like this is not the same as having a systemized way of getting information out to people. I also appreciate your point about hours authorized. Point well taken. One of the ways we’ve been able to get through the pandemic is providers have been providing fewer hours. We have been serving more people, though the waitlist does continue to grow. We have been able to add folks more quickly compared to the numbers being added to the waitlist. We’re looking forward to our new case management system being implemented and being able to produce information such as hours of services provided on a regular basis.
-A provider stated that the 10% HS Settings seems very low, perhaps because the overall number of settings includes shared living providers. It was stated that when you exclude shared living providers the HS Settings percentage is likely far higher. She also asked if it was known how many of the HS Settings were community-based programs.
Betsy: I’m not sure about what the percentage would look like if we excluded shared living. About the community support programs, our goal is to work with all of them and we are. We’re providing a lot of technical assistance so that they can come into compliance. We’re looking forward to that work with them and doing trainings with them. Over the next year our goal is to continue working with these agencies as we have been so they can come into compliance.
Heidi: When I looked back on some of the other data, we’ve only identified 27 shared living settings as being HS Settings. Another piece of information you didn’t see today, as it looks at all the residential settings, 31% of all of the residential settings factors were found in compliance, meaning 69% were not. However, there were 15 primary factors of non-compliance. Many of those 15 indicators are duplicative – meaning there are about 10 remediation steps that cover those 15 indicators. With the Federal HCBS Settings requirements, it required more opportunities for greater inclusion in their communities.
Paul: One of the advantages of being so late to the game in Maine, is there’s lots of experience in other states. Maine is not at all an outlier for the number of HS Settings nor the types of settings subject to HS.
Laura Cordes, Executive Director, MACSP (Maine Association for Community Service Providers): My question is about the HS Settings. My recollection was that there were a number of settings that were included as HS Settings that did not have isolating qualities, but the time ran out and they were not given the amount of time to demonstrate they wouldn’t be a HS Setting. Am I recalling that correctly?
Paul: That is true, some of the sites got caught up in the timeline which would suggest we have even fewer HS Settings.
Heidi: 7/1/21 was a CMS deadline. This was the date by which settings identified as HS Settings had to come into full compliance to avoid completing an evidentiary package. We had 7 settings come into compliance before this deadline. We got started late through this journey, then COVID came into play. This resulted in a more compressed timeline for settings to come into full compliance.
Laura: But we don’t know the number that were not given the originally indicated time to come into compliance?
Heidi: I don’t have that number off the top of my head. Due to COVID, we weren’t able to visit all settings prior to the deadline because not all settings were fully up and running. I can look into the number of settings that fall into the category to which you refer.
Laura: I would suggest when you provide this data to carve those settings out as it would be helpful for people to understand that the HS Settings percentage includes a smaller percentage that otherwise would not have been included.
-A parent stated that having 10% of settings be considered HS Settings in a system that is already static is very troubling. She stated that in her area it’s 18% - losing 18% of resources is a terrible loss. Perhaps this is a communication issue and there’s a plan in place for that 18%. Across the spectrum of people with disabilities, there’s a difference in the number of choices there are for people. It was asked if the 10% is equal across the board or if it’s hitting certain placements more than others. It was also asked what consumer-based transportation means.
Paul: To clarify the statistics, 18% in western Maine does not refer to 18% of your settings, it means 18% of the 170 HS Settings are in that area. From our perspective it does not indicate that those services are coming offline – we want to work with all of them to keep them online. HS does not equate to coming offline or closure – it means there’s extra work to be done with those settings. In terms of choices, it’s our view that everyone ought to have choices. How someone executes those choices will be different for everyone. But across the board everyone should have choices. The Federal HCBS Settings Rule impacts everyone, we think in a positive way, but at the end of the day those choices reside with the individual. Regarding consumer-directed transportation – we want help to look at a range of options for transportation. There’s a distinction between medical transportation versus transportation that’s used to access a waiver service. The latter category is what’s been in contention forever and has been challenging forever. We’d like to look at models where part of the PCP includes consumers having choices about how they use their transportation budget that better fit what they want need. I don’t know where this will land because we haven’t started yet.
-A parent stated that the 18% in western Maine, or 30 programs seems like a lot, but it’s good to hear that HS doesn’t mean closure.
Paul: If providers will engage with us, we’re willing to put as much time and energy in as is needed to get them to where they need to be. We would love to engage with everyone around this.
-A provider stated that he hears quite a bit that the Administration started this at the last moment. Maine was given a two-year extended timeframe to demonstrate compliance. While we’ve had the continued timeline, it doesn’t appear the extension was passed on to providers. And there appears to be an extended wait time for EconSys to respond to providers of HS Settings. Maine is already substantially in compliance with the CMS rules. The provider stated that he doesn’t understand why there is this extremely onerous, administratively burdensome work to report to EconSys when Maine is already substantially compliant. Additionally, he stated that he’s confused about community membership rolled out as part of the Appendix K waiver. He stated that it’s very limiting, as schedules have to be done a week in advance – this doesn’t seem to be driven by consumer choice.
Paul: What you’re pointing out is that we have a significant number of providers that are already in compliance. We have a sizeable group that has work to do. The reality is many providers are already in compliance in Maine. As far as the timeframe to get the rest of the group into compliance, this was raised several times at the public hearing, and we’ll address that in our response to comments. In terms of choice, having a community membership benefit is a huge advancement versus not having one. As we implement it together, we’ll want feedback on how it can be improved over time. I would guess that no agency could implement this spontaneously on an hour-to-hour basis, for staff scheduling etc. So there has to be some kind of balance.
-A parent stated that she’s glad that sustainability was included in the presentation. She stated that she’s had to be home to provide home supports and access trainings etc. She asked what’s out there for parents. The training she had to take to become a DSP for her son was eye-opening. Parents having access to information that DSPs do would be advantageous. She asked if the thought is that there will always be a waitlist for services.
Paul: The waitlist is not something we have to live with indefinitely. In previous legislative sessions completely addressing the waitlists was priced out, it’s not an insignificant amount of money. However, waitlists are one of the issues that’s slated to be addressed in the federal reconciliation bill later this fall. If we get a significant infusion of longer-term federal money, we’d have more to put towards the waitlist, and we could do it with confidence that the money will continue to be there. That’s the sustainability balance we need to find. In terms of the training, my gut reaction is if parents want to take DSP training, we ought to make it available to them. And/or have some other type of training.
Betsy: Parents can access the College of Direct Support, what we use for DSP training. I’ll get more information on this for the minutes.
-A parent stated that transportation has become an immense issue for her personally, including times when it’s simply not safe. As such she decided to provide her son’s transportation herself. She stated that she’s glad they’re looking at options.
-It was stated there was mention of the creation of a PCP Guide. In the past when guides have been put together, the guide through its use, not through intent, became a manual instead. It was asked what thought has gone into the content of the guide, and the training for it, so that it’s truly used as a guide versus a manual. It was also asked how self-advocates have been/will be part of the development process. He stated he would like to hear how self-advocates have been included as part of all the design work.
Betsy: You bring up some excellent points. We’ve had some conversations around the initial draft of the Guide with Disability Rights Maine (DRM) and Speaking Up For Us (SUFU). We don’t want the guide to become a technical manual. That’s part of the work we’ve been doing with the Charting the LifeCourse work with University of Missouri. As we develop training, we will definitely be seeking input. We also have a contract we’re putting together with the University of Minnesota, as they’ve taken the PCP Guide and put it into plain language. I think the way we’ve talked about doing that is to open it up to stakeholders’ meetings around the Guide and how we’re going to roll it out.
Paul: We’ve also had waiver participants in our reform efforts, including as part of the work groups.
Betsy: Yes. We sent out invitations across the board for stakeholders to join the four groups. We have several self-advocates, disability advocates, family members, etc.
-A self-advocate asked if they will be adding the phrases accommodations and accessibility to their vision. The ID/DD community has similar challenges as other disability communities, by needing accommodations for reading, transportation, assistive technology, etc. Incorporating that language would be helpful. She stated that the ability to offer support so that people can have financial control is essential, so people have ways in which they can manage their finances, income, etc. She added that addressing transportation, actually implementing change, is critical. She stated that she hopes this happens during the current Administration so that progress isn’t lost in future Administrations as often happens. She asked if the Department has data regarding the number of people who have passed away while on the waitlists.
Paul: Thank you for the suggestion on accommodation and accessibility. The financial control comment – we have many people who are interested in the self-direction programs we’re establishing, including people would like to have budget authority. It will take us a bit to get to people having budget authority, but it’s the direction in which we’re going. In terms of the Mortality Review Panel, I hadn’t considered including the data for people on the waitlist but the rule making process for this is upcoming and that would be a good opportunity to include this. I like that idea.
-A parent stated that having support to assist parents with the technology aspect of being able to participate in stakeholder opportunities would be very helpful.
-A parent stated that he’s very interested in continuing education for the ID/DD population. He stated that he’s curious to see what the State is doing to expand online learning and continuing education opportunities. He stated that rural life is difficult and Zoom programs can be very useful in integrating people in a number of different ways, but more attention to this is needed. He stated that as a result of LD 924, there’s a taskforce staring on 11/9, for post-secondary young adults, about which people in this group might be interested.
Paul: We promoted telehealth during the pandemic and will continue to, and you can think of online education as a form of that.
-A parent stated that transportation has consistently been identified as a huge challenge. It was stated that a presentation on the transportation final report to the Coalition would be extremely helpful. She added that in Connecticut they had a level of needs assessment tool. She stated that she’s interested in hearing about their progress on a need’s assessment.
Paul: I think transportation would be a good topic when the evaluation report is ready. OMS (Office of MaineCare Services) is taking the lead on that. We’ll let Cullen know when that’s available to schedule a presentation for this group.
Cullen: Before we conclude I wanted to go back to a statement made earlier and the use of the term “misinformation.” This could imply that there’s something disparaging going on, and it could also sow the seeds of an “us against them” mentality. I believe that everyone here is “us.” We’re on the same team and working together towards the same goal of making the world a better place for people with intellectual and developmental disabilities. There’s room for more communication. There’s a lot of stress and anxiety involved for everyone. I think with the stakes so high understanding can take time, and it’s very important to have dialogues like this. A lot of worries and misunderstandings could easily be cured with more open and transparent communication such as this discussion. Paul, I would like to invite you back to continue this discussion at next month’s meeting. It’s very apparent that this discussion would have continued far longer if we had more time. It is important people have a clear and accurate picture of what’s going on. This is what will bring us together, so we can work together towards systems change and improvement.
Paul: Thank you for the invitation. Betsy and I attend these meetings when we can. There are many different venues in which conversations are being had. I really appreciate you dedicating all of this time today. Thank you all.
Cullen: Thank you very much for this presentation, Paul and Betsy, and for the robust dialogue it generated. Please keep coming!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads - No additional updates
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs - No updates
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Libby Stone-Sterling: I wanted to take a minute to say that October is National Disability Employment Awareness month. We’ve put together a calendar of events online. Please feel free to reach out to me with any questions or recordings of past events: [email protected]
Cullen: Thank you, Libby!
SMACT (Southern Maine Advisory Council on Transition)
The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy ([email protected]). SMACT meetings occur the first Friday of each month throughout the school year. The first SMACT meeting was on 10/1 and featured Betsy Morrison, Transitional Services Manager at PSL/STRIVE in South Portland sharing information about TOPS (Transition Outcomes Program for Students) and Anne Ryan, STRIVE Online Program Director, sharing information about STRIVE Worldwide. (Click here for a link to these presentations.)
Disability Rights Maine (DRM) Update:
Staci Converse sent the following update after the meeting for inclusion in the minutes: I wanted to share Employment 1st information with group and particularly the upcoming forum DRM is hosting. (Click here for more information on the forum.)
Federal & Housing Updates:
Cullen: Due to time the federal and housing update will simply be in the minutes. However, I wanted to take a moment to specifically thank Senator King for being one of 36 senators to sign on to a Dear Colleague letter to the President, Speaker Pelosi, and majority Leader Schumer urging them to preserve the housing investments included in the Build back Better Act. Teague, please express our thanks to Senator King!
- Federal Budget: On 9/30 Congress passed and the President signed a short-term Continuing Resolution (CR) to keep the government open through 12/3. The CR maintains current federal funding levels through 12/3. The bill also includes $28.6 billion for communities hit by natural disasters over the past 18 months and $6.3 billion to help support resettlement for Afghan refugees. On 10/14 the President signed a separate measure raising the nation's debt limit until early December, delaying potentially defaulting on the nation’s debts. Advocates are working to ensure that the final FY 22 budget includes the highest possible funding for HUD programs, including Section 8.
- Congress’ Budget Resolution & “Build Back Better Act” Infrastructure Reconciliation Package: On 9/25 the House Budget Committee voted to advance the Build Back Better Act to the House Rule Committee in preparation for a full House vote. The legislation would invest more than $330 billion in affordable housing through a $3.5 trillion over 10 years infrastructure and economic recovery reconciliation bill, which could pass in the Senate with a simple majority rather than the 60 votes required for other legislation. A few items of note from the bill include:
- $90 billion for rental assistance, including $75 billion for Housing Choice Vouchers (Section 8) and $15 billion for Project-Based Rental Assistance.
- $37 billion for the national Housing Trust Fund (as a set-aside within the HOME Investment Partnership Program).
- $1 billion for Section 811 Housing for Persons with Disabilities.
- The Reconciliation Package also includes funding for HCBS. The House Energy and Commerce Committee recommended $190 billion in funding for HCBS within bill. However, advocates estimate that $250 billion is needed to address DSP wages and the waitlists.
- The Decent, Affordable, Safe Housing for All (DASH) Act: On 8/18 Senate Finance Committee Chair Ron Wyden (D-Ore.) announced the DASH Act, legislation to make a generational investment to which would tackle the housing affordability crisis, among various other important measures. Pertinent to this group, the legislation increases funding for low- and middle-income housing development and provides $10 billion in the Housing Trust Fund (HTF) for the next ten years to states to acquire, develop, or rehabilitate deeply affordable housing. In Maine, resources from the HTF are the primary funding mechanism for supportive housing development.
State Legislature Update: No additional Updates
Updates/Other Business: No additional Updates
The next meeting will be on Monday, November 8, 2021, 12-2pm, via Zoom*.
Featured Speaker & Topic TBD.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2022 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].