September 9, 2019
Minutes
Minutes
Present: Bob Carpenter, Andy Taranko, Lydia Dawson, David Cowing, Debbie Dionne, Kim Humphrey, Jennifer Putnam, Derek Fales, Lisa Sturtevant, Libby Stone-Sterling, Betsy Mahoney, Margaret Cardoza, Staci Converse, Mary Chris Semrow, Jenn Brooking, Kathy Son, Alexandria Twombly, Julie Brennan, Scott MacDonald, Peter Stuckey, Kate Shambaugh, Jennifer Karod, Tabatha Boulier, Cullen Ryan, and Vickey Rand. Via Zoom – (Bangor): Bonnie-Jean Brooks. (Winthrop): Cathy Dionne. (Sanford): Emily Spencer. (Orono): Bonnie Robinson, Maria Cameron, Janet May, and Janet Hamill. (Farmington): Kristin McPherson, Daryl Wood, Joyce Daggett, Lisa Marston, and Christa DiGiuseppe. (Auburn): Ann Bentley and Shelley Zielinski. (Blue Hill): Gregory Bush and two others. (Belfast): Linda Lee. Misc. sites: Dixie Redmond, Craig Patterson, Helen Hemminger, Robin Levesque, Chris, and Maggie.
Cullen Ryan introduced himself and welcomed the group. Participants introduced themselves. Minutes from the last meeting were accepted.
Featured Speaker: Acting Associate Director, Developmental Disabilities and Brain Injury Services, DHHS-OADS. www.maine.gov/dhhs/oads Topic: An overview of Maine’s Home and Community-Based Services (HCBS).
Cullen: Today we have Derek Fales, Acting Associate Director, Developmental Disabilities and Brain Injury Services, DHHS-OADS, presenting an overview of Maine’s Home and Community-Based Services (HCBS) Settings Rule. This ought to be helpful as things are changing around us and we work to be an information clearinghouse. Thank you for being here!
Derek Fales: As Cullen said I’m Derek Fales and I’m currently the Acting Associate Director for Developmental Disabilities and Brain Injury Services. Today I’m here to talk about the HCBS Settings Rule. The slides I’m going to go over I have Dr. Lisa Mills to thank for, who is a subcontractor with EconSys (Economic Systems, Inc.) which is assisting us with this project.
Begin Presentation (Click here for the presentation)
Derek: When we talk about HCBS settings we’re talking about the HCBS Setting Rule, a federal CMS (Centers for Medicare and Medicaid Services) Rule, and how it affects Maine services. This regulation defines standards for how services need to be delivered to individuals in the community. CMS worked on this rule and gathered comments during a five-year period. This federal regulation applies to residential settings; however, Maine has decided to go above the threshold and apply these to non-residential settings as well.
Discussion:
Lydia Dawson – MACSP: If a setting was found to be in non-compliance, would the funding be reduced, or would it be entirely eliminated for that setting?
Derek: The rate would have to be reduced by 63.8%, which isn’t feasible for Maine so that setting would no longer exist.
-It was asked if Derek could clarify the requirement regarding distance from an institutional setting.
Derek: The Settings Rule states that settings can’t be adjacent to a public or private institution. Internally we’re doing an assessment regarding this, then we’ll also have a provider assessment. We can’t assume we don’t have those settings and we have to prove to CMS that we’ve done a self-assessment.
Cullen: Years ago, the law changed, such that any group of up to eight individuals can cohabitate in a building, and that building would be zoned as a single-family home. This doesn’t change the fact that the group home can’t be on the grounds of an institution, but it does allow for two groups homes on one street, for instance.
Derek: Regarding settings presumed to have the qualities of an institutional setting – there have been documented homes in other states, where the provider prescribes everything for them, the individual can’t come and go from the home as they please, everything has to go through the provider; essentially the provider controls their entire life. CMS has determined that this would qualify as an institutional setting.
-A parent stated that his daughter needs supervision in order to be safe. He asked how the privacy aspect of the Settings Rule takes this into account.
Derek: All of our residential homes must provide supervision. However, this doesn’t mean that through the PCP (person-cantered planning) process that the person wouldn’t be able to identify the ways in which they could have privacy while also addressing safety concerns.
-It was asked how the Department is looking at current law and current practices regarding the tenancy provisions included within the Settings Rule.
Derek: EconSys is looking at our laws and the Settings Rule, to make recommendations for us to come into compliance with this aspect.
-It was asked how the tenancy laws and adherence to these regulations will be assessed by the Department.
Derek: There will be a provider self-assessment for every setting, so we’ll know if they’re currently in compliance. CMS requires all settings to comply with all aspects of the Settings Rule by March of 2022.
-It was asked how the requirement to permit visitors would work with provider agencies/programs.
Derek: Essentially, through the next two and a half years we would discuss what that means. There is a requirement to ensure people are safe in each of these settings, so it would be how to ensure that safety while also not restricting visitors. Essentially, this means a program couldn’t have a sign that says no visitors – there would have to be a process. This certainly is a significant change. There would be some sort of standards, just like everyone else has in their daily lives. There would be some need to discuss what this looks like for the individual and others at the program.
-A self-advocate stated that under full guardianship, the guardian makes decisions regarding visitors. It was stated that this is complicated.
Derek: If you’re in an institution, the institution has to have a policy regarding visitors. What this is saying is that residential and community settings can’t have a policy on visitors that’s more stringent than an institution.
Staci Converse – Disability Rights Maine: Regardless of guardianship you have rights to visitors. The new probate code also includes information regarding visitors, so this is quite complex.
-A parent stated that his son requires restrictions regarding his diet, to limit his consumption of sugar, etc., because otherwise that is all he would consume, thus jeopardizing his health. It was asked how these types of situations come into play with the Settings Rule.
Derek: There are modification standards that have been very well thought out by CMS. For instance, if dietary restrictions are necessary for the safety of the individual, there would be a justification in the PCP for this.
Lydia: How do the modification standards interrelate with the behavioral regulations?
Derek: This will be a separate process from the behavior regulations.
Staci: Is informed consent is involved with this process?
Derek: Yes, the individual would have to have informed consent for this modification/restriction.
Lydia: It seems like this process and the behavioral support plan are inherently conflicted.
Derek: You have to document why you’re saying there’s a need to restrict that person, and the person needs to have informed consent – the person needs to know that this plan means the person won’t have free access to sugar at any time, the reasons why, the steps being taken to support this, and ultimately if there is a decision-maker that isn’t the individual, there would be discussions with the decision-maker. However, the individual would still need to have the ability to know what’s going on and participate in the plan.
-It was asked if Derek could explain the requirement that these modifications can’t be applied to others in the house/program, as that would seem difficult in situations concerning locked cabinets, fridges, etc., as well as situations in which others in the home have agreed to this.
Derek: CMS says you can’t do that so there has to be a way for others in the household to have access to what the individual can’t, for example there can’t be locks on the fridge. Some states have outlined ways the other people can get into the fridge, while still keeping the other person safe.
-It was stated that last year the Bangor Daily News wrote an article concerning people who had to go out of state in order to receive needed services. It was asked what the Department is doing about this and how many people are currently out of state.
Derek: Right now, I believe there are between 10 and 15 adults receiving services out of state.
-It was asked if this applies to the HIV/AIDS waiver.
Derek: I think that’s different from the HCBS waivers.
-It was asked who will follow up on the site assessments that are soon to be done?
Derek: EconSys will be doing provider education. There will be training dates and webinars, which will detail step-by-step how providers will complete the survey.
-It was asked if there have been discussions about licensing community support services.
Derek: Yes. Many states have licensing standards for community-based programs. There are logistical issues about how we would do that etc., but it is an ongoing discussion.
-It was asked if guardians etc., would be notified about visitors to settings who are registered sex offenders.
Derek: For visitors, there must be a policy regarding how to ensure everyone is safe and what that looks like, but I’m not sure everyone would always know if someone is a registered sex offender, nor could you ask them, so I’d guess this would be covered in policy. Again, if there’s a safety concern, there is a modification process.
-It was asked if with all of the additional requirements, if the PCP will be modified to include more characters.
Derek: I will take that back to our tech team.
-A shared living coordinator stated that there are a lot of required trainings and asked if this will be an additional one.
Derek: Regarding the education around the HCBS Settings Rule, these trainings won’t be required. However, it will be important that people know about them because the provider will be required to follow them.
-It was asked if the Maine College of Direct Support will be updated to reflect these changes.
Derek: The Maine College of Direct Support curriculum is definitely something into which we’re looking, including what that means for our system.
-It was stated that the last Administration reduced funding for emergency housing. It was asked if this has been addressed.
Derek: The State has added funds to the Emergency Transitional Housing contracts so we can add more capacity.
Lydia: With the added positions for the Crisis Services Central Intake, is there a date when that central number will be made public?
Derek: I can take it back to the team for more information about their roll out and communication strategy.
Cullen: Derek, thank you very much for being here. This was very informative, and it’s great having you and OADS around the table. I’m very excited to continue this dialogue in November. Thank you again, well done!
End Presentation (round of applause)
Featured Speakers: Lisa Sturtevant, Employment Services Coordinator, DHHS-OADS, www.maine.gov/dhhs/oads and Libby Stone-Sterling, Voc Rehab Director. www.maine.gov/rehab/dvr/vr Topic: Updates on Employment Services and Voc Rehab.
Cullen: Today we have Lisa Sturtevant, Employment Services Coordinator, DHHS-OADS, and Libby Stone-Sterling, Voc Rehab Director, presenting updates on Voc Rehab (VR) and Employment Services in Maine. You both have been involved since the Coalition began, and we always get the very latest information from you as the system evolves, for which we are very grateful. Thanks for being here!
Libby Stone-Sterling: With the change of Administration there has been a lot of initiatives regarding how we can all work together; there’s very much a sense that these things can’t wait in terms of employment.
Being Presentation (Click here for the presentation)
Libby: With the Workforce Innovation and Opportunity Act (WIOA), 15% of total grant funding is spent on helping younger youth get ready for the world of work. We know how important it is to address employment early on for people with disabilities; as such we are partnering to create a culture of work for students with disabilities. None of this is meant to replace what schools and other agencies are charged to do, but there is the sense that we all need to be working together – there are things going on in the classroom, the home, the community, and things we can do in VR to support this. You don’t have to be a VR client to have access to these pre-employment transition services. There is a strong focus on really preparing all people and working across all systems in regard to employment – it’s quite exciting. The way we’re delivering these services is through partnerships, and some very targeted arrangements with community rehab providers, the schools, etc. We’re also working across system to strengthen connections for youth. The Cross Agency Collaborative for Transition, which includes a broad and comprehensive array of stakeholders, stems from and builds upon the work of the Employment First workgroup, bringing forward some of their recommendations for transition-age youth. We’re all in agreement that this focus on providing more services for youth is important, however we don’t have the youth voice at the table. This summer, we developed a Youth Advisory Council as a way to incorporate the voices of youth with disabilities in the policy making process. We just had our first meeting in August. Moving forward, we envision this group meeting at least quarterly. Additionally, we do have a Transition Career Exploration Workshop, developed by our agency in consultation with others, which is available for anyone to use.
-It was asked if the Cross Agency Collaborative for Transition is a defined group, and if it meets regularly.
Libby: We’re trying to meet with some regularity; currently we’re not but we stay in communication.
-It was asked if they have done outreach to the high schools regarding this collaborative.
Libby: We haven’t because the nature is to look at State agency policies, but as it gets going there may be some pieces where that would make sense.
-It was asked if having Transition VR Counselors in high schools is new.
Libby: This has been a long-standing practice, the difference is we’re reaching down earlier, starting to serve youth at 14.
-It was stated that many parents have noted there not being transition plans in place for their children, and as such it appears that some high schools may not be supporting transition.
Libby: The Commissioner of DOE is looking to strengthen the technical assistance they’re providing to high schools, moving beyond just compliance and into quality transition plans. Transition is a high priority for them as well.
Cullen: You raise a good point about transition. We spent some time in this group creating a Blueprint for Effective Transition. October’s meeting will feature Todd Landry, Director of OCFS, to start the conversation regarding how to optimize and begin implementation of the Blueprint for Effective Transition, and to examine the best ways in which we can work together and eliminate silos within state government to have seamless transitions all throughout the lifespan.
Libby: One of the best indicators of post-secondary employment is having a work experience before high school graduation. VR also has summer work initiatives, which have helped a lot of youth gain work experience. A lot of kids who thought they wouldn’t be able to work have been able to through VR-supported summer work experience. I spoke with a young man who was completing his second summer work experience, through which his confidence and his ability to advocate for himself have grown immensely. We also had our Step Up Program pilot initiative this summer, from which we gained a lot of positive feedback. As such it’s something we’re looking at expanding moving forward.
-It was asked if the Step Up Program will be opened up to people with other disabilities as well (for the pilot participants had a diagnosis on the Autism spectrum).
Libby: Yes, we’re sensitive to the fact that this might be helpful to others as well.
Libby: We have also been partnering to strengthen community rehabilitation provider services. We used to have a wide array of providers for these services, but in recent years we got down to only 40, which created a patchwork of services. In order to increase access for these services we put out an RFP (request for proposals) for community-based employment services. The RFP was regionally-based, and respondents had to be able to serve an entire region soup-to-nut. We have made two awards: Maine Medical Center Department of Vocation Services for Region 1 (Cumberland and York Counties); and Goodwill of Northern New England for Regions 2 and 3. We were not able to make awards in Regions 4 and 5. We’ve been talking with providers to come up with other solutions for these regions, because we can’t leave things as they are. We’re in the transition period for this, as we haven’t started these new contracts yet; we anticipate doing so later this year. However, if people had been receiving services from an agency with which we no longer contract, the transition to the regional agency is happening on an individual basis, to ensure we’re able to provide services when they need them.
-It was asked how individual choice is being honored with so few providers of community-based employment services.
Libby: In the beginning, choice was already a big challenge. Even with 40 providers, a lot of the providers weren’t able to serve people. In some areas there effectively was only one provider, so there wasn’t a choice. In the RFP, we asked how the agencies will ensure informed choice. Goodwill might be the provider, but Goodwill will have a number of employment specialists. If those aren’t a good fit, they’d look to their next region to see if they might have a better fit.
Lydia: The other 38 providers are concerned that they won’t be able to provide that service anymore. Regarding choice – can they pick from Goodwill’s employees, or would they allow for subcontracting?
Libby: The RFP did allow the option for subcontracting. Goodwill will be subcontracting with the IRIS network for people who are blind or visually impaired. We are continuing to provide some separate contracts related to pre-employment transition services. We will also continue to contract with the clubhouses outside of this process.
-A parent stated that her daughter has been working for years at Marshall’s. A lot of the other kids who live with her didn’t have the support they needed when they were younger to develop their employment skills, but they would like to work. Other individuals and families are frustrated with the lack of options for employment services for adults. It was stated that this presentation has provided a lot of information on employment as it pertains to youth, but there are also adults who would like to be out in the world working.
Libby: For VR, youth with disabilities represent about 40% of who we serve. We will cover employment services for adults in Lisa’s portion of the presentation.
-It was asked if there is data available on individuals with disabilities in the workforce in Maine.
Lisa Sturtevant: CWRI (Center for Workforce Research and Information) has published joint employment and disability data for years. You can sort it by different disabilities, etc. (Click here for more information.)
Libby: We’ve been doing a lot more collaborative work with DHHS, the Children’s Cabinet, and around workforce needs. There is a huge workforce need in Maine, and the most recent biennial budget included the creation of the Long Term Care Workforce Commission to study this (The first meeting is on 9/11 at 9:30am. Click here for the agenda).
Lisa: We also wanted to highlight the collaborative work between DHHS and DOL. One partnership is the Benefit Counseling Program through Maine Medical Center. This is one of the best trainings, which I highly recommend. Social workers from the Auburn Police Department, staff from domestic violence programs, and group home staff, among many others, have completed it which is wonderful. The program will kick off again this fall, and we’re more than happy to have Maine Med present for this group. Other DHHS and DOL collaborations include:
Regarding OADS Employment Services – all OADS waivers have career planning. We have about 1,000 people on the waivers currently working and receiving paid work supports. We have 47 agencies who will continue to provide employment support services to members. We continue to discuss what transportation options are available to our members, as transportation to and from waiver-funded employment services is a covered service.
-It was asked what the appeal process is for someone who is not satisfied with Employment Services.
Lisa: The appeal process is that same as it is for any waiver-funded services.
-It was asked how employment services funding works considering the cap on Section 29 services.
Lisa: Work supports are outside of the Section 29 cap because we’re an Employment First state.
-It was asked if this will happen for Section 21 services as well.
Derek: There are ongoing conversations about this. For Section 21, it’s about looking at everyone currently receiving services, looking at the waitlist, ensuring everyone has access to employment, looking at what everyone wants to do, and seeing what will be accepted by CMS.
Lydia: I’ve heard about instances in which someone has already identified a job and long-term work supports, but they still had to go through VR eligibility, and lost the job opportunity while waiting. I believe there used to be an expedited process for situations like this.
Libby: The expedited process isn’t something that is still occurring, but I think things are always open for discussion. There is a lot of support to find people eligible for VR services more quickly than the allowed timeframe.
-A parent asked if there are any linkages between these agencies and the community college system, and if so, if those linkages facilitate connections to continuing education opportunities.
Libby: Our offices are actually on college campuses, so building those partnerships has been a focus.
Lisa: If someone is interested in continuing education, this would be identified in the PCP. It’s based on the individual’s wants, needs, and who is supporting them. We’re looking at whether the community college system can take on the employment specialist training.
-It was asked if people should apply for VR at age 14.
Libby: We can start serving people as young as 14, but you don’t have to apply at 14. You can apply, but most likely you just have to fill out the one-pager.
Cullen: Lisa and Libby, this was great and thank you very much for being here!
End Presentation (round of applause)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Derek Fales: We have hired our new Crisis Program Administrator who, along with Craig Patterson who is attending today’s meeting remotely, is working on the continuous effort to address the crisis system in Maine. We continue to work on the Section 21 renewal application, which should go live on July 1st. With this renewal application we’re looking to make minimal changes, and then later amend it for compliance with the HCBS Settings Rule.
Craig Patterson: Focusing on the crisis re-design is one of our top priorities, which has multiple pieces. We’re hiring additional employees, working on a good communication system, and multiple other things as well. We’ll keep you all as updated as we can.
-A parent asked about the status of the Section 29 waitlist, and whether they would be looking to cure this.
Derek: There has been a lot of discussion regarding the best way to address the Section 29 waitlist, but I don’t have any more information on that today.
Bonnie-Jean Brooks: CMS will be offering a training to get provider and stakeholder buy-in for the HCBS Settings Rule on 9/11. It’s free and you can call in from 1:30-3:00pm, 1-800-719-7514 Access code: 624585 (Click here for more information).
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
-No one from OCFS was in attendance; however, Todd Landry, Director of OCFS, will be the presenter for the October meeting, being held on October 21st, the third Monday of the month due to the holiday on our regular meeting date.
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.
Disability Rights Maine (DRM) Update:
Staci Converse: We’ll be participating in the MADSEC (Maine Administration of Services for Children with Disabilities) Fall Conference (click here for more information) providing information on Supported Decision-Making (SDM). SDM trainings are offered regularly statewide (click here for more information). We also have upcoming Developmental Services Rights trainings in Portland on 9/18 and Augusta on 10/8. Additionally, the SUFU (Speaking Up For Us) Annual Conference is being held on 9/24 and 9/25.
Federal & Housing Updates:
Cullen: Congress is working on the FY 20 allocations and budget, which begins 10/1/19, and is working on reconciling House and Senate appropriations bills, including the T-HUD budget. The House’s T-HUD budget looks very favorable. However, it’s possible we’re looking at a Continuing Resolution, which would not be as favorable as the funding levels in the House budget. More information to follow next month.
State Legislature Update:
Lydia Dawson – MACSP: Cloture is fast approaching; all of the bills will need to be in by the end of the month.
Announcements:
The next meeting will be on ***Monday, October 21, 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: Todd Landry, Director, DHHS Office of Child and Family Services (OCFS).
Topic: Update on Children’s Services.
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.
Featured Speaker: Acting Associate Director, Developmental Disabilities and Brain Injury Services, DHHS-OADS. www.maine.gov/dhhs/oads Topic: An overview of Maine’s Home and Community-Based Services (HCBS).
Cullen: Today we have Derek Fales, Acting Associate Director, Developmental Disabilities and Brain Injury Services, DHHS-OADS, presenting an overview of Maine’s Home and Community-Based Services (HCBS) Settings Rule. This ought to be helpful as things are changing around us and we work to be an information clearinghouse. Thank you for being here!
Derek Fales: As Cullen said I’m Derek Fales and I’m currently the Acting Associate Director for Developmental Disabilities and Brain Injury Services. Today I’m here to talk about the HCBS Settings Rule. The slides I’m going to go over I have Dr. Lisa Mills to thank for, who is a subcontractor with EconSys (Economic Systems, Inc.) which is assisting us with this project.
Begin Presentation (Click here for the presentation)
Derek: When we talk about HCBS settings we’re talking about the HCBS Setting Rule, a federal CMS (Centers for Medicare and Medicaid Services) Rule, and how it affects Maine services. This regulation defines standards for how services need to be delivered to individuals in the community. CMS worked on this rule and gathered comments during a five-year period. This federal regulation applies to residential settings; however, Maine has decided to go above the threshold and apply these to non-residential settings as well.
Discussion:
Lydia Dawson – MACSP: If a setting was found to be in non-compliance, would the funding be reduced, or would it be entirely eliminated for that setting?
Derek: The rate would have to be reduced by 63.8%, which isn’t feasible for Maine so that setting would no longer exist.
-It was asked if Derek could clarify the requirement regarding distance from an institutional setting.
Derek: The Settings Rule states that settings can’t be adjacent to a public or private institution. Internally we’re doing an assessment regarding this, then we’ll also have a provider assessment. We can’t assume we don’t have those settings and we have to prove to CMS that we’ve done a self-assessment.
Cullen: Years ago, the law changed, such that any group of up to eight individuals can cohabitate in a building, and that building would be zoned as a single-family home. This doesn’t change the fact that the group home can’t be on the grounds of an institution, but it does allow for two groups homes on one street, for instance.
Derek: Regarding settings presumed to have the qualities of an institutional setting – there have been documented homes in other states, where the provider prescribes everything for them, the individual can’t come and go from the home as they please, everything has to go through the provider; essentially the provider controls their entire life. CMS has determined that this would qualify as an institutional setting.
-A parent stated that his daughter needs supervision in order to be safe. He asked how the privacy aspect of the Settings Rule takes this into account.
Derek: All of our residential homes must provide supervision. However, this doesn’t mean that through the PCP (person-cantered planning) process that the person wouldn’t be able to identify the ways in which they could have privacy while also addressing safety concerns.
-It was asked how the Department is looking at current law and current practices regarding the tenancy provisions included within the Settings Rule.
Derek: EconSys is looking at our laws and the Settings Rule, to make recommendations for us to come into compliance with this aspect.
-It was asked how the tenancy laws and adherence to these regulations will be assessed by the Department.
Derek: There will be a provider self-assessment for every setting, so we’ll know if they’re currently in compliance. CMS requires all settings to comply with all aspects of the Settings Rule by March of 2022.
-It was asked how the requirement to permit visitors would work with provider agencies/programs.
Derek: Essentially, through the next two and a half years we would discuss what that means. There is a requirement to ensure people are safe in each of these settings, so it would be how to ensure that safety while also not restricting visitors. Essentially, this means a program couldn’t have a sign that says no visitors – there would have to be a process. This certainly is a significant change. There would be some sort of standards, just like everyone else has in their daily lives. There would be some need to discuss what this looks like for the individual and others at the program.
-A self-advocate stated that under full guardianship, the guardian makes decisions regarding visitors. It was stated that this is complicated.
Derek: If you’re in an institution, the institution has to have a policy regarding visitors. What this is saying is that residential and community settings can’t have a policy on visitors that’s more stringent than an institution.
Staci Converse – Disability Rights Maine: Regardless of guardianship you have rights to visitors. The new probate code also includes information regarding visitors, so this is quite complex.
-A parent stated that his son requires restrictions regarding his diet, to limit his consumption of sugar, etc., because otherwise that is all he would consume, thus jeopardizing his health. It was asked how these types of situations come into play with the Settings Rule.
Derek: There are modification standards that have been very well thought out by CMS. For instance, if dietary restrictions are necessary for the safety of the individual, there would be a justification in the PCP for this.
Lydia: How do the modification standards interrelate with the behavioral regulations?
Derek: This will be a separate process from the behavior regulations.
Staci: Is informed consent is involved with this process?
Derek: Yes, the individual would have to have informed consent for this modification/restriction.
Lydia: It seems like this process and the behavioral support plan are inherently conflicted.
Derek: You have to document why you’re saying there’s a need to restrict that person, and the person needs to have informed consent – the person needs to know that this plan means the person won’t have free access to sugar at any time, the reasons why, the steps being taken to support this, and ultimately if there is a decision-maker that isn’t the individual, there would be discussions with the decision-maker. However, the individual would still need to have the ability to know what’s going on and participate in the plan.
-It was asked if Derek could explain the requirement that these modifications can’t be applied to others in the house/program, as that would seem difficult in situations concerning locked cabinets, fridges, etc., as well as situations in which others in the home have agreed to this.
Derek: CMS says you can’t do that so there has to be a way for others in the household to have access to what the individual can’t, for example there can’t be locks on the fridge. Some states have outlined ways the other people can get into the fridge, while still keeping the other person safe.
-It was stated that last year the Bangor Daily News wrote an article concerning people who had to go out of state in order to receive needed services. It was asked what the Department is doing about this and how many people are currently out of state.
Derek: Right now, I believe there are between 10 and 15 adults receiving services out of state.
-It was asked if this applies to the HIV/AIDS waiver.
Derek: I think that’s different from the HCBS waivers.
-It was asked who will follow up on the site assessments that are soon to be done?
Derek: EconSys will be doing provider education. There will be training dates and webinars, which will detail step-by-step how providers will complete the survey.
-It was asked if there have been discussions about licensing community support services.
Derek: Yes. Many states have licensing standards for community-based programs. There are logistical issues about how we would do that etc., but it is an ongoing discussion.
-It was asked if guardians etc., would be notified about visitors to settings who are registered sex offenders.
Derek: For visitors, there must be a policy regarding how to ensure everyone is safe and what that looks like, but I’m not sure everyone would always know if someone is a registered sex offender, nor could you ask them, so I’d guess this would be covered in policy. Again, if there’s a safety concern, there is a modification process.
-It was asked if with all of the additional requirements, if the PCP will be modified to include more characters.
Derek: I will take that back to our tech team.
-A shared living coordinator stated that there are a lot of required trainings and asked if this will be an additional one.
Derek: Regarding the education around the HCBS Settings Rule, these trainings won’t be required. However, it will be important that people know about them because the provider will be required to follow them.
-It was asked if the Maine College of Direct Support will be updated to reflect these changes.
Derek: The Maine College of Direct Support curriculum is definitely something into which we’re looking, including what that means for our system.
-It was stated that the last Administration reduced funding for emergency housing. It was asked if this has been addressed.
Derek: The State has added funds to the Emergency Transitional Housing contracts so we can add more capacity.
Lydia: With the added positions for the Crisis Services Central Intake, is there a date when that central number will be made public?
Derek: I can take it back to the team for more information about their roll out and communication strategy.
Cullen: Derek, thank you very much for being here. This was very informative, and it’s great having you and OADS around the table. I’m very excited to continue this dialogue in November. Thank you again, well done!
End Presentation (round of applause)
Featured Speakers: Lisa Sturtevant, Employment Services Coordinator, DHHS-OADS, www.maine.gov/dhhs/oads and Libby Stone-Sterling, Voc Rehab Director. www.maine.gov/rehab/dvr/vr Topic: Updates on Employment Services and Voc Rehab.
Cullen: Today we have Lisa Sturtevant, Employment Services Coordinator, DHHS-OADS, and Libby Stone-Sterling, Voc Rehab Director, presenting updates on Voc Rehab (VR) and Employment Services in Maine. You both have been involved since the Coalition began, and we always get the very latest information from you as the system evolves, for which we are very grateful. Thanks for being here!
Libby Stone-Sterling: With the change of Administration there has been a lot of initiatives regarding how we can all work together; there’s very much a sense that these things can’t wait in terms of employment.
Being Presentation (Click here for the presentation)
Libby: With the Workforce Innovation and Opportunity Act (WIOA), 15% of total grant funding is spent on helping younger youth get ready for the world of work. We know how important it is to address employment early on for people with disabilities; as such we are partnering to create a culture of work for students with disabilities. None of this is meant to replace what schools and other agencies are charged to do, but there is the sense that we all need to be working together – there are things going on in the classroom, the home, the community, and things we can do in VR to support this. You don’t have to be a VR client to have access to these pre-employment transition services. There is a strong focus on really preparing all people and working across all systems in regard to employment – it’s quite exciting. The way we’re delivering these services is through partnerships, and some very targeted arrangements with community rehab providers, the schools, etc. We’re also working across system to strengthen connections for youth. The Cross Agency Collaborative for Transition, which includes a broad and comprehensive array of stakeholders, stems from and builds upon the work of the Employment First workgroup, bringing forward some of their recommendations for transition-age youth. We’re all in agreement that this focus on providing more services for youth is important, however we don’t have the youth voice at the table. This summer, we developed a Youth Advisory Council as a way to incorporate the voices of youth with disabilities in the policy making process. We just had our first meeting in August. Moving forward, we envision this group meeting at least quarterly. Additionally, we do have a Transition Career Exploration Workshop, developed by our agency in consultation with others, which is available for anyone to use.
-It was asked if the Cross Agency Collaborative for Transition is a defined group, and if it meets regularly.
Libby: We’re trying to meet with some regularity; currently we’re not but we stay in communication.
-It was asked if they have done outreach to the high schools regarding this collaborative.
Libby: We haven’t because the nature is to look at State agency policies, but as it gets going there may be some pieces where that would make sense.
-It was asked if having Transition VR Counselors in high schools is new.
Libby: This has been a long-standing practice, the difference is we’re reaching down earlier, starting to serve youth at 14.
-It was stated that many parents have noted there not being transition plans in place for their children, and as such it appears that some high schools may not be supporting transition.
Libby: The Commissioner of DOE is looking to strengthen the technical assistance they’re providing to high schools, moving beyond just compliance and into quality transition plans. Transition is a high priority for them as well.
Cullen: You raise a good point about transition. We spent some time in this group creating a Blueprint for Effective Transition. October’s meeting will feature Todd Landry, Director of OCFS, to start the conversation regarding how to optimize and begin implementation of the Blueprint for Effective Transition, and to examine the best ways in which we can work together and eliminate silos within state government to have seamless transitions all throughout the lifespan.
Libby: One of the best indicators of post-secondary employment is having a work experience before high school graduation. VR also has summer work initiatives, which have helped a lot of youth gain work experience. A lot of kids who thought they wouldn’t be able to work have been able to through VR-supported summer work experience. I spoke with a young man who was completing his second summer work experience, through which his confidence and his ability to advocate for himself have grown immensely. We also had our Step Up Program pilot initiative this summer, from which we gained a lot of positive feedback. As such it’s something we’re looking at expanding moving forward.
-It was asked if the Step Up Program will be opened up to people with other disabilities as well (for the pilot participants had a diagnosis on the Autism spectrum).
Libby: Yes, we’re sensitive to the fact that this might be helpful to others as well.
Libby: We have also been partnering to strengthen community rehabilitation provider services. We used to have a wide array of providers for these services, but in recent years we got down to only 40, which created a patchwork of services. In order to increase access for these services we put out an RFP (request for proposals) for community-based employment services. The RFP was regionally-based, and respondents had to be able to serve an entire region soup-to-nut. We have made two awards: Maine Medical Center Department of Vocation Services for Region 1 (Cumberland and York Counties); and Goodwill of Northern New England for Regions 2 and 3. We were not able to make awards in Regions 4 and 5. We’ve been talking with providers to come up with other solutions for these regions, because we can’t leave things as they are. We’re in the transition period for this, as we haven’t started these new contracts yet; we anticipate doing so later this year. However, if people had been receiving services from an agency with which we no longer contract, the transition to the regional agency is happening on an individual basis, to ensure we’re able to provide services when they need them.
-It was asked how individual choice is being honored with so few providers of community-based employment services.
Libby: In the beginning, choice was already a big challenge. Even with 40 providers, a lot of the providers weren’t able to serve people. In some areas there effectively was only one provider, so there wasn’t a choice. In the RFP, we asked how the agencies will ensure informed choice. Goodwill might be the provider, but Goodwill will have a number of employment specialists. If those aren’t a good fit, they’d look to their next region to see if they might have a better fit.
Lydia: The other 38 providers are concerned that they won’t be able to provide that service anymore. Regarding choice – can they pick from Goodwill’s employees, or would they allow for subcontracting?
Libby: The RFP did allow the option for subcontracting. Goodwill will be subcontracting with the IRIS network for people who are blind or visually impaired. We are continuing to provide some separate contracts related to pre-employment transition services. We will also continue to contract with the clubhouses outside of this process.
-A parent stated that her daughter has been working for years at Marshall’s. A lot of the other kids who live with her didn’t have the support they needed when they were younger to develop their employment skills, but they would like to work. Other individuals and families are frustrated with the lack of options for employment services for adults. It was stated that this presentation has provided a lot of information on employment as it pertains to youth, but there are also adults who would like to be out in the world working.
Libby: For VR, youth with disabilities represent about 40% of who we serve. We will cover employment services for adults in Lisa’s portion of the presentation.
-It was asked if there is data available on individuals with disabilities in the workforce in Maine.
Lisa Sturtevant: CWRI (Center for Workforce Research and Information) has published joint employment and disability data for years. You can sort it by different disabilities, etc. (Click here for more information.)
Libby: We’ve been doing a lot more collaborative work with DHHS, the Children’s Cabinet, and around workforce needs. There is a huge workforce need in Maine, and the most recent biennial budget included the creation of the Long Term Care Workforce Commission to study this (The first meeting is on 9/11 at 9:30am. Click here for the agenda).
Lisa: We also wanted to highlight the collaborative work between DHHS and DOL. One partnership is the Benefit Counseling Program through Maine Medical Center. This is one of the best trainings, which I highly recommend. Social workers from the Auburn Police Department, staff from domestic violence programs, and group home staff, among many others, have completed it which is wonderful. The program will kick off again this fall, and we’re more than happy to have Maine Med present for this group. Other DHHS and DOL collaborations include:
- The Employment Workforce Development System which provides professional development for employment support providers.
- Your Path to Employment which is a downloadable planning tool designed to start a conversation about employment.
- Maine Association of Professional Supporting Employment First (Me-APSE) which is the State affiliate of National APSE for people who are involved in employment. It is currently open for new members.
Regarding OADS Employment Services – all OADS waivers have career planning. We have about 1,000 people on the waivers currently working and receiving paid work supports. We have 47 agencies who will continue to provide employment support services to members. We continue to discuss what transportation options are available to our members, as transportation to and from waiver-funded employment services is a covered service.
-It was asked what the appeal process is for someone who is not satisfied with Employment Services.
Lisa: The appeal process is that same as it is for any waiver-funded services.
-It was asked how employment services funding works considering the cap on Section 29 services.
Lisa: Work supports are outside of the Section 29 cap because we’re an Employment First state.
-It was asked if this will happen for Section 21 services as well.
Derek: There are ongoing conversations about this. For Section 21, it’s about looking at everyone currently receiving services, looking at the waitlist, ensuring everyone has access to employment, looking at what everyone wants to do, and seeing what will be accepted by CMS.
Lydia: I’ve heard about instances in which someone has already identified a job and long-term work supports, but they still had to go through VR eligibility, and lost the job opportunity while waiting. I believe there used to be an expedited process for situations like this.
Libby: The expedited process isn’t something that is still occurring, but I think things are always open for discussion. There is a lot of support to find people eligible for VR services more quickly than the allowed timeframe.
-A parent asked if there are any linkages between these agencies and the community college system, and if so, if those linkages facilitate connections to continuing education opportunities.
Libby: Our offices are actually on college campuses, so building those partnerships has been a focus.
Lisa: If someone is interested in continuing education, this would be identified in the PCP. It’s based on the individual’s wants, needs, and who is supporting them. We’re looking at whether the community college system can take on the employment specialist training.
-It was asked if people should apply for VR at age 14.
Libby: We can start serving people as young as 14, but you don’t have to apply at 14. You can apply, but most likely you just have to fill out the one-pager.
Cullen: Lisa and Libby, this was great and thank you very much for being here!
End Presentation (round of applause)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Derek Fales: We have hired our new Crisis Program Administrator who, along with Craig Patterson who is attending today’s meeting remotely, is working on the continuous effort to address the crisis system in Maine. We continue to work on the Section 21 renewal application, which should go live on July 1st. With this renewal application we’re looking to make minimal changes, and then later amend it for compliance with the HCBS Settings Rule.
Craig Patterson: Focusing on the crisis re-design is one of our top priorities, which has multiple pieces. We’re hiring additional employees, working on a good communication system, and multiple other things as well. We’ll keep you all as updated as we can.
-A parent asked about the status of the Section 29 waitlist, and whether they would be looking to cure this.
Derek: There has been a lot of discussion regarding the best way to address the Section 29 waitlist, but I don’t have any more information on that today.
Bonnie-Jean Brooks: CMS will be offering a training to get provider and stakeholder buy-in for the HCBS Settings Rule on 9/11. It’s free and you can call in from 1:30-3:00pm, 1-800-719-7514 Access code: 624585 (Click here for more information).
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
-No one from OCFS was in attendance; however, Todd Landry, Director of OCFS, will be the presenter for the October meeting, being held on October 21st, the third Monday of the month due to the holiday on our regular meeting date.
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.
Disability Rights Maine (DRM) Update:
Staci Converse: We’ll be participating in the MADSEC (Maine Administration of Services for Children with Disabilities) Fall Conference (click here for more information) providing information on Supported Decision-Making (SDM). SDM trainings are offered regularly statewide (click here for more information). We also have upcoming Developmental Services Rights trainings in Portland on 9/18 and Augusta on 10/8. Additionally, the SUFU (Speaking Up For Us) Annual Conference is being held on 9/24 and 9/25.
Federal & Housing Updates:
Cullen: Congress is working on the FY 20 allocations and budget, which begins 10/1/19, and is working on reconciling House and Senate appropriations bills, including the T-HUD budget. The House’s T-HUD budget looks very favorable. However, it’s possible we’re looking at a Continuing Resolution, which would not be as favorable as the funding levels in the House budget. More information to follow next month.
State Legislature Update:
Lydia Dawson – MACSP: Cloture is fast approaching; all of the bills will need to be in by the end of the month.
Announcements:
- There is a MDSOAB (Maine Developmental Services Oversight and Advisory Board) and OADS listening session on 9/26 in Lewiston at Community Concepts, 240 Bates St. Lewiston (with parking off of Blake St.), from 5-7pm. (Click here for more information.)
- Click here for information on the Specialized Housing, Inc. Information Session About the Houses on E Street on 9/19.
- Click here for information on the 2019 New England Provider Summit in Portsmouth, NH, on November 6th and 7th.
- Click here for information on the Aucocisco School & Learning Center Young Adult Social Activities Group.
- The Coalition will have additional new remote sites starting next month, which will be highlighted on the next agenda and the email meeting announcement.
- As a reminder, both the October and November meetings will be on the third Monday of the month due to holidays.
The next meeting will be on ***Monday, October 21, 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: Todd Landry, Director, DHHS Office of Child and Family Services (OCFS).
Topic: Update on Children’s Services.
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].