July 30, 2008
Represented in attendance:
4 – DHS/DDSD
1 – OHCA (Oklahoma Health Care Authority)
18 – Parent, Family member or Self advocate
(5 – First time attendees)
(Agencies/Organizations represented by family member in attendance – Center for Learning and Leadership/OU Health Science Center, OASIS, Down Syndrome Society of Central Oklahoma, Oklahoma Infant Transition Program, OASIS, SoonerSUCCESS & OASIS)
Area’s represented by attendance:
Families waiting or receiving DDSD services:
10 families/individuals on the DDSD Waiting List
8 families received DDSD services
Status of the Waiting List – There are currently 4,069 on the Waiting List as of July 14th. DDSD is working applications dated April 26, 2004. Jim Nicholson reports that due to the state’s budget problems the waiting list is virtually stalled. But with that being said, he also reported that at the end of the legislative session that the Governor and the Senate and House leaders sent DHS $500,000 specifically for the Waiting List. Mr. Nicholson feels this is a direct result of families informing their legislators and advocating for more funding for those on the waiting list. (Side note – if you were one of the families who called during that last week, pat yourself on the back, if you weren’t next time I’m sure we’ll be able to count on you. Additionally, please call those you spoke with that week and thank them for listening and supporting our families. This is a must if we want to continue to have the legislators respect us when we call them with our needs). Mr. Nicholson also reported that with this funding they are currently working 80 applications from the Waiting List. I requested that when a final number of approved applications are finalized they send that information so I can get this information out to families. It was also noted that families need to be aware that this money is a “one time” allotment and not a line item for the Waiting List. It was also explained that DHS has made some budget adjustments to the Resource Centers to help support individuals receiving Home & Community Based Waivers. One point of interest mentioned was that currently and for the next year, possibly, our state’s budget will continue to be negatively affected by the nation’s financial crisis, but there is some hope for the future since our state has a large number of business’ who are positively affected by the high energy cost, which will eventually have a positive affect on our state’s finances. This isn’t expected until the end of next year.
Status of Self Directed Services – Jim Nicholson gave an update to the Self Directive Services pilot program. They are currently working with Oklahoma Health Care Authority to finalize the amendment being sent to CMS (Centers for Medicare and Medicaid) for final approval. He did note that once CMS gives its final approval there is still some technical steps before it can move to the full In-Home Supports Waiver. Some of these things include sending out an invitation for bid to find a fiscal agent to provide the employment part of the payment process, and then they have to make needed adjustments to OHCA and OKDHS’ billing system to work with the SDS payment model. There was no estimated time of implementation.
Family Question & Comments: There was comments given regarding the difficulty families are having obtaining HTS staff for those receiving supports in their home. It was mentioned that there is a staffing shortage across the board. The situation mentioned was when an agency provides residential supports and supports for those living in their own home, the agency is required to provide someone to work in the residential setting regardless of the staffing issues. What this causes is if a family has a staff working in their home and if the agency has a shortage in the residential setting, they will put the staff from the private home to fill their obligation at the residential setting. This leaves families vulnerable and without staff during this staffing crisis. It was also mentioned that it seems there is a new movement for agencies, which is taxing on families. This new movement is to offer the family of being their own HTS support and get paid while there is a staffing shortage. The problem with this is families are not receiving any relief or respite during this time. Additionally, it was said that once the family accepts this situation, even for a temporary time, the agency seems to stop trying to obtain staff for that family. (This is only happening with adults on the both IHSW and HCBW, not people under 18) On this same topic there was some discussion regarding low pay for direct care staff (HTS) and that seems to be the reason for the staffing shortage.
Jim Nicholson reports that the agencies have a high over head cost to provide training to direct care staff. They pay for staff hourly pay for time they spend in training and also hourly pay to cover the shift they are missing while attending the training. He explained that starting August 1st that agencies will be giving the opportunity to participate in something called the “College of Direct Supports” which is a web based training for much of the required training. He explained that training can be done at the convenience of the staff, and any place there is high speed internet access. Mr. Nicholson also explained that this training option is not a requirement but only an option for agencies since there is a “start up” cost for those agencies who want to participate. His hope is that once a few agencies come on board that other agencies will follow and find that this will be a way to reduce the high cost of training.
One family asked about if they need to leave the state for a short time, whether for vacation or even to care of a sick family member, would this cause a problem with their waiver services. Mr. Nicholson said this wouldn’t have an affect on waivered services, but to let the case manager, the agency and the direct care staff know so they won’t plan to come out and no one there. It was asked would this be true for an extended amount of time out of state, example given was three months, and Mr. Nicholson said that shouldn’t be a problem.
Another family wanted clarification regarding the writing of the plan of care. She explained that her daughter’s plan was written with an “exact” amount of hours for HTS for each week. This mom explained that there are some weeks she may only need 4 hours but when summer comes around she might need as many hours as she can. She was told by her agency that she can’t just “do it” even though she hasn’t used up her full amount of waiver units because the agency is at risk to have to pay the money back. Ray Hester, DDSD, explained that when a plan of care is written up, the plan will have a “prescribed” amount of units per week for HTS. He said the plan can be written in a way to not be so restricted in hours per week. But he also said it can’t be written so loosely that it can’t be tracked to show needs. (My understanding of what he said was the plan of care can have written something like 10 – 20 units of HTS per week. If there is a time when more than 20 hours is needed the case manager will need to request an amendment to the original plan of care. This may not be exactly correct, but its close)
Schedule Next Meeting – Wednesday, October 15, 2008 at 1:30 pm.