February 10, 2020
Minutes
Minutes
Present: Andy Taranko, Mary Chris Semrow, Kim Humphrey, Ariel Linet, Luc Nya, Margaret Cardoza, Betsy Mahoney, Laura Cordes, Joanna Bulger, Julie Brennan, Brenda Smith, Tammy Pike, Cullen Ryan, and Vickey Rand. Via Zoom – (Orono): Bonnie Robinson. (Brunswick): Ray Nagel and Teague Morris. (Bangor-OHI): Maria Cameron and Bonnie-Jean Brooks. (Auburn): Ann Bentley. (Wilton): Kristin McPherson. Misc. sites: Elissa Wynne, Betsy Hopkins, Stacy Lamontagne, Monique Stairs, Robin Levesque, Alan Cobo-Lewis, Paula Bush, Mark Kemmerle, and Helen Hemminger.
Cullen Ryan introduced himself and welcomed the group. Participants introduced themselves. Minutes from the last meeting were accepted.
Featured Speakers: Elissa Wynne, Associate Director, Children's Development & Behavioral Health, DHHS-Office of Child and Family Services (OCFS). www.maine.gov/dhhs/ocfs Topic: The Blueprint for Effective Transition and the ways in which OCFS and the Coalition can work collaboratively to actualize it.
Cullen: Today we have Elissa Wynne, Associate Director, Children's Development & Behavioral Health with OCFS presenting updates from Children’s Behavioral Health, and hopefully touching upon how we can work together to actualize the Blueprint for Effective Transition. Thanks for being here today and presenting, Elissa!
Elissa Wynne: Thank you for having me today, I’m excited to be here. As Cullen said, my name is Elissa Wynne and I’m the Associate Director of Children's Development & Behavioral Health, DHHS-OCFS. I’ve been in this role since August; however, I have been with OCFS for ten years in total. Children’s Behavioral Health is the newest program to me.
Begin Presentation (Click here for the presentation)
Elissa: When Dr. Landry presented to this group in October, he provided a broad-brush overview of what’s happening in each area of OCFS. Within Children’s Behavioral Health, a report was conducted assessing the system. There were many recommendations within the report. We convened staff and stakeholders to review and prioritize these recommendations. Out of this, we selected the top 13 strategies which were chosen by staff and stakeholders. We have short- and long-term strategies, all of which we hope to start as soon as possible. The strategies and outcomes were all created and agreed upon in the stakeholder group. Regarding the Children’s Behavioral Health Services array – we don’t have them all in Maine currently. We want to focus on building up our community-based services. For our short-term vision strategies, those highlighted in yellow are the first four strategies for which we created roadmaps, those highlighted in orange are the second four, and strategies highlighted in green have been completed. We have hired an OCFS Medical Director, which should be announced publicly soon. We’re feeling great about that and think it will enhance the services we have to offer and the expertise we have on staff. We’re in the process of pulling together stakeholder groups for the non-highlighted strategies; however, that’s not to say we haven’t started work on them yet. The Waitlist Advisory Group (WAG) requested a lot of data, which we’re in the process of gathering, and then we’ll pull them back together and work to finalize the roadmap in that area.
We’re trying to be transparent about the decisions we’re making and where we’re going. In general, we’re trying to rebuild trust and be very transparent. You can go on our website and view the OCFS Data Dashboard, the data from which we’re making decisions. (Click here for the Children’s Behavioral Health Data Dashboard.) We’re working on figuring out how to get services to children who are in need and waiting, while we work on the longer-term system rebuild. The waitlist data is hot off the presses; it is pretty sobering, and it energizes us because these children need services. We’re looking at the trends and making some big changes.
Discussion:
-It was asked if there are any hypotheses as to why PNMI waitlist numbers are the only ones that have gone down, and whether or not it could be correlated with out of state placements and thus may not necessarily be a positive statistic.
Elissa: That’s a good question and I would hate to speculate about the answers. This is something into which the WAG will be looking. We pulled some preliminary data, got a lot of feedback and questions, and then there was a request for more data from the WAG. We’re looking at whether it could be helpful to have more information for agencies being matched off the waitlist. One agency asked about family availability, which might help to make matches more quickly. That new information will be available on the referral form, I believe beginning this week. Matching hiring/workforce practices with the availability of families could bring efficiencies to matching children on the waitlist. Workforce availability is a struggle with community-based services. We need to be more creative to get children matched to agency staffing. We’re looking at the ability to do waivers on the waitlist to help the agencies better match with children. For instance, one agency brought up that they’re in the home serving a child, and they know that this child’s sibling, also living in the home, is on the waitlist for services; however, the sibling isn’t next on the list. It was asked if they could help the sibling get served while that agency is already in the home. We have to take that under advisement in terms of equity while children are waiting, but while there’s already a provider in the home we have to consider that as well. We have started a clinician-only pilot working with four Section 65 providers. With this pilot where perhaps the agency is having a hard time hiring a behavioral health professional (BHP), if the family desired clinician-only services while the agency works to hire a BHP they could be provided. We’re also working with Woodford Family Services on training Section 65 BHPs. It’s hard to hire and train BHPs, and it’s affecting the ability to take people off the waitlist and serve them. For children placed in residential settings, if they are placed 50 miles or more from their home, we’re able to reimburse families for their travel for a year so they can participate in their child’s treatment. We know this will enhance their treatment and hopefully bring them home sooner. It’s important for us to recognize that this travel is a barrier. We’re exploring how we might incentivize community-based providers to be able to serve children in more rural areas. We know now that for Section 65 BCBA (Board Certified Behavior Analyst) and Section 28 Specialized, the travel time of the clinician and the BCBA are not reimbursable for MaineCare. We’re trying to see if there’s a way to use funds to pay that travel time out of OCFS funding, in close partnership with OMS (Office of MaineCare Services), to allow providers to travel to those more rural areas without having to incur that cost.
-It was stated that the creative strategies are quite interesting. It was stated that hopefully OCFS is being careful not to potentially, inadvertently, create a system that allows providers to screen.
Elissa: We’re weighing those things and haven’t come to a decision on them, but I appreciate you saying that.
-It was stated that there is also concern that providers would select children and families that have identified their availability as being standard 9am-5pm schedules.
-It was stated that in the past there was a family choice system that pre-dated KEPRO. It was asked if children are considered truly waiting if they’ve turned down services from provider A because they only want them from provider B.
Elissa: I don’t have the answer to that, but I can certainly take it back.
-It was asked if it is a best practice to have case management done by a separate agency than the service provider.
Elissa: At this time, we’re not weighing in on that either way. We know that there are providers that have provided both.
-It was stated that a child might have an inside track to services with that agency if they’re receiving case management through them as well, providing an advantage over other children. (Click here for the KEPRO information regarding the Preferred Provider list)
-It was stated that one of the short-term objectives is around Section 28 and creating some ID/DD-specific services. It was stated that in this stakeholder group there were a lot of comments in that realm that didn’t appear to generate any energy, and yet it ended up as a short-term objective. It was asked if there is someone in charge of that objective within OCFS, and if any work has been done on that.
Elissa: Yes, each of the strategies has a specific staff lead who’s in charge of monitoring it and making sure it’s going forward. Specifically, the staff person assigned to the Section 28 analysis is Jessica Wood. We’re pulling data from KEPRO about the children accessing that service, their clinical profiles, and the children waiting for that service. The next step is to pull together an advisory group for the Section 28 process.
Elissa: There are a few evidence-based practices in Maine, but not many. There has been a serious decline in the evidence-based practices that are able to be billed under MaineCare right now. Most of this has to do with the rates for these services. There’s a lot of fidelity that needs to happen within the model. We’ve been working with OMS on this, and there was a bill requiring a rate study; that rate study has concluded, and OMS is pulling study participants back together. We’re reviewing the proposed methodology and rates with providers in hopes that a new rate would be more sustainable and more reflective of the provision of these evidence-based services. The new rates would need to be funded through the legislative process; that process is moving forward. This was a great process and I’m hopeful about the direction in which that’s going. TFCBT (Trauma-Focused Cognitive Behavioral Therapy) doesn’t have a specific billing code, so we’re not entirely sure how many people receive that service, but this is something into which OMS is looking. There is new money available for additional trainings for clinicians that want to become TFCBT certified. Additionally, OCFS submitted a SAMHSA (Substance Abuse and Mental Health Services Administration) grant, which would enhance these evidence-based services in rural areas.
Ariel Linet – Disability Rights Maine: Going back to the TFCBT training, would this training be for HCT (Home and Community Based Treatment Services) providers? Hospital clinicians? Who would be able to access this?
Elissa: Yes, HCT providers could participate. Our thought was individual therapy clinicians would perhaps be interested in that as well. This will be open to anyone and everyone who wants to be trained on this model.
Ariel: After the initial training, would there be ongoing support to help maintain fidelity to the model over time?
Elissa: Great question. I’ve been begging for a staff person to help manage that for us. Yes, there will be some work to ensure that once that training happens, that there’s the ability for ongoing monitoring and fidelity for that model.
Ariel: More support from the Department for TA resources for all models is something we’d love to see.
Elissa: Me too! I think we’ll get there.
Elissa: Public Consulting Group, who helped us build out these strategies and move these forward, has started to pull some data on crisis services utilization. Last year, in partnership with AMHC (Aroostook Mental Health Center), crisis providers were trained on how to specifically work with children with ID/DD diagnoses. We’re bringing this trainer back because she had such a positive impact and having her train our Children’s Behavioral Health staff and our Child Welfare staff on specifically working with this population. She’s a psychiatric nurse practitioner that specializes with ID/DD. She has hands-on training that had been very well-received by providers in the field.
We’re also looking to increase the quality of children’s residential services to have them reach Qualified Residential Treatment Provider (QRTP) status, a higher level of accreditation which is required of the Family First Prevention Services Act. The Act will allow the state to use its child welfare dollars for some preventative services, specifically evidence-based practices. In order for us to use this money for prevention there are strings attached, and one of them is that our residential providers meet this QRTP status. Also, Early Childhood Education efforts are important to the continuum of children’s services. We want to spread the word on our Childcare Program. Maine is among very few states without a waitlist for this service, which includes 12-month eligibility for families, and it has the highest income limit in the country. Maine’s reimbursement for this service is among the highest in the country to ensure that providers have adequate incentive to participate, as there is more paperwork involved to accept the subsidy. We want to encourage high-quality care by providing high reimbursement. We really want to get the word out about this important, under-utilized service. (Click here for the guidelines for the Child Care Subsidy Program).
Cullen: I know that this group is especially interested in the Blueprint for Effective Transition. The group that created it, a subcommittee of the Coalition, included a broad cross-section of stakeholders. That document was recently updated and contemplates transitions that occur all throughout a person’s life, from infancy through to end of life care. OCFS has historically been the entity which oversees transition. Working together, along with OADS, we could work to actualize it. Is there anything you could speak to on that?
Elissa: Transition is one of the strategies that we still need to build out. We spoke briefly with Paul Saucier about what it would look like for us to look at the lifespan, and how it would be great if we could use the same language and expectations from start to finish. When we start building out that strategy, I would love for you all to perhaps be the group to inform what that looks like and how we work with OADS to see through the transition to the adult world.
Cullen: That would be most welcome! Do you have any insight on when we might all get together to work on this transition piece?
Elissa: I would want to connect with Paul about it, to see where he and his team are in the process, but I would want to start sooner rather than later.
Ariel: When there is planning being done around transition how is it going to be handled in terms of diagnosis, etc.? One of the aspects about OCFS that I appreciate is that regardless of diagnosis it’s all under one umbrella – people don’t fit into boxes. However, when you transition into adult services it’s either through SAHMS or OADS. I’m wondering how the Department is looking to handle this bifurcation when people age out of children’s services?
Elissa: That’s a good point. We’ll definitely have to bring SAMHS into the conversation as well.
Cullen: We could reconvene the group that created the Blueprint for Effective Transition and pull together interested parties from the Department to take a look at that.
Betsy Hopkins – DHHS/OADS: It’s an area in which we have a lot of interest and have received a lot of feedback. I don’t have an update as to when that will occur, but we’ll definitely get the ball rolling on our end and be in touch.
-It was asked if there was any information on schools billing for behavioral services.
Elissa: I don’t have any updates at the moment, it falls into the Section 28 workgroup. I know that my team has been working closely with OMS. I can get an update to Cullen for the minutes.
-It was asked if the Children’s Cabinet has had any connection with the work OCFS is doing.
Elissa: The Children’s Cabinet is comprised of the Commissioners of five state agencies: Department of Corrections, Department of Education, Department of Health and Human Services, Department of Labor, and Department of Public Safety. All of the work we’re doing is driven by the Children’s Cabinet, which will be releasing plans for young children and older children. What you’ll see in those plans are some specific strategies, many of which I discussed today.
Cullen: Thank you for being here and presenting Elissa; well done! I appreciate your transparency and your willingness to be here. I hope you will continue to attend! I’m excited at the prospect of working collaboratively with OCFS and OADS on Transition. Thank you, again!
End Presentation (round of applause)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins: We do have several initiatives included in the Governor’s Supplemental Budget, the first of which is an initiative to expand family support and respite for Developmental Services (click here for the budget, this budget initiative is on page 46). That request is going to amount to adding $215,000 for family and caregiver support services. These funds are generally for individuals who live at home and aren’t receiving housing support under the waivers. Another budget initiative to try to clear the Section 29 waitlist, to add another 362 individuals to Section 29, amounting to a little more than $7 million dollars between general and federal funds (click here for the budget, this budget initiative is included on pages 46, 50, and 51). The budget also includes funding to put in place the Mortality Review Panel (click here for the budget, this budget initiative is included on pages 49 and 57). We’re specifically asking for a position to put in place and help oversee that Panel, which results from legislation in the First Legislative Session. Additionally, there is a small amount of funding included for training within Developmental Services. We have taken feedback on our Community 2.0 initiative; we’re in the process of prioritizing ideas and will then develop a specific plan. A draft of that plan will be shared at the LD 1984 work session, which has not been scheduled yet. There is an update on our website that includes current waitlist information (Current Section 21 waitlist: 1621; current Section 29 waitlist: 368).
Additionally, currently out for public comments is the Section 21 Waiver Renewal, with comments being accepted through March 4th (by 11:59pm). We welcome public comments on updates to Section 21 (click here to submit comments online). Based on feedback received and great parent group meetings, we will be putting together quarterly parent/family meetings for those folks who have family members with ID/DD, with the first meeting occurring on March 17th at 109 Capitol Street from 3-5pm. I want to thank the everyone suggested this; it will help us continue to receive ongoing feedback and help as we move forward with a lot of complex initiatives.
-A provider stated that this past fall, Paul Saucier noted that OADS was taking action to bridge the gap between adults with ID/DD and those with ID/DD with behavioral issues as well. It was stated that there are 40 people who are out of state that the state can’t support. It was stated that there hasn’t been an update regarding additional behavioral supports for adults with ID/DD. It was stated that one of the biggest barriers is behavioral services and the lack of a behavioral add-on, and it appears this has fallen off the radar.
Betsy: We are having a lot of conversations about what the funding mechanism might be to serve those individuals who are being served out of state, as well as people in our in-state system. Those conversations are still happening, but I don’t have anything specific to share with you today, but within the next month or so we might have more the share. Some of the initiatives we spoke about, for example trying to increase crisis services capacity, are underway in part due to the high needs we see in this area. That’s one avenue we’re taking, but we’re definitely looking at others as well.
-It was asked if Betsy could provide an update on their changes to crisis services.
Betsy: Yes, we received funding to put in place eight new crisis positions, in part to help us be more proactive in how we’re providing supports to individuals. Also, the crisis line in place previously was through the mental health crisis system, which was ineffective and inefficient for individuals with ID/DD. By the end of this month or early March, there will be four separate crisis lines throughout the state, handled by crisis workers, with a backup system in place to provide immediate assistance for people in crisis when they need it. We’re also looking forward to our work with the University of New Hampshire START model, used in other states and developed at the University of New Hampshire Institute on Disability. We’re very close to signing a contract to work with them to get our crisis team aligned with the START philosophy and service delivery model, including training for crisis workers, with a train the trainer model incorporated as well, which will allow this training to be delivered to provider agencies. As soon as the contract is signed, we’ll have access to the training.
-It was asked what evidence-based practice is involved in the START model.
Betsy: They are an evidence-based model. More information can be found on their website.
-It was asked if the eight new crisis positions have been hired.
Betsy: We have four of the eight currently in place. We had some challenges with finding qualified applicants; it took about two or three postings depending on the part of the state. We’re in the interview process for the remaining four positions currently.
-It was asked if there’s any news from the group working on transportation.
Betsy: I do not have any updates on this specifically, unfortunately. I can ask about that and forward information along.
-There was discussion regarding Section 29 being included in the Governor’s Supplemental Budget Request. It was asked if any of those funds would be available to make Section 29 offers in 2020.
Betsy: I believe all of the funding is for 2021.
-It was stated the budget request would not cure the Section 29 waitlist; it would only provide offers to the people currently waiting – it would not solve the prospect of a waitlist moving forward.
Betsy: You’re right, it would clear the existing individuals on the waitlist.
-It was stated that the Section 29 waiver reset on January 1st. It was asked if there are slots available for Section 29 due to people moving to Section 21.
Betsy: There are some slots that still can be filled this year due to people receiving Section 29 being offered Section 21, and these have been rolling out on a regular basis. A new Waiver Manager started in our office today. All of the Section 21 offers we had from the previous year have been made.
-It was stated that having Betsy present at these meetings is more important than her ability to answer all of the questions posed. Betsy was thanked for her attendance as well as the information that she will be providing for the minutes after the meeting.
-It was asked if there is any news on the self-advocacy RFP?
Betsy: Yes, we’ve received the RFP responses, and they are under review.
Cullen: Having an open, transparent dialogue with OADS is wonderful; thank you, Betsy, for being willing and able to be at the table and have these inclusive discussions, from which we all benefit!
Disability Rights Maine (DRM) Update:
Ariel Linet: I wanted to let you all know about a bill on which we collaborated: LD 2016, An Act Regarding School Discipline for Maine's Youngest Students. There is an article in the Bangor Daily News highlighting the bill and why it is important (Click here for the BDN article). There is a public hearing for this bill in front of the Education and Cultural Affairs Committee on Wednesday, February 12, 2020, at 1:00 PM, in Cross Building Room 208. The bill is really crucial as it’s counterproductive for children to be out of school due to behaviors, and this has lasting affects into adulthood as well. This bill works to solve for that.
Cullen: This group is all about community inclusion and it does no one with ID/DD good to be excluded in any way.
Ariel: There are also several trainings coming up, all of which are listed on the state’s Staff Education & Training Unit website, including Developmental Services and visual gestural trainings. We’re also in the process of revamping our supported decision-making trainings.
Federal & Housing Updates:
Teague Morris – Senator King’s Office: We were curious about Section 8 funding. What are you hearing regarding possible cuts?
Cullen: The FY 20 minibus budget, signed into law in December, included favorable funding for HUD, including Section 8. The concern is for the longer-term landscape and the FY 21 budget, which is likely to be a Continuing Resolution due to the election year and would affect Section 8 negatively due to the need for higher funding than FY 20 to sustain all renewals. We’re also looking at budget deficits, for which there is no immediate cure. The President just released his FY 21 budget. Though historically any President’s budget is largely ignored by Congress as it works on appropriations, it acts as a roadmap for the Administration’s policy initiatives, of which we ought to be aware. Additionally, the Administration has issued guidance regarding Medicaid that would radically overhaul coverage as states could apply for waivers that would convert Medicaid programs to block grants, with capped federal funding and new abilities to cut coverage and benefits (click here for more information on this from the Center on Budget and Policy Priorities). This is definitely something on which we want to keep a close eye.
Teague Morris: Senator King signed on to a letter to HUD Secretary Carson regarding radon in public housing.
State Legislature Update:
Laura Cordes – Maine Association for Community Service Providers (MACSP): A lot of the updates I had we already touched upon, such as the Supplemental Budget and the Section 21 Waiver Renewal. The Long Term Workforce Commission released its final report, and its two top recommendations are to increase DSP rates and establish a rate commission. Right after the release of the report, the Health and Human Services (HHS) Committee moved to draw up legislation to put these recommendations into place. There appears to be a growing understanding about the need to raise the rates. When the Long Term Care Workforce Commission looked to make their final report and recommendations, they looked at LD 399, the bill which would increase DSP wages to 125% of minimum wage, and chose not to take that up because they wanted to look at all of the rates not just rates related to ID/DD services. Whatever vehicle they’re going to land on, there’s a lot of momentum regarding rates in the HHS Committee.
I did want to bring up a proposed rule change, as it hasn’t gotten much attention. The MaineCare proposed rule, “10-144 C.M.R., Chapter 101, MaineCare Benefits Manual (MBM), Chapters II and III, Section 106, School-Based Services.” was recently posted and significantly reorganizes the delivery of school-based services for children with disabilities and it appears the consequences exceed any intended benefit. This proposed rule would combine all school-based services for children with special needs. As proposed, the rule would cut children’s services in half. The rule would also limit services to the school year calendar, meaning children would be eligible to receive services only during the school year, as opposed to the full year of eligibility they currently receive. The rule:
These services are too vital to the long-term success of these children to be cut. The public comment period closes on 2/28 (comments can be submitted online by clicking this link). The hearing will be held on Tuesday, 2/18 at 9am the Augusta Civic Center. With the impending public hearing drawing near and the window of opportunity to address this issue closing, providers, families, and advocacy organizations have partnered to launch a unified, statewide effort to engage those that would be affected by these changes and take every action necessary to stop the Section 106 Proposed Rule. Providers in our coalition are sending a letter to families today (click here for the letter). This letter includes details on the hearing and where parents can send their comments. Another way in which we are working to stop this proposed rule is through a petition, which can be signed online (click here for the online petition) (click here for a printable version of the petition). The goal is to present the petition along with all of its signatures at the 2/18 hearing.
As far as the Second Legislative Session goes, a lot of the public hearings are ending, and work sessions are starting.
Announcements/Handouts:
Helen Hemminger – Maine Children’s Alliance: Regarding the Census, any group that wishes to have guidance or training please do not hesitate to reach out. People will start to get Census mailings the 3rd week in March.
-It was asked how people in group homes are counted for the Census.
Helen: People in group homes are counted by the facility. Facilities are the ones that do the counts, this includes group homes, hospitals, etc. Very small, say two-person, homes would need to respond by the address. We’re doing a lot of training on this and would be happy to come to your agency or programs.
The next meeting will be on Monday, March 9, 2020, 12-2pm, Burton Fisher Community Meeting Room, located on the First Floor of One City Center (food court area, next to City Deli), Portland.
Featured Speaker and Topic TBD.
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 Speakers: Elissa Wynne, Associate Director, Children's Development & Behavioral Health, DHHS-Office of Child and Family Services (OCFS). www.maine.gov/dhhs/ocfs Topic: The Blueprint for Effective Transition and the ways in which OCFS and the Coalition can work collaboratively to actualize it.
Cullen: Today we have Elissa Wynne, Associate Director, Children's Development & Behavioral Health with OCFS presenting updates from Children’s Behavioral Health, and hopefully touching upon how we can work together to actualize the Blueprint for Effective Transition. Thanks for being here today and presenting, Elissa!
Elissa Wynne: Thank you for having me today, I’m excited to be here. As Cullen said, my name is Elissa Wynne and I’m the Associate Director of Children's Development & Behavioral Health, DHHS-OCFS. I’ve been in this role since August; however, I have been with OCFS for ten years in total. Children’s Behavioral Health is the newest program to me.
Begin Presentation (Click here for the presentation)
Elissa: When Dr. Landry presented to this group in October, he provided a broad-brush overview of what’s happening in each area of OCFS. Within Children’s Behavioral Health, a report was conducted assessing the system. There were many recommendations within the report. We convened staff and stakeholders to review and prioritize these recommendations. Out of this, we selected the top 13 strategies which were chosen by staff and stakeholders. We have short- and long-term strategies, all of which we hope to start as soon as possible. The strategies and outcomes were all created and agreed upon in the stakeholder group. Regarding the Children’s Behavioral Health Services array – we don’t have them all in Maine currently. We want to focus on building up our community-based services. For our short-term vision strategies, those highlighted in yellow are the first four strategies for which we created roadmaps, those highlighted in orange are the second four, and strategies highlighted in green have been completed. We have hired an OCFS Medical Director, which should be announced publicly soon. We’re feeling great about that and think it will enhance the services we have to offer and the expertise we have on staff. We’re in the process of pulling together stakeholder groups for the non-highlighted strategies; however, that’s not to say we haven’t started work on them yet. The Waitlist Advisory Group (WAG) requested a lot of data, which we’re in the process of gathering, and then we’ll pull them back together and work to finalize the roadmap in that area.
We’re trying to be transparent about the decisions we’re making and where we’re going. In general, we’re trying to rebuild trust and be very transparent. You can go on our website and view the OCFS Data Dashboard, the data from which we’re making decisions. (Click here for the Children’s Behavioral Health Data Dashboard.) We’re working on figuring out how to get services to children who are in need and waiting, while we work on the longer-term system rebuild. The waitlist data is hot off the presses; it is pretty sobering, and it energizes us because these children need services. We’re looking at the trends and making some big changes.
Discussion:
-It was asked if there are any hypotheses as to why PNMI waitlist numbers are the only ones that have gone down, and whether or not it could be correlated with out of state placements and thus may not necessarily be a positive statistic.
Elissa: That’s a good question and I would hate to speculate about the answers. This is something into which the WAG will be looking. We pulled some preliminary data, got a lot of feedback and questions, and then there was a request for more data from the WAG. We’re looking at whether it could be helpful to have more information for agencies being matched off the waitlist. One agency asked about family availability, which might help to make matches more quickly. That new information will be available on the referral form, I believe beginning this week. Matching hiring/workforce practices with the availability of families could bring efficiencies to matching children on the waitlist. Workforce availability is a struggle with community-based services. We need to be more creative to get children matched to agency staffing. We’re looking at the ability to do waivers on the waitlist to help the agencies better match with children. For instance, one agency brought up that they’re in the home serving a child, and they know that this child’s sibling, also living in the home, is on the waitlist for services; however, the sibling isn’t next on the list. It was asked if they could help the sibling get served while that agency is already in the home. We have to take that under advisement in terms of equity while children are waiting, but while there’s already a provider in the home we have to consider that as well. We have started a clinician-only pilot working with four Section 65 providers. With this pilot where perhaps the agency is having a hard time hiring a behavioral health professional (BHP), if the family desired clinician-only services while the agency works to hire a BHP they could be provided. We’re also working with Woodford Family Services on training Section 65 BHPs. It’s hard to hire and train BHPs, and it’s affecting the ability to take people off the waitlist and serve them. For children placed in residential settings, if they are placed 50 miles or more from their home, we’re able to reimburse families for their travel for a year so they can participate in their child’s treatment. We know this will enhance their treatment and hopefully bring them home sooner. It’s important for us to recognize that this travel is a barrier. We’re exploring how we might incentivize community-based providers to be able to serve children in more rural areas. We know now that for Section 65 BCBA (Board Certified Behavior Analyst) and Section 28 Specialized, the travel time of the clinician and the BCBA are not reimbursable for MaineCare. We’re trying to see if there’s a way to use funds to pay that travel time out of OCFS funding, in close partnership with OMS (Office of MaineCare Services), to allow providers to travel to those more rural areas without having to incur that cost.
-It was stated that the creative strategies are quite interesting. It was stated that hopefully OCFS is being careful not to potentially, inadvertently, create a system that allows providers to screen.
Elissa: We’re weighing those things and haven’t come to a decision on them, but I appreciate you saying that.
-It was stated that there is also concern that providers would select children and families that have identified their availability as being standard 9am-5pm schedules.
-It was stated that in the past there was a family choice system that pre-dated KEPRO. It was asked if children are considered truly waiting if they’ve turned down services from provider A because they only want them from provider B.
Elissa: I don’t have the answer to that, but I can certainly take it back.
-It was asked if it is a best practice to have case management done by a separate agency than the service provider.
Elissa: At this time, we’re not weighing in on that either way. We know that there are providers that have provided both.
-It was stated that a child might have an inside track to services with that agency if they’re receiving case management through them as well, providing an advantage over other children. (Click here for the KEPRO information regarding the Preferred Provider list)
-It was stated that one of the short-term objectives is around Section 28 and creating some ID/DD-specific services. It was stated that in this stakeholder group there were a lot of comments in that realm that didn’t appear to generate any energy, and yet it ended up as a short-term objective. It was asked if there is someone in charge of that objective within OCFS, and if any work has been done on that.
Elissa: Yes, each of the strategies has a specific staff lead who’s in charge of monitoring it and making sure it’s going forward. Specifically, the staff person assigned to the Section 28 analysis is Jessica Wood. We’re pulling data from KEPRO about the children accessing that service, their clinical profiles, and the children waiting for that service. The next step is to pull together an advisory group for the Section 28 process.
Elissa: There are a few evidence-based practices in Maine, but not many. There has been a serious decline in the evidence-based practices that are able to be billed under MaineCare right now. Most of this has to do with the rates for these services. There’s a lot of fidelity that needs to happen within the model. We’ve been working with OMS on this, and there was a bill requiring a rate study; that rate study has concluded, and OMS is pulling study participants back together. We’re reviewing the proposed methodology and rates with providers in hopes that a new rate would be more sustainable and more reflective of the provision of these evidence-based services. The new rates would need to be funded through the legislative process; that process is moving forward. This was a great process and I’m hopeful about the direction in which that’s going. TFCBT (Trauma-Focused Cognitive Behavioral Therapy) doesn’t have a specific billing code, so we’re not entirely sure how many people receive that service, but this is something into which OMS is looking. There is new money available for additional trainings for clinicians that want to become TFCBT certified. Additionally, OCFS submitted a SAMHSA (Substance Abuse and Mental Health Services Administration) grant, which would enhance these evidence-based services in rural areas.
Ariel Linet – Disability Rights Maine: Going back to the TFCBT training, would this training be for HCT (Home and Community Based Treatment Services) providers? Hospital clinicians? Who would be able to access this?
Elissa: Yes, HCT providers could participate. Our thought was individual therapy clinicians would perhaps be interested in that as well. This will be open to anyone and everyone who wants to be trained on this model.
Ariel: After the initial training, would there be ongoing support to help maintain fidelity to the model over time?
Elissa: Great question. I’ve been begging for a staff person to help manage that for us. Yes, there will be some work to ensure that once that training happens, that there’s the ability for ongoing monitoring and fidelity for that model.
Ariel: More support from the Department for TA resources for all models is something we’d love to see.
Elissa: Me too! I think we’ll get there.
Elissa: Public Consulting Group, who helped us build out these strategies and move these forward, has started to pull some data on crisis services utilization. Last year, in partnership with AMHC (Aroostook Mental Health Center), crisis providers were trained on how to specifically work with children with ID/DD diagnoses. We’re bringing this trainer back because she had such a positive impact and having her train our Children’s Behavioral Health staff and our Child Welfare staff on specifically working with this population. She’s a psychiatric nurse practitioner that specializes with ID/DD. She has hands-on training that had been very well-received by providers in the field.
We’re also looking to increase the quality of children’s residential services to have them reach Qualified Residential Treatment Provider (QRTP) status, a higher level of accreditation which is required of the Family First Prevention Services Act. The Act will allow the state to use its child welfare dollars for some preventative services, specifically evidence-based practices. In order for us to use this money for prevention there are strings attached, and one of them is that our residential providers meet this QRTP status. Also, Early Childhood Education efforts are important to the continuum of children’s services. We want to spread the word on our Childcare Program. Maine is among very few states without a waitlist for this service, which includes 12-month eligibility for families, and it has the highest income limit in the country. Maine’s reimbursement for this service is among the highest in the country to ensure that providers have adequate incentive to participate, as there is more paperwork involved to accept the subsidy. We want to encourage high-quality care by providing high reimbursement. We really want to get the word out about this important, under-utilized service. (Click here for the guidelines for the Child Care Subsidy Program).
Cullen: I know that this group is especially interested in the Blueprint for Effective Transition. The group that created it, a subcommittee of the Coalition, included a broad cross-section of stakeholders. That document was recently updated and contemplates transitions that occur all throughout a person’s life, from infancy through to end of life care. OCFS has historically been the entity which oversees transition. Working together, along with OADS, we could work to actualize it. Is there anything you could speak to on that?
Elissa: Transition is one of the strategies that we still need to build out. We spoke briefly with Paul Saucier about what it would look like for us to look at the lifespan, and how it would be great if we could use the same language and expectations from start to finish. When we start building out that strategy, I would love for you all to perhaps be the group to inform what that looks like and how we work with OADS to see through the transition to the adult world.
Cullen: That would be most welcome! Do you have any insight on when we might all get together to work on this transition piece?
Elissa: I would want to connect with Paul about it, to see where he and his team are in the process, but I would want to start sooner rather than later.
Ariel: When there is planning being done around transition how is it going to be handled in terms of diagnosis, etc.? One of the aspects about OCFS that I appreciate is that regardless of diagnosis it’s all under one umbrella – people don’t fit into boxes. However, when you transition into adult services it’s either through SAHMS or OADS. I’m wondering how the Department is looking to handle this bifurcation when people age out of children’s services?
Elissa: That’s a good point. We’ll definitely have to bring SAMHS into the conversation as well.
Cullen: We could reconvene the group that created the Blueprint for Effective Transition and pull together interested parties from the Department to take a look at that.
Betsy Hopkins – DHHS/OADS: It’s an area in which we have a lot of interest and have received a lot of feedback. I don’t have an update as to when that will occur, but we’ll definitely get the ball rolling on our end and be in touch.
-It was asked if there was any information on schools billing for behavioral services.
Elissa: I don’t have any updates at the moment, it falls into the Section 28 workgroup. I know that my team has been working closely with OMS. I can get an update to Cullen for the minutes.
-It was asked if the Children’s Cabinet has had any connection with the work OCFS is doing.
Elissa: The Children’s Cabinet is comprised of the Commissioners of five state agencies: Department of Corrections, Department of Education, Department of Health and Human Services, Department of Labor, and Department of Public Safety. All of the work we’re doing is driven by the Children’s Cabinet, which will be releasing plans for young children and older children. What you’ll see in those plans are some specific strategies, many of which I discussed today.
Cullen: Thank you for being here and presenting Elissa; well done! I appreciate your transparency and your willingness to be here. I hope you will continue to attend! I’m excited at the prospect of working collaboratively with OCFS and OADS on Transition. Thank you, again!
End Presentation (round of applause)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins: We do have several initiatives included in the Governor’s Supplemental Budget, the first of which is an initiative to expand family support and respite for Developmental Services (click here for the budget, this budget initiative is on page 46). That request is going to amount to adding $215,000 for family and caregiver support services. These funds are generally for individuals who live at home and aren’t receiving housing support under the waivers. Another budget initiative to try to clear the Section 29 waitlist, to add another 362 individuals to Section 29, amounting to a little more than $7 million dollars between general and federal funds (click here for the budget, this budget initiative is included on pages 46, 50, and 51). The budget also includes funding to put in place the Mortality Review Panel (click here for the budget, this budget initiative is included on pages 49 and 57). We’re specifically asking for a position to put in place and help oversee that Panel, which results from legislation in the First Legislative Session. Additionally, there is a small amount of funding included for training within Developmental Services. We have taken feedback on our Community 2.0 initiative; we’re in the process of prioritizing ideas and will then develop a specific plan. A draft of that plan will be shared at the LD 1984 work session, which has not been scheduled yet. There is an update on our website that includes current waitlist information (Current Section 21 waitlist: 1621; current Section 29 waitlist: 368).
Additionally, currently out for public comments is the Section 21 Waiver Renewal, with comments being accepted through March 4th (by 11:59pm). We welcome public comments on updates to Section 21 (click here to submit comments online). Based on feedback received and great parent group meetings, we will be putting together quarterly parent/family meetings for those folks who have family members with ID/DD, with the first meeting occurring on March 17th at 109 Capitol Street from 3-5pm. I want to thank the everyone suggested this; it will help us continue to receive ongoing feedback and help as we move forward with a lot of complex initiatives.
-A provider stated that this past fall, Paul Saucier noted that OADS was taking action to bridge the gap between adults with ID/DD and those with ID/DD with behavioral issues as well. It was stated that there are 40 people who are out of state that the state can’t support. It was stated that there hasn’t been an update regarding additional behavioral supports for adults with ID/DD. It was stated that one of the biggest barriers is behavioral services and the lack of a behavioral add-on, and it appears this has fallen off the radar.
Betsy: We are having a lot of conversations about what the funding mechanism might be to serve those individuals who are being served out of state, as well as people in our in-state system. Those conversations are still happening, but I don’t have anything specific to share with you today, but within the next month or so we might have more the share. Some of the initiatives we spoke about, for example trying to increase crisis services capacity, are underway in part due to the high needs we see in this area. That’s one avenue we’re taking, but we’re definitely looking at others as well.
-It was asked if Betsy could provide an update on their changes to crisis services.
Betsy: Yes, we received funding to put in place eight new crisis positions, in part to help us be more proactive in how we’re providing supports to individuals. Also, the crisis line in place previously was through the mental health crisis system, which was ineffective and inefficient for individuals with ID/DD. By the end of this month or early March, there will be four separate crisis lines throughout the state, handled by crisis workers, with a backup system in place to provide immediate assistance for people in crisis when they need it. We’re also looking forward to our work with the University of New Hampshire START model, used in other states and developed at the University of New Hampshire Institute on Disability. We’re very close to signing a contract to work with them to get our crisis team aligned with the START philosophy and service delivery model, including training for crisis workers, with a train the trainer model incorporated as well, which will allow this training to be delivered to provider agencies. As soon as the contract is signed, we’ll have access to the training.
-It was asked what evidence-based practice is involved in the START model.
Betsy: They are an evidence-based model. More information can be found on their website.
-It was asked if the eight new crisis positions have been hired.
Betsy: We have four of the eight currently in place. We had some challenges with finding qualified applicants; it took about two or three postings depending on the part of the state. We’re in the interview process for the remaining four positions currently.
-It was asked if there’s any news from the group working on transportation.
Betsy: I do not have any updates on this specifically, unfortunately. I can ask about that and forward information along.
-There was discussion regarding Section 29 being included in the Governor’s Supplemental Budget Request. It was asked if any of those funds would be available to make Section 29 offers in 2020.
Betsy: I believe all of the funding is for 2021.
-It was stated the budget request would not cure the Section 29 waitlist; it would only provide offers to the people currently waiting – it would not solve the prospect of a waitlist moving forward.
Betsy: You’re right, it would clear the existing individuals on the waitlist.
-It was stated that the Section 29 waiver reset on January 1st. It was asked if there are slots available for Section 29 due to people moving to Section 21.
Betsy: There are some slots that still can be filled this year due to people receiving Section 29 being offered Section 21, and these have been rolling out on a regular basis. A new Waiver Manager started in our office today. All of the Section 21 offers we had from the previous year have been made.
-It was stated that having Betsy present at these meetings is more important than her ability to answer all of the questions posed. Betsy was thanked for her attendance as well as the information that she will be providing for the minutes after the meeting.
-It was asked if there is any news on the self-advocacy RFP?
Betsy: Yes, we’ve received the RFP responses, and they are under review.
Cullen: Having an open, transparent dialogue with OADS is wonderful; thank you, Betsy, for being willing and able to be at the table and have these inclusive discussions, from which we all benefit!
Disability Rights Maine (DRM) Update:
Ariel Linet: I wanted to let you all know about a bill on which we collaborated: LD 2016, An Act Regarding School Discipline for Maine's Youngest Students. There is an article in the Bangor Daily News highlighting the bill and why it is important (Click here for the BDN article). There is a public hearing for this bill in front of the Education and Cultural Affairs Committee on Wednesday, February 12, 2020, at 1:00 PM, in Cross Building Room 208. The bill is really crucial as it’s counterproductive for children to be out of school due to behaviors, and this has lasting affects into adulthood as well. This bill works to solve for that.
Cullen: This group is all about community inclusion and it does no one with ID/DD good to be excluded in any way.
Ariel: There are also several trainings coming up, all of which are listed on the state’s Staff Education & Training Unit website, including Developmental Services and visual gestural trainings. We’re also in the process of revamping our supported decision-making trainings.
Federal & Housing Updates:
Teague Morris – Senator King’s Office: We were curious about Section 8 funding. What are you hearing regarding possible cuts?
Cullen: The FY 20 minibus budget, signed into law in December, included favorable funding for HUD, including Section 8. The concern is for the longer-term landscape and the FY 21 budget, which is likely to be a Continuing Resolution due to the election year and would affect Section 8 negatively due to the need for higher funding than FY 20 to sustain all renewals. We’re also looking at budget deficits, for which there is no immediate cure. The President just released his FY 21 budget. Though historically any President’s budget is largely ignored by Congress as it works on appropriations, it acts as a roadmap for the Administration’s policy initiatives, of which we ought to be aware. Additionally, the Administration has issued guidance regarding Medicaid that would radically overhaul coverage as states could apply for waivers that would convert Medicaid programs to block grants, with capped federal funding and new abilities to cut coverage and benefits (click here for more information on this from the Center on Budget and Policy Priorities). This is definitely something on which we want to keep a close eye.
Teague Morris: Senator King signed on to a letter to HUD Secretary Carson regarding radon in public housing.
State Legislature Update:
Laura Cordes – Maine Association for Community Service Providers (MACSP): A lot of the updates I had we already touched upon, such as the Supplemental Budget and the Section 21 Waiver Renewal. The Long Term Workforce Commission released its final report, and its two top recommendations are to increase DSP rates and establish a rate commission. Right after the release of the report, the Health and Human Services (HHS) Committee moved to draw up legislation to put these recommendations into place. There appears to be a growing understanding about the need to raise the rates. When the Long Term Care Workforce Commission looked to make their final report and recommendations, they looked at LD 399, the bill which would increase DSP wages to 125% of minimum wage, and chose not to take that up because they wanted to look at all of the rates not just rates related to ID/DD services. Whatever vehicle they’re going to land on, there’s a lot of momentum regarding rates in the HHS Committee.
I did want to bring up a proposed rule change, as it hasn’t gotten much attention. The MaineCare proposed rule, “10-144 C.M.R., Chapter 101, MaineCare Benefits Manual (MBM), Chapters II and III, Section 106, School-Based Services.” was recently posted and significantly reorganizes the delivery of school-based services for children with disabilities and it appears the consequences exceed any intended benefit. This proposed rule would combine all school-based services for children with special needs. As proposed, the rule would cut children’s services in half. The rule would also limit services to the school year calendar, meaning children would be eligible to receive services only during the school year, as opposed to the full year of eligibility they currently receive. The rule:
- Reduces rates to providers of early intervention and other services by 29%;
- Cuts essential service hours for preschool children with disabilities upwards of 65%;
- Forces providers to cut programs and reduce staff;
- Increases the waitlist for services;
- Jeopardizes long-term outcomes for children with disabilities; and
- Undercuts Maine families with children with disabilities.
These services are too vital to the long-term success of these children to be cut. The public comment period closes on 2/28 (comments can be submitted online by clicking this link). The hearing will be held on Tuesday, 2/18 at 9am the Augusta Civic Center. With the impending public hearing drawing near and the window of opportunity to address this issue closing, providers, families, and advocacy organizations have partnered to launch a unified, statewide effort to engage those that would be affected by these changes and take every action necessary to stop the Section 106 Proposed Rule. Providers in our coalition are sending a letter to families today (click here for the letter). This letter includes details on the hearing and where parents can send their comments. Another way in which we are working to stop this proposed rule is through a petition, which can be signed online (click here for the online petition) (click here for a printable version of the petition). The goal is to present the petition along with all of its signatures at the 2/18 hearing.
As far as the Second Legislative Session goes, a lot of the public hearings are ending, and work sessions are starting.
Announcements/Handouts:
Helen Hemminger – Maine Children’s Alliance: Regarding the Census, any group that wishes to have guidance or training please do not hesitate to reach out. People will start to get Census mailings the 3rd week in March.
-It was asked how people in group homes are counted for the Census.
Helen: People in group homes are counted by the facility. Facilities are the ones that do the counts, this includes group homes, hospitals, etc. Very small, say two-person, homes would need to respond by the address. We’re doing a lot of training on this and would be happy to come to your agency or programs.
The next meeting will be on Monday, March 9, 2020, 12-2pm, Burton Fisher Community Meeting Room, located on the First Floor of One City Center (food court area, next to City Deli), Portland.
Featured Speaker and Topic TBD.
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].