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CSHA HOT TOPIC |
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Conflict of Interest Task Force Meeting Minutes: May 2010 | June 2010
Colorado Department of Human Services (CDHS) The departments named above have created the Task Force to develop a resolution to the conflict of interest issues inherent in the Developmental Disabilities system: services regarding the provision of single entry point, case management and program services for individuals with developmental disabilities. The Task Force is charged with evaluating options for system re-design to resolving these conflict of interest issues and to make recommendations to CDHS and HCPF. The meetings are open to the public. Written comments will also be accepted to ensure all stakeholders have the opportunity for input. DDD has Task Force minutes on their website http://www.cdhs.state.co.us/ddd/COI_Documents.htm Task Force shared their thoughts on the Public Comment Meetings. Copies of written comment from the public were provided to all members. Service Planning Statutory Requirement: concern for service provider experience, years, what input would be used, source of input for RFP process. Turnover for case management is high, epidemic for CCB’s. Job/role of case manager has changed, more of compliance manager, paperwork than relationship with family. No longer salaried employees, hourly employees now, no longer decision making role. Pathways now 2/3 turnover of case managers. Heard testimony, written comment of importance of relationships with family and case manager. Keep this in mind when TF making recommendations. Consumer/Self Advocate Input Plan: Division of DD had self advocate council for some years until last year because of laid off program quality staff. 10-15 self advocates typically attended. Sharon will get more info to Task Force when meeting scheduled. South Dakota update: in process of working with Medicaid waiver and don’t want to participate in a public forum. They have 19 entities that provide case management and services. In the comprehensive waiver, only 19 entities can provide services. Under family, other entities can be providers. They are restricted for comprehensive service. Service coordination is done in 15 mins. With $14, no process for mitigating conflict of interest. Only 2 individuals enrolled in a pilot program for reducing COI because of CMS concern. No specific complaints of COI. Participate in core indicators, more training for person centered planning and hoping part of next waiver. ED: state has team of assessors and pays when necessary. If for some reason, they pulled out case management they worry that service provision would collapse because lots of overlap. Worked on Areas of Conflict: Generation and Evaluation of options for I & R, service planning After lunch the facilitator suggested a process change in the Task Force work. We started to voice our suggestions for options for the DD system instead of going through the categories and options as there was an expressed concern over time for that process. All Task Force members presented their options, added on to options to solve COI. Jean will write up the options presented so TF members can review, formulate opinion, make determinations and get ready to vote at the next meeting. She will not eliminate even what she thinks is redundant. She will categorize by function. As part of the report, we can make a recommendation for DDD to follow up to Task Force members and DD community at large, asking specifics how to communicate this to us.
The departments named above have created the Task Force to develop a
resolution to the conflict of interest issues inherent in the
Developmental Disabilities system: services regarding the provision of
single entry point, case management and program services for individuals
with developmental disabilities. The Task Force is charged with
evaluating options for system re-design to resolving these conflict of
interest issues and to make recommendations to CDHS and HCPF. The
meetings are open to the public. Written comments will also be accepted
to ensure all stakeholders have the opportunity for input. Data on Conflict of Interest: Sharon Jacksi spoke with the directors of the National Association of Developmental Disabilities and asked what they see across the states regarding CMS. They said that this is happening in other states where waivers are coming up for renewal and specific questions asked regarding COI. They see a tightening of resolutions in states. No specific rules or timelines have been developed. Focus now is healthcare reform and growing Medicare population. Whatever the model is, mitigation or separation, the state must evaluate. In states allowing case management and services in one entity, there must be clear resolutions, avenues for appeal, choice is major theme. States must be accountable to Feds. In most states where case mgmt and services are together, they don’t allow from one agency. For ex. Dev Pathways provide service for Johnny, but separate org in Dev Pathways provides case management. Can’t do both for the same person. If a rural area, that agency could provide both to the same person under an exemption process. But this would require a higher level of state involvement because of federal assurances. State provides oversight, so another layer for COI. Networking, local plan and communities is very important. Building collaborations is important and must be kept in mind. One potential model seen in other states with similar issues with COI, an organization does case management and crisis management and training function (maybe like OHC Context: info given informally, some examples Division was involved in, a lot of it is informal. Specific Data:
Aileen McGinley emailed an example identified by advocates in her
office. Marijo Rymer presented examples gathered from colleages at ARC:
family told that EBD waiver might suit better than the waiver they were
on, when asked why not on that waiver responded that case manager did
not have time to learn all waivers and providers, more examples will be
shared in email and in minutes. Sharon Jacksi shared that DDD had
information from the Legal Center and families: DDD was informed that
PASA was told by CCB if they join provider organization they would not
receive any more CCB referrals. Indiana Feedback from Arc and Parent to Parent Marijo Rymer spoke to Arc of Indiana-local Arc chapters are service providers, this is the case in most states. She spoke to Arc chapters, and service providers. What do they think of case management, state agencies? How affected families? One service provider said they are very pleased. They get quick info from case managers. Service providers have ready access. One person said was averse from the beginning for several months because she didn’t want to lose relationships with case managers. Those relationships didn’t change. The information processes they use make it easier, quicker, to get and share info with case managers. Overall, families are much more satisfied. Providers are satisfied as well.
Carol Meredith contacted Parent to Parent in Indiana. They will get back
to her and email will be passed on. Bruce Christiansen, CARF, council on accreditation of rehab facilities, says national contacts say works well for state of Indiana but not always well for families or providers
Per Jean McAllister, Public comment meeting on June 1st, 1-5 pm. 4 sites
verified
Carol Meredith (Autism Society of America)
Arc of the US and AAIDD Policy Statement regarding Service Coordination Back to Areas of Conflict, Generation and Evaluation of Options:
Specifically for Rate Negotiation and Monitoring Services |
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