Advisory Committee on Services to Persons with Developmental Disabilities
Tuesday, July 28, 2020
10 a.m. – via Zoom
Call to Order:
Chairperson, Wanda Felty called the meeting to order. Sonya Hunter, Secretary called the roll.
The following Committee members was present: Robin Arter, Marcellius Bell, Tori Collier, John Corpolongo, Michelle Disario, Wanda Felty, Janie Fugit, Rex Hennen, James Hill, Sonya Hunter, Jennifer Jones, Consuela Logan, Traylor Rains, Collen Stice, Lorraine Sylvester, Terry Trego, and Lisa Turner.
A quorum was met.
APPROVAL OF MINUTES:
The January, 28 2020 Committee minutes were approved with the following correction: The language in (b) (6) (F) mirrors OHCA language. The g was added to language.
DDS UPDATE – Beth Scrutchins DDS director:
Beth opened the meeting with introducing Services First. Services First means as an agency we are prioritizing services for the people we support and to the people who provide those services. Our goal is to reach out to community partners to share space so we provide better services in wider service areas including rural areas.
COVID changed everything for all of us and accelerated the use of telework for DHS. We are settling in with and have partnered with OMES to make sure employees have the technology they need to work from home. The Department has done a remarkable job in a time when the needs are so great. The SNAP applications we have processed is at least tripled compared to what it normally is.
We are in phase 1 of our office closure plan. There are 13 county offices in this phase. There has been thoughtful discussions with affected communities and divisions to make sure there is no stone unturned in relation to needs. The closure plan includes two longtime DDS area offices in Pauls Valley and Enid. We will be working out of our homes. One of the things this includes is a digitization effort, so we are moving to an electronic system. In Enid today there are scanners there where we are working to move to an electronic system.
Beth welcomed and introduced two new Committee members: Traylor Rains, Deputy State Medicaid Director with Oklahoma Health Care Authority, and James Hill, Meadows Director.
We developed a disaster plan early on that is called an addendum to the appendix K that allows us some flexibility to support people during this time. We are continuing with the appendix K and will make a revision to allow for case management to document verbal approval to implement the Plan to be able to get things done more quickly. CMS has moved quickly with the appendix K approval. These changes have allowed us to try some things out like Remote Monitoring. This has been exciting and informative because it has provided opportunities for independence for people.
Beth shared the wait list statistics with the Committee. We received a question about the reported case closure reasons. Specifically what does closed due to tracking only means. We clarified with Amy after the meeting and this category means we are tracking this because the individual does not need services now. We are tracking in case their situation changes.
We are drafting a Request For Proposals (RFP) for the waitlist. This will include two points, a case management IT platform that allows us to collect data we are unable to collect right now and exchange data between us, providers, and families. The second piece is the navigation/ assessment piece to assist families to obtain referrals for needed services while they are on the waitlist. We received questions about sharing the waitlist data, and when home visits may reoccur again. We will share the waitlist data with the Committee. We have discussed when home visits can occur, it concerns us that we won't be visiting homes in residential services during the period of May to December. We need to discuss when we would restart the visits, and who we would visit if it would be only those who receive community residential supports. If things are going well do we need to visit during the pandemic, we want to balance the risk vs. benefit for those we serve.
The next question was do you refer families to the area office in light of its closure; are we keeping the 1800 numbers. For the time being the 1800 numbers are current. The area 1 number will be changing in the next month or so. We are meeting to discuss the best options for the public to contact intake.
We received a question about how long it should take for self-directed services should begin. Beverly asked for the names of the individuals in a private chat. Sometimes the employee of record has to complete a training before the services begin. Beverly will follow up to see what the obstacles are to assist with the implementation of services.
We received a question is are we releasing one or two RFP'S. We are issuing two RFP'S one for data management, and one for assessment/navigation. Our goal is to issue them within a week but we have partners with contracts and purchasing who have to complete their work before they can be issued.
We heard concerns about difficulty getting ahold of DDS staff. Beth will follow up with DDS leadership to inform staff that we received this feedback and discuss ways to ensure that our partners have our contact information and emphasize to staff the expectation that calls and emails are returned timely.
APPROVAL OF RULES:
The rules below were approved by the Committee.
- OAC 340:100-3-2 is amended to:
revise area office record requirements from area office to case management electronic records; update terminology to current usage.
- OAC 340: 100-3-4 is amended to:
clarify that room and board costs do not include medications, and co-pays not provided by Medicare, Medicaid, or other health insurance; and update terminology to current usage.
- OAC 340:100-3-13 is amended to:
update terminology to current usage.
- OAC 340:100-3-34 is amended:
define critical and non-critical incidents; emergency room visits is moved to the critical category; add a requirement that all admissions to psychiatric facilities are required to be reported as a critical incident; add a requirement that suspected maltreatment of a child by a service recipient is a critical incident; revised (d) to add language that contract provider staff report incidents after observing or discovering an occurrence; clarified the appropriate reporting authority for suspected maltreatment; and set forth case manager responsibilities for reviewing and responding to incident reports to ensure DDS meets Centers for Medicare and Medicaid Services (CMS) assurances to continue to receive approval for Home and Community-Based Services (HCBS) Waivers.
A clarification to the $500 dollar property loss was moved to the non-critical section because when the rule was initially developed property loss of $500 dollars was considered a felony.
Defining critical incidents in which the person has law enforcement involvement due to challenging behaviors was clarified. The Committee member's question was intended to make sure the definition of challenging behaviors does not omit critical incidents that should be reported. The revised critical incident form includes sub categories that will make it clear to staff when a critical incident should be reported for this category. Here is the subcategories law enforcement due to: 1. Criminal activity; 2. Behavioral 3. Arrested or held in law enforcement custody. This change was made because we receive critical incidents when the police is called to a neighbor's house or the home was broken into. We needed to clarify the reporting parameters specific to the individual's risk.
We received an inquiry about non-verbal individuals involved in a minor accident. We are streamlining the reporting requirements because the Team need to focus on the events that are the most critical to the individual. The agencies have protocols to address injury accidents. If it rises to the level where the person receives care in the ER it is considered critical. We can address the other concerns in the health care coordination training and process.
We received a question from a Committee member about the alignment of the critical incident definition (b) (7) admission to a psychiatric facility or hospital behavioral unit because the admission itself does not pose a potential to cause risk. We clarified that this is classified as a critical incident because Teams need to address the health and safety reasons contributing to the need for the psychiatric admission.
- OAC 340:100-5-26 is amended:
clarify contract providers initiate first aid and cardio pulmonary resuscitation (CPR) unless a Do-Not-Resuscitate Consent Form is signed; remove the requirement that the Health Care Coordinator (HCC) completes and submits the Health Status and Monthly Medication Review form monthly; define an invasive procedure; add a requirement for waiver recipients who receive community residential supports or group home services that the Personal Support Team (Team) holds a discharge planning meeting for all hospital admissions prior to discharge to assess service and support needs; and add the requirement that the Team meets to review pharmacy recommendations within 30 business days of receipt of a completed pharmacy review.
We received an inquiry that the Team meeting within 30 business days is a long time after discharge from a facility. The 30 business day requirement if for annual reviews, not non-routine request. When a person discharges from a facility with medications changes Teams are reviewing those changes within 5 business days of discharge.
- OAC 340:100-5-35 is amended:
to clarify that non-residential HTS services are not authorized for services provided by the legal guardian, biological or adoptive parent of a minor child per OAC 340:100-3-33.2; clarify that the 40 hours per week HTS limit applies to the entire household and not per person; remove hospital settings as a prohibited service location; and update terminology to current usage.
We received an inquiry if this negates flexibility for families during the COVID response. The changes to the appendix K did not negate this policy.
The new language clarified the new language clarifies this rule applies to parents of minor children and legally responsible individuals. This includes a spouse as well. This is a CMS rule that is specific to CMS.
- OAC 340:100-5-35.1 is created:
to allow the provision of services in acute care hospitals per the 21st Century Cares Act.
We received an inquiry about setting the limits for Agency Companion Services, Specialized Foster Care, and Group Home to an average of 9 hours per day. (3) provides an exception to authorized additional hours per day when the service authorization standards are met.
- OAC 340:100-5-52 is amended:
to include provisions for electronic Individual Plan meeting notices; and increase the meeting notification requirements from two weeks to 30 calendar days in order to provide improved customer service.
- OAC 340:100-17-10 is amended:
to remove an inaccurate policy cite that was revoked; and update terminology to current usage.
- OAC 340:100-17-17 is revoked:
because it describes a billing process. The process will be detailed in instructions to staff in another state funded employment policy
- OAC 340:100-17-25 is amended:
to clarify that provider agencies submit claims to DDS state office instead of the area office; and the usage of terminology was updated to reflect current usage.
Dr. Jones informed the Committee to changes to the book group facilitated by OSU. The book club is going virtual and increasing from 2 groups to 15. They are in contact with ABLE Tech who has devices that could be utilized. Internet access can be a barrier. Arkansas is utilizing Cares Act fund to improve internet access for school age children for educational purposes. We could reach out to the Governor's Office to suggest a similar approach. State Department of Ed has funds as well.