Meeting Minutes

Advisory Committee on Services for People with Developmental Disabilities

January 22, 2016

CALL TO ORDER – Teri Egner, Chairperson

ROLL CALL – Wanda Felty, Vice Chairperson

Teri Egner, Eddie Miller, Brian Ferguson, Angela Donley, Ellen Hefner, Wanda Felty, John Corpolongo, Dyann Arnett, Theresa Flannery, Jennifer Jones, Rene' Daman, LaKenya Antwine, Tori Collier, Nina Peschka, Terry Trego

*APPROVAL OF MINUTES – September 8, 2015

DDS UPDATE – JoAnne Goin, DDS Director

Announced this morning an $18 million is state dollars ($28 million with federal included) shortfall in DHS. DHS announced voluntary buyouts for the staff agency wide. Each division of the department will be reducing FTE and restructuring who does what within the agency to reduce our internal cost. When the board of equalization meets and the legislation is back in session in February, we will have a better idea of the budget for FY 2017.

The Blue Ribbon Executive Group and Advisory Board are working around some issues that the No Wrong Door Group has put together to develop a statewide database and system of referrals that will involve most state agencies that provide support to people with disabilities. There is potential in that work effort to really streamline information and supports to people with disabilities and for people in long-term care into one system. It is a step in the right direction is providing information to families.

We are going to amend our waiver when the renewal is completed as early as late summer but most likely in the fall to allow self-direction in family homes on the community waiver.

* APPROVAL OF RULES – Terry Trego, Policy Sub-Committee Chair

OAC 317:40-5-103. Passed

Is amended to permit billing of map miles between two locations with the use of global positioning system (GPS) software as an alternative to keeping odometer readings.

OAC 317:40-7-12. (Rescinded until the next Committee meeting.)

Is amended to remove the requirement that provider agency Human Rights Committees review members' protective intervention protocols in order for enhanced vocational rates to be approved.

OAC 317:40-7-13. (Rescinded until the next Committee meeting.)

Is amended to remove the requirement that provider agency Human Rights Committees review members' protective intervention protocols in order to be eligible for continuous supplemental supports.

OAC 317:30-5-518. Passed

Is amended to correct the policy cite for agency companion services limits.

OAC 340:100-3-6.

Is revoked to remove Human Rights Committee functions from providers.

The Human Rights Committee (HRC) does not have the same authority it used to. The State Behavior Review Board (SBRC) is the one who makes the final decisions and have the ability to overturn any decision made by local HRC's.

Wanda served on the HRC at Dungarvin for 6 years and she feels it is a valuable asset because, while they did not oversee the same regulation the SBRC did, the local HRC provided valuable insight into incident report patterns. Wanda was asked to bring the opinion of Dr. Valerie Williams, Director of the Center for Learning Leadership, which include the concern that moving it away from the local level for input is not a best practice for the individuals with disabilities. While they may not have the same authority as the SBRC, they do have an oversight and a voice for the individuals from a community level.

Ellen feels like the HRC are valuable because many of the volunteers are parents who will look at issues differently than those at the state level might. It is comforting to have a parent on the HRC who will have the same concerns as other parents. The cost of eliminating the HRC may not be worth depriving the voice of the clients.

Teri is concerned about the process of how this was decided and implemented before it came thru this committee and is concerned about if this is going to continue to be a practice put in place by DDS.

JoAnne clarifies that the Director made this decision in conjunction with the rate cuts and the feeling that there had to be administrative relief to the providers.

Theresa is concerned about the state-funded people and how the SBRC does not look at them. They are not represented because they do not receive the waiver services from DDS so they do not have a case manager to voice their issues. For them, QA goes thru the checklist asking if certain policies are in place but does not ask about the content or if anyone is following thru on that or about the documentation. Looking for the evidence on how those policies are being implemented is not part of the QA review. Half of the people receiving her services are not part of the electronic review process nor are they being reviewed by the SBRC. The HRC is the only group monitoring the policies and procedures affecting their daily life.

Teri wants to know how having a local committee watches guard what the agency is doing. The agency may not report an incident to the SBRC and it is more likely the local HRC will review them so why is there a better chance of that problem being reviewed at a local level versus the SBRC?

It would be very easy to keep the incidents from going to the SBRC and keeping that documentation hidden. However, there is a different relationship between sending a fax to a state committee and having a conversation with a group of people you already have a relationship with and who know your agency and your constituency. It feels safer to present the challenges to a group of people who understand your challenges.

Terry clarifies that all critical incidents go to the SBRC and do any PIP's with restrictions must be approved thru the SBRC even if the client is a state-funded person.

Wanda and Ellen believe the HRC is another layer of protection for vulnerable clients and that it needs to stay in place to add another safeguard.

Eddie knows they are moving towards person-centered plans but if the family doesn't agree with it and takes it to the HRC but their decision has no teeth when the issue goes to the SBRC. How many plans went up to the SBRC that were in favor of the HRC decision or against it?

Wanda thinks the HRC at the local level is more of an advisory committee since the SBRC is the one who makes the final decision. Either advisory committees are needed to provide valuable input, like the DD Advisory Committee, even though the state agency can act differently or they are not. So, either we agree with advisory committees, like the HRC and the DD Advisory Committee, or we don't.

Nina knows the HRC is valuable and agrees it is a wonderful support system but due to the massive budget cuts, it is one of the things that had to be eliminated in order to maintain more important parts of the agencies, like staff.

John wants to know how urgent it is for this committee to take action on this today. He can see both sides to the discussion of the HRC but would like a chance to gather data and continue to discuss at the next meeting. He would be eager to hear the cost savings and if that outweighs the benefits of eliminating the HRC.

JoAnne agrees to gather more data on the cost savings of eliminating the HRC and also wants to ask what other structures they have to get support and input. Many agencies have boards and a lot of parent involvement.

Theresa's HRC looks at all incident reports that have to do with any kind of disruption of services for the person that are not considered critical and are not sent to the SBRC. The HRC looks for patterns in those incident reports that would otherwise be missed. The HRC can provide valuable insight into other supports that could be offered to the state-funded people who are not on the waiver and do not have a PIP. The HRC also looks at any policy changes and asks the questions of "what was changed?" and "why was it changed?"

Terry outlines the critical functions of the HRC and they include

Annual review of PIP (also done by the SBRC)
Reviews and approves research initiatives (DHS has just formed an Institutional Review Board who will review all research initiatives)
Reviews complaints (also done by OCA & DHS)
Reviews allegations of abuse/neglect (also done by OCA & DHS-APS, CWS, LTCI)
Reviews incident reports (also done by DHS via the electronic provider reporting system except for state-funded persons.) *Theresa believes this area is a little weak when it comes to state-funded people. She agrees that these are being covered somewhere else in a very effective manor but the state-funded people fall thru the cracks. If we were to keep the HRC in some fashion that this would be an area of value in picking up those pieces.
Reviews policy (also done by QA) *Theresa would like to point out that in the process; QA does not require proof of the policy being followed only that you have the policy in place. JoAnne points out that QA has very extensive annual survey that is many pages long and very detailed.
HRC participates quarterly in community activities to get to know the clients, staff and families. This is difficult to coordinate due to varying schedules with volunteers.
Reviews discharges from group homes (also done by QA) *group home discharges are the only ones required to be reviewed by the HRC and this is from a legacy policy created when the HRC was founded.

Wanda would like to point out that all the oversight is at the state level rather than the community level which is our concern. A restriction went thru at the HRC and another suggestion was offered that stayed in line with the PIP rather than violating it.

The HRC was eliminated as of 10/1/2015. Several agencies still have their HRC's even though they are no longer required.

Theresa would like to have seen an option somewhere between retaining their HRC and completely eliminating them.

Jennifer asks if the HRC is a watch dog for self-directed clients. QA and the SBRC review those incident reports.

Eddie wants to know how this change will affect QA audits and Genny replies that it won't.

There is a motion to proceed with this meeting and table this discussion until data can be gathered about cost savings. Motion passes.

OAC 340:100-3-1. Passed

Is amended to update the terminology used in this Section.

OAC 340:100-3-10. (Rescinded until the next Committee meeting.)

Is amended to add the requirement that research activities that may place a client's rights at risk are initiated with the authorization of the DDS director or designee.
Is amended to update the terminology used in this Section.

OAC 340:100-3-38.10. Passed

Is amended to provide a two-year recertification to replace the one-year certification for the medication administration training course for employees who administer medications as a paid certified staff within the two-year period.

OAC 340:100-3-38.1 through 340:100-3-38.5 (Rescinded until the next Committee meeting.)

Is amended to change that the person designated by the team to provide individual specific training is identified by position and not by name.
Terminology is revised to reflect current usage.

OAC 340:100-3-38.12 through 340:100-3-38.13 Passed

Is amended to change that the person designated by the team to provide individual specific training is identified by position and not by name.

Terminology is revised to reflect current usage.

OAC 340:100-5-22.1 Passed

Is amended to increase program coordinator ratios for community residential and in-home supports waiver program coordinator caseload ratios up from 1:20 to up to 1:27, and amend the calculating factors to allow non-residential cases to be counted as 1:5, an increase form 1:3.

OAC 340:100-6-55. Passed

Is amended to remove the requirement that group homes retain the services of a registered nurse to act as a consultant.

OAC 340:100-6-85. (Rescinded until the next Committee meeting.)

Is amended to remove the requirement that provider agency Human Rights Committee's review all proposed discharges.

OAC 340:100-6-95. (Rescinded until the next Committee meeting.)

Is amended to remove provider agency Human Rights Committee references.

Rule impact:

The classes of persons affected by the proposed rule changes are individuals receiving DDS, who bear no costs associated with the implementation of the rule.

*Nominating committee recommendation for new officer – Secretary

Judy Myers vacated the position of secretary and Wanda Felty is voted in as the new one.

Public Comment – Joanie with Oklahoma Family Network presents JoAnne with an engraved vase as a retirement gift. No other public comment.

*Possible Action Item