Shawnee County CDDO Affiliate Meeting Oct. 8, 2012

Present: Tandy Kimbrough, Sheltered Living; Mitzie Tyree, Sheltered Living; Doug Gerdel, Life Patterns; Shelby Fry, TARC; MaryAnn Hughes, Sunflower Supports

I. CDDO Updates:  September Affiliate Report Overview  1,057individuals receiving services (815 adults, 242 children) in Shawnee County.  There were 5 individuals determined eligible; 2 determined ineligible; 0 ported in and 0 ported out of Shawnee County.  There were 4 crisis requests reviewed by the funding committee; 4 were approved; 0 were denied and 0 pending.  9 individuals have been crisis approved during FY2011.  Ramona stated that we are continuing to see a high number of residential and day services provider changes.  Individuals changing service providers included: 15- day services (includes multiple providers); 13 - residential services; 2 - case management; and 7 - FMS Provider.  There are 51 individuals who have not chosen a case manager; 28 Medicaid eligible and 23 Non-Medicaid eligible. We have been averaging 50 people that have not chosen a case manager 28 of which are Medicaid eligible. Ramona stated that we are continuing to see a high number of residential and day services provider changes.  There were 306 POC’s reviewed for the month. Of the POCs reviewed for in home supports, 36% was over allocation and 64% at allocation.

 Statewide Funding Committee Update:  The committee reviewed the crisis notification forms for FY12. She stated that more people had exited services for various reasons statewide. However, the Medicaid Management Information System (MMIS) which is the states projection for FY2012 it was $6,162,257 higher than the CDDOs estimated expenditures. Causes of this included not budgeting MFP people converting to HCBS and funds not being transferred to the DD budget to compensate for the loss of $2.7 million.  It was stated that additionally FY2012 had the added day for leap year that was not budgeted for an additional cost of $900,000. Ramona stated that Greg Wintle, State of Kansas, also stated that approximately every five or six years there is an additional three to four days of extra claims which was also not budgeted for.  In the end DD services had overspent $1 million which is justifiable each fiscal year due to contract exceptions by contract waivers for those that are coming out of SRS custody, Traumatic Brain Injury (TBI) Waiver, and Technical Assistance (TA) Waiver. The contract exceptions for FY2012 for 147 people statewide were $2,494,831. Ramona stated that there was statewide there were quite of few statewide transfer from the TA waiver.  There were 42 people determined no longer in need of extraordinary funding due to moving out of state, death or not meeting the financial threshold or no longer meeting the eligibility requirements.  Reported CDDO administration expenses were $10 million.  The projected cost for the FY2013 HCBS for I/DD Waiver has been budgeted for $321,158,000. The statewide funding committee will be monitoring individuals transferring over from MFP to HCBS as there is a potential of a $30 million over expenditure.  The FY2013 contract exceptions are projected to be $1.2 million for the state. It was $2.5 million for FY2012.  There was also discussion regarding the waiting list and the following week CDDOs were notified of people coming off the list. There was one person identified for Shawnee County for HCBS funding who is currently receiving day and residential funded by state aide.  The state now has two separate lists one for individuals who are in services that are private paying or with county/state funding waiting for HCBS and one for those on the waiting list not receiving any services. Ramona stated that our one person accepted as if they are already in services on the HCBS list and had declined they would not go to the local list as those dollars are allocated to that CDDO area. There were also five others identified for in-home supports (Personal Assistant Services, PAS). Ramona stated that what is unique this year is that we don’t complete a BASIS assessment on individual’s not in services unless they are a tier 0. The CDDO will be contacting the person and the case manager to schedule a BASIS meeting prior to offering HCBS funding to make sure they are still eligible. Ramona stated that she had advocated for assessments should be done yearly due to things like this and crisis.  Ramona stated that all the exceptions and crisis funding goes against waiting list allocations. It was asked who managed the statewide waiting list. Greg Wintle oversees the list.  There was also discussion regarding the voluntary foster placements as the foster placing agencies do pull down the residential tier rates. Greg reminded everyone that the intent voluntary placements were set in place to keep children from going into state custody. There has to be a risk before it would be automatically approve  It was asked if CDDOs would need to contract with MCOs to bill for assessments and at this time the answer is no it should be included in with the waiver for case management.  If we need to do a BASIS Assessment prior to 336 days from the last assessment we have been getting approval from Greg. It was asked it would continue to be the same or through the MCO. There are specific reasons they are approved for example is if someone has had a life- changing issue.  Ramona stated that there is a conference call scheduled at the end of the month to discuss the HCBS projected numbers and the exceptions since the last meeting. They will be reviewing more of FY2013. Ramona stated that they usually meet quarterly but they may have additional conference calls.

 Day service provider policy for persons supported are sick: o The Healthcare regulation reads: That whenever there are two or more providers provide services to the same person the providers shall work together to meet the healthcare needs of the person.  Ramona stated that basically if there is a problem reported to the CDDO the providers will be referred back to the policy and need to get together. She encouraged that residential provider to know what the day service policy is for different illnesses to assist in eliminating confusion on what to do as it does take time to get staff to pick up the person  If the person were to be taken to the emergency room when at day services would also have to be worked out.  Ramona stated that there are residential providers that have policies in place. It was asked if it were day service provider’s responsibility to know all the residential providers policies. Ramona stated that she knew that TARC does inform residential providers. Shelby stated that it is also in their person served handbook. Tandy stated that she carries the SLI emergency day phone and that it can take up to an one hour to 1 ½ hours to get someone there. She also stated that she believes that in the case of someone needing to be taken to the ER it is the responsibility of the day service provider and a call to her informing her that someone is being taken to the ER and she will then get someone to the ER. The issue becomes that as soon as someone is admitted to the hospital the day service provider can no longer bill. Shelby stated that there are times when they are not sure if they should be taken and want to conference as to how to handle the situation. Ramona stated that there are two issues the hypochondriac and the ones with high medical needs that can be identified what to do for that person but to keep in mind agency policy. It was stated that if there is any question they should be taken to the hospital. Tandy stated that she there are other non-issues also such as the day service provider is pulling staff to go to the ER to support the person until they are relieved by the health care coordinator getting there or they are admitted. Once the person is admitted providers can no longer bill. Shelby stated that there to is an issue as she can send someone but not being the healthcare coordinator she cannot give more information or make any decisions. Discussions continued as what to do under each circumstance. It was stated that there are times when it’s more of a matter of calling the healthcare coordinator call the doctor to make an appointment rather than take them to the ER. Residential providers also deal with this issue of when something happens and staff is unsure of what to do and staff calls the nurse. It was stated that the problem is that we are providing a community service but expected to behave as a health care institution that has 24 hour nursing/medical services available and that service providers are not medical providers. It was stated that there is the mindset that they are still in an institution and should have the same level of services but they are being served in the community without have the same access to doctors and 24 hour nursing so the level of of getting it wrong from a legal standpoint of not getting sued is to take them to the ER. It was stated that this contributes to our excessive health care costs.  Ramona stated that the CDDO is not going to micromanage the agency policy of when someone is sick as there is variance. She stated that she encouraged all the residential providers make contact with day providers regarding their policy as there is variance. The CDDO recognizes that there are challenges but providers need to work together. She also stated that it does need to be identified for those individuals that want to go to the ER all the time and how to support that.  It was stated there are times when providers call the doctor and told to just take them to the ER. There are times if they are taken to urgent care facilities they are told to take them to the hospital. It was asked if providers are to call MCO care coordinators for these kinds of things. Yes.  Ramona stated that she was going was going to address this issue again of people having access to medical services at KNI, including dental. It was stated that there is a need are to replace feeding tubes or a catheters come out. It was stated that it would be nice if there was someone one that come put it back i9in vs. the cost of a visit to the ER.  After hour contacts:  Sabrina is going to be talking to with residential providers at the monthly meetings to get after hour emergency contacts. As she will be carrying the CDDO phone as typically if someone is at Valeo getting a screen in and are being screened out she will get a call letting her know that a person served is there as most times a provider may not know that they are there and will send staff to pick them up or law enforcement contact.  At the Q&A at KNI on managed care they were encouraged to visit the KanKare website as there was over provider and beneficiary 1,000 questions. Ramona stated that she had been to the Amerigroup website and that it seemed basic. II. Questions/Suggestions & Concerns:  It was asked if one of the five declined services the next person on the list in Shawnee County could be asked. Ramona stated that we can as they are not getting any services. The difficulty is if someone coming off the list is requesting more services than what is allocated as it has to stay cost neutral. Ramona stated that in-home-supports are now a flat rate regardless of their tier rate.  It was asked what the Amerigroup training goal was. Ramona stated that it was an educational training for this MCO. Ramona stated that the minimum general liability insurance is $5 million which is higher than what the CDDO requires. This has been taken back to KDADS to review.  It was asked about the procedure once a recipient is auto-assigned to a MCO. What is understood is that the person is responsible to go to that website to see if your physician is contracted through that MCO and if they are not who do they contact? If they are not and they want to join a different MCO it is all done online. Once they are assigned to an MCO they will be able to change MCOs by Dec. 31 then they will have from Jan. 1 to Feb 15 to switch MCOs but after that after that cannot change again for a year.  It was asked about client obligation notifications. Ramona stated that though the CDDO POC system in BCI you can click on client obligation for the amount. Ramona stated that perhaps some kind of notification could be sent out once it is entered on the POC. It was stated that it is great that the notifications from Shawnee County but that it is a statewide issue. Ramona stated that she would bring it up at the next statewide funding committee meeting. V. Upcoming training opportunities  Amerigroup educational session for case managers – 3-5 pm Oct. 30th. RSVP to [email protected].

Next meeting is scheduled Nov. 12th, 2012