[0:00] All right, we're going to go ahead and

[0:00] get started. I think we're missing a few

[0:02] folks. Um, but I know with the rain and

[0:05] who knows what's going on out there in

[0:07] the parking lot. Um, I am going to go

[0:10] ahead and um do roll call and we've got

[0:14] um possibly two folks I can't see all

[0:17] the way at the end of the table who are

[0:18] joining us as new members um that I will

[0:21] have introduced themselves. But I'm

[0:22] going to go ahead. Lexi is online. So

[0:24] Lexi, I'll go ahead and um see who's

[0:27] here just because it's easier for me

[0:28] obviously being in the room. Um so Kelly

[0:31] Mitchell I know is absent, so I will

[0:33] just say absent for her. Um Dr. Jim

[0:36] Wiltz

[0:37] » Here.

[0:38] » Uh Katie Stafford Cunningham

[0:40] » Here.

[0:41] » Uh Ty Clark

[0:42] » Here.

[0:43] » Uh Lexi Westerfield

[0:47] » Here.

[0:48] » Uh Laura Fe

[0:50] » Here.

[0:50] » Uh Kate Barro

[0:52] » Here.

[0:52] » I always forget. Do I pronounce that

[0:54] right? Kate Barrow. Bar. Okay, that

[0:57] helps me. Sorry, I I've been pronouncing

[0:58] it wrong. Uh Kim Dodson.

[1:04] Uh Melissa Keys here. Um and then we

[1:08] have Nicole Hicks. Nicole, would you

[1:10] mind um introducing yourself and who

[1:12] you're representing?

[1:14] » Sorry. Yeah, you and if you can just

[1:16] remember to speak into the microphone or

[1:18] you'll get a yell from me just because

[1:21] uh it is if you do not folks online

[1:24] cannot hear so.

[1:26] » Sure. I'm Nicole Hicks. I'm representing

[1:28] insource.

[1:28] » Great. Can do you mind telling us just

[1:30] about yourself? I know I introduced just

[1:32] » Sure. Um uh I have four children. I have

[1:35] one with special needs. He is uh going

[1:37] to be 30 in uh November and we are

[1:40] navigating um you know the adult world

[1:43] with his uh layers that he is requiring

[1:46] which is fun. So um and I've worked for

[1:48] insource for going on 14 years. I am the

[1:51] supervisor of the north team. So I

[1:53] supervise the whole north side of the

[1:55] state. Um

[1:58] that's me. Great. Thank you. Appreciate

[2:00] it. Welcome. Um we're excited to have

[2:02] you.

[2:03] » Um let's see Derek Nord. I'm here.

[2:07] » Uh Carrie Lee

[2:08] » Here.

[2:09] » Ann Titus

[2:10] » Here.

[2:11] » Um Kim Han, I know she had messaged me

[2:13] that she was unable to make it, but

[2:15] she'll be um watching either online or

[2:16] watch the recording. And uh Jory Zulman,

[2:20] I don't think she's here. Trying to

[2:21] look. Um she is our um new family

[2:24] representative who is joining us. So um

[2:27] she might be having some traffic issues,

[2:29] but um she should be joining us. And

[2:30] I'll have her introduce herself um uh

[2:34] after she gets here. Okay, I am going to

[2:38] tee up this video. Um, and this is

[2:41] timely and I know Erin is very excited

[2:44] that I'm sharing this with her in the

[2:45] room. Um,

[2:46] » Yes, you might be too. So, uh, this, uh,

[2:49] this is Aaron Wright, um, is the, uh,

[2:51] director of, um, the Bureau of Better

[2:53] Aging. And as you guys, um, over the

[2:56] course of gosh, I don't know, eight

[2:57] months, I think, since, um, maybe a

[2:59] year, has it been a year since aging,

[3:02] um, you know, was the name change as

[3:05] well as, um, we were lucky to have them

[3:07] join the DD ARS family. So, um, I'm

[3:11] going to share the video, um, that we,

[3:13] as you guys know, over the last couple

[3:14] meetings, we've been sharing the videos

[3:16] that we created, um, about the bureaus

[3:18] that we're excited about and are great

[3:20] videos. Um, and I'm going to share this

[3:22] and then, uh, Aaron is going to, um, I

[3:26] know obviously most of you know what BBA

[3:29] is, but, they've had, um, some

[3:31] structural changes, um, nothing, you

[3:33] know, crazy improvements um, if you

[3:35] will, but just uh, in the way that BBA

[3:37] is structured. So, she's going to

[3:38] introduce some of that. So, I'm going to

[3:40] share the video and crossing fingers

[3:42] people online can hear and tech is

[3:44] working this morning.

[3:50] See, I just changed it. Hold on. And

[3:52] then they leave the room and it's not

[3:54] going to work.

[3:54] » Where's Scott?

[3:56] » Hold on. Let me see. Let me try

[3:57] something. And if not, Erin, I might

[3:58] just have you go and then we can share.

[4:00] I should have

[4:04] » Well,

[4:05] » I know, but it's not. No,

[4:08] » I can't do I know. Sorry, Erin. And then

[4:10] you're like, really? No, because then it

[4:12] it doesn't

[4:18] » I can't do that because then it

[4:20] » I know what I need to do. Hold on. Talks

[4:22] amongst yourself. Hold on.

[4:24] » I gotta I gotta hit You have to go on

[4:26] here and hit share. Share sound.

[4:34] » Says share sound. Hold on. And I didn't

[4:36] click it.

[4:39] Does anyone remember where share sound

[4:40] is? There's like a button on Zoom that

[4:42] has share sound.

[4:46] Do you know what I'm talking about?

[4:49] » Erin, just go ahead. Do you mind go

[4:51] ahead and starting and I'll mess with

[4:53] it.

[4:54] » It's there's a button on here and I just

[4:56] never remember where it is and you have

[4:58] to hit it every single time. So, I'm

[4:59] going to wait. Go ahead. I don't want to

[5:01] hold people up and have everyone staring

[5:02] at you and me as we're trying to figure

[5:04] this out. So, um I'll go ahead and uh

[5:07] just we'll work on the slides and we'll

[5:08] work on it as you're talking um you know

[5:11] just sharing about um BBA.

[5:15] » Hi, I'm Aaron Wright. I am the director

[5:17] of Bureau of Better Aging. I have been

[5:20] with aging for about eight and a half

[5:24] years. Before I assumed this role, I

[5:28] oversaw our state and federal grant-f

[5:30] funed programs for home and community

[5:33] based services, our functions as the

[5:36] state unit on aging, and also the aging

[5:39] and disability resource centers.

[5:43] So, the Bureau of Better Aging really

[5:46] works to help individuals access

[5:49] resources, supports, and home and

[5:52] community based services. We

[5:55] are designated as I mentioned as the

[5:58] state unit on aging under the federal

[6:00] older Americans act. And with that comes

[6:03] the responsibility to designate local

[6:06] organizations to really serve as focal

[6:09] points and resources for older adults

[6:11] and caregivers in their communities.

[6:15] About 67%

[6:17] of our grant funds go to these local

[6:22] area agencies on aging. We also

[6:25] administer other programs such as adult

[6:28] protective services, some limited

[6:30] guardianship programs, residential care

[6:33] assessment programs. with our transition

[6:37] to being a standalone division to part

[6:41] of the ARS. Now we really are trying to

[6:49] kind of reident re

[6:52] determine our priorities while really

[6:55] staying true to our role as the state

[6:59] unit on aging.

[7:02] Um we have gone through a recent

[7:05] restructure prior to our merger with

[7:10] DBRS. We operated very much in

[7:14] programmatic silos. So we have tried to

[7:19] restructure ourselves to better support

[7:22] the programs and services that we

[7:24] administer. We can go to the next.

[7:25] » Okay. Sorry, that's what I was trying to

[7:27] read you.

[7:28] » By

[7:30] creating a centralized program and

[7:33] policy team with provider and vendor

[7:36] relations and quality and outcomes kind

[7:38] of wrapping around those core programs

[7:41] and services that we administer. We've

[7:44] been very fortunate to be able to grow

[7:46] our team in the last couple of months to

[7:51] increase our capacity to improve the

[7:56] programs and services that we deliver.

[7:58] So this is our hidden organizational

[8:01] structure. If you had seen it before, it

[8:03] was almost like a straight line. So

[8:05] we've really tried to move towards a

[8:08] very collaborative

[8:10] integrated

[8:12] but also functional structure.

[8:15] » Next

[8:18] with our transition we are really

[8:22] focused on improving our internal

[8:26] policies and procedures. As I mentioned

[8:29] just trying to settle into our new

[8:33] identity. We are really focused on

[8:38] trying to integrate with now DDARS.

[8:43] I will say I've been very welcomed and

[8:45] supported as our we've become one of the

[8:49] four bureaus within um DDRs.

[8:54] We are um

[8:57] with our new structure really trying to

[9:00] champion

[9:02] our multis- sector plan for aging called

[9:06] age forward together. This was a

[9:09] collaborative initiative

[9:12] that's

[9:14] started and I guess was approved in the

[9:18] end of calendar year 2024. It is a

[9:22] 10-year forwardthinking plan that was

[9:26] really focused on aging within Indiana.

[9:30] It centers around age friendly

[9:32] communities, reducing barriers to

[9:35] accessing services.

[9:37] There's a focus on civic engagement,

[9:40] employment,

[9:42] volunteerism, which really ties into

[9:45] some of the work that DBRS have been

[9:48] doing with SEM and around community

[9:53] integrated

[9:55] employment. So have that collaboration

[9:58] and tie in there.

[10:01] And then another component of the multis

[10:04] sector plan for aging is around

[10:07] reframing aging and trying to combat

[10:10] agism. Not looking at aging as a disease

[10:15] or a disability but just a process

[10:18] in life.

[10:22] Um, as part of our responsibility as a

[10:25] state unit on aging, we complete a state

[10:29] plan on aging every four years that we

[10:32] submit to the federal um health and

[10:34] human services administration for

[10:37] community living. We are in the process

[10:39] of drafting our next state plan on

[10:41] aging. We currently are in the public

[10:43] comment period. So I hope um we are

[10:48] holding a series of listening sessions

[10:51] or stakeholder feedback sessions. The

[10:53] first one is today up in South Bend. We

[10:57] have one in Indianapolis next week, one

[11:01] in Evansville, and then we will be doing

[11:03] a virtual one next week as well. If

[11:06] anyone would like a copy of the state

[11:08] plan, email DA comments or let me know

[11:11] and I will send it. Um the public

[11:15] comment period ends on the 30th.

[11:21] We also have a dementia strategic plan

[11:24] and we've really been trying to focus to

[11:27] ensure there's alignment between all of

[11:29] these different plans. Um, an initiative

[11:32] that we are working on relates to

[11:36] legislation that was passed last year

[11:39] about um, conducting a study and

[11:42] preparing a report around realigning and

[11:46] consolidating the area agencies on aging

[11:48] map. Here's our current map. We

[11:51] currently have 16 different areas. These

[11:55] were

[11:57] introduced in the mid 1970s

[12:01] and

[12:02] there has not been a change in the

[12:05] structure of the map since that time.

[12:09] So we are looking at the map to see if

[12:13] there may be

[12:15] areas that can be consolidated,

[12:19] realigned to better support

[12:21] administrative efficiencies and also

[12:24] just recognizing that the landscape of

[12:27] aging and long-term services and

[12:29] supports has changed significantly in

[12:31] the last 50 years. So we're using this

[12:35] opportunity to just kind of take a step

[12:38] back and say does this structure make

[12:40] sense?

[12:42] There are federal and state processes we

[12:44] have to follow if we are going to make

[12:48] any changes to the map. There. First is

[12:52] the structure about the map itself and

[12:56] then the next part of the process is

[13:00] designating local entities to serve as

[13:05] the area agencies on aging for those

[13:08] specific service areas. So in

[13:12] redesigning the map, it's not

[13:15] really the focus is not on the agencies

[13:19] that are serving as the area agency, but

[13:22] it's really the structure of the service

[13:25] areas. Are there counties that would

[13:27] make more sense to be in an aligned

[13:30] service region? Does it make sense to

[13:33] focus more on a smaller

[13:37] urban area and change the boundaries of

[13:40] rural areas? There's a lot of

[13:43] demographic data that we're reviewing.

[13:45] We're having conversations with the area

[13:48] agencies about this. We had a dayong

[13:51] visioning session yesterday.

[13:55] Our goal is Oh, Jessica, go next. Um,

[14:00] » Hold on. Sorry.

[14:01] » Oh, that's it was just the timeline

[14:03] which is probably yeah more detailed

[14:05] than anyone wants to know, but um we're

[14:09] really focused on coming up with the

[14:11] recommendations and part of that is the

[14:15] funding formula that we'll use to

[14:17] distribute funds to each of the areas

[14:20] which has to be approved by our federal

[14:23] funer. Um, if there are any changes that

[14:26] come from this process, we wouldn't be

[14:28] looking at really implementing the

[14:31] changes with new a new structure and new

[14:35] grants to local organizations until

[14:37] October of 2018.

[14:44] » There any questions?

[14:51] » It's too easy. Were you able to get the

[14:53] video?

[14:54] » I was. And

[14:58] » Nope. Kathy's not going to let that go.

[15:01] » I have a question. Sorry, Jess.

[15:03] » Oh, yeah. Go ahead. Yeah, Lexi.

[15:05] » Um, so

[15:06] » I'll get rid of it.

[15:07] » What's going to be the BBA's

[15:09] relationship with Pathways then? Because

[15:11] I didn't hear you mention Pathways.

[15:16] » So, currently we

[15:18] » Hey, Erin. Sorry. Oh, I don't think I

[15:21] was talking to Mike at all. Um,

[15:26] in the current state, the

[15:30] we work with both pathways and beads

[15:33] related to our role as the aging

[15:36] supporting the aging and disability

[15:38] resource centers. The ADRC's have a role

[15:43] in waiting list management. So, um,

[15:47] helping with that process as well as

[15:50] really helping to navigate and support

[15:54] individuals when they have questions

[15:56] just around how does LTSS work in

[15:59] Indiana. We don't currently have any

[16:03] direct oversight or involvement in the

[16:07] delivery of pathways waiver or even the

[16:10] pathways managed care services. That's

[16:12] all.

[16:18] » Thank you.

[16:20] » Thanks, Lexi. Okay, I do have it

[16:23] working. So, hold on one second. I got

[16:24] to go back.

[16:26] Cross your fingers. Someone chatted me

[16:28] to fix it. See if it works.

[16:36] Dang it. I did what she told me to do.

[16:41] It looks like it's muted in the top

[16:42] right hand.

[16:43] » I know. I don't know if it's weird

[16:45] because then it'll then it plays from my

[16:51] » Well, I did it. I wonder if it's changed

[16:53] because I did what she told me to do and

[16:54] I

[16:55] » Primarily

[16:58] But we also provide services and

[17:02] » Fourth fifth times a term.

[17:06] BBA stands for Bureau of Better Aging.

[17:09] BBA primarily supports older adults and

[17:12] their caregivers, but we also provide

[17:14] services and supports for individuals

[17:17] with disabilities. Livestream is one of

[17:20] 15 agencies in Indiana serving as an

[17:22] area agency on aging. And as an area

[17:25] agency on aging, we provide a variety of

[17:28] programs and resources to help older

[17:30] adults live their best lives. EVA

[17:32] provides an array of services. We fund

[17:36] local agencies and support local

[17:38] communities to operate everything from

[17:42] senior centers to home delivered meal

[17:44] programs to inhome services such as help

[17:48] with bathing, dressing, cooking. Those

[17:52] services that can help older adults

[17:54] remain independent and in the community.

[17:56] Various agencies on aging such as

[17:58] liveream provide a lot of different

[18:00] services for older users. We provide

[18:03] everything from basic information and

[18:05] assistance. Where can I get energy

[18:07] assistance? Where can I get tax help to

[18:11] more involved options counseling? What

[18:13] are my options for long-term services

[18:15] and supports? Care management which is

[18:18] help coordinating those services and

[18:19] supports. There is a whole network of

[18:22] local service providers that help

[18:26] individuals wherever they are on their

[18:30] journey through long-term services and

[18:32] support. So, an individual can go to a

[18:35] senior center and get a nutritionally

[18:38] balanced meal and socialize, or an

[18:41] individual can have somebody come to

[18:43] their home and help them get ready for

[18:46] the day or take them to the doctor.

[18:48] those types of services. One of the

[18:51] things that we do is we help people with

[18:53] all kinds of resources and information.

[18:55] For example, their medications they're

[18:57] on. How can they afford them? What are

[18:59] some programs that can help them better

[19:01] afford their medications? So, we make

[19:03] sure that they are taking the

[19:04] medications their physicians have have

[19:06] ordered for them so they can manage

[19:08] those chronic conditions better. So,

[19:10] what brings me joy in my work with the

[19:12] Bureau of Better Aging is knowing on a

[19:15] daily basis that I'm making a difference

[19:18] in my community and helping older adults

[19:21] to age in the manner of their choosing.

[19:24] I feel like doing this work, I have seen

[19:26] the impact of systems and systems change

[19:29] and how we can make things better and

[19:32] how we can make the world better in

[19:34] Indiana better for older adults who want

[19:36] to age in their home and have services

[19:39] and programs available to help them do

[19:40] that. So, I think it's a win-win. The

[19:42] person gets to stay where their friends

[19:44] and the people they know are, and it's

[19:47] supporting the community.

[19:51] Awesome.

[19:57] » Thank you. I think you did a good job,

[19:59] Erin.

[20:00] » Maybe you should watch it a second time.

[20:02] » Do you want to watch it one more time or

[20:03] do you want me to freeze it for the

[20:05] entire time when you're

[20:07] um Thank you. Uh yeah,

[20:10] » So what's the age limit on the age

[20:15] living?

[20:16] So the majority of our programs are for

[20:20] individuals 60 and over. Okay. We do

[20:23] have state funded home and community

[20:25] based services program called choice

[20:27] that can serve individuals under 60 with

[20:31] disability.

[20:32] » Thank you.

[20:34] » Thank you. Okay. And if you guys have

[20:36] any questions, if you think of

[20:37] something, put it on your little parking

[20:39] lot sticker um for Aaron. She'll be here

[20:41] the whole time. Okay. I'm going to have

[20:43] Jory. Do you mind introducing yourself?

[20:45] feel like a grand entrance. No. Um Jory

[20:48] Zulman is our um we have the pleasure of

[20:51] having her as our newest family member

[20:53] representative. Um and so do you mind

[20:55] just introducing yourself a little bit

[20:57] about yourself as well?

[20:59] » You just if you can use the microphone

[21:03] » Maybe a little closer. It's kind of

[21:05] There you go. Perfect.

[21:06] » I'm Jory. Sorry I'm late. I parked at

[21:08] Idol Jore because I couldn't find it was

[21:09] so then I went to South.

[21:12] So anyway, I made it. But um I am I have

[21:15] a 47 year old brother with significant

[21:17] disabilities. Um he lives in a group

[21:19] home in Northwest Indiana, Opportunity

[21:21] Enterprises, the Sheffield House. Um my

[21:24] parents live up there. They're 80 and

[21:26] 82. Um and so just kind of three boys, a

[21:30] 21 year 21 year old and two 18 year olds

[21:32] are getting ready to graduate and a

[21:34] husband English he's an English teacher.

[21:36] I've been a special education teacher

[21:37] and social worker my whole life. So that

[21:40] » Thank you. Yeah. No, great. Thank you.

[21:42] not to put you on the spot right when

[21:43] you

[21:45] » Um Okay, we're going to move right along

[21:47] here to um Holly who will be presenting

[21:52] most of the rest of the agenda. Um

[21:54] follow along. We'll probably take a

[21:55] break. Um just as you guys know, three

[21:57] hours I need a break. Most of us

[21:59] probably do. So, um I will turn it over

[22:01] to Holly and try to follow her lead with

[22:03] her slides.

[22:07] » Thank you. Um Jess,

[22:10] » Are you guys hearing in the back? Okay.

[22:12] Okay. Because I can't tell if it's

[22:13] working or not.

[22:14] » I think it is. I think it is because

[22:16] Lexi could hear us earlier. So,

[22:18] » Doesn't feel like it's

[22:19] » Yeah,

[22:25] » Okay. Okay. I'll have them check.

[22:27] » All right. Um well, hello everyone. Uh

[22:30] good to see everybody. Um hope everybody

[22:33] made it through the rain.

[22:35] » Yes, that's good because it was raining

[22:37] quite a bit on my drive-in this morning.

[22:39] So I want to start with an update on

[22:42] case management. Um as we have discussed

[22:46] um we have waiver amendments at CMS

[22:49] right now to move to the selective

[22:51] contracting model for case management

[22:53] for the beads administered waiverss. Um

[22:57] the slide here is slightly inaccurate.

[22:59] It says preliminary awards but yesterday

[23:01] the final awards were uh notice was

[23:04] posted. So um but we had already sent

[23:06] these out. So, um, just wanted to call

[23:10] that out. Um, the, uh, final awards, uh,

[23:14] were to IPMG, Aging and Inhome Services,

[23:18] Unity, Inspire, and Columbus. Um, again,

[23:23] those are the entities that had the

[23:24] preliminary awards, and the final award

[23:26] notice went out yesterday.

[23:29] Um,

[23:32] » Does that mean, sorry to interrupt,

[23:34] you're fine.

[23:34] » Does that mean that like Those

[23:38] are the case managements

[23:41] for everyone now or is there others?

[23:43] » No, that's a great question. We're going

[23:45] to talk some through that. That means

[23:47] that as of August 1st, individuals, the

[23:51] only entities that can provide case

[23:54] management on the family support, CI,

[23:56] health and wellness, and TBI waiverss

[23:58] are one of these five.

[24:00] » I already have inspired so I'm good.

[24:01] » Okay. All right. Very good. Um but we'll

[24:04] talk through kind of that process

[24:06] because I think that's that's important.

[24:08] So um so we are moving from um slightly

[24:13] over

[24:14] uh 30 case management entities today um

[24:19] to five. So I wanted to just spend a few

[24:22] minutes um and that's meant to be

[24:24] demonstrated there with the uh the

[24:26] graphic you see. So while we are seeing

[24:28] a decrease or will see a decrease in the

[24:31] number of case management entities, we

[24:34] anticipate we will see an increase in

[24:36] the number of case managers. Um and um

[24:39] when we went to selective contracting

[24:42] before on the FS and CI um what we saw

[24:46] largely were case managers continued in

[24:48] the field. Um I think you all have heard

[24:50] me say before that was the funnest job I

[24:52] ever had.

[24:54] Kathy, don't listen. Um but um case

[24:58] management was yeah fun job. But anyway

[25:01] um it also has uh case management has a

[25:03] lot of individuals in that work that

[25:06] have a heart for what we do. Um so we

[25:09] anticipate a lot of the case managers

[25:11] the bulk of them um will continue to

[25:13] provide case management services. We do

[25:16] expect as I mentioned an increase in the

[25:18] number of case managers um as we move to

[25:21] the selective contracting because of the

[25:22] case load

[25:24] uh parameters involved in the contract

[25:27] um which is 47 no more than 47 across

[25:31] all CA an average of 47 across all case

[25:33] manage full-time case managers. So, um,

[25:38] we know that we have some, um, case

[25:41] managers currently supporting

[25:43] individuals on the health and wellness

[25:44] and traumatic brain injury waiverss that

[25:47] have pretty pretty significant case

[25:49] loads above that. So, um, that's why we

[25:52] believe we will see an increase in in

[25:54] the number of case managers.

[25:57] So, um, these five case management

[25:59] entities are um, actively recruiting. Um

[26:04] so uh if you follow any of them on

[26:06] Facebook you you will see that um so

[26:09] they are gearing up um for the um the

[26:14] change.

[26:16] So as uh Ty pointed out um everyone

[26:21] currently supported on our waiverss will

[26:23] need to choose one of these five

[26:25] entities if they have not already. Um

[26:29] and all five are going to provide case

[26:32] management statewide

[26:34] as well. If we can move to the next

[26:37] slide, please.

[26:41] So, one of the things that um we have

[26:44] already done is send a letter to

[26:46] everyone supported through those four

[26:49] home and community based service

[26:51] waiverss um making them aware of um this

[26:56] change in model coming forward and the

[26:59] uh

[27:01] case management entities that will be

[27:03] providing case management um as of

[27:06] August 1st.

[27:08] those letters um went to everyone even

[27:11] if they had a case management entity

[27:14] that currently that is one of those five

[27:17] because we again wanted to ensure

[27:19] awareness. We have also been um working

[27:22] with the existing case management

[27:24] entities um and have provided them with

[27:27] toolkits that are on our website um to

[27:30] support their conversations with

[27:33] individuals that they work with and

[27:35] their families about this transition and

[27:39] what this looks like and what decisions

[27:41] they may need to make um depending on

[27:44] their situation and what their options

[27:46] are. um that is tied to the case

[27:50] management uh monthly reimbursement for

[27:53] those current case management entities

[27:55] right now. So they have to do those

[27:57] things in order to be able to bill. Um

[28:00] and we have gotten some um positive

[28:04] feedback about how that's going. Um and

[28:08] um

[28:10] we know that some case managers are

[28:12] texting

[28:14] families with all the things we've asked

[28:17] them to to cover. Um even if for example

[28:21] if someone has um IPMG today um IPMG is

[28:29] still required to reach out to them and

[28:30] make sure they're aware of this. make

[28:32] sure they know that as of August 1st

[28:34] these are the providing entities and you

[28:38] can stay with IPMG or I can offer you

[28:41] choice of another. So, everyone, all the

[28:45] case managers are handling this in the

[28:47] same way. And we are seeing phone calls

[28:50] being made, text messages. Um, and I was

[28:53] smiling at Carrie because she was a

[28:55] recipient of one of those text messages

[28:58] um from one of her current case managers

[29:00] and um um she shared that and it was it

[29:05] was spot on. They case manager did

[29:07] exactly what we needed them to do. So,

[29:10] um, so as of now, case managers are

[29:14] talking with individuals, um, and

[29:17] offering making sure there's awareness

[29:20] and families can start choosing now what

[29:22] case management organization they want

[29:24] to go with. I do want to note that um,

[29:28] the choice list for case management with

[29:31] those five entities working across all

[29:33] the four waiverss um, will be updated

[29:36] for June 1st. So, a family may say, "I

[29:39] want provider A." Um, and the choice

[29:43] list may not be updated yet if they're

[29:44] on the family support waiver for

[29:46] provider A. So, that case manager will

[29:49] follow up with them to get them that

[29:51] choice list um come June 1st and then

[29:53] we'll move it we'll we'll move that

[29:56] situation forward.

[29:58] » Hey, Holly.

[29:58] » Yes.

[29:59] » Lexi, is your do you want to ask your

[30:01] question now? Is it really does it

[30:03] pertinent to this? Um, I'd like to ask

[30:05] you before we get too far. Um,

[30:08] » Okay. Go ahead. Go ahead.

[30:10] » So, you went over the waiverss that will

[30:14] be under these new um that will have

[30:17] these new five well not new but like the

[30:20] updated 5CMOs. Um, my question is when

[30:24] you look at the DDRS or the Ark of

[30:29] Indiana or any of those websites that

[30:31] lists like the information about it, it

[30:35] talks about um also pathways fee for

[30:39] service and money follows the person. um

[30:42] not to confuse anybody but from what I

[30:46] understood especially with pathways is

[30:48] that they weren't like case management

[30:51] uh CMOs weren't involved it was like

[30:54] through the MCE but from what I

[30:56] understand fee for service means like

[30:58] traditional Medicaid but I thought all

[31:00] pathways recipients were under an MCE

[31:03] sorry that was a lot but

[31:05] » No Lexi no that's a great question and

[31:08] you are correct um this does case

[31:11] management also does um impact the money

[31:15] follows the person. Um it also does

[31:18] include a very small number of

[31:21] individuals in pathways fee for service

[31:24] and it's a really really small number

[31:26] but those those individuals um on

[31:30] pathways fee for service operate much

[31:34] more similarly to the uh individuals on

[31:37] the health and wellness waiver today as

[31:39] an example. they actually have a case

[31:41] manager. So, um that works with them

[31:44] because they're not managed care. So,

[31:47] again, very small number. People um meet

[31:51] very specific uh detailed situations

[31:54] that that can allow them to opt into the

[31:57] managed care for pathways, but it's it's

[32:00] again it's a very small number, but this

[32:02] does impact them as well.

[32:06] » Great question.

[32:07] » Thank you.

[32:08] » Thank you.

[32:10] So, um, we are also, um, hosting meet

[32:14] and greets both in person and virtual.

[32:16] We had our first one last night in

[32:18] Evansville. Uh, we had 26 different

[32:21] families show up to that, which I think

[32:23] was really good for the first

[32:25] » That's awesome.

[32:26] » For the first one. Um, we have a virtual

[32:29] one today. Um but um those are scheduled

[32:33] and have been announced and and are um

[32:37] have been published and we are getting

[32:40] um we are getting people to attend. So

[32:43] that is that is great and we do I want

[32:46] to shout out to um our partners uh our

[32:49] external partners for sharing those as

[32:52] well um and helping us get the word out

[32:54] um to individuals and families. So, um,

[32:58] and those meet and greets, if you have

[32:59] never been to one, I will just give a

[33:01] real brief description. Each of the CMOs

[33:05] has a table there. Um, and they are just

[33:08] there to answer questions um, and for

[33:11] individuals and families to have that

[33:13] opportunity to meet them and ask them,

[33:16] you know, some of the questions that

[33:17] they would ask a case manager um, when

[33:20] they were interviewing a case manager,

[33:22] for example. So, um, and they have some

[33:25] of their swag there, too. Um, but, uh,

[33:29] but yeah, they're they're uh it went

[33:31] very well last night and, um, we got

[33:34] some positive feedback from the families

[33:36] that that attended. So, um,

[33:39] » And the virtual tonight.

[33:40] » There is a virtual today. There's

[33:42] several virtuals. Um, but the first one

[33:44] is today. I believe it's at two o'clock,

[33:46] but

[33:47] » Just make sure you're um, we put those

[33:50] out through our list serve, too. So, um

[33:53] hopefully everyone in this room is

[33:54] signed up for our list serve. Um but, uh

[33:57] make sure if you're not, you know, sh

[33:59] that's where a lot of this information I

[34:00] mean multiple ways is being shared, but

[34:02] » It's also

[34:04] » Um it's a so um I can put it in the

[34:07] chat. The uh DDRS for to get updates. I

[34:10] don't even know what it's called, a list

[34:11] serve. You can subscribe to it and then

[34:14] you get um emails with updates.

[34:17] » Yeah, I send you the link. You just need

[34:19] an email basically and it's and it's

[34:21] multiple updates. It's not just about

[34:22] beads, but um it's a good way. Yeah.

[34:25] Yeah. Yeah. And anyone can sign up. It

[34:28] doesn't have to you don't have to be in

[34:29] the way. I mean, it's just information.

[34:31] So, thank you.

[34:32] » Welcome.

[34:34] » And we are keeping um updated

[34:36] information on the waiver reset page

[34:38] that has all this information about case

[34:40] management as well. So, um, we do have

[34:44] to because case management is a required

[34:47] service for HCBS, we do have to ensure

[34:49] there's a case manager

[34:52] from one of those five entities on board

[34:54] with every single person August 1. So,

[34:58] if individuals and families have not

[35:00] made a choice by July 15th, we will auto

[35:03] assign them. Um, they will retain the

[35:06] ability to make a choice after August

[35:08] 1st, right? if they want to go with

[35:10] someone else, that's that is absolutely

[35:13] um fine, but we need to make sure that

[35:16] there's a case manager in place on

[35:17] August 1. So, if a choice hasn't been

[35:20] made by the 15th after, you know, our

[35:24] efforts, um we're sending additional

[35:26] letters out in May, we'll be making

[35:28] phone calls to people who do not make a

[35:30] choice. Um then we will auto assign.

[35:35] We are um monitoring on a weekly basis

[35:38] the movement um of individuals who need

[35:41] to make a change in case management um

[35:44] by July 15th. Um we are monitoring that

[35:47] on a weekly basis. Um as you can imagine

[35:50] right now there hasn't been a lot of

[35:52] movement. There's been a some

[35:53] individuals who have have made a choice

[35:55] already to um to change um but we still

[36:00] um the bulk have not. We anticipate

[36:03] we'll see a spike due one because those

[36:05] conversations are being had now.

[36:07] » Have caps.

[36:08] » I'm sorry.

[36:09] » Do any of the providers have caps? Like

[36:11] we can only take so many.

[36:12] » No.

[36:13] » Okay.

[36:13] » No, they in fact that is part of the

[36:15] contract. They have to be positioned to

[36:17] accept uh individuals. Yep.

[36:20] » On a statewide basis.

[36:23] » Yeah, good question.

[36:26] Next slide, please.

[36:31] So the other thing that we are

[36:33] introducing in this um contract uh for

[36:38] the case management is our value based

[36:41] payment or value based purchasing. Um

[36:44] what that essentially means is that

[36:46] we're um

[36:48] going to be paying for certain outcomes

[36:51] with case management. This is just I I

[36:54] want to reiterate this. This is just the

[36:56] beginning. It's pretty basic as you can

[36:58] tell. It's um pretty complianceoriented

[37:02] at this point on um timely completion of

[37:05] the PCISPs and the level of care um

[37:10] completion or timely completion on

[37:12] incident reporting and responding to

[37:14] CAPS. um that uh for followup, mortality

[37:19] review, case load size um and then

[37:22] trainings for case managers outside of

[37:26] state state trainings included with

[37:27] that. So again, this is a start u for

[37:30] the first uh contract year. Um but we

[37:34] will be growing that uh element in case

[37:38] management as we move forward.

[37:40] » Yes. So m maybe this can go on the

[37:42] parking lot um and be addressed at an

[37:45] future meeting. I would love to see what

[37:48] those value uh services, value added

[37:51] services are and what your expectations

[37:54] are for those quality indicators just as

[37:57] part of that advisory piece so we have a

[38:00] good idea of what to look for.

[38:01] » Sure.

[38:02] » Especially when our our constituents are

[38:05] calling us and asking questions.

[38:08] » No, that's great. question.

[38:11] » Yes.

[38:11] » So,

[38:13] you guys know I I'm Ty Clark, but I have

[38:16] a disability, but

[38:19] I have struggled with case management

[38:21] issues

[38:23] for the past

[38:25] seven years, I think. I don't know how

[38:28] long, but I have a new case manager.

[38:31] She's sweet. But what I struggle with is

[38:34] when a case manager takes my case and

[38:39] then it becomes too stressful or

[38:42] whatever,

[38:44] they drop me and then I have to have

[38:47] someone fill in. So that's frustrating.

[38:50] So does this mean like they need to

[38:56] what would happen if they keep doing

[38:58] that?

[39:00] » Yeah, I think that's a good question. we

[39:01] can kind of talk about specifics. Um,

[39:04] but you know, ultimately, um, when

[39:07] individuals or families receiving case

[39:09] management services have concerns,

[39:11] similar concerns, what we want them to

[39:14] do is reach out to us and we will work

[39:15] with them on an individual basis.

[39:18] » Sounds good to resolve.

[39:19] » I I met my new case manager at my last

[39:22] quarterly meeting. Um, I had to do the

[39:28] waiver reset stuff. So, the questions

[39:31] were very personal and I kind of like

[39:34] didn't like them because my mom used to

[39:37] do them, but I have to sit in that. And

[39:41] Darlene and I were playing with my

[39:43] Neidato and it helped me calm down, but

[39:47] I was like very emotional and frustrated

[39:51] because

[39:54] of the questions they had to ask. I

[39:56] didn't really like them cuz they were

[39:59] too they were like

[40:03] personal too personal and I felt like

[40:09] I yes I struggle with things on a daily

[40:12] basis like depression and anxiety

[40:16] and mental health but it's like

[40:20] I don't think every time they need to

[40:23] ask that cuz that

[40:25] makes me feel a certain way and I feel

[40:30] like it's it puts me it sets me back

[40:34] basically.

[40:35] » Okay,

[40:37] » Thanks for sharing that. I think I know

[40:39] what you're referencing.

[40:41] » Thanks.

[40:43] » It is good feedback. Um

[40:46] so with regard to the uh value based

[40:49] purchasing or value based payment um

[40:52] like I mentioned there these are and to

[40:54] your point Kate these are very much

[40:57] compliance as we move forward um with

[41:03] this model of case management across all

[41:05] our waiverss. We will be looking at how

[41:07] to infuse more quality measures over and

[41:10] above just mere compliance. Right? So,

[41:14] um, did want to note that. All right,

[41:17] next slide.

[41:19] » Can I ask one more question? U, just as

[41:22] a recommendation, when it comes to those

[41:24] valuebased uh, payments and those value

[41:26] based services, how is the department or

[41:30] the division planning on um,

[41:33] communicating those to our community

[41:36] members who are receiving services? So

[41:39] there's a broad understanding of what

[41:42] value based services means

[41:45] » Because I think that could mean a lot of

[41:46] things to different people.

[41:48] » It can it boils down to the metrics that

[41:50] are that are being used to incentivize,

[41:54] » Right? So yes, and this is again sharing

[41:58] that we don't have I mean we have some

[42:01] of this data but starting fresh August

[42:03] first when we're talking about sorry

[42:06] when we're talking about a much larger

[42:09] um pool of individuals with varying

[42:12] needs um the data may look a little

[42:14] different than it does today. So we will

[42:16] be sharing that that information with

[42:18] this committee

[42:19] » Just how that it it is

[42:22] » Good these like you said are compliance

[42:25] focus and I get it and I think I'm not

[42:27] suggesting that these don't have a

[42:30] I don't want that problem

[42:32] » Sure

[42:32] » But it's it's a bit different this is

[42:34] about pushing providers to to be very

[42:37] and I think that's a really good thing

[42:39] » It's a good opportunity though to test

[42:42] some internal processes

[42:45] um how do you communicate this out to

[42:47] individual people receiving services

[42:50] » Because if this is step one where I

[42:53] would imagine some of these value based

[42:55] will be much more about individual

[42:57] potenti I'm assuming individual outcomes

[43:00] um that's going to affect them much more

[43:03] acutely than you know u training of case

[43:06] managers and I I realize that that

[43:08] affects but it's just it the

[43:10] responsibility the impact is felt far

[43:12] more so this might provide a good kind

[43:14] of a low entry way to how do we

[43:17] communicate this and get this message

[43:18] out because two or later on to a value

[43:23] base that's really about needing a

[43:25] service

[43:26] » Right

[43:26] » I'm already in the house so just just a

[43:29] thought

[43:30] » No I no I appreciate that Derek and I

[43:32] think we are completely aligned on that

[43:34] right this is our first kind of foray

[43:36] into it it's very basic it's very

[43:38] compliance driven but

[43:42] we will grow that right like we have to

[43:44] grow our system to be able to to really

[43:47] look at what quality measures are

[43:49] important, true quality, and how do we

[43:52] measure those and then how do we

[43:54] incentivize providers, case managers or

[43:56] whomever, right? To

[44:00] um to provide high quality services that

[44:03] results in the outcomes that people are

[44:05] needing.

[44:05] » Yeah.

[44:06] » Right. Yeah. I feel like this is

[44:09] something we'll be talking about more um

[44:12] because we have um identified as part of

[44:15] waiver reset that we really want

[44:18] » To be more focused on the outcomes of

[44:21] services and supports for people. What's

[44:23] really meaningful? Are people getting

[44:25] something meaningful from our services?

[44:27] And what what does that look like? And

[44:31] how do we how do we you know pat those

[44:34] providers on the back that are doing

[44:36] that, right? that are resulting in the

[44:38] outcomes. Yeah. Yep.

[44:42] » Yes.

[44:43] » Do you need to like literally go like

[44:45] this? I mean, how close do like how

[44:47] close? Okay. So, dearly, you guys

[44:49] literally have to be up on this cuz it's

[44:52] not I don't know. People are texting and

[44:55] messaging me that they're not hearing

[44:57] you guys. I don't know. They're telling

[44:59] me it's working. So, I mean, I would

[45:00] just get up into the microphone. They're

[45:03] hearing you, but I don't know. So, um,

[45:06] but yeah, I would just talk as direct as

[45:08] you can into it. I know it's kind of

[45:10] annoying. Um, but just not as productive

[45:13] because I think it's multiple people are

[45:14] messaging me that they can't hear. So,

[45:16] trying to fix it.

[45:18] » So, be very love the microphone today.

[45:21] Okay.

[45:24] » Love it.

[45:27] » Hopefully no one's sick of that.

[45:30] » What you do? What' you say?

[45:32] » Yeah. Love that microphone.

[45:35] » I mean, I have a loud voice, so I don't

[45:36] have that problem.

[45:37] » Yeah.

[45:37] » Okay.

[45:37] » All right. Let's go ahead and move the

[45:39] next slide, please.

[45:41] » All right. Um, want to spend some time

[45:45] around level of care in our uh

[45:47] assessment tools, but want to start with

[45:51] just some level setting on level of care

[45:54] requirements for ICF, right? Um, this is

[45:58] not new. This is in federal code. um we

[46:03] address it. We define developmental

[46:05] disability in Indiana code um but wanted

[46:09] to review it um because and again stress

[46:11] that has not changed. We have not

[46:13] changed the eligibility requirement. So

[46:16] that is an intellectual developmental

[46:18] disability um or related condition that

[46:22] manifests before the age of 22

[46:25] that is likely to continue indefinitely

[46:28] um and then results in and this is key

[46:31] here substantial functional limitations

[46:33] in three of six major life areas that's

[46:36] mobility um self-care understanding and

[46:39] use of language learning self-direction

[46:42] and capacity for independent living. So

[46:45] again, that has not changed. Um, but

[46:48] wanted to include that here. Um, because

[46:50] I do think sometimes there is um some

[46:54] confusion around if a person has a

[46:58] developmental disability,

[47:01] they meet level of care. And that's not

[47:04] that's not accurate. There has to be

[47:06] » It's not completely true because

[47:08] everyone

[47:09] has different levels.

[47:11] » That's true. That's true. Right. And

[47:13] it's really about functional need,

[47:15] » Right?

[47:16] » Yep. Good point. All right, next slide.

[47:20] No, you're fine. You're fine. Just use

[47:22] the microphone. Okay,

[47:24] » I will.

[47:25] » Love it. Love it.

[47:27] » Love it. Goodness.

[47:31] » Um, so I did want to provide an update,

[47:34] a bit of an update. So um we have of

[47:38] course implemented new tools to assess

[47:40] individuals for ICF level of care from

[47:43] the enter suite of instruments which is

[47:46] also used for assessing nursing facility

[47:49] level of care different tools in that

[47:52] suite of instruments but but tools um

[47:55] all from the same suite um and all from

[47:59] interi

[48:00] right now we are using those tools it's

[48:04] the um interi DD for adults, the interi

[48:11] chime DD for youth for and 4 to 17 and

[48:16] then the inry early years um for 0 to

[48:20] three or through three. Right now we use

[48:24] those tools for eligibility reasons,

[48:28] right? But future state they will be

[48:31] used um in support of the design of the

[48:34] support level framework. So um way way

[48:38] back way back to waiver redesign uh one

[48:42] of the things that we've heard very

[48:44] consistently from individuals and

[48:46] families is around the you know multiple

[48:48] assessments right um

[48:52] every time they turned around they felt

[48:55] like they were having yet another

[48:56] assessment. Maybe it was for

[48:57] eligibility, maybe it was for level of

[48:59] service, maybe it was for

[49:02] allocation, all kinds of different

[49:04] reasons. So, um, one of our goals was,

[49:08] um, to reduce the number of assessments

[49:09] that people have to quite frankly

[49:12] endure. Um, we can't we have to reassess

[49:15] level of care every year, but it's once

[49:18] a year. So,

[49:20] um, so these are the um, currently used

[49:23] for eligibility will be used in design

[49:24] of the support level framework. We'll

[49:26] talk a little bit more about that today.

[49:29] Um, I do want to note the ICF ID level

[49:33] of care assessments you utilization of

[49:35] those three tools I mentioned must be

[49:38] done in person.

[49:41] That is how assessors have been trained.

[49:43] Um, that is the expectation that they

[49:46] are done in person engaging with the

[49:48] individual.

[49:50] Um it is possible that uh

[49:56] the assessor who has been trained. Um

[50:01] there may be gaps if they're meeting

[50:03] with the individual and in or things

[50:05] that they want or need to verify and

[50:08] they may reach out to, you know, a

[50:10] direct support staff perhaps that knows

[50:12] the person or a family member that knows

[50:15] the person. Um, but that individual

[50:19] needs to be engaged and I think that's

[50:20] what you were referencing a moment ago

[50:22] is that you you sat and answered a lot

[50:25] of questions, right?

[50:26] » Yeah, it was with my team, too. So, like

[50:29] I I prefer to do it on my quarterly

[50:31] meeting because then they get to

[50:34] understand everything that I do,

[50:37] » But it I didn't like it.

[50:39] » Yeah. So um to your point there are

[50:42] these are very comprehensive tools and

[50:44] they are used um every question is not

[50:47] related to eligibility. Right. Right.

[50:51] » But they are related to the individual's

[50:53] needs and can support the team taking a

[50:56] more holistic approach about what are

[50:58] what what does Holly really need? Um and

[51:02] how can we connect her whether it's

[51:05] » Sister?

[51:06] » Yeah. whether it's waiver services or

[51:08] something different like

[51:11] um energy assistance,

[51:13] » Right,

[51:14] » Or repair affair for some home repairs

[51:17] that need to occur. So um so they're

[51:19] very comprehensive. Um they really

[51:21] should be administered more as a

[51:23] conversation than just a a whole list of

[51:26] questions. Um so we continue to work

[51:29] with assessors on um best practice um

[51:33] with those assessments. But to your

[51:36] point, individuals can choose to have

[51:38] other people present during the

[51:41] assessment, but it is not required. So

[51:44] sometimes those personal questions

[51:47] may feel a little easier to answer if

[51:50] it's just the assessor and

[51:52] » Definitely with like other people

[51:54] surrounded me, it made me feel better.

[51:58] But like my mom's my legal guardian and

[52:01] so

[52:03] I prefer to have her there too

[52:05] sometimes. It's just we all feel about

[52:10] our moms.

[52:11] » We but heads but it's like I love her

[52:14] but it's just what it is.

[52:20] » Kind of bouncing off um what Ty was

[52:23] talking about. Um, so

[52:27] I'm hearing you say if there's like gaps

[52:30] that a DSP or a family member might be

[52:34] reached out to. Um,

[52:37] excuse me, my throat got scratchy. I

[52:39] just want to um like make sure that when

[52:44] those conversations are being had with

[52:45] the family member of the DSP that if the

[52:48] individual wants to be included, they

[52:51] should definitely be asked first if they

[52:53] want to be included because they don't

[52:55] feel like things like that should be

[52:57] talked about without the individual just

[53:00] in case the individual kind of disagrees

[53:02] with what

[53:03] » The DSP or family members view is. They

[53:05] don't want inaccuracies

[53:08] um from because we our lived experience

[53:10] we know ourselves best right so yeah

[53:13] » You are absolutely right Lexi absolutely

[53:16] and those

[53:17] » Assessors whether that's a beads staff

[53:20] or a case manager should um would always

[53:24] be expected to make sure that's okay

[53:26] with the individual that they talk with

[53:28] someone else about them right or that

[53:31] they're actually engaged in that

[53:33] conversation. Absolutely.

[53:36] » Mine was with my case manager. So,

[53:38] » Yes.

[53:39] » Yeah, there's there's a reason um we uh

[53:43] have continued for uh with case managers

[53:46] doing those level of care assessments

[53:48] um for ICFID and and a lot of that is

[53:51] because those case managers know the

[53:53] individual, right? Um and um

[53:59] the expectation would be that there's

[54:00] some if something doesn't kind of ring

[54:03] true in that assessment that that case

[54:05] manager would be like, "Oh, I might we

[54:07] need to delve into that a little bit

[54:09] more in this conversation to make sure

[54:11] we're getting accurate accurately

[54:13] capturing things."

[54:14] » Can I just go on?

[54:17] » Okay. Um and apparently I was the

[54:20] problem here with the speaker with the

[54:21] microphone. Sorry everyone. Um

[54:24] this tool is being used for eligibility.

[54:28] It its intention is also to be used and

[54:30] maybe it already is um for the the kind

[54:33] of level of care as well. So I I I'm

[54:36] looking at these somewhat separately but

[54:37] I there and I realize they overlap. Is

[54:39] that help? Correct me because I'm

[54:41] looking at you right now and you're

[54:42] » So apparently you're it's better. So

[54:44] you're

[54:46] » Good job loving the microphone

[54:47] » Because I was pushing I was turning it

[54:48] off. Sorry.

[54:50] » Good job. Sorry, it says push. I pushed

[54:53] the button.

[54:54] » I did that one time, too, and then I'm

[54:56] like, "Oh, great. You don't push

[54:58] » This." It was really you.

[54:59] » It was I was the problem.

[55:01] » So,

[55:02] » All Derek's fault.

[55:04] » And I'm going to try to answer that, but

[55:06] I may not. Let me know if I don't answer

[55:08] your question. When I talk about

[55:10] eligibility and level of care, I'm kind

[55:12] of lumping those together. Okay? Right.

[55:14] level of care is the requirement that

[55:17] has to be met or the threshold that has

[55:19] to be met to be eligible for home and

[55:21] community based services.

[55:22] » Uh so elgo level how about that? Oh so

[55:26] so I'm sorry. So so at this point this

[55:29] isn't being folded into that but the

[55:32] intention the intention is to go that

[55:34] direction. So, so that that's one thing

[55:37] I wanted just to get out there and make

[55:38] sure I was So, then I think my my

[55:41] question is really about what we were

[55:42] just kind of talking about and and I

[55:45] think it the concerns that was expressed

[55:48] about these are very private questions.

[55:51] Um, and then the involvement of family

[55:54] members or just the individual

[55:56] themselves, they have they should have

[55:57] the right people should have the right

[55:59] to just be them answering the questions.

[56:01] I I so I'm going to just um share a

[56:04] concern that was brought to me yesterday

[56:05] by a family member and it was really a

[56:07] question about you know a person's their

[56:09] own guardian and they didn't want any

[56:11] family there. that's they're right and I

[56:12] I point that um but their concern was

[56:17] was the anere were the answers correct

[56:19] right or were they accurate and and I

[56:21] think some of the social potential

[56:23] social

[56:26] I think it's very common for anybody in

[56:29] being asked very private questions to

[56:31] not if be it in a doctor's office and

[56:33] I'm sure some of these processes to

[56:36] maybe not be truthful because of the

[56:38] some of the social pressures related to

[56:39] that and talking to a stranger so it's

[56:41] totally totally makes sense depending on

[56:42] how intimate those questions are. But so

[56:45] I just wonder how that's being how that

[56:48] affects the elbow level if somebody's

[56:50] really not comfortable answering that

[56:51] question. So maybe they'll answer it in

[56:53] a more socially acceptable way. Um and

[56:56] what's the consequence of that and is

[56:58] this something that we need to help

[56:59] people truly understand if there is a

[57:02] potential consequence with and the

[57:04] consequence being an elgo level that

[57:06] maybe doesn't represent their need is

[57:08] really you know maybe it's at a

[57:09] different level. So, I don't know if we

[57:11] have to we don't have to solve this.

[57:12] Maybe this is on um on a parking lot

[57:15] issue, but I think it's one of those big

[57:17] topics that's worth us kind of

[57:19] struggling with because it's going to as

[57:21] that becomes a greater um uh gateway to

[57:25] the levels of support or the types of

[57:27] supports that you're able to access. We

[57:30] need to make sure that's as accurate as

[57:31] possible and that people are comfortable

[57:33] sharing that their private information.

[57:36] » Um it that's uncomfortable at times. So

[57:39] anyway, that's all

[57:41] » I I think what I'll add and um just to

[57:46] step back a little bit is

[57:49] that

[57:51] prior to the utilization of this suite

[57:55] of assessments, the level of care

[57:58] conversation was a very basic level of

[58:01] care conversation merely to establish

[58:04] that minimum threshold for eligibility.

[58:07] We didn't get into a lot of these other

[58:10] conversations about what ultimately

[58:13] lends itself to the service planning

[58:15] piece. We're asking those questions now.

[58:17] And I think those are helpful for

[58:22] the team. I think it's also helpful for

[58:25] us as a system to to Holly's earlier

[58:28] point, minimize the number of encounters

[58:30] that people have to have those kinds of

[58:33] conversations with us. Um but I do think

[58:36] it's an adjustment for people who have

[58:38] been used to that annual um routine of

[58:42] the level of care conversation and the

[58:45] service planning being an entirely

[58:47] different conversation that we have.

[58:50] They're completely in our system today

[58:52] very separate processes. There's maybe

[58:55] some overlap. Um but it has to be to a

[58:59] certain extent

[59:01] previously very disjointed in the way in

[59:03] which those conversations unfolded. Now

[59:06] it does probably feel like now I'm

[59:10] unpacking everything all at once and

[59:13] that is certainly I think an adjustment

[59:14] for people. Um but hopefully as as the

[59:18] system

[59:20] evolves in this waiver reset space and

[59:22] people see how that information is being

[59:26] utilized um both from the eligibility

[59:28] standpoint but also to Holly's point in

[59:30] the service planning. We now don't have

[59:33] to come back to them and have another

[59:37] engagement around le the service

[59:39] planning unless there's a change unless

[59:41] something it looks different than it did

[59:43] before then yes. Um, so I do think this

[59:47] is a maybe a little bit of a culture

[59:49] shock or a shock to the system for

[59:51] people to be like, there's a lot of

[59:53] questions here. Um, and I and I do think

[59:56] that that's um

[59:59] the new norm. Um, I think for for lack

[1:00:02] of a better term, as people adjust to um

[1:00:06] the types of questions being asked, I

[1:00:09] think to your point, it's up to us to

[1:00:11] also educate people as to why there's

[1:00:14] value in engaging in that and being

[1:00:17] authentic and honest in in what's

[1:00:19] working, what's not working for the

[1:00:21] person. um so that we don't have to come

[1:00:24] back again or circle back on those areas

[1:00:26] where they felt I have to be socially

[1:00:28] acceptable in my response or I have to

[1:00:30] answer this because I really like my

[1:00:32] team and I don't you know I don't want

[1:00:34] to let them down so I better uh they've

[1:00:36] been helping me with this particular

[1:00:37] area so I better tell people I can do

[1:00:39] this now even though maybe I can't.

[1:00:41] Those types of things I think are things

[1:00:42] that we're um just going to have to be

[1:00:45] um supportive to our assessors in

[1:00:48] navigating and making sure that the

[1:00:51] information that we're we're gathering

[1:00:53] has um is valid and that we have other

[1:00:57] ways to either triangulate some

[1:00:59] information or tell us that what we're

[1:01:01] hearing is is accurate. But um certainly

[1:01:04] I think we're just we're in a bit of a

[1:01:07] growing space right now as far as how

[1:01:10] people are adjusting to how that

[1:01:13] assessment just looks and feels

[1:01:14] different than what we've been used to.

[1:01:16] » Well, and I think I think it's I think

[1:01:18] the culture changes. Yes, absolutely.

[1:01:20] And I think that's a big change and

[1:01:24] but the connectivity of these of this

[1:01:27] exercise with the not just eligibility

[1:01:29] but the algo level is essential and I

[1:01:32] think connecting it is I so this is such

[1:01:34] an important role and I I I I think it

[1:01:37] makes sense and I think it's a really

[1:01:39] important direction especially if the

[1:01:41] int as the intention is to be to

[1:01:44] actually get services that people need

[1:01:45] when they need it rather than saying and

[1:01:47] this is what you get because we ask you

[1:01:49] these these questions and sorry, I don't

[1:01:51] know if you need it or don't. So, I

[1:01:53] think I think that is spot on and I

[1:01:56] think this is part of that evolution and

[1:01:58] I think for all of us, I think the

[1:01:59] culture change we need to help folks

[1:02:01] » And I'm loving the microphone. Um it um

[1:02:05] I think also to keep in mind

[1:02:08] particularly the I mean for the

[1:02:11] intellectual developmental disability

[1:02:13] side

[1:02:15] what we've been doing is assessing for

[1:02:18] most people for that family support

[1:02:19] waiver which service planning is

[1:02:24] not absent from that but

[1:02:27] you get a certain amount of money and

[1:02:28] that's the allocation. And so the focus

[1:02:31] on gathering information to build out

[1:02:34] sort of the service array and supports

[1:02:35] that somebody would need um I don't

[1:02:38] think there's the right amount of

[1:02:39] attention being placed on it because of

[1:02:42] the way in which that waiver is been set

[1:02:44] up to serve as many people as we

[1:02:47] possibly can with what money we have and

[1:02:48] that's doesn't lend itself to good

[1:02:51] service planning discussion as part of

[1:02:54] that level of care. Right? So I I think

[1:02:56] that we'll get to a better space um for

[1:02:59] for those folks who maybe this is a

[1:03:01] feels very new because we're getting

[1:03:03] we're getting definitely into more of

[1:03:05] the nuts and bolts of their lives than

[1:03:07] we were previously.

[1:03:08] » Sorry. I think oh Tia I was gonna say

[1:03:11] one thing that struck me when you said

[1:03:13] it's not so much maybe I mean your

[1:03:17] experience of what you were asked which

[1:03:18] I'm not but maybe better preparing you

[1:03:21] right like I think that's what I heard

[1:03:23] too is I think may and I'm not saying it

[1:03:25] wouldn't have made you uncomfortable I

[1:03:26] don't mean to say that but I think

[1:03:27] sounds like you weren't prepared

[1:03:29] necessarily to know so I think going in

[1:03:33] maybe that's just something we're and I

[1:03:34] think you should have been I'm not but I

[1:03:36] think it should because if you were I

[1:03:37] think maybe you wouldn't have been I'm

[1:03:38] not saying you wouldn't have been

[1:03:39] uncomfortable I'm just saying this is my

[1:03:41] first assessment I ever sat in on. And

[1:03:44] that's the thing like my mom would use

[1:03:48] » It. Still if you were better prepared,

[1:03:49] you know what I mean? To have a

[1:03:50] conversation. Hey, this is because I

[1:03:52] think then you would have maybe know

[1:03:54] known more of hey I don't want this

[1:03:55] person here or not. So I think it just

[1:03:56] that's what I hear too is I think you it

[1:03:59] would have helped to make sure you know

[1:04:00] we want to make sure people are

[1:04:02] supported and knowing what's going to

[1:04:03] happen. I guess

[1:04:04] » Greatly supported. It's just I didn't

[1:04:07] like the questions. It made me feel

[1:04:09] really uncomfortable.

[1:04:11] » Okay.

[1:04:11] » And and I just

[1:04:13] » Yeah, that's fair.

[1:04:14] » I just felt like they were prying into

[1:04:17] my daily life, which they need to know

[1:04:20] how I feel and stuff, but like one

[1:04:23] question was like, "How's your

[1:04:25] relationship with your family?" I said,

[1:04:27] "It's poorly because one, me and my mom

[1:04:29] don't get always get along and I

[1:04:32] struggle with that like

[1:04:35] She nitpicks and then like I snap or get

[1:04:39] an attitude and

[1:04:40] » But I think maybe knowing

[1:04:42] » I go to zero and 100 and I'm like wait I

[1:04:46] shouldn't have done that but I

[1:04:47] apologize.

[1:04:47] » Yeah. Yeah. But maybe under helping you

[1:04:49] understand why those are being asked

[1:04:51] because I think because sometimes I

[1:04:52] think if we're just going and I'm not

[1:04:53] saying this is what happened but if I

[1:04:54] just go in and I start with a list like

[1:04:56] Holly said it shouldn't be hey Ty do you

[1:04:59] know do you like your family? I'm not

[1:05:00] saying that's what happened, but I think

[1:05:01] to know why we're asking it because I

[1:05:04] think if if you don't and I'm not I

[1:05:06] think if I was me too and someone just

[1:05:07] started asking me questions, I'd be

[1:05:08] like, "What the heck? Why?" But I think

[1:05:10] to know why you're being asked that it's

[1:05:12] not here's why. And I think that's

[1:05:15] probably not always happening.

[1:05:16] » Yeah, I would like that because honestly

[1:05:18] then I'd be okay like answering, but

[1:05:22] still it's going to be a struggle for me

[1:05:23] to do.

[1:05:24] » I'm not saying it's not going to be

[1:05:25] uncomfortable, but it might better give

[1:05:26] you a sense of why it's being asked,

[1:05:28] » Right?

[1:05:31] Sorry.

[1:05:31] » Yeah.

[1:05:32] » Yeah.

[1:05:32] » Uh I think she had a question over

[1:05:34] there.

[1:05:34] » Thank you so much.

[1:05:36] » You're welcome.

[1:05:36] » We have to finish.

[1:05:38] » You know, I'm not ignoring you, right? I

[1:05:40] just need to finish.

[1:05:41] » I know.

[1:05:42] » So, and

[1:05:45] » It's just to Jessica's point was all I

[1:05:46] will be I will be so brief if if that's

[1:05:48] okay. And then you can move to wherever.

[1:05:51] » Um I'm I'm gonna go ahead. I'm sorry. Go

[1:05:53] ahead. Um, so I think this points to a

[1:05:56] couple of things that we see at the

[1:05:58] council. One is that advanced

[1:06:00] preparation and is really a support tool

[1:06:03] for people with ID, but also as a

[1:06:06] sibling who has and a parent who's

[1:06:08] navigating this system.

[1:06:10] » I've seen the communications that come

[1:06:13] and they are very thorough,

[1:06:16] » But also it's not necessarily plain

[1:06:19] language and it's definitely not easy

[1:06:22] read. And so maybe uh one recommendation

[1:06:27] is to work with a group of self-

[1:06:29] advocates um who can help put materials

[1:06:33] into plain language and easy read using

[1:06:37] images. Um you know that's I think

[1:06:40] that's going to help a lot of people

[1:06:42] better understand and prepare for what

[1:06:45] is in that tool. And also I would if

[1:06:49] it's possible maybe a peer-to-peer

[1:06:52] training or if if people are more

[1:06:56] comfortable answering those types of

[1:06:58] very personal questions uh with a peer

[1:07:01] rather than their I mean if there's a a

[1:07:05] poor relationship with the case manager

[1:07:08] or any other team members

[1:07:10] » Then I can see how any any way you

[1:07:14] deploy that

[1:07:15] » Tool is not going to be well received.

[1:07:18] So, if there's a way to have a peer

[1:07:21] relationship that helps somebody prepare

[1:07:23] to answer those regardless of the

[1:07:26] relationship with the case manager, um

[1:07:29] that might be another tool, another

[1:07:32] approach to supporting people.

[1:07:34] » Um I know you probably can't have a peer

[1:07:38] conduct or deploy that instrument with

[1:07:41] that person.

[1:07:42] » It has to be the case manager. Um, but I

[1:07:45] think letting individuals know what

[1:07:47] their rights are if they want a friend

[1:07:49] with them when they're answering. I

[1:07:51] think that's a very reasonable thing to

[1:07:55] communicate to people.

[1:07:56] » And then they can also help communicate

[1:08:00] with seeing how they're doing too, you

[1:08:04] know, like maybe they are struggling.

[1:08:06] And like I struggle every day, but like

[1:08:08] I it's just it's hard to answer those

[1:08:12] questions

[1:08:14] personally when I just answered them

[1:08:18] like truthfully. Like you do have to

[1:08:21] answer them truthfully cuz like if you

[1:08:24] don't then it butts you bites you in the

[1:08:26] ass at the end. But

[1:08:29] I mean I I just it's just whatever. Um

[1:08:34] to your point who spoke whoever spoke

[1:08:36] before Tilly um

[1:08:38] » And now I can't remember oh uh not to

[1:08:41] speak for the whole SAI board but I

[1:08:43] think like the peer-to-peer or creating

[1:08:46] documents in plain language is something

[1:08:49] that um you who um somebody could

[1:08:53] approach self- advocates of Indiana on

[1:08:56] as a board um because you know that's

[1:09:01] something you know We we do and

[1:09:05] typically and we're not to not to brag

[1:09:08] but we're pretty good at it. So we're

[1:09:10] you know not to speak for the whole

[1:09:12] board SAI board but I think typically

[1:09:15] we'd be willing to help with things like

[1:09:17] that to an extent. So

[1:09:19] » Okay go ahead.

[1:09:20] » Thanks. Um I agree the preparation is is

[1:09:25] really huge um because some individuals

[1:09:28] are having assessments for different

[1:09:29] systems. Um, just an example, I we

[1:09:32] getting my son reevaluated at school and

[1:09:34] we were sent I was sent an email from

[1:09:36] the school psychologist who I had never

[1:09:38] talked to and she said, "Please complete

[1:09:39] this eval this evaluation, whatever."

[1:09:42] And it was almost 200 questions that I

[1:09:45] was really emotional answering at the

[1:09:47] end because I was not prepared to answer

[1:09:49] 200 questions about his deficits at that

[1:09:51] moment. And so I think the preparation

[1:09:53] is key and I I'm encouraged that case

[1:09:56] managers are being told to do these

[1:09:59] things conversationally because I think

[1:10:00] that's different and having a

[1:10:02] conversation where it is tough to still

[1:10:04] answer those questions but I'm not faced

[1:10:06] with

[1:10:06] » 200 questions of the same thing over and

[1:10:09] over. So I think that that preparation

[1:10:12] will be helpful. And again, and I think

[1:10:14] we've talked about this in other

[1:10:15] meetings for different things, like

[1:10:16] setting the expectation of knowing what

[1:10:18] they're walking into when they're doing

[1:10:19] it because for that school evaluation,

[1:10:22] that wasn't it. Um, and it's different.

[1:10:25] You know, my art case manager has said,

[1:10:26] you know, his evaluation will come up

[1:10:28] next month. You know, we have a little

[1:10:29] preparation. I'm prepared because I'm

[1:10:31] here. Um, but I think in general

[1:10:34] » That those extra steps really make a

[1:10:36] difference. I agree with you because

[1:10:39] like I it's just hard

[1:10:43] to express myself

[1:10:47] to others. But I cuz I'm a little shy or

[1:10:52] you know going through something. But

[1:10:54] like I will say this, Sunday I went to

[1:10:57] church and I loved it because I felt the

[1:11:01] presence of God and Jesus on a certain

[1:11:04] hymn like a song. It's called it is well

[1:11:09] and I felt sad and then joy and it it

[1:11:14] reminds me of like doing self advocates

[1:11:18] to help other individuals express what

[1:11:21] they need. But when I express things,

[1:11:25] sometimes it doesn't go forward and it's

[1:11:30] just frustrating.

[1:11:31] » So I I'd like to add um one thought to

[1:11:35] this and and it kind of goes along with

[1:11:37] what Dr. Nord said about um you know

[1:11:40] having a having a wholesome conversation

[1:11:43] about this. They call me doctor. I

[1:11:45] figured nobody nobody calls me anything

[1:11:47] but you

[1:11:49] » That that was what that was. And I also

[1:11:51] didn't press the mute button. Um,

[1:11:54] » Yes.

[1:11:55] » So, uh,

[1:11:57] you know, the stakes are really high

[1:11:59] when you get into I I mean, I get the

[1:12:01] level of care where you're establishing

[1:12:03] eligibility, but if you we get into

[1:12:05] whatever a new Oasis or a new ALGO or

[1:12:08] what whatever the new iteration of um

[1:12:11] figuring out how this um translates into

[1:12:17] uh you know, support needs and budgets

[1:12:18] and all that kind of thing. the stakes

[1:12:20] are very very high and one concern I

[1:12:22] have is um the the time frame of three

[1:12:26] days which in the inter eye over and

[1:12:28] over and over again it's has this

[1:12:30] occurred in the last three days so

[1:12:34] I you know first of all for a lot of

[1:12:38] things like if you're kind of sad you

[1:12:41] have kind of depression there's a good

[1:12:42] chance that that probably has manifested

[1:12:44] itself in the last three days but there

[1:12:46] are a lot of um highly acute who, you

[1:12:50] know, very problematic behaviors that

[1:12:52] may occur once in a blue moon. I mean,

[1:12:55] some people it's like around Christmas

[1:12:56] and all of a sudden they're

[1:12:57] hospitalized. That person has a little

[1:12:59] bit different support need than somebody

[1:13:01] who absolutely never ever ever is

[1:13:04] hospitalized, right?

[1:13:06] » Um, and the one thing I would I would

[1:13:09] really encourage you to consider is how

[1:13:13] um an appeal can work. And I, you know,

[1:13:15] I'm not talking about every single

[1:13:16] person goes, "Oh, I lost a tiny bit of

[1:13:19] budget and every every everybody's going

[1:13:21] to appeal to get more and more and more,

[1:13:23] but there are going to be some people

[1:13:24] who this upends their budget or this

[1:13:27] upends something in their support in

[1:13:30] their support um the supports they're

[1:13:32] provided." And I I'm just very concerned

[1:13:34] about that three days aspect. Um, you

[1:13:37] know, made positive statements. I mean,

[1:13:40] sometimes I go three days without that.

[1:13:43] You know, I there there are other ones

[1:13:45] where you're talking about more

[1:13:47] explosive behavior and aggression and

[1:13:49] that kind of thing. Even the most

[1:13:50] aggressive person is not aggressive

[1:13:52] every week, you know, and so you might

[1:13:54] have somebody who has physical

[1:13:56] aggression, property destruction, and

[1:13:59] sometimes it's big enough where some,

[1:14:01] you know, law enforcement's involved,

[1:14:03] but that happened last week, so I give

[1:14:04] it a no. And that's going to really

[1:14:06] affect what your supports

[1:14:10] » Assessment is. And so I'm always

[1:14:11] concerned when we kind of give up the

[1:14:13] human aspect to say here it's a

[1:14:16] checklist. And I I encourage you to give

[1:14:20] » Some thought to how that appeal process

[1:14:22] can work, especially in cases where

[1:14:24] everybody knows it's obvious this person

[1:14:26] shouldn't have, you know, dropped half

[1:14:29] his budget because of the inter eye.

[1:14:33] » So no, I I appreciate that um and

[1:14:36] appreciate your comments, Jim. I think

[1:14:39] what I will go back to is these

[1:14:40] assessments are are very comprehensive.

[1:14:43] Um, and yeah, there's there is certain

[1:14:47] look back periods for certain items, but

[1:14:50] that's not every item. And it also asks

[1:14:53] things like how often and not just in

[1:14:56] the last three days. So, without getting

[1:14:58] into too many details, I I hear your

[1:15:00] concern and I appreciate it. Um I think

[1:15:04] um and I alluded to this before, there's

[1:15:06] a reason we have case managers doing

[1:15:08] these, right? Because they know the

[1:15:11] individual. They also and if in the

[1:15:14] event that they don't, let's say it's a

[1:15:15] newer case manager, right? They have

[1:15:18] that individual's file as well, right?

[1:15:21] All their information about their

[1:15:23] progress towards, you know, in various

[1:15:25] services and and all of that

[1:15:27] information.

[1:15:29] um so that when they're doing that

[1:15:31] assessment, if something doesn't quite

[1:15:33] ring true, they can dig in a little

[1:15:35] deeper in that conversation and find

[1:15:37] out. We expect that people would grow in

[1:15:40] their skills as a result of our

[1:15:42] services, right?

[1:15:43] um that growth will look different

[1:15:45] depending on the person in the area, but

[1:15:48] you know, we want to make space for

[1:15:49] people to actually gain skills and to

[1:15:51] recognize that as well as when

[1:15:54] individuals maybe um I'll choose this

[1:15:58] because it's it's me. Um as they age,

[1:16:02] sometimes we lose some skills, right? Or

[1:16:05] or our our strength areas change. So

[1:16:08] these tools are sensitive enough um that

[1:16:12] I think it will or we believe it will

[1:16:14] pick up on all those things. I also want

[1:16:16] to mention because of all the great

[1:16:18] conversation around kind of setting the

[1:16:20] stage and and those conversations to

[1:16:23] help prepare individuals for these

[1:16:25] assessments because they are very

[1:16:27] different um than what we have been

[1:16:29] doing for um a number of years.

[1:16:33] There is we have a learning

[1:16:34] collaborative for those assessors, the

[1:16:36] mentor assessors. Um and all of this

[1:16:39] information we can take back to that

[1:16:41] learning collaborative. Um and talk

[1:16:43] through what you know what what are some

[1:16:46] maybe some individuals are doing that

[1:16:48] preparation a certain way. You know, how

[1:16:51] can we share that information and that

[1:16:53] best practice to better position

[1:16:55] individuals and families to be ready for

[1:16:57] these assessments? So um those your

[1:17:01] comments around um preparation and

[1:17:03] setting that stage is is very much

[1:17:06] appreciated and we will share that.

[1:17:08] » Thank you.

[1:17:09] » I um I I suspect this is maybe your last

[1:17:12] bullet so I'll I'll um I'll just preempt

[1:17:15] it. Um

[1:17:18] I'm only I'm I'm asking these questions

[1:17:21] mostly because I I think there's a

[1:17:22] broader community with these questions.

[1:17:24] I was in a conversation with a family

[1:17:25] member yesterday and kind of three

[1:17:28] things that came up. So, I figure this

[1:17:30] is a great time because I can say it,

[1:17:32] but I think it's more important that

[1:17:33] they hear and and Holly, I think you and

[1:17:36] I have had we we chatted about this last

[1:17:38] week. Um,

[1:17:41] there's a perception or or there's

[1:17:44] there's conversation out there that

[1:17:46] people have lost their waiver through

[1:17:48] because of these assessments. That's the

[1:17:51] first. The second is the denial pending

[1:17:53] language in the review process for those

[1:17:56] that and that language and what does

[1:17:58] that mean? And then um the third is

[1:18:02] appeal process. Those weren't even

[1:18:05] phrases questions, but I'm just going to

[1:18:06] throw those really volatile words out

[1:18:09] and let you manage what comes next.

[1:18:12] » Well, thank you for preempting it

[1:18:14] because that's the perfect segue, Derek.

[1:18:16] Um so yes so we um have been doing these

[1:18:20] assessments now since February. Um very

[1:18:24] few um

[1:18:28] finalized denials have been issued and

[1:18:31] there is a reason for that. Um these are

[1:18:34] new tools as we all know these are um in

[1:18:38] many cases not all because we have been

[1:18:41] using the interrise suite of instruments

[1:18:43] on the nursing facility level of care

[1:18:45] side but for some case managers

[1:18:48] um particularly in the space of uh

[1:18:53] individuals with intellectual and

[1:18:54] developmental disabilities these may be

[1:18:56] completely new tools to them right so um

[1:19:00] as a result of that we've got new tools

[1:19:02] new assessors. We are taking um a lot of

[1:19:07] care in reviewing any assessment that is

[1:19:11] flagged for us to review because that is

[1:19:14] case managers can do that. Um but also

[1:19:17] any assessment that appears to be

[1:19:19] borderline on eligibility, right? And

[1:19:22] when I say we're reviewing it, we're not

[1:19:24] just looking at it and going, "Oh,

[1:19:25] okay." Right? And clicking a button.

[1:19:28] We're looking at it for that individual.

[1:19:31] And does that Is that assessment

[1:19:33] consistent with what we see in the

[1:19:35] individual's records?

[1:19:37] Right? Um as a way to validate on an

[1:19:41] individual level that okay, this

[1:19:43] assessment

[1:19:45] looks to be accurate based on the

[1:19:46] information we have and the the actual

[1:19:49] assessment. So um we are taking all that

[1:19:52] very seriously obviously because um we

[1:19:57] and we've talked about this but we know

[1:19:59] we need to get the right services to the

[1:20:01] right people.

[1:20:04] Um we also know that there are

[1:20:07] individuals in services who are not

[1:20:09] going to continue to meet level of care.

[1:20:12] Um

[1:20:13] and that's hard.

[1:20:15] That's hard for them. Um, it's hard for

[1:20:20] uh the case manager to deliver that.

[1:20:22] It's hard for bead staff, right? It's

[1:20:25] just it's a a space we haven't been in

[1:20:27] in a really really really long time

[1:20:29] approving 99% of people that come in the

[1:20:32] door. So, we are um working with case

[1:20:36] managers

[1:20:38] um about what that looks like, how those

[1:20:41] conversations can be had and should be

[1:20:43] had and how we're connecting people to

[1:20:47] um to other resources. Um but we are

[1:20:50] taking great care in any of those uh

[1:20:54] reviewing any of those assessments that

[1:20:55] appear to be result in denial as we

[1:20:58] should.

[1:21:00] um

[1:21:03] the appeals process. Glad you brought

[1:21:05] that up. Thank you. Um that as with

[1:21:09] anything um any adverse action,

[1:21:11] individuals will get written notice of

[1:21:14] the decision with their appeal rights.

[1:21:18] Um so the due process will is in place

[1:21:21] and will will remain in place through

[1:21:24] through um this entire um process.

[1:21:28] individuals that are um determined not

[1:21:33] to meet level of care, whether that's

[1:21:35] people walking in our doors at the

[1:21:37] district office, so to speak, um you

[1:21:40] know, part of what we do today is

[1:21:41] connecting them with other things,

[1:21:43] right? Um because very few individuals

[1:21:47] walk into a bead's office, apply for

[1:21:49] services, and immediately get services,

[1:21:51] right? That doesn't happen. Um, so we're

[1:21:53] in uh we've been referring folks for

[1:21:56] other and connecting them with other

[1:21:58] resources for some time in that in those

[1:22:00] situations. For individuals in services,

[1:22:02] there will be a transition period if if

[1:22:05] they lose um eligibility or level of

[1:22:08] care. Um, and during that time, the case

[1:22:10] manager will work with the individual

[1:22:12] and the team on a transition plan, what

[1:22:15] that looks like, and what other

[1:22:18] resources that person needs to be

[1:22:19] connected to. Um,

[1:22:22] as an example, if if uh we're talking

[1:22:25] about maybe a 40-year-old individual

[1:22:28] who's been in services,

[1:22:31] um, is working a job,

[1:22:34] um, gets,

[1:22:36] let's just say the person's on the CI

[1:22:37] gets residential HAB, some behavior

[1:22:39] supports,

[1:22:41] um, and, uh, extended services. Um,

[1:22:47] you know, what what's that look like?

[1:22:49] what's that transition plan for that

[1:22:50] individual. It might be, it depends on

[1:22:53] the person certainly, but it might be a

[1:22:55] referral to the Center for Independent

[1:22:57] Living. Um, if they need some just

[1:23:01] connections, right? Or maybe some

[1:23:03] centers for independent living, they all

[1:23:04] do things a little different, right?

[1:23:06] They're all a little different in what

[1:23:07] they offer. Um, it might be rep payee or

[1:23:12] that might be a local bank, right?

[1:23:14] Depending on the community and the

[1:23:15] person. Um it may be um

[1:23:20] uh a referral for or a discussion around

[1:23:23] state plan services. It might be a

[1:23:26] connection with um some sort of support

[1:23:29] group or a CHC perhaps or you know uh

[1:23:33] whatever whatever might support that

[1:23:36] person. Um but we're not here to say

[1:23:39] you're no longer eligible and uh next

[1:23:42] week we're terminating your services.

[1:23:44] Right? services will remain in place

[1:23:46] through the appeal process if people

[1:23:48] appeal. But I will say this and this

[1:23:52] will date me too like 30 years or

[1:23:55] whatever or 20 something years. Um, if a

[1:23:58] person is determined not to meet level

[1:24:01] of care and launches an appeal, that

[1:24:02] team, that case manager needs still to

[1:24:05] be having those very real conversations

[1:24:07] about, you know, if

[1:24:10] this appeal results in a denial of level

[1:24:14] of care. Um,

[1:24:16] » We need to be ready.

[1:24:17] » We need to be planning for that and we

[1:24:18] need to position them to be ready for

[1:24:20] that. If that makes sense.

[1:24:22] » I want to just circle back really

[1:24:24] quickly to

[1:24:27] this conversation around level of care

[1:24:30] with the NRI suite of tools. Obviously,

[1:24:33] I think and maybe this bears reminding I

[1:24:36] think our system is working to or toward

[1:24:39] a place where

[1:24:42] we can

[1:24:44] hopefully have one encounter

[1:24:46] and identify the right waiver for the

[1:24:49] right person at the right time with with

[1:24:51] the array of tools that we are

[1:24:53] operationalizing.

[1:24:54] and also be in a position to have that

[1:24:57] service planning happen essentially

[1:25:00] simultaneously.

[1:25:02] Um, and I know there are some

[1:25:05] concerns around how some of the

[1:25:07] questions are framed and time look back

[1:25:09] periods and

[1:25:12] we have seen some communications around

[1:25:16] people being advised to go into that

[1:25:18] assessment and share their worst day and

[1:25:23] that that be the lens through which they

[1:25:25] answer those assessment questions. Share

[1:25:29] your worst day in the last 30 days and

[1:25:32] the last 60 days, whatever that may be.

[1:25:34] It needs to be your worst day.

[1:25:38] And I would just say we can't do that.

[1:25:45] And I would really I would really

[1:25:48] put forth to this council that if we are

[1:25:52] doing service planning based on

[1:25:55] someone's worst day and we do that for

[1:25:59] 50,000 people,

[1:26:01] we are going to be in a very tough spot.

[1:26:07] Service planning conversations can

[1:26:09] happen at any point in time, even after

[1:26:12] their service plan budget has been

[1:26:14] issued. If something changes, that

[1:26:16] service plan should change to reflect

[1:26:18] that. So, I just encourage folks to be

[1:26:21] thinking about we do we do not want to

[1:26:24] move forward

[1:26:26] with a deficit-based mindset about the

[1:26:29] people that we are supporting. We do

[1:26:32] want to move forward with a dynamic

[1:26:34] system that can adjust

[1:26:36] to be respondent to that person's

[1:26:39] changing needs over time.

[1:26:42] » Thanks, Kathy. Yeah, Tom,

[1:26:43] » Just question on the back to the appeal

[1:26:45] question. Um, if someone is appealing

[1:26:48] their denial of eligibility, if the NRI

[1:26:51] suite of tools is utilized for that

[1:26:52] determination, do they get any

[1:26:54] information about their assessment from

[1:26:56] NRI for the purpose of their appeal?

[1:26:59] » Oh, sure. the the actual assessment like

[1:27:01] their their responses and stuff they

[1:27:03] » Utilize. Okay. So they they'll they'll

[1:27:04] receive that for the appeal process. Uh

[1:27:08] if they

[1:27:08] » Receive the reason.

[1:27:10] » Yes, they'll receive the reason. Um

[1:27:14] ask me your question again, Tom, because

[1:27:16] I don't think it's I don't think it's

[1:27:19] » Just what

[1:27:22] » Lawyers arguing.

[1:27:26] » So the the actual assessment is being

[1:27:28] utilized to make a determination for

[1:27:29] eligibility. So that's what is being

[1:27:31] relied upon. So, if someone's going to

[1:27:33] appeal that denial of eligibility, what

[1:27:36] information from that assessment are

[1:27:38] they going to have access to to argue

[1:27:40] their appeal?

[1:27:42] » They will they will have their

[1:27:43] determination letter and they can have a

[1:27:46] copy of their assessment.

[1:27:47] » Okay.

[1:27:48] » Yeah.

[1:27:48] » Okay. Thank you.

[1:27:57] » I I do have one question. This is Kate

[1:27:59] on the example you gave with somebody

[1:28:01] who seems to is on the CI waiver and

[1:28:05] they're getting lots of residential

[1:28:06] support but they're successfully

[1:28:09] employed and have living their good

[1:28:11] life, their vision of a good life. Is

[1:28:14] there a mechanism for you all to

[1:28:16] determine whether or not those supports

[1:28:18] are what is leading to that person's

[1:28:21] success? like maybe they are employed

[1:28:24] because they have the level of care

[1:28:25] support that they that are receiving. Is

[1:28:28] there do you understand what I'm trying

[1:28:30] to ask? And is there I I just worry

[1:28:33] about going from a CIH waiver level of

[1:28:37] care down to community referrals if

[1:28:41] there's a possibility that a family

[1:28:43] support waiver structure with still some

[1:28:46] of those things in place could continue

[1:28:48] to support that person to live

[1:28:50] independently

[1:28:52] with the right level of support uh

[1:28:54] rather than just going down to all

[1:28:56] community based services. So,

[1:28:59] » And that's just based on your example.

[1:29:01] » Yes. No, that's that's a good question.

[1:29:03] I I I do want to clarify that if someone

[1:29:06] doesn't meet level of care, they would

[1:29:08] not have access to CI or family support

[1:29:13] because it's the same eligibility for

[1:29:15] those two waiverss in terms of the level

[1:29:18] of care.

[1:29:21] So, we would again work with what are

[1:29:24] the person's needs today, right? and how

[1:29:28] can we connect them with other resources

[1:29:31] outside of HCBS to address those needs.

[1:29:35] » And I think to your I wanted to clarify

[1:29:38] something you said because you talked

[1:29:41] about CI level people

[1:29:44] and

[1:29:46] the folks on that waiver are a heavy

[1:29:49] mix. There are some people who have some

[1:29:52] truly exceptional needs on that waiver

[1:29:54] and there are individuals who have

[1:29:55] transitioned out of a group home to the

[1:29:58] CI waiver or they've met some other

[1:30:00] priority criteria at some point in time.

[1:30:04] So their budget may not reflect and

[1:30:07] their service need not reflect an

[1:30:09] emergent need at the time that they are

[1:30:12] assessed.

[1:30:13] » So that's a I think just an important

[1:30:15] clarification for people. I think what

[1:30:17] you mean is those folks who are

[1:30:18] currently getting a a a higher level of

[1:30:22] support from our system and then are

[1:30:25] determined at some point to no longer

[1:30:27] meet our level of care. Uh and I do

[1:30:30] think that's where we need um I mean

[1:30:34] truly suggestions, input from this group

[1:30:37] on how best to maybe walk somebody

[1:30:40] through that transition to um kind of

[1:30:43] offboard them off of that waiver.

[1:30:45] because to your point, we wouldn't be

[1:30:47] able to offer them a lesser amount of

[1:30:49] services or an alternate waiver

[1:30:52] because they wouldn't meet that criteria

[1:30:54] either. So, it's really thinking about

[1:30:59] forcing the system to have conversations

[1:31:02] all along someone's journey in the

[1:31:04] system about transitioning down or

[1:31:07] stepping down from services and supports

[1:31:08] when they don't need them. Um,

[1:31:11] obviously, we don't want to create a

[1:31:12] cliff for anyone. Um, but I certainly

[1:31:16] also don't, and I think I've said this

[1:31:18] at other meetings, I don't want people

[1:31:20] to wait until that level of care to to

[1:31:23] figure out that someone's that we kind

[1:31:26] of already know maybe that somebody's

[1:31:27] not going to meet that eligibility

[1:31:29] criteria um before we start talking

[1:31:31] about this isn't going to work and we

[1:31:33] can't continue to offer this this level

[1:31:34] of service. I can't think of an example

[1:31:37] of somebody who would have those higher

[1:31:39] need waiver supports who it may may be

[1:31:43] impacted by that to be honest, but that

[1:31:46] doesn't mean that there there isn't any.

[1:31:48] So,

[1:31:51] » I just want I just want to add I think

[1:31:53] it comes down to the case managers um

[1:31:55] because they're the ones in the homes

[1:31:57] and seeing it. And for the case managers

[1:32:00] to have the best training in

[1:32:02] communication because they're the ones

[1:32:04] that are going to be seeing it coming

[1:32:06] » More than a piece of paper.

[1:32:09] » Yeah, good point. Okay, I'm gonna Lexi,

[1:32:11] I'm going to go to you and then we need

[1:32:12] to keep moving. So, um and then we'll

[1:32:14] take after your question, we'll take a

[1:32:16] break. you know.

[1:32:18] » Okay. Awesome. Thank you. Um I think I

[1:32:21] want to go like I want to go back a

[1:32:23] minute. It's been a minute since it's

[1:32:24] been mentioned, but we talked about um

[1:32:28] Holly talked about uh the good thing is

[1:32:32] like the case managers that are the

[1:32:34] assessors, they know most likely

[1:32:38] um probably more often than not, they

[1:32:40] know the individual being assessed um or

[1:32:44] they know their file. Um, but I think

[1:32:48] kind of the elephant in the room,

[1:32:50] something people are a lot of people are

[1:32:52] concerned about, um, is will there when

[1:32:57] Waverista happens be a transition to

[1:32:59] Maximus because Maximus assesses

[1:33:03] individuals and knows pretty much

[1:33:06] nothing about it. And we're seeing an

[1:33:08] issue with that a lot on um, health and

[1:33:11] wellness, TBI, stuff like that. So I

[1:33:14] think a lot of people receiving ICF ID

[1:33:17] services are very concerned that Maximus

[1:33:21] is also going to be those doing those

[1:33:23] ICC or ICF ID level of care assessments.

[1:33:28] » Yeah, that's a good question, Lexi, but

[1:33:30] currently there are no um no plans to to

[1:33:35] um move those eligibility or level of

[1:33:38] care assessments for ICFD.

[1:33:42] That's good news because I'm one of the

[1:33:43] people that was concerned about it and I

[1:33:45] think a lot of people were. So,

[1:33:47] » All right.

[1:33:48] » Thank you.

[1:33:49] » Thanks, Lexi. Okay, we are going to take

[1:33:51] a This is exactly on time. It's crazy.

[1:33:55] Okay. Um

[1:33:57] uh 10:05. We're going to take a

[1:33:59] 10-minute break. So, we will be back at

[1:34:01] 10:15.

[1:34:03] » That's okay.

[1:34:05] » 11:15. Okay.

[1:34:07] » Question. Hold on one second to just

[1:34:09] because it's loud.

[1:34:10] » Gota get people. Okay, go ahead.

[1:34:14] » Sorry.

[1:34:14] » Just start talking.

[1:34:15] » So, I have a question. So, like,

[1:34:20] » Hey guys, we're gonna go ahead and get

[1:34:21] started just so we can get through it.

[1:34:24] I'm not holding you guys. Um, okay. Go

[1:34:26] ahead.

[1:34:26] » I have a question. So, like say,

[1:34:29] » Is this related? Sorry. Just I just want

[1:34:31] to make sure is same same. Okay. I just

[1:34:33] want to make sure in case it was Okay.

[1:34:35] » No, you're fine. Go. know how people get

[1:34:38] money for assistance

[1:34:40] for their bills.

[1:34:42] » They get what? I'm sorry.

[1:34:43] » Money assistance for their bills.

[1:34:45] » Yeah.

[1:34:46] » Let's just say,

[1:34:49] well, for me, I was trying to get for

[1:34:51] the energy assistance and I got denied.

[1:34:54] But what's frustrating on that is I have

[1:34:59] a lot of bills, but I don't I don't know

[1:35:03] how to put it any of them. Oh, I think

[1:35:06] just she was mentioning that it can be

[1:35:08] for people that were referring to that

[1:35:10] as a as a support. It is not consistent

[1:35:13] and who gets approved for that kind of

[1:35:15] support.

[1:35:16] » So, just more of a I think FYI for

[1:35:19] » Okay, thanks.

[1:35:20] » Thank you.

[1:35:20] » Okay. Thanks. Okay, we're going to move

[1:35:23] on here. Let me get my

[1:35:29] get here. Okay, so we're going to move

[1:35:31] on to uh waiver amendments. Moving on

[1:35:34] with Holly.

[1:35:37] » Me again. All right.

[1:35:39] » Right. Um, good thing I got a strong

[1:35:42] voice here. Um, so just a reminder that

[1:35:45] we do have waiver amendments for all of

[1:35:48] the beads administered waiverss as well

[1:35:50] as and that's not on here, but the the

[1:35:53] pathways for aging waiverss um are at

[1:35:56] CMS with a planned effective date of

[1:35:58] August 1st. That includes, of course,

[1:36:01] the the case management that we've been

[1:36:03] talking about um as well as some other

[1:36:07] um

[1:36:09] components that we've discussed uh uh in

[1:36:12] previous meetings. Um but those are at

[1:36:16] CMS under review and we anticipate

[1:36:18] having those back um in July. I can't

[1:36:21] give a date because I'm not sure when

[1:36:23] that will be, but we expect them um to

[1:36:26] come in in July. So just wanted to

[1:36:29] provide that update

[1:36:32] and then wanted to talk um some more

[1:36:34] about waiver reset just to ensure that

[1:36:37] we um that we are providing information

[1:36:41] to you all so that you all can kind of

[1:36:43] track what's happening with regard to

[1:36:44] waiver reset and that we continue to

[1:36:47] focus on um the goals and understanding

[1:36:50] the why behind um the reset. So,

[1:36:55] um, and you've seen this slide before,

[1:36:57] you're probably going to be tired of it,

[1:36:59] so I'll apologize in advance, but, um,

[1:37:02] the goals of the waiver reset, um, have

[1:37:05] been steady throughout this process. And

[1:37:07] one is simplifying the system. Um, it's

[1:37:10] not news to anyone that the system can

[1:37:13] be difficult to navigate and confusing

[1:37:16] um, for individuals and families. So,

[1:37:18] um, we know that as part of waiver

[1:37:20] reset, we want to make our system more

[1:37:23] understandable. Um, we already talked

[1:37:25] about reducing the number of assessments

[1:37:27] that individuals have to go through. Um,

[1:37:30] and then also updating the services that

[1:37:33] are offered again based on feedback

[1:37:35] we've received um, from those that we

[1:37:38] support

[1:37:40] and those individuals that we will

[1:37:42] likely one day support. um we know that

[1:37:46] our services um need to be updated um

[1:37:49] and we need to to reexamine kind of what

[1:37:52] we offer and how that's how those

[1:37:54] services are delivered in some

[1:37:55] situations.

[1:37:57] We also know we need to improve support

[1:37:59] coordination. I think we've heard a lot

[1:38:01] about that this morning when we were

[1:38:03] talking about the assessments and those

[1:38:05] conversations that are taking place or

[1:38:07] should be taking place. Um, we know that

[1:38:11] uh in in the coordination of of services

[1:38:15] and supports that those case managers

[1:38:18] need to know what's out there and

[1:38:21] available and they need to um be able to

[1:38:23] connect individuals um with other

[1:38:27] services, paid and unpaid, and actually

[1:38:29] help them maximize um all of those

[1:38:32] resources they may have available to

[1:38:33] them. That's not new. Um we've been

[1:38:37] talking about that for years. Um and

[1:38:39] that is unrelated to an individual's

[1:38:42] eligibility status, right? Um it really

[1:38:46] um all of our services should be focused

[1:38:48] on connecting people so that they're

[1:38:50] more included in their communities,

[1:38:53] whatever that looks like for them. um

[1:38:55] enhancing quality outcomes. You know,

[1:38:58] how can we um as part of waiver reset

[1:39:01] offer quality services and then support

[1:39:04] providers

[1:39:06] um

[1:39:08] in ways that they can provide those

[1:39:10] services. Um and you know, I think the

[1:39:13] the quality uh piece is part of that

[1:39:18] valuebased purchasing or paying for

[1:39:21] outcomes, whatever whatever terminology

[1:39:23] we want to use. It really is how do we

[1:39:26] support those providers of services

[1:39:29] um to aggressively work with individuals

[1:39:32] and families to to help them reach the

[1:39:34] outcomes um they need from our services.

[1:39:40] » Polly,

[1:39:41] » Yes. Um I I know that the the whole idea

[1:39:44] of um paying for quality and the value

[1:39:46] based payments and all that that's a

[1:39:48] that's something that we're all getting

[1:39:50] kind of used to that terminology and

[1:39:51] feeling like that's some that's a

[1:39:53] direction that we're heading in. Right.

[1:39:55] » Um can you give any salient examples

[1:39:57] from other states that you've learned or

[1:40:00] just that that beads that DAR is

[1:40:03] thinking of in what what direction are

[1:40:06] we going with this? I mean if you look

[1:40:08] at the value based pay payments that

[1:40:10] were in that one slide for case

[1:40:11] management I think we already discussed

[1:40:13] that being primary primarily compliance

[1:40:17] what might be a good quality metric that

[1:40:21] you would pay for or what are you guys

[1:40:23] thinking? Well, I think, you know,

[1:40:25] that's a great question, Jim, and I

[1:40:27] don't have any um other states in my

[1:40:28] back pocket that I would speak to just

[1:40:30] because I don't think I could

[1:40:32] necessarily adequately represent another

[1:40:34] state without, you know, making sure um

[1:40:37] and reviewing it recently. But we have

[1:40:39] and we'll continue to look at um what's

[1:40:42] happening in other states around this

[1:40:44] valuebased purchasing um

[1:40:47] so that that can inform any decisions we

[1:40:50] make. Um, I think one of the things that

[1:40:54] is important,

[1:40:56] um, from my perspective when we're

[1:40:58] thinking about paying for outcomes is,

[1:41:02] you know, not just saying, okay, we're

[1:41:05] going to pay for this, but we really do

[1:41:06] have to build to it. And I think Derek

[1:41:08] kind of alluded to this. We kind of

[1:41:10] start with

[1:41:12] gathering that data, looking at those

[1:41:14] compliance matters, getting that nailed

[1:41:17] down and in place and then build from

[1:41:20] there. Um, but I think the outcomes

[1:41:22] would differ depending on the service,

[1:41:25] right? I mean we have music therapy,

[1:41:27] recreck therapy that are therapeutic

[1:41:30] services and then we have things like

[1:41:32] today and this is we're talking waiver

[1:41:35] reset so things will look differently

[1:41:37] but then we're thinking about like

[1:41:39] participant assistance and care or pack

[1:41:42] in attendant care those outcomes would

[1:41:44] look very different right and and so I

[1:41:47] think it would depend on the service but

[1:41:49] certainly we can take that back um and

[1:41:52] um perhaps carve out some time in a

[1:41:54] future meeting about how we might

[1:41:57] consider uh valuebased payment for some

[1:42:00] of the services. So I think that's a

[1:42:03] great question

[1:42:05] » And and I appreciate your answer because

[1:42:06] that that's a basically I think that's

[1:42:08] sort of the stepping stones that you you

[1:42:11] need to get to to get to where we are. I

[1:42:13] got to say that when when um in your

[1:42:17] comment about like wreck therapy and

[1:42:19] music therapy, those are therapeutic

[1:42:20] surf ser services and they're going to

[1:42:22] look different than pack. I mean, I can

[1:42:26] see from a compliance standpoint where

[1:42:27] there are some similarities, but like on

[1:42:29] quality, I I guess maybe I'm just like

[1:42:33] lacking imagination because it's really

[1:42:35] hard for me to come up with specifics

[1:42:37] that I'm thinking, oh, okay, here's

[1:42:39] something that would be a quality metric

[1:42:40] that the state would pay for in lie of

[1:42:43] um unit space system and the quantity.

[1:42:47] you know,

[1:42:49] simply saying we're going to move away

[1:42:50] from units and we're going to move away

[1:42:53] from quantity and we're going to move to

[1:42:55] quality. I don't think anybody would

[1:42:58] disagree with that as a as a goal. The

[1:43:01] devil's in the details though and and it

[1:43:04] seems difficult if you're designing a

[1:43:06] new system and then the payment

[1:43:08] structure is based on this thing that we

[1:43:11] are even having a hard time discussing

[1:43:13] or or putting a putting our finger on

[1:43:17] that gives me a little bit of

[1:43:18] trepidation going into the future of

[1:43:20] like well what is this going to look

[1:43:22] like? Um, so I and I think I'll probably

[1:43:25] I'll try to hone my imagination skills

[1:43:28] in the future to be able to come up with

[1:43:30] something because I you know it's it's

[1:43:33] really difficult to really you know it's

[1:43:35] everybody knows quality when you see it.

[1:43:38] How do you measure it and how do you put

[1:43:39] that forward into something that then

[1:43:41] becomes a billable service?

[1:43:43] » Yep. No, I think we're I I agree with

[1:43:46] you and we are always open to feedback

[1:43:49] if you uh do come up with suggestions um

[1:43:53] for um value based payment or paying for

[1:43:56] outcomes. But um I'll just speak to I

[1:44:00] think um

[1:44:04] we've talked ad nauseium with this group

[1:44:06] about employment.

[1:44:09] I think we've emphasized at the advisory

[1:44:11] council quite a bit outcomes around

[1:44:13] employment that will be an area of focus

[1:44:16] more than likely

[1:44:19] » The degree to which the services being

[1:44:21] provided are leading to toward someone's

[1:44:24] employment outcomes

[1:44:27] will be looked at and evaluated as far

[1:44:29] as how can we incentivize

[1:44:32] services that that get someone

[1:44:35] successfully toward an employment

[1:44:36] outcome or the outcome that they are

[1:44:38] working toward.

[1:44:40] » Um, and that could be something that's

[1:44:42] not employment, but in that same kind of

[1:44:45] realm, I think I'm that one's coming to

[1:44:47] mind again because we've talked about it

[1:44:50] so heavily at the with this group, but

[1:44:52] also because

[1:44:54] the origin of us talking about it at

[1:44:57] this group have been self- advocates

[1:44:59] saying we want competitive integrated

[1:45:01] employment. Um and so I think at least

[1:45:04] from my perspective

[1:45:07] and this is where you all you know are

[1:45:09] welcome to bring forth successful ideas

[1:45:12] or innovative ideas from other states

[1:45:14] where who have implemented a valuebased

[1:45:16] payment model around employment supports

[1:45:18] or employment outcomes that

[1:45:22] either for a particular service or for a

[1:45:24] team um to to share in a valuebased

[1:45:27] payment because they were collectively

[1:45:29] able to work together to get somebody

[1:45:31] that outcome. Um those are that's a just

[1:45:33] a high very high level example and to

[1:45:36] your point Jim the devil's always in the

[1:45:38] details about how you execute that but

[1:45:41] that's probably where the most attention

[1:45:45] or emphasis has been internally for our

[1:45:47] team um because of just some of the work

[1:45:50] that has been occurring um with the

[1:45:53] innovation pilot projects and some of

[1:45:55] the um other uh APA related um

[1:45:59] initiatives that we undertook um a

[1:46:02] couple years ago.

[1:46:03] » Yeah, I was going to I was going to say

[1:46:04] that Kathy, I think that um and Melissa

[1:46:07] has a lot of experience in this too, I

[1:46:09] think, with employment, but right, if if

[1:46:11] there is an employment goal and again it

[1:46:13] can't just be does a person want a job

[1:46:15] or not, you had the conversation, you

[1:46:17] get paid, right? That's not going to

[1:46:18] fly, right? So, if if if you've

[1:46:21] discussed employment and it's an

[1:46:23] obstacle, what have what are you doing

[1:46:26] to either address that obstacle, right?

[1:46:28] And so I think that for employment, it's

[1:46:30] not just is there an employment goal,

[1:46:32] you get money, right? You've you've

[1:46:34] reached the outcome because that's not

[1:46:37] what's going to happen. Someone's going

[1:46:38] to write an employment goal so they can

[1:46:40] get that extra $20. Let's a lot of times

[1:46:42] unfortunately that's what's going to

[1:46:43] happen, right? So how do we build it so

[1:46:46] that it's actually um there's things in

[1:46:49] place that's uh

[1:46:52] you know incentivizing more than just

[1:46:54] maybe checking the boxes sometimes. So,

[1:46:56] um, but employment's like Kathy I was

[1:46:59] going to say is what's coming to mind

[1:47:01] because I think there's I don't know all

[1:47:03] the research on valuebased, but I think

[1:47:04] that's probably the Melissa could jump

[1:47:06] in. Probably the most

[1:47:09] probably the mo most used right now or

[1:47:11] at least being explored at least

[1:47:12] nationally, I would think. Do you think

[1:47:14] that's accurate? Maybe. Maybe not. I

[1:47:17] don't know. Am I putting you on the

[1:47:19] spot? I don't know.

[1:47:20] » No, that's fine. Am I

[1:47:22] » I don't know if

[1:47:22] » Yeah, you're okay. Just don't hit the

[1:47:23] button like Derek. Don't mess up

[1:47:26] everything like Derek did.

[1:47:28] » All right.

[1:47:32] » Yeah.

[1:47:33] » So, you know, when you think about

[1:47:36] values-based outcomes,

[1:47:38] there's almost two different types of of

[1:47:41] outcomes based things. There's there's

[1:47:43] services that are meant to teach a skill

[1:47:45] and services that are meant to help a

[1:47:48] person achieve a an independence goal or

[1:47:50] an ability to um increase their their uh

[1:47:54] proficiency at doing something. And so

[1:47:56] the outcome for that might be the

[1:47:58] attainment or progression towards that

[1:48:00] goal. But then there's other services

[1:48:02] that are more uh filling a need that the

[1:48:05] person may not be able to meet

[1:48:06] themselves. transportation,

[1:48:09] um, feeding,

[1:48:12] um,

[1:48:14] whatever ADLs, whatever that is. And so

[1:48:18] the outcome measures for those types of

[1:48:20] services might look a lot different

[1:48:23] because those um are more based on the

[1:48:27] quality of the service provided, the the

[1:48:30] deliverability of it. So for example, if

[1:48:32] it's transportation, is was the person

[1:48:34] on time? Did they, you know, get picked

[1:48:37] up within a reasonable um, you know,

[1:48:41] distance from where they were were

[1:48:42] going? And I'm just using transportation

[1:48:44] because that's kind of a very concrete

[1:48:45] one, but versus something like an

[1:48:49] employment or um like a behavior goal

[1:48:52] where it's like we're going to reduce

[1:48:53] the number of self-injurious incidents

[1:48:56] or reduce the number of aggressions. you

[1:48:58] can objectively measure are we working

[1:49:00] towards that goal versus you know um

[1:49:04] we've got a a tedicare or or pack or

[1:49:08] something that is you know helping the

[1:49:10] person um feed themselves the person may

[1:49:15] never be able to feed themselves due to

[1:49:17] their disability but we can still

[1:49:19] determine quality metrics

[1:49:21] » From that based on um just looking at it

[1:49:24] but I agree there's not going to be a

[1:49:25] reversal

[1:49:27] » Quality metric.

[1:49:28] » So, so I'm not going to try to get

[1:49:30] totally down the rabbit. Sorry, sorry,

[1:49:31] K. This is just to follow up on kind of

[1:49:33] what I was already saying. So, not to

[1:49:35] just go totally rabbit hole on this, but

[1:49:40] um like I bill for my agency and it

[1:49:42] there's a certain way that you bill. You

[1:49:44] go into the ICP portal and then you like

[1:49:47] put in people's names and all this stuff

[1:49:49] and their their Medicaid number and then

[1:49:51] you get down to like what's the service

[1:49:53] you're providing and what are the number

[1:49:54] of units.

[1:49:56] It's hard for me while I'm sitting at my

[1:49:58] computer doing this to think, okay, for

[1:50:02] this particular

[1:50:04] uh this particular um BC visiting this

[1:50:09] person, they took the this uh this guy

[1:50:11] to Goodwill and that part of it was they

[1:50:13] went and talked to somebody about it and

[1:50:15] person's got a VR referral. They're they

[1:50:18] they they don't have a job coach yet. So

[1:50:21] the BC is kind of doing a little bit of

[1:50:22] exploration which you know a couple

[1:50:24] years ago you all added to be behavior

[1:50:26] support as a as an appropriate um way

[1:50:29] for BC to interact with an individual.

[1:50:32] How do I bill for that? I mean do I look

[1:50:34] into an individual service note and say

[1:50:37] oh on this particular occasion they were

[1:50:39] doing something that was relevant to to

[1:50:42] um employment. They did a little bit of

[1:50:45] exploration. They talked about it. Maybe

[1:50:46] they talked to an employee. I don't know

[1:50:49] how to I mean I agree that that's

[1:50:51] quality

[1:50:52] » But compared to being able to say and

[1:50:54] they spent an hour and a half doing it

[1:50:56] and so that's six units you know and I'm

[1:50:59] not saying

[1:51:00] » You know we have to keep unit I just

[1:51:02] can't and again it may be my deficit in

[1:51:07] um

[1:51:07] » Well I think you're looking you're

[1:51:08] looking maybe for the

[1:51:10] » The howto way before process defined

[1:51:15] » I think it is hard to envision because

[1:51:18] that's that's kind of the struggle we

[1:51:19] have is we can't envision it. Yeah.

[1:51:21] » Um at the same time I will say and and

[1:51:24] and because we haven't done it

[1:51:26] » Ever, right? Um and right but I do think

[1:51:30] here and here's the opportunity is and I

[1:51:32] think employment's a really good example

[1:51:34] is whatever that quality outcome is

[1:51:37] isn't necessarily I would argue it's not

[1:51:40] about what I as the provider did every

[1:51:43] every minute of the day because every

[1:51:45] minute of the day might be I had to work

[1:51:47] I had to help the the employer

[1:51:49] understand what their responsibility was

[1:51:51] and I I had to provide support to the

[1:51:54] individual. It's a big kind of holistic

[1:51:57] that isn't just about me as the employ

[1:51:59] as the provider that in other words the

[1:52:02] outcome isn't just because of me and

[1:52:04] what I did. The outcome is this whole

[1:52:06] ecology or ecosystem around a person and

[1:52:09] and how we set up the supports that

[1:52:11] isn't just about what we deliver to them

[1:52:13] but about what the community also

[1:52:15] delivers. And I think I think that's a

[1:52:17] really important and powerful

[1:52:18] opportunity because at the end of the

[1:52:20] day a quality employment outcome in the

[1:52:22] community isn't I and having worked as

[1:52:24] an vocational service provider it's not

[1:52:27] because of me

[1:52:28] » It's because the individual and those

[1:52:30] around and yes of course we are

[1:52:32] facilitators of that and those supports

[1:52:35] but if if the outcome is is only because

[1:52:37] of me and that's a failure I think and I

[1:52:40] think so I just say I I really commend

[1:52:42] it. Is that complex? Abs. Absolutely.

[1:52:45] That's complex

[1:52:47] and there's not going to be a metric in

[1:52:48] the very traditional and how do I bill

[1:52:51] for that? And I I do think that's an

[1:52:53] important thing because it gets me away

[1:52:55] from being the responsible party for

[1:52:58] every outcome in this person's life and

[1:52:59] realize that my my responsibility is

[1:53:01] much bigger. That's hard to do. That's

[1:53:03] going to be some big changes. I commend

[1:53:05] it. It's going to be hard.

[1:53:06] » It's be hard for us to struggle with

[1:53:08] because we've got a long legacy. And I

[1:53:10] mean that not as a not as a critique.

[1:53:12] It's not a critique. This is I think

[1:53:14] it's pretty

[1:53:15] » Just to talk about employment. Sorry.

[1:53:20] » Sorry, Katie. Do you want to go before

[1:53:22] me?

[1:53:22] » Yeah.

[1:53:24] » Okay. Um, just to talk about employment,

[1:53:26] like I just recently got a job, but it's

[1:53:30] through the company I'm with, the LEAL

[1:53:34] Foundation. I love it because they

[1:53:38] look towards

[1:53:41] people and other people with or without

[1:53:44] intellectual disabilities. So that's my

[1:53:48] main thing. Like most of the jobs that I

[1:53:51] applied to didn't hire me because I put

[1:53:54] I have an a disability. And I think

[1:53:58] that's criticism.

[1:54:00] I think it's discrimination.

[1:54:02] It's not fair to us that we want to work

[1:54:05] at Kroger, Walmart, Target, wherever.

[1:54:09] They don't want to hire people with

[1:54:11] disabilities anymore. It's frustrating.

[1:54:14] So, I just went with the job that I feel

[1:54:18] like that I love now. It's called

[1:54:21] Feeling Fine. It's off of Massav. that's

[1:54:23] pretty close to here. But,

[1:54:26] um, it's a cute boutique and I just love

[1:54:29] working there. And I feel like as if I

[1:54:33] if I had a mental breakdown here in a

[1:54:36] week or so, just for example, and I was

[1:54:40] working at a different job that they

[1:54:43] didn't understand, they would have fired

[1:54:45] me on the spot.

[1:54:47] Let's just let's just put it that point

[1:54:49] in perspective because that's what

[1:54:51] people do.

[1:54:53] they don't care about our mental health.

[1:54:56] » So, I think uh this is Kate for those of

[1:54:58] you who are online, just so we can have

[1:55:00] that for the transcript, too. Um I

[1:55:03] really appreciate you sharing that

[1:55:05] because I think when from the council's

[1:55:07] perspective, we hear very often that

[1:55:10] mental health and support for people

[1:55:13] with ID who are also experiencing mental

[1:55:16] health challenges is really important.

[1:55:18] And it's not just, you know, getting

[1:55:21] mental health services like therapy.

[1:55:24] It's also having access to the words to

[1:55:27] be able to describe how you're feeling

[1:55:30] and share that experience so you can get

[1:55:33] the help that you need. That's really

[1:55:35] important. And it sounds to me like

[1:55:38] there also is a need on the employment

[1:55:40] side to do more training for um hiring

[1:55:45] managers and in the community about like

[1:55:48] you said you love your job and you work

[1:55:50] at a boutique and I I would love to

[1:55:53] visit your boutique because that sounds

[1:55:55] amazing but I also saw your face light

[1:55:58] up when you were talking about how much

[1:56:01] you love your job and happiness. It's

[1:56:04] not a goal that we work into care plans.

[1:56:08] But ultimately, life is about being

[1:56:11] happy. And you can't do that if the

[1:56:14] things around you are not supporting you

[1:56:16] to be happy and what you want for

[1:56:19] yourself.

[1:56:19] » Right? So, when I was doing job

[1:56:22] applications with my job coach and I

[1:56:25] wouldn't receive anything back, I'm

[1:56:27] like,

[1:56:29] "These jobs don't want to hire people."

[1:56:31] » So, the L Yeah. And the LEO Foundation,

[1:56:36] Home Services Foundation, is the company

[1:56:39] I'm with. And Darlene, she's back there

[1:56:42] beautiful and everything. But she she

[1:56:46] going she put it out there that like,

[1:56:50] "Hey, we have this new boutique opening.

[1:56:53] Would you like to work there?" I was

[1:56:54] like, "Yeah."

[1:56:56] But it took quite a while for me to get

[1:56:59] the job, but I was still patient.

[1:57:03] So I I wanted to just comment on some of

[1:57:06] the valuebased services. It's because it

[1:57:09] sounds like there's two com

[1:57:11] conversations here. What are the value

[1:57:12] based services that you're looking to

[1:57:14] integrate into waiver redesign or waiver

[1:57:17] reset? Sorry, wrong word. Um and how

[1:57:20] will you measure it is those are the two

[1:57:23] things and I know some of those

[1:57:25] measurement pieces come out of national

[1:57:26] core indicators. Um, when we look at

[1:57:30] that data, I always wonder if there's a

[1:57:33] way to increase the response rate to

[1:57:35] that those number of people that are on

[1:57:38] those waiverss versus how many people

[1:57:41] actually respond to national core

[1:57:43] indicators seems relatively low. Um,

[1:57:46] that might be one thing to consider in

[1:57:48] is how do you increase that? Um, the

[1:57:51] other thing uh I would look at is um

[1:57:56] self- advocacy as a service, a value

[1:57:59] added service. Um, the ver there's a few

[1:58:02] states that have self- advocacy

[1:58:05] integrated into their waiver system. Um,

[1:58:08] I don't know how well that works or what

[1:58:10] that entails, but I know that it's on

[1:58:13] it's a service provision. That might be

[1:58:15] something when we're talking about

[1:58:17] self-determination and HCBS helping

[1:58:20] people live in the community.

[1:58:22] Something like self- advocacy

[1:58:25] to build those skill sets uh for better

[1:58:28] community living would be a value added.

[1:58:32] » Thank you. I think Katie had No. Okay.

[1:58:35] Oh, okay.

[1:58:39] » Okay.

[1:58:41] » Yeah. All right. Um, thank you guys for

[1:58:44] the good conversation. Um,

[1:58:47] so you're fine. It's good conversation.

[1:58:50] Um, so lastly, oh, you switched.

[1:58:53] » Were you ready? I'm sorry.

[1:58:54] » That's okay. I think, um, yeah, just the

[1:58:57] last goal of course is implementing the

[1:58:59] sustainable service delivery system and

[1:59:01] we have talked about that as well. So,

[1:59:04] let's go ahead. Um,

[1:59:06] I don't know what the music is. Sounds

[1:59:08] like the ice cream truck. If anyone

[1:59:10] remembers any pizza, too. I did too.

[1:59:15] » Actually, I can't wait.

[1:59:16] » I want the Superman ice cream, please.

[1:59:22] » Um, so um, as we think about a

[1:59:26] sustainable framework, I want to just

[1:59:28] quickly go through those three levers

[1:59:30] we've talked about before. Um, one is

[1:59:33] the support needs tiers. That is again

[1:59:36] where individuals um those interi

[1:59:40] assessments, right? Those will inform

[1:59:45] support level tiers that are in

[1:59:47] development. Okay, those aren't done

[1:59:49] yet. We are gathering all that data um

[1:59:52] from the assessments that have been

[1:59:53] completed.

[1:59:55] Um somebody does have an ice cream truck

[1:59:57] somewhere in this building. Um and then

[2:00:00] we'll be looking at developing or are

[2:00:02] developing support level tiers. those

[2:00:04] those tiers will be individuals who have

[2:00:08] similar needs will be grouped

[2:00:11] um together, right? And according to

[2:00:13] their need and that's what we're

[2:00:15] referring to when we talk about support

[2:00:17] levels or support need tiers. That's

[2:00:21] what we're talking about. That's in

[2:00:22] development from that. Once we have

[2:00:25] those developed, there will be a model

[2:00:27] service mix. And I know we we've talked

[2:00:29] about this before or a model service or

[2:00:32] a combination of services that one would

[2:00:35] typically expect an individual with that

[2:00:38] need level to utilize.

[2:00:42] It's not telling people what services

[2:00:45] they should get and saying here you're

[2:00:46] in this support level. This these are

[2:00:49] the services you get and this is how

[2:00:50] much. That's not the intent. is just to

[2:00:52] give some kind of some parameters for

[2:00:54] teams so they can think about you know

[2:00:57] what that might what a service mix might

[2:00:59] look like um with the individual.

[2:01:03] Then there's support budget tiers and

[2:01:06] those budget tiers will be um determined

[2:01:10] based on available resources the

[2:01:13] Medicaid appropriation right and they

[2:01:16] will be connected if you will to these

[2:01:19] are the support level support need

[2:01:21] levels these are the budget levels and

[2:01:24] there'll be a relationship there but

[2:01:27] they are two separate things I do want

[2:01:29] to stress they are two separate

[2:01:30] » Does that the Medicaid

[2:01:34] Does that mean like a Medicaid um

[2:01:37] redetermination or what

[2:01:40] » To the amount of funds you know to

[2:01:42] believe how we've kind of talked about

[2:01:44] pie that we have of funding that's what

[2:01:46] I'm talking about okay

[2:01:47] » Is that overall kind of pie of funding

[2:01:50] that gets divided with support level

[2:01:53] framework more equitably across the

[2:01:56] individuals and services

[2:01:58] » So my question is is like do they do

[2:02:01] Medicaid determination

[2:02:03] do or no?

[2:02:04] » No, that is that will remain with the

[2:02:06] division of family resources as it is

[2:02:08] now.

[2:02:09] » Okay, that was my question.

[2:02:10] » No, that's a good question. Um, and I

[2:02:12] think the other piece is when we think

[2:02:14] about the budget tiers, we're also

[2:02:17] looking at some things other than the

[2:02:19] assessment that would include living

[2:02:21] arrangement and age and even what are

[2:02:25] those other long-term ser LTSS or

[2:02:28] long-term services and supports um,

[2:02:31] expenses or costs for that individual?

[2:02:34] what are they receiving not just in

[2:02:36] waiver or what are their needs not just

[2:02:39] from a waiver perspective but more

[2:02:40] holistically what are an individual's

[2:02:43] needs and then what are those resources

[2:02:45] that are being used or needed across

[2:02:48] waiver and state plan to address those

[2:02:51] needs

[2:02:53] um and then of course the sustainable

[2:02:55] framework number and type of waivers um

[2:02:58] simplification of the service array and

[2:03:00] and the budget tiers and then the slots

[2:03:03] assigned per waiver

[2:03:04] once we have um the waivers designed or

[2:03:08] or the number of waiverss determined.

[2:03:10] Next slide,

[2:03:13] » Please.

[2:03:15] » Speaking of mental health, maybe we need

[2:03:16] to go over there.

[2:03:17] » Yeah, maybe.

[2:03:20] » Um so, I did want to um just also kind

[2:03:23] of put in one list, if you will, those

[2:03:26] things that we're doing um related to

[2:03:29] waiver reset. Um, we could call them

[2:03:31] phases. Um, but waiver reset is big as

[2:03:35] you guys know. Um, and everything that

[2:03:37] we're doing is working towards

[2:03:40] that final full waiver reset, right? So,

[2:03:44] we've done stakeholder engagement. We we

[2:03:46] will continue to do that. Um, we have

[2:03:49] the support budget community advisory

[2:03:51] board. I didn't name it. um the SB CAB

[2:03:55] um that is meeting monthly um around

[2:03:58] waiver reset. We have the intri

[2:04:01] implementation which you can see how

[2:04:03] that um utilizing those tools across all

[2:04:06] the beads waiverss supports

[2:04:10] that future look at support levels and

[2:04:12] and developing those support levels.

[2:04:16] We have the case management, the

[2:04:17] selective contracting. Um we know with

[2:04:20] waiver reset um however that ends up

[2:04:24] looking right um in 2028, we need case

[2:04:28] managers in place that are well trained

[2:04:30] and well informed so that they can

[2:04:32] adequately support individuals and

[2:04:34] families through those changes.

[2:04:37] Um and then the transition planning of

[2:04:39] course um for individuals on waiverss

[2:04:43] today um that will transition at the

[2:04:46] time of waiver reset. We can't start

[2:04:48] that too soon. And then of course we

[2:04:50] have talked um I believe last month

[2:04:53] about um our pursuit for a youth waiver.

[2:04:57] Um we have heard um for uh quite some

[2:05:01] time that there is a desire um for a

[2:05:05] youth waiver. ch needs of children are

[2:05:08] significantly different than those of

[2:05:10] adults. Um so we are um looking at

[2:05:14] pursuing a youth waiver um likely in

[2:05:18] advance a little bit in advance of the

[2:05:21] full waiver reset. So um I know that's a

[2:05:25] lot. If we have questions we can

[2:05:27] certainly talk through those. But this

[2:05:29] surprise this will not be the last time

[2:05:30] you hear about waiver reset. We'll

[2:05:32] continue to have those conversations.

[2:05:34] So, next slide.

[2:05:37] Um, I won't go through this slide. You

[2:05:40] all have seen it before. It just

[2:05:42] provides a little more information on

[2:05:43] the support budgets. Um,

[2:05:47] but just wanted to call that out. Also

[2:05:50] wanted to include the slide. Yes, that

[2:05:53] talks about why we're pursuing support

[2:05:55] budgets. Again, I think you know um I

[2:05:58] will I will confess um I am steeped

[2:06:02] enough in waiver reset that that I have

[2:06:04] to remind myself to talk about the why,

[2:06:07] right? Why are we doing this? Um why are

[2:06:11] we pursuing um waiver reset and why are

[2:06:14] we pursuing this different model of of

[2:06:17] support level needs or support needs

[2:06:20] levels and support budgets?

[2:06:23] Um, at the end of the day, um, we're

[2:06:26] doing it, um, we're pursuing it because,

[2:06:30] um,

[2:06:33] today there isn't, um, there is perhaps

[2:06:37] a lack of lack of equity in in resources

[2:06:40] individuals can access through HCBS,

[2:06:43] right? It's dependent some on the waiver

[2:06:46] you're on and and some other factors.

[2:06:48] And the support level framework um

[2:06:51] allows us to um objectively identify an

[2:06:56] individual's needs.

[2:06:58] And then the support budget allows us a

[2:07:02] way to objectively say people with this

[2:07:04] level of need should have access to this

[2:07:07] level of funds.

[2:07:08] » So on the waiver reset, are you talking

[2:07:11] about all the waivers? Are you gonna

[2:07:13] like like go through all the waivers and

[2:07:16] see which need which waivers need more

[2:07:20] budget?

[2:07:21] » No, the actual the full waiver reset,

[2:07:25] right, is when we will sunset

[2:07:27] » The waivers we have today

[2:07:30] » And they will be replaced and we will

[2:07:33] stand up new waivers completely new.

[2:07:37] » Um there will be a transition period,

[2:07:40] right? So, individuals in all likelihood

[2:07:42] will transition when their annual

[2:07:46] » Um plan is due. Okay. Right. Um but the

[2:07:49] waiverss as we know them today

[2:07:53] » Won't be here. That's 2028 probably.

[2:07:55] » Okay. Cool. Yeah. So, we're still

[2:07:57] » It's not tomorrow. So, it's okay.

[2:07:59] » That's what I was wondering.

[2:08:01] » If it was tomorrow, all hair on my head

[2:08:04] would be gray. But it's not. It's 25.

[2:08:07] Me, too.

[2:08:08] » So, it's all right.

[2:08:11] Yeah,

[2:08:11] » It it does. It feels like it's next

[2:08:13] month around 2028, but but but we have

[2:08:16] some time

[2:08:17] » In two years.

[2:08:18] » Holly,

[2:08:19] » Yes. Has it completely like because I

[2:08:22] know at one point we were talking like

[2:08:24] late 2027.

[2:08:26] Has it completely changed to the

[2:08:28] transition period being 2028? And the

[2:08:30] reason I asked this is I believe my

[2:08:32] annual meeting is typically in December.

[2:08:35] So, would I start transitioning in

[2:08:37] December of 2027 or would I have to wait

[2:08:39] till December of 2028?

[2:08:42] » So, I can't give you a firm answer on

[2:08:43] that right now, Lexi. Um, you know, we

[2:08:48] we would we are full steam ahead. I want

[2:08:51] to be clear about that. But we also want

[2:08:53] to be very thoughtful and I do feel like

[2:08:56] um previously we had talked about 2027.

[2:08:59] I do feel like we are sliding into early

[2:09:02] 2028.

[2:09:04] Um so um but we will keep you all

[2:09:07] apprised of kind of where we are on that

[2:09:09] timeline. Um

[2:09:13] but we we again we're full speed ahead

[2:09:15] but we want to make sure that um we

[2:09:19] don't we want to be very thoughtful and

[2:09:21] intentional in the process. So

[2:09:23] » Understandable.

[2:09:25] » Yeah. Yeah. But we'll keep you all I

[2:09:27] mean we'll we'll be talking about this a

[2:09:29] lot. You're going to have to hear from

[2:09:30] me a lot more. I'm sorry.

[2:09:32] » No problem. I like hearing about this

[2:09:34] stuff, so it's cool.

[2:09:35] » Okay. Thank you,

[2:09:38] » So then go ahead.

[2:09:39] » Sorry. I was gonna say, um, with the

[2:09:41] youth waiver being a possibility, will

[2:09:44] there be any kind of, um, I guess

[2:09:49] movement forward to

[2:09:52] coordinating how that might uh, work

[2:09:56] with the schools or with the um, IdoE as

[2:10:00] well? Yeah, that's a a a great question.

[2:10:04] Um yes, I think um as we get further in

[2:10:09] with the youth waiver, I do think it's

[2:10:13] important um that we engage with

[2:10:17] Department of Education. Um, I I will

[2:10:20] say, and I know you know this, um,

[2:10:25] a family's experience with the

[2:10:27] educational system often is related

[2:10:31] almost solely to their local school

[2:10:33] district. Um

[2:10:36] so um but yes I think that's an

[2:10:40] important call out is and we do need to

[2:10:42] account for again those entitlement

[2:10:45] services for youth and how do we support

[2:10:47] them in accessing those

[2:10:50] in an appropriate way. Yeah good call

[2:10:53] » With the youth waiver um possible

[2:10:56] transition before like is there an idea

[2:10:57] of how much sooner that that transition

[2:11:00] would start than the full waiver reset?

[2:11:02] Um, not right now. I think we would like

[2:11:05] to I think if we we need to get it we

[2:11:08] would need to to work through the youth

[2:11:10] waiver um and get it implemented in 2027

[2:11:14] probably early to mid 2027.

[2:11:17] Um if we're going to do it before waiver

[2:11:20] reset and that that is next week by the

[2:11:23] way. Um not really but um but yeah

[2:11:26] that's that's kind of in discuss or that

[2:11:29] is in discussion right now as well is

[2:11:30] watching that timeline.

[2:11:32] » Holly is the envision that if youth only

[2:11:36] on like only on that waiver and not on

[2:11:38] the other waivers. So if they're youth

[2:11:39] are on that waiver only that waiver.

[2:11:41] » Yeah.

[2:11:41] » Okay.

[2:11:42] » Yep.

[2:11:46] » Um let's see. Oh, and another thing on

[2:11:49] here that I just want to want to note is

[2:11:51] the supports budget does promote some

[2:11:53] transparency there so that individuals

[2:11:56] will know um walking into their annual

[2:12:00] meeting so to speak what resources they

[2:12:03] have available through state uh not

[2:12:04] through state plan through the waiver um

[2:12:08] in terms of in in consideration of also

[2:12:12] what other services they may be

[2:12:14] accessing through state plan and other

[2:12:16] resources.

[2:12:18] And again, it allows us to predict

[2:12:21] predict predict I've been talking for

[2:12:24] way too long today. Um spending

[2:12:27] um both for people on the wait list as

[2:12:31] well as um individuals and services. So

[2:12:34] yeah, we can go ahead and go to the next

[2:12:36] one.

[2:12:36] » One more question. The the requirement

[2:12:39] um from last legislative session to

[2:12:40] create an assisted living waiver, how

[2:12:42] does that interplay with the waiver

[2:12:43] reset?

[2:12:44] » I'm so sorry. living.

[2:12:46] » Oh. Oh,

[2:12:47] » The assisted living waiver is 460 plus.

[2:12:50] » Okay. No implications just on that.

[2:12:52] Okay.

[2:12:53] » Good question though.

[2:12:54] » That would fall under

[2:12:57] » OMP.

[2:12:58] » Yeah.

[2:13:01] » Yep. Um I won't go through this again.

[2:13:03] I'm wanted to include it though. If we

[2:13:05] can go to the next slide. I've updated

[2:13:08] this next slide and graphic. Please note

[2:13:12] that those uh participant counts are

[2:13:14] current um as of

[2:13:18] » April. April. As of April um

[2:13:21] » Say current people say

[2:13:22] » Yeah I know um

[2:13:25] » The devil's in the details as Jim said.

[2:13:27] Yes. Okay. I can add that

[2:13:29] » Just in because people will say

[2:13:30] » Yes. So I've added in the youth waiver

[2:13:33] there that you can see that is a

[2:13:35] difference from the last time you saw

[2:13:36] this slide as well. We have the case

[2:13:38] management and the youth waiver. And

[2:13:40] then that green is more representative

[2:13:42] of the new waiver structure that would

[2:13:45] that we would be in um at the time of

[2:13:48] waiver reset.

[2:13:52] » Um let's go ahead and

[2:13:56] » Can you maybe just go back?

[2:13:58] » Yes, please go back.

[2:13:59] » I just want to highlight on that because

[2:14:01] I think you did this intentionally.

[2:14:04] » Oh, I did. Um,

[2:14:06] Holly appears to have bolded

[2:14:09] the kid numbers.

[2:14:11] » Um, and I I I just wanted to call out

[2:14:14] the numbers of kids that we are serving

[2:14:17] is now outnumbering the adults.

[2:14:23] » Thank you, Kathy.

[2:14:25] » I mean,

[2:14:27] » Yeah. So, lots of use.

[2:14:29] » So, the bold ones mean kids.

[2:14:32] » Yeah. The bold ones like the 10,000

[2:14:34] There are some that are

[2:14:36] » So basically 10,000 FS is 0 to 17 I mean

[2:14:41] over 10 you know then 18 to 26 is 7,000

[2:14:44] 27 to 56 and then H&W 2000

[2:14:50] to 17 798 18 to 26 okay

[2:14:56] » Yes and our ages on the family support

[2:14:58] waiver weight list very much

[2:15:02] um correlate with this as well um in

[2:15:05] terms of the age of of individuals on

[2:15:08] the FS weight list. So Jory, just

[2:15:10] quickly, I saw your face. So it's

[2:15:12] interesting because I think you probably

[2:15:13] didn't realize. It's interesting. I just

[2:15:15] was because I think we are noticing

[2:15:17] people don't necessarily real I mean we

[2:15:19] say it sometimes but I don't think it's

[2:15:21] I not to call you out. I just saw your

[2:15:23] face was like oh

[2:15:25] » My so I'm assistant special ed director

[2:15:27] in the district and I think that's very

[2:15:29] reflective though of the needs that

[2:15:31] we're seeing in schools. the school

[2:15:32] needs are significant and the I oversee

[2:15:35] the uh developmental preschool program

[2:15:38] as well as the my board of our

[2:15:41] classrooms for students who have more

[2:15:42] intense needs and just the level of the

[2:15:45] growth in those needs is startling um

[2:15:49] and then how are we providing it's very

[2:15:52] passionate topic because it is this the

[2:15:55] classrooms um we are adding a fourth

[2:15:57] classroom our development preschool

[2:15:59] classrooms are exploding and we're a

[2:16:01] smaller district um some of the larger

[2:16:03] districts and these are we have students

[2:16:05] I mean every we've tried to figure out

[2:16:07] how do we catch these kids as two or

[2:16:09] three or four year olds who already have

[2:16:11] the identified disability versus like a

[2:16:13] developmental delay how do we catch them

[2:16:15] get them on the waiting list for the

[2:16:17] waiver um so we've just added little

[2:16:19] bits to like our case conference

[2:16:21] templates and things to ask but the

[2:16:23] number of students that are not on the

[2:16:25] wait list yet that haven't even signed

[2:16:26] up and then match the number of kids

[2:16:28] that are on it and just knowing in my

[2:16:30] head like the conferences that in with

[2:16:32] 11 year olds or 15 year olds that are

[2:16:33] still that have not been caught.

[2:16:35] » It's just I think it's very reflective

[2:16:38] kind of

[2:16:38] » I think what they should do is like have

[2:16:42] someone test them and then figure it out

[2:16:45] because that's what my mom had me do was

[2:16:47] be tested every year to see where I

[2:16:50] struggle at and then they could help

[2:16:53] them get on there. And these are

[2:16:55] students.

[2:16:59] » Even if they weren't evaluated, they

[2:17:01] should still test them, you know.

[2:17:03] » And I think to your point, Jo, I think

[2:17:05] that's where the youth waiver comes in

[2:17:06] because the services and supports that

[2:17:08] are offered, right? I mean, aren't um I

[2:17:12] I think about this as my first day on

[2:17:14] the job years ago is what are you

[2:17:16] waiting for? Because the problem is I

[2:17:18] think people are waiting but it's it's

[2:17:20] what services are on that array right

[2:17:22] for a child and there's other services

[2:17:24] that the school system provides right

[2:17:26] that is not a waiver service and so I

[2:17:28] think that's you know the the movement

[2:17:31] is because what you know what what are

[2:17:34] you wait I mean you know because a lot

[2:17:36] of times it's not it the services that

[2:17:39] are there other DOE's you know what I

[2:17:41] mean there's other services and supports

[2:17:42] that are already in place that are

[2:17:44] helping that so it's kind of

[2:17:46] » Can I throw something out there about

[2:17:47] the numbers. This is Lexi.

[2:17:49] » Um,

[2:17:51] so I think so I found out I got on I was

[2:17:56] got on the A andd waiver originally.

[2:17:58] I've been on the waiver for almost 10

[2:18:00] years and h about half of that was A&D

[2:18:02] um which is now health and wellness. Um,

[2:18:06] and I found out from my doctor, believe

[2:18:08] it or not, which I heard is rare to find

[2:18:10] out about the waiver from your doctor.

[2:18:13] Um I think we're seeing more kids on the

[2:18:15] waiver, more youth on the wa on the

[2:18:18] waiver or on the waiting list now than

[2:18:21] historically is because um and I see

[2:18:24] this a lot on but on social media

[2:18:27] especially Facebook and stuff there's a

[2:18:29] lot of peer-to-peer support for families

[2:18:32] like parents are supporting parents and

[2:18:34] caregivers are supporting caregivers

[2:18:36] their you know Facebook groups for stuff

[2:18:38] like that and I think more parents are

[2:18:41] hearing about the waiver honestly ly

[2:18:42] through other parents through social

[2:18:44] media um than historic, you know, that

[2:18:48] wasn't a thing. That wasn't even as much

[2:18:50] of a thing when I got on the waiver 10

[2:18:53] years ago. But, um I think historically

[2:18:56] for people my age, schools weren't

[2:18:59] talking about it. Doctors weren't

[2:19:00] talking about it. And now parents are

[2:19:02] seeing other parents with their kids on

[2:19:04] it on social media and finding out from

[2:19:07] parents. And there's just so much

[2:19:08] peer-to-peer support, especially with

[2:19:10] social media.

[2:19:13] Yeah, good point, Lexi.

[2:19:15] » Thank you.

[2:19:15] » Thank you, Kathy. Thanks for bringing us

[2:19:17] back to point that out. No, I appreciate

[2:19:19] it. I'm glad you did.

[2:19:21] » I'm glad you did. Um, just want to note

[2:19:24] we've already talked about most of this.

[2:19:26] Um, but do want to just reiterate that

[2:19:29] we are um analyzing that data from the

[2:19:33] interrise now. Um and then um if we can

[2:19:36] move to the next slide, I want to

[2:19:38] provide an update on

[2:19:40] some of the activities that we're in

[2:19:43] process of or have completed already um

[2:19:46] with regards to waiver reset. Um HSRI,

[2:19:50] human services research institute is a

[2:19:53] contracted entity with beads. um they

[2:19:56] now have two years of Medicaid claims

[2:19:59] data that includes the waiver, the HCBS

[2:20:03] data as well as state plan data. So

[2:20:05] we're looking again at that holistic

[2:20:07] approach right um and they are cleaning

[2:20:11] that right from a data perspective um

[2:20:14] and then uh working on that analysis. We

[2:20:18] have also and this is not we bees. This

[2:20:21] is one of our internal partners in FSSA

[2:20:23] our uh friends over at office of

[2:20:25] Medicaid policy and planning have

[2:20:27] launched an internal workg group

[2:20:29] exploring state plan home health

[2:20:31] services um and we are a part of that.

[2:20:34] Um we've held some initial meetings on

[2:20:36] the plans and goals for waiver reset

[2:20:39] with our cross system partners that

[2:20:40] includes um our friends at um DMHA of

[2:20:45] course our our family now in the Bureau

[2:20:48] of Better Aging um as well as OMP.

[2:20:54] We have also um completed an in-depth

[2:20:58] review of our current service

[2:21:01] definitions across all four of the beads

[2:21:03] waivers. I think we've talked about

[2:21:05] before um we have a lot of services that

[2:21:08] we offer and how can we simplify that,

[2:21:11] right?

[2:21:12] um how can we kind of consolidate

[2:21:14] services or combine services or in in

[2:21:18] some way make that system that's those

[2:21:21] that that service array a little easier

[2:21:23] to understand. Um while also keeping

[2:21:27] that eye on on quality services. Um so

[2:21:31] we have completed that. Um we have

[2:21:33] completed round one of research into

[2:21:36] some promising practices in other states

[2:21:38] on all things waiver reset. Right. Um

[2:21:41] all different topics there. And then we

[2:21:43] begin um or began some additional um

[2:21:47] research into promising practices

[2:21:49] earlier this month. We have a

[2:21:52] preliminary service array recommendation

[2:21:54] from HSRI or No, I'm sorry. We don't

[2:21:57] have it yet, but it's in process of

[2:21:59] being um developed for us to review.

[2:22:05] And then um Yes. Oh, I'm sorry. You're

[2:22:09] fine. We're fine. Um on that preliminary

[2:22:12] service array recommendations, is that

[2:22:14] going to be uh discussed with the SB?

[2:22:18] » Probably. So I'm not sure the timeline

[2:22:20] for it yet, but I would think we will

[2:22:22] talk about that with the SB group. Yes.

[2:22:24] Thank you.

[2:22:25] » Good question.

[2:22:28] We have also provided weight list data

[2:22:31] um to HSRI um because as we talk about

[2:22:35] the launch of a youth waiver and waiver

[2:22:37] reset um we know we've got multiple

[2:22:40] waiting lists now for HCBS. So we need

[2:22:44] to be looking at that and deciding how

[2:22:46] that's going to work moving forward.

[2:22:49] Um and then

[2:22:50] » Sorry Holly.

[2:22:51] » Oh yeah sure. Well, Kate left, so

[2:22:54] somebody asked that question, but you

[2:22:56] know, she she passed it on to me. Um,

[2:23:00] that weight list data, is that kind of

[2:23:02] demographic data, age? Okay, so it's not

[2:23:07] um level of care, nothing like that.

[2:23:09] Okay.

[2:23:11] » Well, let me rephrase that. That waiting

[2:23:14] list data would include what level of

[2:23:16] care was met by the person, right?

[2:23:19] because we have different we have the

[2:23:21] nursing facility level of care and the

[2:23:22] ICF ID level of care. So,

[2:23:25] » Does that make sense?

[2:23:26] » Yes, it does. It's you're not looking at

[2:23:28] you're not looking at NRI data

[2:23:31] essentially.

[2:23:32] » We're looking at the level of care.

[2:23:33] » Got it. Thank you.

[2:23:34] » Yeah.

[2:23:37] All right. Good questions. Um and then

[2:23:39] again, need to update this because the

[2:23:41] final awards um for the new case

[2:23:43] management contracts have been made. So

[2:23:46] um and we've talked quite a bit about

[2:23:48] case management and also the data

[2:23:50] analysis for the budget framework um

[2:23:53] development has begun. So while we're

[2:23:55] working on the identifying the support

[2:23:57] levels

[2:24:00] um for individuals um and what that will

[2:24:03] look like or the support level

[2:24:04] framework, we're also analyzing that

[2:24:07] data or HSRI is analyzing the data uh

[2:24:10] regard regarding the budget framework

[2:24:12] which again considers

[2:24:15] HCBS and state planning. So, it's all of

[2:24:18] the long-term services and supports

[2:24:20] data.

[2:24:26] Okay.

[2:24:27] Okay. Going to shift just a little

[2:24:31] shift. Any questions? I'm going to reset

[2:24:33] before I jump in here. Okay. Okay. So,

[2:24:36] the home and community support

[2:24:38] professionals uh statistics. So, we have

[2:24:41] a reporting period. This is the the

[2:24:43] training registry that the HCSP

[2:24:46] um training registry that we've

[2:24:48] launched. Um the total number of

[2:24:52] learning path certificates granted since

[2:24:54] July is over almost 37,000

[2:24:58] which is really good. Um total time

[2:25:02] spent learning is um about 188,000

[2:25:06] hours. Uh Wednesday appears to be the

[2:25:09] day that most people do their training.

[2:25:11] Huh.

[2:25:12] » Yeah, that is interesting. Um, it's

[2:25:16] middle of the week and then the user

[2:25:18] device description just talks about what

[2:25:20] device people are using, right, for um

[2:25:23] for the training. So, um, again, we've

[2:25:27] had really positive, uh, feedback on the

[2:25:32] HCSP training.

[2:25:34] » Is that is the this

[2:25:37] professional stats like the tests that

[2:25:40] people have to take to be a caregiver or

[2:25:44] anything?

[2:25:44] » So, is the the HCSP training, right,

[2:25:48] includes th that competency testing.

[2:25:51] » Okay. So get the certificate. You

[2:25:53] correct me if I'm mistake. Um

[2:25:56] » When you say caregiver

[2:25:58] » I don't know to what you're

[2:26:00] » Like

[2:26:00] » You know what I mean

[2:26:01] » Support staff.

[2:26:02] » Yes like Yes. I just want to make sure

[2:26:05] because it's not all service like but I

[2:26:08] Yes. Traditional

[2:26:10] » Is CI on it or Okay.

[2:26:12] » Yes. But like a music therapist which I

[2:26:14] know you wouldn't call it is not

[2:26:16] considered a home but yes but

[2:26:17] traditionally the what you're thinking

[2:26:18] of is Yes.

[2:26:19] » Yes. CI. Yeah.

[2:26:21] » Yeah.

[2:26:22] » Yeah. DS

[2:26:24] » Or day programs day programs. Okay.

[2:26:28] Cool. Thanks.

[2:26:31] » We had really positive feedback. We've

[2:26:33] been very pleased with how

[2:26:35] » Yeah. And we're going to provide the

[2:26:37] reertification is coming up um in terms

[2:26:40] of um folks. And then also the med admin

[2:26:43] we're still working on. It's taking a

[2:26:45] little bit longer. The the providers are

[2:26:47] obviously able to still use their own,

[2:26:48] right? they're not being penalized for

[2:26:50] um anything. So um yeah, so it's going

[2:26:52] pretty well. We're going to share u much

[2:26:54] more information and we're also coming

[2:26:56] up on a year. So we're going to be able

[2:26:58] it's hard because we didn't have data on

[2:27:01] direct support professionals prior to

[2:27:02] this. So we don't have anything to

[2:27:04] compare it to much. I mean we have some

[2:27:07] obviously national um you know surveys

[2:27:10] that are done but um so but now that

[2:27:13] we're almost at a year we can really

[2:27:15] look at um you know some things and I

[2:27:19] think it's going to be interesting as

[2:27:20] we're moving forward. So we will be

[2:27:21] presenting at the quarterly

[2:27:24] MFR which is what?

[2:27:27] Yeah. When is that? August. I don't

[2:27:29] remember when the next one is. Um sorry

[2:27:31] I'm blanking but we will be providing

[2:27:33] details on this. Um just some more data

[2:27:36] and everything. So it's exciting stuff.

[2:27:38] » We all have brain farts sometimes.

[2:27:40] » I know I can't.

[2:27:42] Yeah.

[2:27:46] » Yeah.

[2:27:49] » Okay. We have about I mean 20 minutes.

[2:27:51] Obviously not going to hold you here and

[2:27:53] to stare at each other, but if

[2:27:56] Oh yeah,

[2:27:58] » I know.

[2:28:04] » Good job.

[2:28:05] » Wait, we've got 20 minutes worth of

[2:28:07] questions. Go.

[2:28:10] » So,

[2:28:13] » We need Kate We need Kate back.

[2:28:16] I'm just going to um add since we do

[2:28:19] have some time and we um obviously I

[2:28:23] mentioned earlier around sort of the

[2:28:26] questions related to the valuebased

[2:28:28] payment or purchasing our interest in

[2:28:31] the employment space uh competitive

[2:28:33] integrated employment space. Um and

[2:28:37] that's an area that we've continued to

[2:28:39] to work toward making incremental

[2:28:42] progress. Um, but as of I think this

[2:28:48] week, and you two correct me if I'm if I

[2:28:52] can't read clearly, apparently, um, we

[2:28:55] have less than 500 subminimum wage

[2:28:58] workers in the state of Indiana right

[2:29:00] now.

[2:29:01] » Um, and that is a significant decrease

[2:29:04] from where we started um, I don't know,

[2:29:08] feels like yesterday, but it was a

[2:29:10] couple years ago. Um and so for for us

[2:29:14] that continue when I said that earlier

[2:29:17] it's because we have um we have a a

[2:29:20] desire here to make some meaningful

[2:29:22] progress um in Indiana and I think we

[2:29:25] are very much on the right track. Um, we

[2:29:28] do still have a number of 14C entities,

[2:29:32] but those a number of those are working

[2:29:35] at um transitioning out uh or phasing

[2:29:38] out their 14C's uh even so later this

[2:29:42] year. So, um I I want to just

[2:29:45] acknowledge the work that everyone has

[2:29:48] has done in that front, but we are that

[2:29:51] don't feel like that's an opportunity to

[2:29:53] let up on the gas at this point, which

[2:29:55] is why we're talking about valuebased

[2:29:58] payment as a mechanism to help forward

[2:30:01] um the employment um outcomes for people

[2:30:04] even further. So, I just I wanted to

[2:30:06] take a minute to share some of that

[2:30:08] data. Didn't totally fit into the agenda

[2:30:11] um today. And I certainly will have some

[2:30:14] more information to to share with you at

[2:30:16] future uh advisory meetings. But um I I

[2:30:21] I because you all have been so invested

[2:30:24] and involved in these conversations and

[2:30:27] some of the work that we've laid forth

[2:30:29] in our plan. Um I I wanted to take just

[2:30:32] take an opportunity to to to put that in

[2:30:34] front of folks and uh share that update.

[2:30:38] » Yep. So in that 500 does it is it with

[2:30:42] people with intellectual disabilities or

[2:30:45] that

[2:30:47] because they can't have a job or

[2:30:51] the person

[2:30:53] wants a job but

[2:30:56] the com the base the jobs like Target,

[2:31:00] Walmart, Kroger,

[2:31:02] Goodwill. I I know Goodwill hires

[2:31:05] people, but I don't preferly like

[2:31:08] working there. But

[2:31:11] um is that because the 500 is because

[2:31:16] jobs now these days are not accepting

[2:31:19] people with intellectual disabilities?

[2:31:24] » You feel free to to jump in. Um I

[2:31:26] there's actually it's a number of

[2:31:28] reasons why they're they haven't and and

[2:31:31] some of it is at this point either they

[2:31:34] they haven't had those conversations and

[2:31:36] been planning around competitive

[2:31:38] integrated employment. They're just at

[2:31:40] different places and spaces depending on

[2:31:42] their own um kind of trajectory kind of

[2:31:46] how long have they been in a subminimum

[2:31:48] wage scenario. And um obviously

[2:31:51] sometimes it's harder for folks to

[2:31:53] transition away from that. um there

[2:31:56] there's a lot of forces at play for some

[2:31:58] some of those people for maybe why

[2:32:00] that's the case. Um but knowing that

[2:32:04] that number I think is a much more um a

[2:32:08] number that's much better I guess from

[2:32:10] tackling those very um individualized

[2:32:14] issues on an individual basis um to be

[2:32:17] able to help them work through that or

[2:32:19] navigate look at a trajectory of where

[2:32:21] they're headed and how to get there.

[2:32:23] Holly or Jess, anything else you would

[2:32:26] ask?

[2:32:27] » Yeah, no, I think that was a great

[2:32:29] response. I would I would also add that

[2:32:31] I think um some of the individuals um

[2:32:34] that are maybe still in those settings

[2:32:36] too may just have lots of questions

[2:32:40] about competitive integrated employment.

[2:32:42] And I think um I'll I'll be selfish here

[2:32:45] and make a little plug for a couple of

[2:32:47] the newer services, the career

[2:32:49] exploration and planning and and also

[2:32:51] that benefits

[2:32:53] » Those benefit discussions because I

[2:32:55] think um those are opportunities to um

[2:32:59] for our system to engage with those

[2:33:02] individuals and their families about

[2:33:05] what other what are the other

[2:33:07] possibilities, you know, right? Um, I

[2:33:10] think my mom's supposed to do my

[2:33:12] benefits review with someone, but they

[2:33:15] haven't reached back out. So, then

[2:33:18] my um VR counselor and I met yesterday

[2:33:23] with my mom and Darlene and she said,

[2:33:26] "We're thinking about taking you to the

[2:33:28] next step and closing your case."

[2:33:32] because they couldn't really work with

[2:33:34] me because my case manager is in Johnson

[2:33:37] County and I work in Marian. Um, but I

[2:33:41] would have I like the job where I'm at

[2:33:43] because it's just easier. They love

[2:33:47] people with intellectual disabilities

[2:33:49] and they want us to succeed and move on

[2:33:53] from what what's going on right now.

[2:33:56] Like, you know, like I get it. It's hard

[2:33:59] to

[2:34:01] like my like if I was looking for a job

[2:34:05] like let's say 5 years ago which I I did

[2:34:09] have a job but then

[2:34:14] it's harder these days to get a job

[2:34:18] because of all the changes in the state

[2:34:24] and with the government and sorry I have

[2:34:27] to say his name even though I don't like

[2:34:29] him. Trump's stuff, but I just I don't

[2:34:35] understand why he's doing this to people

[2:34:38] with an abilities.

[2:34:41] But my point is like he doesn't know how

[2:34:44] well we succeed. He doesn't know

[2:34:46] anything. And he has someone with a

[2:34:49] disability and he probably disown them

[2:34:51] like crazily, but I don't like them. So,

[2:34:57] » Well, again, I think as as you mentioned

[2:34:59] though, you know your possibilities,

[2:35:00] right? And I think we have we likely

[2:35:03] have some individuals maybe who don't

[2:35:05] and we need to be having those

[2:35:06] conversations.

[2:35:08] » They they need more support in it.

[2:35:11] » Yeah.

[2:35:13] » I'd also like to make a statement and

[2:35:15] the two other lawyers in my room, they

[2:35:16] can people cannot not hire you because

[2:35:18] you have a disability. So, just

[2:35:19] » We can have a we'll have a side

[2:35:21] conversation that is not okay. So just

[2:35:24] just making that public statement.

[2:35:26] Someone cannot hire you. That's

[2:35:27] discrimination. So anyway, um but uh

[2:35:31] okay. So I think did you have a

[2:35:32] question, Lexi? And then I know Katie

[2:35:34] has a question as well.

[2:35:36] » Oh,

[2:35:38] » Um yeah, I had a question. Um actually I

[2:35:40] have a couple. So um

[2:35:44] I was asked by an individual uh two

[2:35:47] questions. So the first was how do you

[2:35:50] plan on targeting the weight list for

[2:35:53] FSWC

[2:35:54] health and wellness and TVI? And my

[2:35:57] second question is um it's kind of a

[2:36:00] two-parter. uh like when when kind of

[2:36:05] when slots open up in on July 1st,

[2:36:09] uh how do you plan to target the FSW

[2:36:11] weight list and kind of what's the plan

[2:36:14] for addressing CI

[2:36:18] » Questions?

[2:36:18] » Yeah. And Lexi, I'm sorry I didn't get a

[2:36:21] response out to you until this morning

[2:36:23] that I'll I'll follow up with you on

[2:36:24] that. I think those are

[2:36:26] » Yeah, that's those are those are that's

[2:36:28] a longer conversation than today and I

[2:36:31] um but I can follow up with you for

[2:36:32] sure. Those are good questions.

[2:36:34] » Okay, thank you. Sorry, I haven't been

[2:36:36] on my email so I haven't seen

[2:36:37] » No, believe me, I understand. I will

[2:36:39] never criticize someone for not reading

[2:36:40] their email immediately. Okay, you're

[2:36:43] good.

[2:36:43] » Okay, thank you.

[2:36:46] » Katie, you had a question. I think

[2:36:48] » Is there a timeline on the updated

[2:36:50] living caregiver bulletin?

[2:36:54] the amended one. Yes. Um I don't have a

[2:36:58] date that we will be able to issue that,

[2:37:00] but we are working to get that out as

[2:37:01] soon as we can. I'll let you know

[2:37:04] » Soon as we have that. Thank you.

[2:37:07] I was just going to ask if in the future

[2:37:09] at a meeting maybe we could have um

[2:37:12] conversation about choice and how that

[2:37:14] since it is serving families under 60

[2:37:16] and how that intersects with then the

[2:37:18] beads HCBS and how someone might find

[2:37:21] themselves on one path or the other just

[2:37:24] since we have someone here now that can

[2:37:26] speak to that I would love to to learn

[2:37:28] more about

[2:37:29] » We can watch that PDA video again right

[2:37:37] I have one kind of um follow-up comment

[2:37:40] from last uh from our last meeting which

[2:37:42] I believe was our March meeting. Um at

[2:37:45] that time, Holly, you had you had

[2:37:47] expressed the um opportunity for NABC

[2:37:49] members to provide you um and beads with

[2:37:53] um claims issues from December. And

[2:37:55] these were these were issues that

[2:37:57] happened because no nobody did anything

[2:37:59] like intentionally wrong, but there were

[2:38:01] some autogenerated budgets in January

[2:38:03] that then ended up where there was some

[2:38:06] shortfall in December and we were having

[2:38:08] difficulty finding traction to get those

[2:38:11] those um legitimate claims paid. And um

[2:38:14] NABC, all the members, we really

[2:38:17] appreciate the way that beads partnered

[2:38:19] with us to look at over 500 claims. Um,

[2:38:23] and I mean, and it took a minute. I

[2:38:26] don't think that you were expecting it

[2:38:27] to be quite that big a number. Um, but

[2:38:30] you know, a lot of members of NABC have

[2:38:32] expressed to me gratitude um, for your

[2:38:35] willingness to to do that. And I I think

[2:38:37] that it's um, it's important. I mean,

[2:38:39] you brought it up uh, two months ago

[2:38:41] that you were willing to do this and you

[2:38:43] followed through and we really do

[2:38:44] appreciate it.

[2:38:46] » No problem at all. We're all in this

[2:38:48] together, so

[2:38:50] through things together.

[2:38:52] » Thank you.

[2:38:55] Okay. Uh, next meeting July 15th here at

[2:38:58] the government center in room B and BRS

[2:39:01] Teresa Kazar um will be giving an update

[2:39:04] from BRS.

[2:39:06] All right. Thank you everyone. Thanks

[2:39:08] everyone online.

[2:39:09] » Thanks. Thanks everyone.

DDARS Advisory Council May 20, 2026

Transcript