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All right, we're going to go ahead and

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get started. I think we're missing a few

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folks. Um, but I know with the rain and

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who knows what's going on out there in

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the parking lot. Um, I am going to go

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ahead and um do roll call and we've got

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um possibly two folks I can't see all

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the way at the end of the table who are

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joining us as new members um that I will

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have introduced themselves. But I'm

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going to go ahead. Lexi is online. So

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Lexi, I'll go ahead and um see who's

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here just because it's easier for me

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obviously being in the room. Um so Kelly

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Mitchell I know is absent, so I will

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just say absent for her. Um Dr. Jim

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Wiltz

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» Here.

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» Uh Katie Stafford Cunningham

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» Here.

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» Uh Ty Clark

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» Here.

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» Uh Lexi Westerfield

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» Here.

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» Here.

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» Uh Laura Fe

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» Here.

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» Uh Kate Barro

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» Here.

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» I always forget. Do I pronounce that

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right? Kate Barrow. Bar. Okay, that

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helps me. Sorry, I I've been pronouncing

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it wrong. Uh Kim Dodson.

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Uh Melissa Keys here. Um and then we

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have Nicole Hicks. Nicole, would you

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mind um introducing yourself and who

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you're representing?

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» Sorry. Yeah, you and if you can just

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remember to speak into the microphone or

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you'll get a yell from me just because

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uh it is if you do not folks online

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cannot hear so.

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» Sure. I'm Nicole Hicks. I'm representing

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insource.

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» Great. Can do you mind telling us just

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about yourself? I know I introduced just

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» Sure. Um uh I have four children. I have

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one with special needs. He is uh going

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to be 30 in uh November and we are

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navigating um you know the adult world

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with his uh layers that he is requiring

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which is fun. So um and I've worked for

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insource for going on 14 years. I am the

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supervisor of the north team. So I

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supervise the whole north side of the

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state. Um

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that's me. Great. Thank you. Appreciate

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it. Welcome. Um we're excited to have

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you.

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» Um let's see Derek Nord. I'm here.

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» Uh Carrie Lee

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» Here.

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» Ann Titus

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» Here.

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» Um Kim Han, I know she had messaged me

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that she was unable to make it, but

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she'll be um watching either online or

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watch the recording. And uh Jory Zulman,

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I don't think she's here. Trying to

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look. Um she is our um new family

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representative who is joining us. So um

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she might be having some traffic issues,

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but um she should be joining us. And

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I'll have her introduce herself um uh

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after she gets here. Okay, I am going to

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tee up this video. Um, and this is

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timely and I know Erin is very excited

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that I'm sharing this with her in the

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room. Um,

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» Yes, you might be too. So, uh, this, uh,

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this is Aaron Wright, um, is the, uh,

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director of, um, the Bureau of Better

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Aging. And as you guys, um, over the

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course of gosh, I don't know, eight

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months, I think, since, um, maybe a

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year, has it been a year since aging,

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um, you know, was the name change as

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well as, um, we were lucky to have them

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join the DD ARS family. So, um, I'm

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going to share the video, um, that we,

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as you guys know, over the last couple

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meetings, we've been sharing the videos

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that we created, um, about the bureaus

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that we're excited about and are great

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videos. Um, and I'm going to share this

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and then, uh, Aaron is going to, um, I

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know obviously most of you know what BBA

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is, but, they've had, um, some

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structural changes, um, nothing, you

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know, crazy improvements um, if you

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will, but just uh, in the way that BBA

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is structured. So, she's going to

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introduce some of that. So, I'm going to

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share the video and crossing fingers

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people online can hear and tech is

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working this morning.

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See, I just changed it. Hold on. And

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then they leave the room and it's not

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going to work.

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» Where's Scott?

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» Hold on. Let me see. Let me try

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something. And if not, Erin, I might

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just have you go and then we can share.

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I should have

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» Well,

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» I know, but it's not. No,

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» I can't do I know. Sorry, Erin. And then

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you're like, really? No, because then it

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it doesn't

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» I can't do that because then it

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» I know what I need to do. Hold on. Talks

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amongst yourself. Hold on.

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» I gotta I gotta hit You have to go on

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here and hit share. Share sound.

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» Says share sound. Hold on. And I didn't

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click it.

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Does anyone remember where share sound

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is? There's like a button on Zoom that

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has share sound.

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Do you know what I'm talking about?

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» Erin, just go ahead. Do you mind go

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ahead and starting and I'll mess with

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it.

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» It's there's a button on here and I just

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never remember where it is and you have

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to hit it every single time. So, I'm

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going to wait. Go ahead. I don't want to

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hold people up and have everyone staring

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at you and me as we're trying to figure

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this out. So, um I'll go ahead and uh

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just we'll work on the slides and we'll

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work on it as you're talking um you know

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just sharing about um BBA.

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» Hi, I'm Aaron Wright. I am the director

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of Bureau of Better Aging. I have been

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with aging for about eight and a half

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years. Before I assumed this role, I

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oversaw our state and federal grant-f

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funed programs for home and community

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based services, our functions as the

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state unit on aging, and also the aging

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and disability resource centers.

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So, the Bureau of Better Aging really

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works to help individuals access

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resources, supports, and home and

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community based services. We

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are designated as I mentioned as the

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state unit on aging under the federal

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older Americans act. And with that comes

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the responsibility to designate local

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organizations to really serve as focal

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points and resources for older adults

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and caregivers in their communities.

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About 67%

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of our grant funds go to these local

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area agencies on aging. We also

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administer other programs such as adult

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protective services, some limited

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guardianship programs, residential care

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assessment programs. with our transition

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to being a standalone division to part

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of the ARS. Now we really are trying to

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kind of reident re

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determine our priorities while really

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staying true to our role as the state

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unit on aging.

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Um we have gone through a recent

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restructure prior to our merger with

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DBRS. We operated very much in

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programmatic silos. So we have tried to

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restructure ourselves to better support

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the programs and services that we

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administer. We can go to the next.

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» Okay. Sorry, that's what I was trying to

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read you.

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» By

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creating a centralized program and

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policy team with provider and vendor

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relations and quality and outcomes kind

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of wrapping around those core programs

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and services that we administer. We've

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been very fortunate to be able to grow

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our team in the last couple of months to

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increase our capacity to improve the

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programs and services that we deliver.

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So this is our hidden organizational

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structure. If you had seen it before, it

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was almost like a straight line. So

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we've really tried to move towards a

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very collaborative

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integrated

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but also functional structure.

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» Next

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with our transition we are really

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focused on improving our internal

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policies and procedures. As I mentioned

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just trying to settle into our new

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identity. We are really focused on

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trying to integrate with now DDARS.

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I will say I've been very welcomed and

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supported as our we've become one of the

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four bureaus within um DDRs.

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We are um

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with our new structure really trying to

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champion

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our multis- sector plan for aging called

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age forward together. This was a

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collaborative initiative

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that's

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started and I guess was approved in the

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end of calendar year 2024. It is a

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10-year forwardthinking plan that was

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really focused on aging within Indiana.

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It centers around age friendly

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communities, reducing barriers to

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accessing services.

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There's a focus on civic engagement,

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employment,

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volunteerism, which really ties into

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some of the work that DBRS have been

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doing with SEM and around community

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integrated

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employment. So have that collaboration

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and tie in there.

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And then another component of the multis

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sector plan for aging is around

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reframing aging and trying to combat

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agism. Not looking at aging as a disease

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or a disability but just a process

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in life.

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Um, as part of our responsibility as a

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state unit on aging, we complete a state

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plan on aging every four years that we

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submit to the federal um health and

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human services administration for

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community living. We are in the process

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of drafting our next state plan on

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aging. We currently are in the public

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comment period. So I hope um we are

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holding a series of listening sessions

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or stakeholder feedback sessions. The

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first one is today up in South Bend. We

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have one in Indianapolis next week, one

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in Evansville, and then we will be doing

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a virtual one next week as well. If

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anyone would like a copy of the state

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plan, email DA comments or let me know

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and I will send it. Um the public

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comment period ends on the 30th.

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We also have a dementia strategic plan

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and we've really been trying to focus to

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ensure there's alignment between all of

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these different plans. Um, an initiative

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that we are working on relates to

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legislation that was passed last year

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about um, conducting a study and

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preparing a report around realigning and

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consolidating the area agencies on aging

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map. Here's our current map. We

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currently have 16 different areas. These

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were

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introduced in the mid 1970s

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and

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there has not been a change in the

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structure of the map since that time.

276
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So we are looking at the map to see if

277
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there may be

278
00:12:15,839 --> 00:12:21,760
areas that can be consolidated,

279
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realigned to better support

280
00:12:21,760 --> 00:12:27,440
administrative efficiencies and also

281
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just recognizing that the landscape of

282
00:12:27,440 --> 00:12:31,920
aging and long-term services and

283
00:12:29,360 --> 00:12:35,120
supports has changed significantly in

284
00:12:31,920 --> 00:12:38,000
the last 50 years. So we're using this

285
00:12:35,120 --> 00:12:40,800
opportunity to just kind of take a step

286
00:12:38,000 --> 00:12:42,639
back and say does this structure make

287
00:12:40,800 --> 00:12:44,880
sense?

288
00:12:42,639 --> 00:12:48,240
There are federal and state processes we

289
00:12:44,880 --> 00:12:52,959
have to follow if we are going to make

290
00:12:48,240 --> 00:12:56,959
any changes to the map. There. First is

291
00:12:52,959 --> 00:13:00,639
the structure about the map itself and

292
00:12:56,959 --> 00:13:05,040
then the next part of the process is

293
00:13:00,639 --> 00:13:08,399
designating local entities to serve as

294
00:13:05,040 --> 00:13:12,079
the area agencies on aging for those

295
00:13:08,399 --> 00:13:15,920
specific service areas. So in

296
00:13:12,079 --> 00:13:19,920
redesigning the map, it's not

297
00:13:15,920 --> 00:13:22,800
really the focus is not on the agencies

298
00:13:19,920 --> 00:13:25,200
that are serving as the area agency, but

299
00:13:22,800 --> 00:13:27,040
it's really the structure of the service

300
00:13:25,200 --> 00:13:30,160
areas. Are there counties that would

301
00:13:27,040 --> 00:13:33,200
make more sense to be in an aligned

302
00:13:30,160 --> 00:13:37,120
service region? Does it make sense to

303
00:13:33,200 --> 00:13:40,000
focus more on a smaller

304
00:13:37,120 --> 00:13:43,360
urban area and change the boundaries of

305
00:13:40,000 --> 00:13:45,920
rural areas? There's a lot of

306
00:13:43,360 --> 00:13:48,480
demographic data that we're reviewing.

307
00:13:45,920 --> 00:13:51,680
We're having conversations with the area

308
00:13:48,480 --> 00:13:55,200
agencies about this. We had a dayong

309
00:13:51,680 --> 00:14:00,320
visioning session yesterday.

310
00:13:55,200 --> 00:14:01,440
Our goal is Oh, Jessica, go next. Um,

311
00:14:00,320 --> 00:14:03,760
» Hold on. Sorry.

312
00:14:01,440 --> 00:14:05,600
» Oh, that's it was just the timeline

313
00:14:03,760 --> 00:14:09,040
which is probably yeah more detailed

314
00:14:05,600 --> 00:14:11,440
than anyone wants to know, but um we're

315
00:14:09,040 --> 00:14:15,199
really focused on coming up with the

316
00:14:11,440 --> 00:14:17,600
recommendations and part of that is the

317
00:14:15,199 --> 00:14:20,399
funding formula that we'll use to

318
00:14:17,600 --> 00:14:23,279
distribute funds to each of the areas

319
00:14:20,399 --> 00:14:26,720
which has to be approved by our federal

320
00:14:23,279 --> 00:14:28,959
funer. Um, if there are any changes that

321
00:14:26,720 --> 00:14:31,600
come from this process, we wouldn't be

322
00:14:28,959 --> 00:14:35,680
looking at really implementing the

323
00:14:31,600 --> 00:14:37,839
changes with new a new structure and new

324
00:14:35,680 --> 00:14:41,480
grants to local organizations until

325
00:14:37,839 --> 00:14:41,480
October of 2018.

326
00:14:44,240 --> 00:14:47,720
» There any questions?

327
00:14:51,519 --> 00:14:54,240
» It's too easy. Were you able to get the

328
00:14:53,519 --> 00:14:58,040
video?

329
00:14:54,240 --> 00:14:58,040
» I was. And

330
00:14:58,320 --> 00:15:03,440
» Nope. Kathy's not going to let that go.

331
00:15:01,680 --> 00:15:05,360
» I have a question. Sorry, Jess.

332
00:15:03,440 --> 00:15:06,399
» Oh, yeah. Go ahead. Yeah, Lexi.

333
00:15:05,360 --> 00:15:07,839
» Um, so

334
00:15:06,399 --> 00:15:09,680
» I'll get rid of it.

335
00:15:07,839 --> 00:15:11,680
» What's going to be the BBA's

336
00:15:09,680 --> 00:15:15,639
relationship with Pathways then? Because

337
00:15:11,680 --> 00:15:15,639
I didn't hear you mention Pathways.

338
00:15:16,320 --> 00:15:21,839
» So, currently we

339
00:15:18,720 --> 00:15:26,279
» Hey, Erin. Sorry. Oh, I don't think I

340
00:15:21,839 --> 00:15:26,279
was talking to Mike at all. Um,

341
00:15:26,639 --> 00:15:33,760
in the current state, the

342
00:15:30,240 --> 00:15:36,720
we work with both pathways and beads

343
00:15:33,760 --> 00:15:38,639
related to our role as the aging

344
00:15:36,720 --> 00:15:43,440
supporting the aging and disability

345
00:15:38,639 --> 00:15:47,760
resource centers. The ADRC's have a role

346
00:15:43,440 --> 00:15:50,320
in waiting list management. So, um,

347
00:15:47,760 --> 00:15:54,079
helping with that process as well as

348
00:15:50,320 --> 00:15:56,240
really helping to navigate and support

349
00:15:54,079 --> 00:15:59,759
individuals when they have questions

350
00:15:56,240 --> 00:16:03,920
just around how does LTSS work in

351
00:15:59,759 --> 00:16:07,519
Indiana. We don't currently have any

352
00:16:03,920 --> 00:16:10,720
direct oversight or involvement in the

353
00:16:07,519 --> 00:16:12,800
delivery of pathways waiver or even the

354
00:16:10,720 --> 00:16:15,800
pathways managed care services. That's

355
00:16:12,800 --> 00:16:15,800
all.

356
00:16:18,000 --> 00:16:23,199
» Thank you.

357
00:16:20,560 --> 00:16:24,639
» Thanks, Lexi. Okay, I do have it

358
00:16:23,199 --> 00:16:26,480
working. So, hold on one second. I got

359
00:16:24,639 --> 00:16:28,399
to go back.

360
00:16:26,480 --> 00:16:32,680
Cross your fingers. Someone chatted me

361
00:16:28,399 --> 00:16:32,680
to fix it. See if it works.

362
00:16:36,240 --> 00:16:41,000
Dang it. I did what she told me to do.

363
00:16:41,440 --> 00:16:43,440
It looks like it's muted in the top

364
00:16:42,880 --> 00:16:45,680
right hand.

365
00:16:43,440 --> 00:16:50,600
» I know. I don't know if it's weird

366
00:16:45,680 --> 00:16:50,600
because then it'll then it plays from my

367
00:16:51,600 --> 00:16:54,639
» Well, I did it. I wonder if it's changed

368
00:16:53,120 --> 00:16:55,040
because I did what she told me to do and

369
00:16:54,639 --> 00:16:58,040
I

370
00:16:55,040 --> 00:16:58,040
» Primarily

371
00:16:58,160 --> 00:17:06,240
But we also provide services and

372
00:17:02,959 --> 00:17:09,679
» Fourth fifth times a term.

373
00:17:06,240 --> 00:17:12,480
BBA stands for Bureau of Better Aging.

374
00:17:09,679 --> 00:17:14,959
BBA primarily supports older adults and

375
00:17:12,480 --> 00:17:17,679
their caregivers, but we also provide

376
00:17:14,959 --> 00:17:20,480
services and supports for individuals

377
00:17:17,679 --> 00:17:22,880
with disabilities. Livestream is one of

378
00:17:20,480 --> 00:17:25,919
15 agencies in Indiana serving as an

379
00:17:22,880 --> 00:17:28,400
area agency on aging. And as an area

380
00:17:25,919 --> 00:17:30,559
agency on aging, we provide a variety of

381
00:17:28,400 --> 00:17:32,960
programs and resources to help older

382
00:17:30,559 --> 00:17:36,080
adults live their best lives. EVA

383
00:17:32,960 --> 00:17:38,400
provides an array of services. We fund

384
00:17:36,080 --> 00:17:42,080
local agencies and support local

385
00:17:38,400 --> 00:17:44,559
communities to operate everything from

386
00:17:42,080 --> 00:17:48,880
senior centers to home delivered meal

387
00:17:44,559 --> 00:17:52,160
programs to inhome services such as help

388
00:17:48,880 --> 00:17:54,080
with bathing, dressing, cooking. Those

389
00:17:52,160 --> 00:17:56,880
services that can help older adults

390
00:17:54,080 --> 00:17:58,720
remain independent and in the community.

391
00:17:56,880 --> 00:18:00,400
Various agencies on aging such as

392
00:17:58,720 --> 00:18:03,520
liveream provide a lot of different

393
00:18:00,400 --> 00:18:05,440
services for older users. We provide

394
00:18:03,520 --> 00:18:07,440
everything from basic information and

395
00:18:05,440 --> 00:18:11,039
assistance. Where can I get energy

396
00:18:07,440 --> 00:18:13,120
assistance? Where can I get tax help to

397
00:18:11,039 --> 00:18:15,200
more involved options counseling? What

398
00:18:13,120 --> 00:18:18,000
are my options for long-term services

399
00:18:15,200 --> 00:18:19,679
and supports? Care management which is

400
00:18:18,000 --> 00:18:22,480
help coordinating those services and

401
00:18:19,679 --> 00:18:26,400
supports. There is a whole network of

402
00:18:22,480 --> 00:18:30,160
local service providers that help

403
00:18:26,400 --> 00:18:32,480
individuals wherever they are on their

404
00:18:30,160 --> 00:18:35,520
journey through long-term services and

405
00:18:32,480 --> 00:18:38,640
support. So, an individual can go to a

406
00:18:35,520 --> 00:18:41,840
senior center and get a nutritionally

407
00:18:38,640 --> 00:18:43,679
balanced meal and socialize, or an

408
00:18:41,840 --> 00:18:46,400
individual can have somebody come to

409
00:18:43,679 --> 00:18:48,480
their home and help them get ready for

410
00:18:46,400 --> 00:18:51,039
the day or take them to the doctor.

411
00:18:48,480 --> 00:18:53,120
those types of services. One of the

412
00:18:51,039 --> 00:18:55,360
things that we do is we help people with

413
00:18:53,120 --> 00:18:57,120
all kinds of resources and information.

414
00:18:55,360 --> 00:18:59,520
For example, their medications they're

415
00:18:57,120 --> 00:19:01,600
on. How can they afford them? What are

416
00:18:59,520 --> 00:19:03,840
some programs that can help them better

417
00:19:01,600 --> 00:19:04,880
afford their medications? So, we make

418
00:19:03,840 --> 00:19:06,960
sure that they are taking the

419
00:19:04,880 --> 00:19:08,720
medications their physicians have have

420
00:19:06,960 --> 00:19:10,400
ordered for them so they can manage

421
00:19:08,720 --> 00:19:12,400
those chronic conditions better. So,

422
00:19:10,400 --> 00:19:15,840
what brings me joy in my work with the

423
00:19:12,400 --> 00:19:18,160
Bureau of Better Aging is knowing on a

424
00:19:15,840 --> 00:19:21,440
daily basis that I'm making a difference

425
00:19:18,160 --> 00:19:24,000
in my community and helping older adults

426
00:19:21,440 --> 00:19:26,799
to age in the manner of their choosing.

427
00:19:24,000 --> 00:19:29,919
I feel like doing this work, I have seen

428
00:19:26,799 --> 00:19:32,799
the impact of systems and systems change

429
00:19:29,919 --> 00:19:34,799
and how we can make things better and

430
00:19:32,799 --> 00:19:36,799
how we can make the world better in

431
00:19:34,799 --> 00:19:39,280
Indiana better for older adults who want

432
00:19:36,799 --> 00:19:40,960
to age in their home and have services

433
00:19:39,280 --> 00:19:42,799
and programs available to help them do

434
00:19:40,960 --> 00:19:44,720
that. So, I think it's a win-win. The

435
00:19:42,799 --> 00:19:47,280
person gets to stay where their friends

436
00:19:44,720 --> 00:19:51,039
and the people they know are, and it's

437
00:19:47,280 --> 00:19:54,039
supporting the community.

438
00:19:51,039 --> 00:19:54,039
Awesome.

439
00:19:57,600 --> 00:20:00,960
» Thank you. I think you did a good job,

440
00:19:59,360 --> 00:20:02,480
Erin.

441
00:20:00,960 --> 00:20:03,760
» Maybe you should watch it a second time.

442
00:20:02,480 --> 00:20:05,360
» Do you want to watch it one more time or

443
00:20:03,760 --> 00:20:07,760
do you want me to freeze it for the

444
00:20:05,360 --> 00:20:10,960
entire time when you're

445
00:20:07,760 --> 00:20:15,039
um Thank you. Uh yeah,

446
00:20:10,960 --> 00:20:16,799
» So what's the age limit on the age

447
00:20:15,039 --> 00:20:20,000
living?

448
00:20:16,799 --> 00:20:23,039
So the majority of our programs are for

449
00:20:20,000 --> 00:20:25,520
individuals 60 and over. Okay. We do

450
00:20:23,039 --> 00:20:27,760
have state funded home and community

451
00:20:25,520 --> 00:20:31,280
based services program called choice

452
00:20:27,760 --> 00:20:32,320
that can serve individuals under 60 with

453
00:20:31,280 --> 00:20:34,880
disability.

454
00:20:32,320 --> 00:20:36,480
» Thank you.

455
00:20:34,880 --> 00:20:37,600
» Thank you. Okay. And if you guys have

456
00:20:36,480 --> 00:20:39,200
any questions, if you think of

457
00:20:37,600 --> 00:20:41,679
something, put it on your little parking

458
00:20:39,200 --> 00:20:43,200
lot sticker um for Aaron. She'll be here

459
00:20:41,679 --> 00:20:45,039
the whole time. Okay. I'm going to have

460
00:20:43,200 --> 00:20:48,240
Jory. Do you mind introducing yourself?

461
00:20:45,039 --> 00:20:51,760
feel like a grand entrance. No. Um Jory

462
00:20:48,240 --> 00:20:53,840
Zulman is our um we have the pleasure of

463
00:20:51,760 --> 00:20:55,919
having her as our newest family member

464
00:20:53,840 --> 00:20:57,600
representative. Um and so do you mind

465
00:20:55,919 --> 00:20:59,679
just introducing yourself a little bit

466
00:20:57,600 --> 00:21:03,280
about yourself as well?

467
00:20:59,679 --> 00:21:05,039
» You just if you can use the microphone

468
00:21:03,280 --> 00:21:06,080
» Maybe a little closer. It's kind of

469
00:21:05,039 --> 00:21:08,000
There you go. Perfect.

470
00:21:06,080 --> 00:21:09,600
» I'm Jory. Sorry I'm late. I parked at

471
00:21:08,000 --> 00:21:12,080
Idol Jore because I couldn't find it was

472
00:21:09,600 --> 00:21:15,360
so then I went to South.

473
00:21:12,080 --> 00:21:17,280
So anyway, I made it. But um I am I have

474
00:21:15,360 --> 00:21:19,760
a 47 year old brother with significant

475
00:21:17,280 --> 00:21:21,679
disabilities. Um he lives in a group

476
00:21:19,760 --> 00:21:24,240
home in Northwest Indiana, Opportunity

477
00:21:21,679 --> 00:21:26,400
Enterprises, the Sheffield House. Um my

478
00:21:24,240 --> 00:21:30,000
parents live up there. They're 80 and

479
00:21:26,400 --> 00:21:32,080
82. Um and so just kind of three boys, a

480
00:21:30,000 --> 00:21:34,400
21 year 21 year old and two 18 year olds

481
00:21:32,080 --> 00:21:36,480
are getting ready to graduate and a

482
00:21:34,400 --> 00:21:37,919
husband English he's an English teacher.

483
00:21:36,480 --> 00:21:40,320
I've been a special education teacher

484
00:21:37,919 --> 00:21:42,480
and social worker my whole life. So that

485
00:21:40,320 --> 00:21:43,919
» Thank you. Yeah. No, great. Thank you.

486
00:21:42,480 --> 00:21:45,600
not to put you on the spot right when

487
00:21:43,919 --> 00:21:47,840
you

488
00:21:45,600 --> 00:21:52,080
» Um Okay, we're going to move right along

489
00:21:47,840 --> 00:21:54,000
here to um Holly who will be presenting

490
00:21:52,080 --> 00:21:55,440
most of the rest of the agenda. Um

491
00:21:54,000 --> 00:21:57,440
follow along. We'll probably take a

492
00:21:55,440 --> 00:21:59,200
break. Um just as you guys know, three

493
00:21:57,440 --> 00:22:01,600
hours I need a break. Most of us

494
00:21:59,200 --> 00:22:03,600
probably do. So, um I will turn it over

495
00:22:01,600 --> 00:22:06,840
to Holly and try to follow her lead with

496
00:22:03,600 --> 00:22:06,840
her slides.

497
00:22:07,360 --> 00:22:12,080
» Thank you. Um Jess,

498
00:22:10,240 --> 00:22:13,600
» Are you guys hearing in the back? Okay.

499
00:22:12,080 --> 00:22:14,640
Okay. Because I can't tell if it's

500
00:22:13,600 --> 00:22:16,480
working or not.

501
00:22:14,640 --> 00:22:18,640
» I think it is. I think it is because

502
00:22:16,480 --> 00:22:19,919
Lexi could hear us earlier. So,

503
00:22:18,640 --> 00:22:22,919
» Doesn't feel like it's

504
00:22:19,919 --> 00:22:22,919
» Yeah,

505
00:22:25,120 --> 00:22:30,880
» Okay. Okay. I'll have them check.

506
00:22:27,440 --> 00:22:33,679
» All right. Um well, hello everyone. Uh

507
00:22:30,880 --> 00:22:35,760
good to see everybody. Um hope everybody

508
00:22:33,679 --> 00:22:37,760
made it through the rain.

509
00:22:35,760 --> 00:22:39,760
» Yes, that's good because it was raining

510
00:22:37,760 --> 00:22:42,480
quite a bit on my drive-in this morning.

511
00:22:39,760 --> 00:22:46,799
So I want to start with an update on

512
00:22:42,480 --> 00:22:49,039
case management. Um as we have discussed

513
00:22:46,799 --> 00:22:51,440
um we have waiver amendments at CMS

514
00:22:49,039 --> 00:22:53,440
right now to move to the selective

515
00:22:51,440 --> 00:22:57,039
contracting model for case management

516
00:22:53,440 --> 00:22:59,360
for the beads administered waiverss. Um

517
00:22:57,039 --> 00:23:01,520
the slide here is slightly inaccurate.

518
00:22:59,360 --> 00:23:04,000
It says preliminary awards but yesterday

519
00:23:01,520 --> 00:23:06,960
the final awards were uh notice was

520
00:23:04,000 --> 00:23:10,000
posted. So um but we had already sent

521
00:23:06,960 --> 00:23:14,080
these out. So, um, just wanted to call

522
00:23:10,000 --> 00:23:18,640
that out. Um, the, uh, final awards, uh,

523
00:23:14,080 --> 00:23:23,039
were to IPMG, Aging and Inhome Services,

524
00:23:18,640 --> 00:23:24,480
Unity, Inspire, and Columbus. Um, again,

525
00:23:23,039 --> 00:23:26,400
those are the entities that had the

526
00:23:24,480 --> 00:23:29,520
preliminary awards, and the final award

527
00:23:26,400 --> 00:23:32,080
notice went out yesterday.

528
00:23:29,520 --> 00:23:34,000
Um,

529
00:23:32,080 --> 00:23:34,559
» Does that mean, sorry to interrupt,

530
00:23:34,000 --> 00:23:38,400
you're fine.

531
00:23:34,559 --> 00:23:41,039
» Does that mean that like Those

532
00:23:38,400 --> 00:23:43,919
are the case managements

533
00:23:41,039 --> 00:23:45,440
for everyone now or is there others?

534
00:23:43,919 --> 00:23:47,600
» No, that's a great question. We're going

535
00:23:45,440 --> 00:23:51,840
to talk some through that. That means

536
00:23:47,600 --> 00:23:54,080
that as of August 1st, individuals, the

537
00:23:51,840 --> 00:23:56,640
only entities that can provide case

538
00:23:54,080 --> 00:23:58,400
management on the family support, CI,

539
00:23:56,640 --> 00:24:00,000
health and wellness, and TBI waiverss

540
00:23:58,400 --> 00:24:01,840
are one of these five.

541
00:24:00,000 --> 00:24:04,400
» I already have inspired so I'm good.

542
00:24:01,840 --> 00:24:06,559
» Okay. All right. Very good. Um but we'll

543
00:24:04,400 --> 00:24:08,400
talk through kind of that process

544
00:24:06,559 --> 00:24:13,200
because I think that's that's important.

545
00:24:08,400 --> 00:24:14,720
So um so we are moving from um slightly

546
00:24:13,200 --> 00:24:19,039
over

547
00:24:14,720 --> 00:24:22,000
uh 30 case management entities today um

548
00:24:19,039 --> 00:24:24,240
to five. So I wanted to just spend a few

549
00:24:22,000 --> 00:24:26,159
minutes um and that's meant to be

550
00:24:24,240 --> 00:24:28,799
demonstrated there with the uh the

551
00:24:26,159 --> 00:24:31,679
graphic you see. So while we are seeing

552
00:24:28,799 --> 00:24:34,159
a decrease or will see a decrease in the

553
00:24:31,679 --> 00:24:36,080
number of case management entities, we

554
00:24:34,159 --> 00:24:39,760
anticipate we will see an increase in

555
00:24:36,080 --> 00:24:42,240
the number of case managers. Um and um

556
00:24:39,760 --> 00:24:46,159
when we went to selective contracting

557
00:24:42,240 --> 00:24:48,799
before on the FS and CI um what we saw

558
00:24:46,159 --> 00:24:50,799
largely were case managers continued in

559
00:24:48,799 --> 00:24:52,640
the field. Um I think you all have heard

560
00:24:50,799 --> 00:24:54,640
me say before that was the funnest job I

561
00:24:52,640 --> 00:24:58,640
ever had.

562
00:24:54,640 --> 00:25:01,440
Kathy, don't listen. Um but um case

563
00:24:58,640 --> 00:25:03,919
management was yeah fun job. But anyway

564
00:25:01,440 --> 00:25:06,240
um it also has uh case management has a

565
00:25:03,919 --> 00:25:09,120
lot of individuals in that work that

566
00:25:06,240 --> 00:25:11,039
have a heart for what we do. Um so we

567
00:25:09,120 --> 00:25:13,760
anticipate a lot of the case managers

568
00:25:11,039 --> 00:25:16,240
the bulk of them um will continue to

569
00:25:13,760 --> 00:25:18,320
provide case management services. We do

570
00:25:16,240 --> 00:25:21,120
expect as I mentioned an increase in the

571
00:25:18,320 --> 00:25:22,880
number of case managers um as we move to

572
00:25:21,120 --> 00:25:24,880
the selective contracting because of the

573
00:25:22,880 --> 00:25:27,919
case load

574
00:25:24,880 --> 00:25:31,039
uh parameters involved in the contract

575
00:25:27,919 --> 00:25:33,600
um which is 47 no more than 47 across

576
00:25:31,039 --> 00:25:38,080
all CA an average of 47 across all case

577
00:25:33,600 --> 00:25:41,360
manage full-time case managers. So, um,

578
00:25:38,080 --> 00:25:43,120
we know that we have some, um, case

579
00:25:41,360 --> 00:25:44,960
managers currently supporting

580
00:25:43,120 --> 00:25:47,200
individuals on the health and wellness

581
00:25:44,960 --> 00:25:49,600
and traumatic brain injury waiverss that

582
00:25:47,200 --> 00:25:52,400
have pretty pretty significant case

583
00:25:49,600 --> 00:25:54,159
loads above that. So, um, that's why we

584
00:25:52,400 --> 00:25:57,279
believe we will see an increase in in

585
00:25:54,159 --> 00:25:59,919
the number of case managers.

586
00:25:57,279 --> 00:26:04,400
So, um, these five case management

587
00:25:59,919 --> 00:26:06,640
entities are um, actively recruiting. Um

588
00:26:04,400 --> 00:26:09,200
so uh if you follow any of them on

589
00:26:06,640 --> 00:26:14,559
Facebook you you will see that um so

590
00:26:09,200 --> 00:26:16,559
they are gearing up um for the um the

591
00:26:14,559 --> 00:26:21,919
change.

592
00:26:16,559 --> 00:26:23,760
So as uh Ty pointed out um everyone

593
00:26:21,919 --> 00:26:25,520
currently supported on our waiverss will

594
00:26:23,760 --> 00:26:29,039
need to choose one of these five

595
00:26:25,520 --> 00:26:32,240
entities if they have not already. Um

596
00:26:29,039 --> 00:26:34,240
and all five are going to provide case

597
00:26:32,240 --> 00:26:37,120
management statewide

598
00:26:34,240 --> 00:26:40,520
as well. If we can move to the next

599
00:26:37,120 --> 00:26:40,520
slide, please.

600
00:26:41,440 --> 00:26:46,960
So, one of the things that um we have

601
00:26:44,080 --> 00:26:49,919
already done is send a letter to

602
00:26:46,960 --> 00:26:51,039
everyone supported through those four

603
00:26:49,919 --> 00:26:56,159
home and community based service

604
00:26:51,039 --> 00:26:59,840
waiverss um making them aware of um this

605
00:26:56,159 --> 00:27:01,760
change in model coming forward and the

606
00:26:59,840 --> 00:27:03,520
uh

607
00:27:01,760 --> 00:27:06,000
case management entities that will be

608
00:27:03,520 --> 00:27:08,159
providing case management um as of

609
00:27:06,000 --> 00:27:11,279
August 1st.

610
00:27:08,159 --> 00:27:14,720
those letters um went to everyone even

611
00:27:11,279 --> 00:27:17,840
if they had a case management entity

612
00:27:14,720 --> 00:27:19,679
that currently that is one of those five

613
00:27:17,840 --> 00:27:22,960
because we again wanted to ensure

614
00:27:19,679 --> 00:27:24,799
awareness. We have also been um working

615
00:27:22,960 --> 00:27:27,600
with the existing case management

616
00:27:24,799 --> 00:27:30,880
entities um and have provided them with

617
00:27:27,600 --> 00:27:33,840
toolkits that are on our website um to

618
00:27:30,880 --> 00:27:35,840
support their conversations with

619
00:27:33,840 --> 00:27:39,120
individuals that they work with and

620
00:27:35,840 --> 00:27:41,840
their families about this transition and

621
00:27:39,120 --> 00:27:44,240
what this looks like and what decisions

622
00:27:41,840 --> 00:27:46,159
they may need to make um depending on

623
00:27:44,240 --> 00:27:50,640
their situation and what their options

624
00:27:46,159 --> 00:27:53,279
are. um that is tied to the case

625
00:27:50,640 --> 00:27:55,120
management uh monthly reimbursement for

626
00:27:53,279 --> 00:27:57,440
those current case management entities

627
00:27:55,120 --> 00:28:00,480
right now. So they have to do those

628
00:27:57,440 --> 00:28:04,640
things in order to be able to bill. Um

629
00:28:00,480 --> 00:28:08,720
and we have gotten some um positive

630
00:28:04,640 --> 00:28:10,320
feedback about how that's going. Um and

631
00:28:08,720 --> 00:28:12,559
um

632
00:28:10,320 --> 00:28:14,080
we know that some case managers are

633
00:28:12,559 --> 00:28:17,600
texting

634
00:28:14,080 --> 00:28:21,840
families with all the things we've asked

635
00:28:17,600 --> 00:28:29,120
them to to cover. Um even if for example

636
00:28:21,840 --> 00:28:30,720
if someone has um IPMG today um IPMG is

637
00:28:29,120 --> 00:28:32,240
still required to reach out to them and

638
00:28:30,720 --> 00:28:34,880
make sure they're aware of this. make

639
00:28:32,240 --> 00:28:38,240
sure they know that as of August 1st

640
00:28:34,880 --> 00:28:41,679
these are the providing entities and you

641
00:28:38,240 --> 00:28:45,679
can stay with IPMG or I can offer you

642
00:28:41,679 --> 00:28:47,520
choice of another. So, everyone, all the

643
00:28:45,679 --> 00:28:50,000
case managers are handling this in the

644
00:28:47,520 --> 00:28:53,520
same way. And we are seeing phone calls

645
00:28:50,000 --> 00:28:55,360
being made, text messages. Um, and I was

646
00:28:53,520 --> 00:28:58,159
smiling at Carrie because she was a

647
00:28:55,360 --> 00:29:00,399
recipient of one of those text messages

648
00:28:58,159 --> 00:29:05,039
um from one of her current case managers

649
00:29:00,399 --> 00:29:07,440
and um um she shared that and it was it

650
00:29:05,039 --> 00:29:10,480
was spot on. They case manager did

651
00:29:07,440 --> 00:29:14,880
exactly what we needed them to do. So,

652
00:29:10,480 --> 00:29:17,520
um, so as of now, case managers are

653
00:29:14,880 --> 00:29:20,080
talking with individuals, um, and

654
00:29:17,520 --> 00:29:22,720
offering making sure there's awareness

655
00:29:20,080 --> 00:29:24,480
and families can start choosing now what

656
00:29:22,720 --> 00:29:28,640
case management organization they want

657
00:29:24,480 --> 00:29:31,279
to go with. I do want to note that um,

658
00:29:28,640 --> 00:29:33,600
the choice list for case management with

659
00:29:31,279 --> 00:29:36,559
those five entities working across all

660
00:29:33,600 --> 00:29:39,279
the four waiverss um, will be updated

661
00:29:36,559 --> 00:29:43,039
for June 1st. So, a family may say, "I

662
00:29:39,279 --> 00:29:44,960
want provider A." Um, and the choice

663
00:29:43,039 --> 00:29:46,880
list may not be updated yet if they're

664
00:29:44,960 --> 00:29:49,600
on the family support waiver for

665
00:29:46,880 --> 00:29:51,120
provider A. So, that case manager will

666
00:29:49,600 --> 00:29:53,919
follow up with them to get them that

667
00:29:51,120 --> 00:29:56,240
choice list um come June 1st and then

668
00:29:53,919 --> 00:29:58,000
we'll move it we'll we'll move that

669
00:29:56,240 --> 00:29:58,799
situation forward.

670
00:29:58,000 --> 00:29:59,840
» Hey, Holly.

671
00:29:58,799 --> 00:30:01,360
» Yes.

672
00:29:59,840 --> 00:30:03,200
» Lexi, is your do you want to ask your

673
00:30:01,360 --> 00:30:05,679
question now? Is it really does it

674
00:30:03,200 --> 00:30:08,399
pertinent to this? Um, I'd like to ask

675
00:30:05,679 --> 00:30:10,080
you before we get too far. Um,

676
00:30:08,399 --> 00:30:14,240
» Okay. Go ahead. Go ahead.

677
00:30:10,080 --> 00:30:17,520
» So, you went over the waiverss that will

678
00:30:14,240 --> 00:30:20,559
be under these new um that will have

679
00:30:17,520 --> 00:30:24,960
these new five well not new but like the

680
00:30:20,559 --> 00:30:29,279
updated 5CMOs. Um, my question is when

681
00:30:24,960 --> 00:30:31,360
you look at the DDRS or the Ark of

682
00:30:29,279 --> 00:30:35,760
Indiana or any of those websites that

683
00:30:31,360 --> 00:30:39,679
lists like the information about it, it

684
00:30:35,760 --> 00:30:42,799
talks about um also pathways fee for

685
00:30:39,679 --> 00:30:46,159
service and money follows the person. um

686
00:30:42,799 --> 00:30:48,720
not to confuse anybody but from what I

687
00:30:46,159 --> 00:30:51,679
understood especially with pathways is

688
00:30:48,720 --> 00:30:54,320
that they weren't like case management

689
00:30:51,679 --> 00:30:56,559
uh CMOs weren't involved it was like

690
00:30:54,320 --> 00:30:58,640
through the MCE but from what I

691
00:30:56,559 --> 00:31:00,799
understand fee for service means like

692
00:30:58,640 --> 00:31:03,520
traditional Medicaid but I thought all

693
00:31:00,799 --> 00:31:05,200
pathways recipients were under an MCE

694
00:31:03,520 --> 00:31:08,080
sorry that was a lot but

695
00:31:05,200 --> 00:31:11,600
» No Lexi no that's a great question and

696
00:31:08,080 --> 00:31:15,360
you are correct um this does case

697
00:31:11,600 --> 00:31:18,640
management also does um impact the money

698
00:31:15,360 --> 00:31:21,600
follows the person. Um it also does

699
00:31:18,640 --> 00:31:24,480
include a very small number of

700
00:31:21,600 --> 00:31:26,720
individuals in pathways fee for service

701
00:31:24,480 --> 00:31:30,559
and it's a really really small number

702
00:31:26,720 --> 00:31:34,000
but those those individuals um on

703
00:31:30,559 --> 00:31:37,679
pathways fee for service operate much

704
00:31:34,000 --> 00:31:39,519
more similarly to the uh individuals on

705
00:31:37,679 --> 00:31:41,840
the health and wellness waiver today as

706
00:31:39,519 --> 00:31:44,799
an example. they actually have a case

707
00:31:41,840 --> 00:31:47,440
manager. So, um that works with them

708
00:31:44,799 --> 00:31:51,279
because they're not managed care. So,

709
00:31:47,440 --> 00:31:54,640
again, very small number. People um meet

710
00:31:51,279 --> 00:31:57,840
very specific uh detailed situations

711
00:31:54,640 --> 00:32:00,000
that that can allow them to opt into the

712
00:31:57,840 --> 00:32:02,880
managed care for pathways, but it's it's

713
00:32:00,000 --> 00:32:06,000
again it's a very small number, but this

714
00:32:02,880 --> 00:32:07,039
does impact them as well.

715
00:32:06,000 --> 00:32:07,600
» Great question.

716
00:32:07,039 --> 00:32:08,320
» Thank you.

717
00:32:07,600 --> 00:32:10,320
» Thank you.

718
00:32:08,320 --> 00:32:14,399
» Thank you.

719
00:32:10,320 --> 00:32:16,640
So, um, we are also, um, hosting meet

720
00:32:14,399 --> 00:32:18,720
and greets both in person and virtual.

721
00:32:16,640 --> 00:32:21,360
We had our first one last night in

722
00:32:18,720 --> 00:32:23,840
Evansville. Uh, we had 26 different

723
00:32:21,360 --> 00:32:25,760
families show up to that, which I think

724
00:32:23,840 --> 00:32:26,480
was really good for the first

725
00:32:25,760 --> 00:32:29,039
» That's awesome.

726
00:32:26,480 --> 00:32:33,360
» For the first one. Um, we have a virtual

727
00:32:29,039 --> 00:32:37,519
one today. Um but um those are scheduled

728
00:32:33,360 --> 00:32:40,880
and have been announced and and are um

729
00:32:37,519 --> 00:32:43,519
have been published and we are getting

730
00:32:40,880 --> 00:32:46,240
um we are getting people to attend. So

731
00:32:43,519 --> 00:32:49,200
that is that is great and we do I want

732
00:32:46,240 --> 00:32:52,000
to shout out to um our partners uh our

733
00:32:49,200 --> 00:32:54,880
external partners for sharing those as

734
00:32:52,000 --> 00:32:58,080
well um and helping us get the word out

735
00:32:54,880 --> 00:32:59,840
um to individuals and families. So, um,

736
00:32:58,080 --> 00:33:01,679
and those meet and greets, if you have

737
00:32:59,840 --> 00:33:05,120
never been to one, I will just give a

738
00:33:01,679 --> 00:33:08,240
real brief description. Each of the CMOs

739
00:33:05,120 --> 00:33:11,360
has a table there. Um, and they are just

740
00:33:08,240 --> 00:33:13,120
there to answer questions um, and for

741
00:33:11,360 --> 00:33:16,240
individuals and families to have that

742
00:33:13,120 --> 00:33:17,679
opportunity to meet them and ask them,

743
00:33:16,240 --> 00:33:20,320
you know, some of the questions that

744
00:33:17,679 --> 00:33:22,159
they would ask a case manager um, when

745
00:33:20,320 --> 00:33:25,519
they were interviewing a case manager,

746
00:33:22,159 --> 00:33:29,840
for example. So, um, and they have some

747
00:33:25,519 --> 00:33:31,919
of their swag there, too. Um, but, uh,

748
00:33:29,840 --> 00:33:34,880
but yeah, they're they're uh it went

749
00:33:31,919 --> 00:33:36,559
very well last night and, um, we got

750
00:33:34,880 --> 00:33:39,360
some positive feedback from the families

751
00:33:36,559 --> 00:33:40,640
that that attended. So, um,

752
00:33:39,360 --> 00:33:42,240
» And the virtual tonight.

753
00:33:40,640 --> 00:33:44,799
» There is a virtual today. There's

754
00:33:42,240 --> 00:33:46,720
several virtuals. Um, but the first one

755
00:33:44,799 --> 00:33:47,840
is today. I believe it's at two o'clock,

756
00:33:46,720 --> 00:33:50,080
but

757
00:33:47,840 --> 00:33:53,600
» Just make sure you're um, we put those

758
00:33:50,080 --> 00:33:54,880
out through our list serve, too. So, um

759
00:33:53,600 --> 00:33:57,679
hopefully everyone in this room is

760
00:33:54,880 --> 00:33:59,200
signed up for our list serve. Um but, uh

761
00:33:57,679 --> 00:34:00,640
make sure if you're not, you know, sh

762
00:33:59,200 --> 00:34:02,480
that's where a lot of this information I

763
00:34:00,640 --> 00:34:04,320
mean multiple ways is being shared, but

764
00:34:02,480 --> 00:34:07,360
» It's also

765
00:34:04,320 --> 00:34:10,879
» Um it's a so um I can put it in the

766
00:34:07,360 --> 00:34:11,679
chat. The uh DDRS for to get updates. I

767
00:34:10,879 --> 00:34:14,000
don't even know what it's called, a list

768
00:34:11,679 --> 00:34:17,839
serve. You can subscribe to it and then

769
00:34:14,000 --> 00:34:19,359
you get um emails with updates.

770
00:34:17,839 --> 00:34:21,440
» Yeah, I send you the link. You just need

771
00:34:19,359 --> 00:34:22,960
an email basically and it's and it's

772
00:34:21,440 --> 00:34:25,359
multiple updates. It's not just about

773
00:34:22,960 --> 00:34:28,240
beads, but um it's a good way. Yeah.

774
00:34:25,359 --> 00:34:29,440
Yeah. Yeah. And anyone can sign up. It

775
00:34:28,240 --> 00:34:31,280
doesn't have to you don't have to be in

776
00:34:29,440 --> 00:34:32,399
the way. I mean, it's just information.

777
00:34:31,280 --> 00:34:34,159
So, thank you.

778
00:34:32,399 --> 00:34:36,480
» Welcome.

779
00:34:34,159 --> 00:34:38,320
» And we are keeping um updated

780
00:34:36,480 --> 00:34:40,159
information on the waiver reset page

781
00:34:38,320 --> 00:34:44,879
that has all this information about case

782
00:34:40,159 --> 00:34:47,280
management as well. So, um, we do have

783
00:34:44,879 --> 00:34:49,599
to because case management is a required

784
00:34:47,280 --> 00:34:52,000
service for HCBS, we do have to ensure

785
00:34:49,599 --> 00:34:54,800
there's a case manager

786
00:34:52,000 --> 00:34:58,079
from one of those five entities on board

787
00:34:54,800 --> 00:35:00,640
with every single person August 1. So,

788
00:34:58,079 --> 00:35:03,200
if individuals and families have not

789
00:35:00,640 --> 00:35:06,160
made a choice by July 15th, we will auto

790
00:35:03,200 --> 00:35:08,240
assign them. Um, they will retain the

791
00:35:06,160 --> 00:35:10,160
ability to make a choice after August

792
00:35:08,240 --> 00:35:13,599
1st, right? if they want to go with

793
00:35:10,160 --> 00:35:16,000
someone else, that's that is absolutely

794
00:35:13,599 --> 00:35:17,520
um fine, but we need to make sure that

795
00:35:16,000 --> 00:35:20,000
there's a case manager in place on

796
00:35:17,520 --> 00:35:24,320
August 1. So, if a choice hasn't been

797
00:35:20,000 --> 00:35:26,480
made by the 15th after, you know, our

798
00:35:24,320 --> 00:35:28,480
efforts, um we're sending additional

799
00:35:26,480 --> 00:35:30,640
letters out in May, we'll be making

800
00:35:28,480 --> 00:35:35,280
phone calls to people who do not make a

801
00:35:30,640 --> 00:35:38,400
choice. Um then we will auto assign.

802
00:35:35,280 --> 00:35:41,920
We are um monitoring on a weekly basis

803
00:35:38,400 --> 00:35:44,400
the movement um of individuals who need

804
00:35:41,920 --> 00:35:47,839
to make a change in case management um

805
00:35:44,400 --> 00:35:50,720
by July 15th. Um we are monitoring that

806
00:35:47,839 --> 00:35:52,000
on a weekly basis. Um as you can imagine

807
00:35:50,720 --> 00:35:53,599
right now there hasn't been a lot of

808
00:35:52,000 --> 00:35:55,760
movement. There's been a some

809
00:35:53,599 --> 00:36:00,960
individuals who have have made a choice

810
00:35:55,760 --> 00:36:03,040
already to um to change um but we still

811
00:36:00,960 --> 00:36:05,599
um the bulk have not. We anticipate

812
00:36:03,040 --> 00:36:07,440
we'll see a spike due one because those

813
00:36:05,599 --> 00:36:08,400
conversations are being had now.

814
00:36:07,440 --> 00:36:09,440
» Have caps.

815
00:36:08,400 --> 00:36:11,280
» I'm sorry.

816
00:36:09,440 --> 00:36:12,960
» Do any of the providers have caps? Like

817
00:36:11,280 --> 00:36:13,280
we can only take so many.

818
00:36:12,960 --> 00:36:13,680
» No.

819
00:36:13,280 --> 00:36:15,280
» Okay.

820
00:36:13,680 --> 00:36:17,119
» No, they in fact that is part of the

821
00:36:15,280 --> 00:36:20,960
contract. They have to be positioned to

822
00:36:17,119 --> 00:36:23,119
accept uh individuals. Yep.

823
00:36:20,960 --> 00:36:26,480
» On a statewide basis.

824
00:36:23,119 --> 00:36:30,040
» Yeah, good question.

825
00:36:26,480 --> 00:36:30,040
Next slide, please.

826
00:36:31,440 --> 00:36:38,480
So the other thing that we are

827
00:36:33,440 --> 00:36:41,200
introducing in this um contract uh for

828
00:36:38,480 --> 00:36:44,400
the case management is our value based

829
00:36:41,200 --> 00:36:46,160
payment or value based purchasing. Um

830
00:36:44,400 --> 00:36:48,640
what that essentially means is that

831
00:36:46,160 --> 00:36:51,119
we're um

832
00:36:48,640 --> 00:36:54,320
going to be paying for certain outcomes

833
00:36:51,119 --> 00:36:56,240
with case management. This is just I I

834
00:36:54,320 --> 00:36:58,800
want to reiterate this. This is just the

835
00:36:56,240 --> 00:37:02,079
beginning. It's pretty basic as you can

836
00:36:58,800 --> 00:37:05,599
tell. It's um pretty complianceoriented

837
00:37:02,079 --> 00:37:10,880
at this point on um timely completion of

838
00:37:05,599 --> 00:37:12,800
the PCISPs and the level of care um

839
00:37:10,880 --> 00:37:14,960
completion or timely completion on

840
00:37:12,800 --> 00:37:19,200
incident reporting and responding to

841
00:37:14,960 --> 00:37:22,320
CAPS. um that uh for followup, mortality

842
00:37:19,200 --> 00:37:26,240
review, case load size um and then

843
00:37:22,320 --> 00:37:27,839
trainings for case managers outside of

844
00:37:26,240 --> 00:37:30,960
state state trainings included with

845
00:37:27,839 --> 00:37:34,320
that. So again, this is a start u for

846
00:37:30,960 --> 00:37:38,560
the first uh contract year. Um but we

847
00:37:34,320 --> 00:37:40,079
will be growing that uh element in case

848
00:37:38,560 --> 00:37:42,960
management as we move forward.

849
00:37:40,079 --> 00:37:45,520
» Yes. So m maybe this can go on the

850
00:37:42,960 --> 00:37:48,160
parking lot um and be addressed at an

851
00:37:45,520 --> 00:37:51,200
future meeting. I would love to see what

852
00:37:48,160 --> 00:37:54,320
those value uh services, value added

853
00:37:51,200 --> 00:37:57,839
services are and what your expectations

854
00:37:54,320 --> 00:38:00,079
are for those quality indicators just as

855
00:37:57,839 --> 00:38:01,839
part of that advisory piece so we have a

856
00:38:00,079 --> 00:38:02,480
good idea of what to look for.

857
00:38:01,839 --> 00:38:05,359
» Sure.

858
00:38:02,480 --> 00:38:08,960
» Especially when our our constituents are

859
00:38:05,359 --> 00:38:11,040
calling us and asking questions.

860
00:38:08,960 --> 00:38:11,599
» No, that's great. question.

861
00:38:11,040 --> 00:38:13,359
» Yes.

862
00:38:11,599 --> 00:38:16,480
» So,

863
00:38:13,359 --> 00:38:19,119
you guys know I I'm Ty Clark, but I have

864
00:38:16,480 --> 00:38:21,440
a disability, but

865
00:38:19,119 --> 00:38:23,440
I have struggled with case management

866
00:38:21,440 --> 00:38:25,520
issues

867
00:38:23,440 --> 00:38:28,079
for the past

868
00:38:25,520 --> 00:38:31,280
seven years, I think. I don't know how

869
00:38:28,079 --> 00:38:34,640
long, but I have a new case manager.

870
00:38:31,280 --> 00:38:39,760
She's sweet. But what I struggle with is

871
00:38:34,640 --> 00:38:42,480
when a case manager takes my case and

872
00:38:39,760 --> 00:38:44,880
then it becomes too stressful or

873
00:38:42,480 --> 00:38:47,200
whatever,

874
00:38:44,880 --> 00:38:50,880
they drop me and then I have to have

875
00:38:47,200 --> 00:38:56,400
someone fill in. So that's frustrating.

876
00:38:50,880 --> 00:38:58,720
So does this mean like they need to

877
00:38:56,400 --> 00:39:00,160
what would happen if they keep doing

878
00:38:58,720 --> 00:39:01,760
that?

879
00:39:00,160 --> 00:39:04,480
» Yeah, I think that's a good question. we

880
00:39:01,760 --> 00:39:07,359
can kind of talk about specifics. Um,

881
00:39:04,480 --> 00:39:09,920
but you know, ultimately, um, when

882
00:39:07,359 --> 00:39:11,680
individuals or families receiving case

883
00:39:09,920 --> 00:39:14,160
management services have concerns,

884
00:39:11,680 --> 00:39:15,920
similar concerns, what we want them to

885
00:39:14,160 --> 00:39:18,640
do is reach out to us and we will work

886
00:39:15,920 --> 00:39:19,920
with them on an individual basis.

887
00:39:18,640 --> 00:39:22,480
» Sounds good to resolve.

888
00:39:19,920 --> 00:39:28,240
» I I met my new case manager at my last

889
00:39:22,480 --> 00:39:31,200
quarterly meeting. Um, I had to do the

890
00:39:28,240 --> 00:39:34,640
waiver reset stuff. So, the questions

891
00:39:31,200 --> 00:39:37,520
were very personal and I kind of like

892
00:39:34,640 --> 00:39:41,839
didn't like them because my mom used to

893
00:39:37,520 --> 00:39:43,760
do them, but I have to sit in that. And

894
00:39:41,839 --> 00:39:47,280
Darlene and I were playing with my

895
00:39:43,760 --> 00:39:51,920
Neidato and it helped me calm down, but

896
00:39:47,280 --> 00:39:54,480
I was like very emotional and frustrated

897
00:39:51,920 --> 00:39:56,720
because

898
00:39:54,480 --> 00:39:59,440
of the questions they had to ask. I

899
00:39:56,720 --> 00:40:03,520
didn't really like them cuz they were

900
00:39:59,440 --> 00:40:09,599
too they were like

901
00:40:03,520 --> 00:40:12,640
personal too personal and I felt like

902
00:40:09,599 --> 00:40:16,240
I yes I struggle with things on a daily

903
00:40:12,640 --> 00:40:20,720
basis like depression and anxiety

904
00:40:16,240 --> 00:40:23,520
and mental health but it's like

905
00:40:20,720 --> 00:40:25,920
I don't think every time they need to

906
00:40:23,520 --> 00:40:30,079
ask that cuz that

907
00:40:25,920 --> 00:40:34,240
makes me feel a certain way and I feel

908
00:40:30,079 --> 00:40:35,920
like it's it puts me it sets me back

909
00:40:34,240 --> 00:40:37,599
basically.

910
00:40:35,920 --> 00:40:39,119
» Okay,

911
00:40:37,599 --> 00:40:41,200
» Thanks for sharing that. I think I know

912
00:40:39,119 --> 00:40:43,359
what you're referencing.

913
00:40:41,200 --> 00:40:46,079
» Thanks.

914
00:40:43,359 --> 00:40:49,920
» It is good feedback. Um

915
00:40:46,079 --> 00:40:52,640
so with regard to the uh value based

916
00:40:49,920 --> 00:40:54,880
purchasing or value based payment um

917
00:40:52,640 --> 00:40:57,680
like I mentioned there these are and to

918
00:40:54,880 --> 00:41:03,040
your point Kate these are very much

919
00:40:57,680 --> 00:41:05,280
compliance as we move forward um with

920
00:41:03,040 --> 00:41:07,359
this model of case management across all

921
00:41:05,280 --> 00:41:10,400
our waiverss. We will be looking at how

922
00:41:07,359 --> 00:41:14,560
to infuse more quality measures over and

923
00:41:10,400 --> 00:41:17,280
above just mere compliance. Right? So,

924
00:41:14,560 --> 00:41:19,440
um, did want to note that. All right,

925
00:41:17,280 --> 00:41:22,000
next slide.

926
00:41:19,440 --> 00:41:24,160
» Can I ask one more question? U, just as

927
00:41:22,000 --> 00:41:26,800
a recommendation, when it comes to those

928
00:41:24,160 --> 00:41:30,480
valuebased uh, payments and those value

929
00:41:26,800 --> 00:41:33,680
based services, how is the department or

930
00:41:30,480 --> 00:41:36,960
the division planning on um,

931
00:41:33,680 --> 00:41:39,200
communicating those to our community

932
00:41:36,960 --> 00:41:42,400
members who are receiving services? So

933
00:41:39,200 --> 00:41:45,280
there's a broad understanding of what

934
00:41:42,400 --> 00:41:46,880
value based services means

935
00:41:45,280 --> 00:41:48,319
» Because I think that could mean a lot of

936
00:41:46,880 --> 00:41:50,319
things to different people.

937
00:41:48,319 --> 00:41:54,160
» It can it boils down to the metrics that

938
00:41:50,319 --> 00:41:58,160
are that are being used to incentivize,

939
00:41:54,160 --> 00:42:01,200
» Right? So yes, and this is again sharing

940
00:41:58,160 --> 00:42:03,599
that we don't have I mean we have some

941
00:42:01,200 --> 00:42:06,560
of this data but starting fresh August

942
00:42:03,599 --> 00:42:09,119
first when we're talking about sorry

943
00:42:06,560 --> 00:42:12,240
when we're talking about a much larger

944
00:42:09,119 --> 00:42:14,640
um pool of individuals with varying

945
00:42:12,240 --> 00:42:16,400
needs um the data may look a little

946
00:42:14,640 --> 00:42:18,160
different than it does today. So we will

947
00:42:16,400 --> 00:42:19,599
be sharing that that information with

948
00:42:18,160 --> 00:42:22,640
this committee

949
00:42:19,599 --> 00:42:25,119
» Just how that it it is

950
00:42:22,640 --> 00:42:27,839
» Good these like you said are compliance

951
00:42:25,119 --> 00:42:30,880
focus and I get it and I think I'm not

952
00:42:27,839 --> 00:42:32,319
suggesting that these don't have a

953
00:42:30,880 --> 00:42:32,800
I don't want that problem

954
00:42:32,319 --> 00:42:34,640
» Sure

955
00:42:32,800 --> 00:42:37,760
» But it's it's a bit different this is

956
00:42:34,640 --> 00:42:39,520
about pushing providers to to be very

957
00:42:37,760 --> 00:42:42,640
and I think that's a really good thing

958
00:42:39,520 --> 00:42:45,359
» It's a good opportunity though to test

959
00:42:42,640 --> 00:42:47,839
some internal processes

960
00:42:45,359 --> 00:42:50,640
um how do you communicate this out to

961
00:42:47,839 --> 00:42:53,359
individual people receiving services

962
00:42:50,640 --> 00:42:55,359
» Because if this is step one where I

963
00:42:53,359 --> 00:42:57,200
would imagine some of these value based

964
00:42:55,359 --> 00:43:00,800
will be much more about individual

965
00:42:57,200 --> 00:43:03,280
potenti I'm assuming individual outcomes

966
00:43:00,800 --> 00:43:06,560
um that's going to affect them much more

967
00:43:03,280 --> 00:43:08,400
acutely than you know u training of case

968
00:43:06,560 --> 00:43:10,160
managers and I I realize that that

969
00:43:08,400 --> 00:43:12,400
affects but it's just it the

970
00:43:10,160 --> 00:43:14,319
responsibility the impact is felt far

971
00:43:12,400 --> 00:43:17,119
more so this might provide a good kind

972
00:43:14,319 --> 00:43:18,800
of a low entry way to how do we

973
00:43:17,119 --> 00:43:23,599
communicate this and get this message

974
00:43:18,800 --> 00:43:25,599
out because two or later on to a value

975
00:43:23,599 --> 00:43:26,640
base that's really about needing a

976
00:43:25,599 --> 00:43:26,960
service

977
00:43:26,640 --> 00:43:29,599
» Right

978
00:43:26,960 --> 00:43:30,079
» I'm already in the house so just just a

979
00:43:29,599 --> 00:43:32,240
thought

980
00:43:30,079 --> 00:43:34,079
» No I no I appreciate that Derek and I

981
00:43:32,240 --> 00:43:36,560
think we are completely aligned on that

982
00:43:34,079 --> 00:43:38,800
right this is our first kind of foray

983
00:43:36,560 --> 00:43:42,640
into it it's very basic it's very

984
00:43:38,800 --> 00:43:44,720
compliance driven but

985
00:43:42,640 --> 00:43:47,920
we will grow that right like we have to

986
00:43:44,720 --> 00:43:49,520
grow our system to be able to to really

987
00:43:47,920 --> 00:43:52,079
look at what quality measures are

988
00:43:49,520 --> 00:43:54,079
important, true quality, and how do we

989
00:43:52,079 --> 00:43:56,800
measure those and then how do we

990
00:43:54,079 --> 00:44:00,079
incentivize providers, case managers or

991
00:43:56,800 --> 00:44:03,119
whomever, right? To

992
00:44:00,079 --> 00:44:05,440
um to provide high quality services that

993
00:44:03,119 --> 00:44:05,839
results in the outcomes that people are

994
00:44:05,440 --> 00:44:06,560
needing.

995
00:44:05,839 --> 00:44:09,760
» Yeah.

996
00:44:06,560 --> 00:44:12,480
» Right. Yeah. I feel like this is

997
00:44:09,760 --> 00:44:15,520
something we'll be talking about more um

998
00:44:12,480 --> 00:44:18,880
because we have um identified as part of

999
00:44:15,520 --> 00:44:21,119
waiver reset that we really want

1000
00:44:18,880 --> 00:44:23,520
» To be more focused on the outcomes of

1001
00:44:21,119 --> 00:44:25,440
services and supports for people. What's

1002
00:44:23,520 --> 00:44:27,920
really meaningful? Are people getting

1003
00:44:25,440 --> 00:44:31,200
something meaningful from our services?

1004
00:44:27,920 --> 00:44:34,480
And what what does that look like? And

1005
00:44:31,200 --> 00:44:36,160
how do we how do we you know pat those

1006
00:44:34,480 --> 00:44:38,240
providers on the back that are doing

1007
00:44:36,160 --> 00:44:42,240
that, right? that are resulting in the

1008
00:44:38,240 --> 00:44:43,680
outcomes. Yeah. Yep.

1009
00:44:42,240 --> 00:44:45,359
» Yes.

1010
00:44:43,680 --> 00:44:47,680
» Do you need to like literally go like

1011
00:44:45,359 --> 00:44:49,520
this? I mean, how close do like how

1012
00:44:47,680 --> 00:44:52,640
close? Okay. So, dearly, you guys

1013
00:44:49,520 --> 00:44:55,680
literally have to be up on this cuz it's

1014
00:44:52,640 --> 00:44:57,760
not I don't know. People are texting and

1015
00:44:55,680 --> 00:44:59,520
messaging me that they're not hearing

1016
00:44:57,760 --> 00:45:00,880
you guys. I don't know. They're telling

1017
00:44:59,520 --> 00:45:03,520
me it's working. So, I mean, I would

1018
00:45:00,880 --> 00:45:06,880
just get up into the microphone. They're

1019
00:45:03,520 --> 00:45:08,960
hearing you, but I don't know. So, um,

1020
00:45:06,880 --> 00:45:10,400
but yeah, I would just talk as direct as

1021
00:45:08,960 --> 00:45:13,280
you can into it. I know it's kind of

1022
00:45:10,400 --> 00:45:14,880
annoying. Um, but just not as productive

1023
00:45:13,280 --> 00:45:16,720
because I think it's multiple people are

1024
00:45:14,880 --> 00:45:18,400
messaging me that they can't hear. So,

1025
00:45:16,720 --> 00:45:21,760
trying to fix it.

1026
00:45:18,400 --> 00:45:24,079
» So, be very love the microphone today.

1027
00:45:21,760 --> 00:45:27,200
Okay.

1028
00:45:24,079 --> 00:45:30,160
» Love it.

1029
00:45:27,200 --> 00:45:32,800
» Hopefully no one's sick of that.

1030
00:45:30,160 --> 00:45:35,119
» What you do? What' you say?

1031
00:45:32,800 --> 00:45:36,560
» Yeah. Love that microphone.

1032
00:45:35,119 --> 00:45:37,119
» I mean, I have a loud voice, so I don't

1033
00:45:36,560 --> 00:45:37,440
have that problem.

1034
00:45:37,119 --> 00:45:37,839
» Yeah.

1035
00:45:37,440 --> 00:45:39,760
» Okay.

1036
00:45:37,839 --> 00:45:41,200
» All right. Let's go ahead and move the

1037
00:45:39,760 --> 00:45:45,040
next slide, please.

1038
00:45:41,200 --> 00:45:47,839
» All right. Um, want to spend some time

1039
00:45:45,040 --> 00:45:51,119
around level of care in our uh

1040
00:45:47,839 --> 00:45:54,160
assessment tools, but want to start with

1041
00:45:51,119 --> 00:45:58,880
just some level setting on level of care

1042
00:45:54,160 --> 00:46:03,520
requirements for ICF, right? Um, this is

1043
00:45:58,880 --> 00:46:05,280
not new. This is in federal code. um we

1044
00:46:03,520 --> 00:46:09,040
address it. We define developmental

1045
00:46:05,280 --> 00:46:11,839
disability in Indiana code um but wanted

1046
00:46:09,040 --> 00:46:13,680
to review it um because and again stress

1047
00:46:11,839 --> 00:46:16,319
that has not changed. We have not

1048
00:46:13,680 --> 00:46:18,079
changed the eligibility requirement. So

1049
00:46:16,319 --> 00:46:22,319
that is an intellectual developmental

1050
00:46:18,079 --> 00:46:25,359
disability um or related condition that

1051
00:46:22,319 --> 00:46:28,480
manifests before the age of 22

1052
00:46:25,359 --> 00:46:31,040
that is likely to continue indefinitely

1053
00:46:28,480 --> 00:46:33,280
um and then results in and this is key

1054
00:46:31,040 --> 00:46:36,880
here substantial functional limitations

1055
00:46:33,280 --> 00:46:39,760
in three of six major life areas that's

1056
00:46:36,880 --> 00:46:42,160
mobility um self-care understanding and

1057
00:46:39,760 --> 00:46:45,359
use of language learning self-direction

1058
00:46:42,160 --> 00:46:48,160
and capacity for independent living. So

1059
00:46:45,359 --> 00:46:50,800
again, that has not changed. Um, but

1060
00:46:48,160 --> 00:46:54,880
wanted to include that here. Um, because

1061
00:46:50,800 --> 00:46:58,160
I do think sometimes there is um some

1062
00:46:54,880 --> 00:47:01,599
confusion around if a person has a

1063
00:46:58,160 --> 00:47:04,000
developmental disability,

1064
00:47:01,599 --> 00:47:06,160
they meet level of care. And that's not

1065
00:47:04,000 --> 00:47:08,160
that's not accurate. There has to be

1066
00:47:06,160 --> 00:47:09,839
» It's not completely true because

1067
00:47:08,160 --> 00:47:11,440
everyone

1068
00:47:09,839 --> 00:47:13,680
has different levels.

1069
00:47:11,440 --> 00:47:15,599
» That's true. That's true. Right. And

1070
00:47:13,680 --> 00:47:16,240
it's really about functional need,

1071
00:47:15,599 --> 00:47:20,000
» Right?

1072
00:47:16,240 --> 00:47:22,960
» Yep. Good point. All right, next slide.

1073
00:47:20,000 --> 00:47:24,480
No, you're fine. You're fine. Just use

1074
00:47:22,960 --> 00:47:25,839
the microphone. Okay,

1075
00:47:24,480 --> 00:47:27,440
» I will.

1076
00:47:25,839 --> 00:47:31,040
» Love it. Love it.

1077
00:47:27,440 --> 00:47:34,000
» Love it. Goodness.

1078
00:47:31,040 --> 00:47:38,079
» Um, so I did want to provide an update,

1079
00:47:34,000 --> 00:47:40,720
a bit of an update. So um we have of

1080
00:47:38,079 --> 00:47:43,760
course implemented new tools to assess

1081
00:47:40,720 --> 00:47:46,160
individuals for ICF level of care from

1082
00:47:43,760 --> 00:47:49,440
the enter suite of instruments which is

1083
00:47:46,160 --> 00:47:52,560
also used for assessing nursing facility

1084
00:47:49,440 --> 00:47:55,839
level of care different tools in that

1085
00:47:52,560 --> 00:47:59,040
suite of instruments but but tools um

1086
00:47:55,839 --> 00:48:00,800
all from the same suite um and all from

1087
00:47:59,040 --> 00:48:04,400
interi

1088
00:48:00,800 --> 00:48:11,040
right now we are using those tools it's

1089
00:48:04,400 --> 00:48:16,880
the um interi DD for adults, the interi

1090
00:48:11,040 --> 00:48:20,400
chime DD for youth for and 4 to 17 and

1091
00:48:16,880 --> 00:48:24,559
then the inry early years um for 0 to

1092
00:48:20,400 --> 00:48:28,160
three or through three. Right now we use

1093
00:48:24,559 --> 00:48:31,119
those tools for eligibility reasons,

1094
00:48:28,160 --> 00:48:34,480
right? But future state they will be

1095
00:48:31,119 --> 00:48:38,800
used um in support of the design of the

1096
00:48:34,480 --> 00:48:42,640
support level framework. So um way way

1097
00:48:38,800 --> 00:48:44,640
back way back to waiver redesign uh one

1098
00:48:42,640 --> 00:48:46,240
of the things that we've heard very

1099
00:48:44,640 --> 00:48:48,960
consistently from individuals and

1100
00:48:46,240 --> 00:48:52,720
families is around the you know multiple

1101
00:48:48,960 --> 00:48:55,119
assessments right um

1102
00:48:52,720 --> 00:48:56,319
every time they turned around they felt

1103
00:48:55,119 --> 00:48:57,440
like they were having yet another

1104
00:48:56,319 --> 00:48:59,119
assessment. Maybe it was for

1105
00:48:57,440 --> 00:49:02,480
eligibility, maybe it was for level of

1106
00:48:59,119 --> 00:49:04,160
service, maybe it was for

1107
00:49:02,480 --> 00:49:08,079
allocation, all kinds of different

1108
00:49:04,160 --> 00:49:09,839
reasons. So, um, one of our goals was,

1109
00:49:08,079 --> 00:49:12,319
um, to reduce the number of assessments

1110
00:49:09,839 --> 00:49:15,680
that people have to quite frankly

1111
00:49:12,319 --> 00:49:18,400
endure. Um, we can't we have to reassess

1112
00:49:15,680 --> 00:49:20,800
level of care every year, but it's once

1113
00:49:18,400 --> 00:49:23,040
a year. So,

1114
00:49:20,800 --> 00:49:24,880
um, so these are the um, currently used

1115
00:49:23,040 --> 00:49:26,640
for eligibility will be used in design

1116
00:49:24,880 --> 00:49:29,040
of the support level framework. We'll

1117
00:49:26,640 --> 00:49:33,359
talk a little bit more about that today.

1118
00:49:29,040 --> 00:49:35,839
Um, I do want to note the ICF ID level

1119
00:49:33,359 --> 00:49:38,880
of care assessments you utilization of

1120
00:49:35,839 --> 00:49:41,119
those three tools I mentioned must be

1121
00:49:38,880 --> 00:49:43,760
done in person.

1122
00:49:41,119 --> 00:49:46,559
That is how assessors have been trained.

1123
00:49:43,760 --> 00:49:48,720
Um, that is the expectation that they

1124
00:49:46,559 --> 00:49:50,400
are done in person engaging with the

1125
00:49:48,720 --> 00:49:56,000
individual.

1126
00:49:50,400 --> 00:50:01,359
Um it is possible that uh

1127
00:49:56,000 --> 00:50:03,359
the assessor who has been trained. Um

1128
00:50:01,359 --> 00:50:05,680
there may be gaps if they're meeting

1129
00:50:03,359 --> 00:50:08,160
with the individual and in or things

1130
00:50:05,680 --> 00:50:10,319
that they want or need to verify and

1131
00:50:08,160 --> 00:50:12,720
they may reach out to, you know, a

1132
00:50:10,319 --> 00:50:15,520
direct support staff perhaps that knows

1133
00:50:12,720 --> 00:50:19,440
the person or a family member that knows

1134
00:50:15,520 --> 00:50:20,880
the person. Um, but that individual

1135
00:50:19,440 --> 00:50:22,960
needs to be engaged and I think that's

1136
00:50:20,880 --> 00:50:25,359
what you were referencing a moment ago

1137
00:50:22,960 --> 00:50:26,800
is that you you sat and answered a lot

1138
00:50:25,359 --> 00:50:29,359
of questions, right?

1139
00:50:26,800 --> 00:50:31,839
» Yeah, it was with my team, too. So, like

1140
00:50:29,359 --> 00:50:34,480
I I prefer to do it on my quarterly

1141
00:50:31,839 --> 00:50:37,119
meeting because then they get to

1142
00:50:34,480 --> 00:50:39,200
understand everything that I do,

1143
00:50:37,119 --> 00:50:42,559
» But it I didn't like it.

1144
00:50:39,200 --> 00:50:44,960
» Yeah. So um to your point there are

1145
00:50:42,559 --> 00:50:47,680
these are very comprehensive tools and

1146
00:50:44,960 --> 00:50:51,200
they are used um every question is not

1147
00:50:47,680 --> 00:50:53,920
related to eligibility. Right. Right.

1148
00:50:51,200 --> 00:50:56,960
» But they are related to the individual's

1149
00:50:53,920 --> 00:50:58,720
needs and can support the team taking a

1150
00:50:56,960 --> 00:51:02,480
more holistic approach about what are

1151
00:50:58,720 --> 00:51:05,440
what what does Holly really need? Um and

1152
00:51:02,480 --> 00:51:06,160
how can we connect her whether it's

1153
00:51:05,440 --> 00:51:08,240
» Sister?

1154
00:51:06,160 --> 00:51:11,359
» Yeah. whether it's waiver services or

1155
00:51:08,240 --> 00:51:13,680
something different like

1156
00:51:11,359 --> 00:51:14,160
um energy assistance,

1157
00:51:13,680 --> 00:51:17,119
» Right,

1158
00:51:14,160 --> 00:51:19,599
» Or repair affair for some home repairs

1159
00:51:17,119 --> 00:51:21,760
that need to occur. So um so they're

1160
00:51:19,599 --> 00:51:23,280
very comprehensive. Um they really

1161
00:51:21,760 --> 00:51:26,079
should be administered more as a

1162
00:51:23,280 --> 00:51:29,119
conversation than just a a whole list of

1163
00:51:26,079 --> 00:51:33,280
questions. Um so we continue to work

1164
00:51:29,119 --> 00:51:36,079
with assessors on um best practice um

1165
00:51:33,280 --> 00:51:38,319
with those assessments. But to your

1166
00:51:36,079 --> 00:51:41,119
point, individuals can choose to have

1167
00:51:38,319 --> 00:51:44,079
other people present during the

1168
00:51:41,119 --> 00:51:47,119
assessment, but it is not required. So

1169
00:51:44,079 --> 00:51:50,079
sometimes those personal questions

1170
00:51:47,119 --> 00:51:52,640
may feel a little easier to answer if

1171
00:51:50,079 --> 00:51:54,640
it's just the assessor and

1172
00:51:52,640 --> 00:51:58,079
» Definitely with like other people

1173
00:51:54,640 --> 00:52:01,680
surrounded me, it made me feel better.

1174
00:51:58,079 --> 00:52:03,359
But like my mom's my legal guardian and

1175
00:52:01,680 --> 00:52:05,839
so

1176
00:52:03,359 --> 00:52:10,160
I prefer to have her there too

1177
00:52:05,839 --> 00:52:11,359
sometimes. It's just we all feel about

1178
00:52:10,160 --> 00:52:14,720
our moms.

1179
00:52:11,359 --> 00:52:19,400
» We but heads but it's like I love her

1180
00:52:14,720 --> 00:52:19,400
but it's just what it is.

1181
00:52:20,640 --> 00:52:27,839
» Kind of bouncing off um what Ty was

1182
00:52:23,520 --> 00:52:30,880
talking about. Um, so

1183
00:52:27,839 --> 00:52:34,160
I'm hearing you say if there's like gaps

1184
00:52:30,880 --> 00:52:37,200
that a DSP or a family member might be

1185
00:52:34,160 --> 00:52:39,760
reached out to. Um,

1186
00:52:37,200 --> 00:52:44,079
excuse me, my throat got scratchy. I

1187
00:52:39,760 --> 00:52:45,839
just want to um like make sure that when

1188
00:52:44,079 --> 00:52:48,800
those conversations are being had with

1189
00:52:45,839 --> 00:52:51,280
the family member of the DSP that if the

1190
00:52:48,800 --> 00:52:53,680
individual wants to be included, they

1191
00:52:51,280 --> 00:52:55,599
should definitely be asked first if they

1192
00:52:53,680 --> 00:52:57,839
want to be included because they don't

1193
00:52:55,599 --> 00:53:00,000
feel like things like that should be

1194
00:52:57,839 --> 00:53:02,079
talked about without the individual just

1195
00:53:00,000 --> 00:53:03,599
in case the individual kind of disagrees

1196
00:53:02,079 --> 00:53:05,760
with what

1197
00:53:03,599 --> 00:53:08,000
» The DSP or family members view is. They

1198
00:53:05,760 --> 00:53:10,480
don't want inaccuracies

1199
00:53:08,000 --> 00:53:13,520
um from because we our lived experience

1200
00:53:10,480 --> 00:53:16,079
we know ourselves best right so yeah

1201
00:53:13,520 --> 00:53:17,359
» You are absolutely right Lexi absolutely

1202
00:53:16,079 --> 00:53:20,400
and those

1203
00:53:17,359 --> 00:53:24,160
» Assessors whether that's a beads staff

1204
00:53:20,400 --> 00:53:26,319
or a case manager should um would always

1205
00:53:24,160 --> 00:53:28,400
be expected to make sure that's okay

1206
00:53:26,319 --> 00:53:31,280
with the individual that they talk with

1207
00:53:28,400 --> 00:53:33,119
someone else about them right or that

1208
00:53:31,280 --> 00:53:36,000
they're actually engaged in that

1209
00:53:33,119 --> 00:53:38,720
conversation. Absolutely.

1210
00:53:36,000 --> 00:53:39,200
» Mine was with my case manager. So,

1211
00:53:38,720 --> 00:53:43,200
» Yes.

1212
00:53:39,200 --> 00:53:46,160
» Yeah, there's there's a reason um we uh

1213
00:53:43,200 --> 00:53:48,720
have continued for uh with case managers

1214
00:53:46,160 --> 00:53:51,839
doing those level of care assessments

1215
00:53:48,720 --> 00:53:53,839
um for ICFID and and a lot of that is

1216
00:53:51,839 --> 00:53:59,280
because those case managers know the

1217
00:53:53,839 --> 00:54:00,960
individual, right? Um and um

1218
00:53:59,280 --> 00:54:03,119
the expectation would be that there's

1219
00:54:00,960 --> 00:54:05,599
some if something doesn't kind of ring

1220
00:54:03,119 --> 00:54:07,520
true in that assessment that that case

1221
00:54:05,599 --> 00:54:09,119
manager would be like, "Oh, I might we

1222
00:54:07,520 --> 00:54:11,200
need to delve into that a little bit

1223
00:54:09,119 --> 00:54:13,599
more in this conversation to make sure

1224
00:54:11,200 --> 00:54:14,880
we're getting accurate accurately

1225
00:54:13,599 --> 00:54:17,440
capturing things."

1226
00:54:14,880 --> 00:54:20,079
» Can I just go on?

1227
00:54:17,440 --> 00:54:21,680
» Okay. Um and apparently I was the

1228
00:54:20,079 --> 00:54:24,720
problem here with the speaker with the

1229
00:54:21,680 --> 00:54:28,160
microphone. Sorry everyone. Um

1230
00:54:24,720 --> 00:54:30,800
this tool is being used for eligibility.

1231
00:54:28,160 --> 00:54:33,839
It its intention is also to be used and

1232
00:54:30,800 --> 00:54:36,480
maybe it already is um for the the kind

1233
00:54:33,839 --> 00:54:37,920
of level of care as well. So I I I'm

1234
00:54:36,480 --> 00:54:39,839
looking at these somewhat separately but

1235
00:54:37,920 --> 00:54:41,520
I there and I realize they overlap. Is

1236
00:54:39,839 --> 00:54:42,720
that help? Correct me because I'm

1237
00:54:41,520 --> 00:54:44,880
looking at you right now and you're

1238
00:54:42,720 --> 00:54:46,160
» So apparently you're it's better. So

1239
00:54:44,880 --> 00:54:47,200
you're

1240
00:54:46,160 --> 00:54:48,720
» Good job loving the microphone

1241
00:54:47,200 --> 00:54:50,400
» Because I was pushing I was turning it

1242
00:54:48,720 --> 00:54:53,359
off. Sorry.

1243
00:54:50,400 --> 00:54:54,960
» Good job. Sorry, it says push. I pushed

1244
00:54:53,359 --> 00:54:56,960
the button.

1245
00:54:54,960 --> 00:54:58,640
» I did that one time, too, and then I'm

1246
00:54:56,960 --> 00:54:59,680
like, "Oh, great. You don't push

1247
00:54:58,640 --> 00:55:01,760
» This." It was really you.

1248
00:54:59,680 --> 00:55:02,559
» It was I was the problem.

1249
00:55:01,760 --> 00:55:04,319
» So,

1250
00:55:02,559 --> 00:55:06,000
» All Derek's fault.

1251
00:55:04,319 --> 00:55:08,720
» And I'm going to try to answer that, but

1252
00:55:06,000 --> 00:55:10,160
I may not. Let me know if I don't answer

1253
00:55:08,720 --> 00:55:12,400
your question. When I talk about

1254
00:55:10,160 --> 00:55:14,960
eligibility and level of care, I'm kind

1255
00:55:12,400 --> 00:55:17,520
of lumping those together. Okay? Right.

1256
00:55:14,960 --> 00:55:19,359
level of care is the requirement that

1257
00:55:17,520 --> 00:55:21,359
has to be met or the threshold that has

1258
00:55:19,359 --> 00:55:22,880
to be met to be eligible for home and

1259
00:55:21,359 --> 00:55:26,559
community based services.

1260
00:55:22,880 --> 00:55:29,920
» Uh so elgo level how about that? Oh so

1261
00:55:26,559 --> 00:55:32,240
so I'm sorry. So so at this point this

1262
00:55:29,920 --> 00:55:34,240
isn't being folded into that but the

1263
00:55:32,240 --> 00:55:37,040
intention the intention is to go that

1264
00:55:34,240 --> 00:55:38,800
direction. So, so that that's one thing

1265
00:55:37,040 --> 00:55:41,119
I wanted just to get out there and make

1266
00:55:38,800 --> 00:55:42,960
sure I was So, then I think my my

1267
00:55:41,119 --> 00:55:45,520
question is really about what we were

1268
00:55:42,960 --> 00:55:48,480
just kind of talking about and and I

1269
00:55:45,520 --> 00:55:51,200
think it the concerns that was expressed

1270
00:55:48,480 --> 00:55:54,400
about these are very private questions.

1271
00:55:51,200 --> 00:55:56,160
Um, and then the involvement of family

1272
00:55:54,400 --> 00:55:57,760
members or just the individual

1273
00:55:56,160 --> 00:55:59,200
themselves, they have they should have

1274
00:55:57,760 --> 00:56:01,359
the right people should have the right

1275
00:55:59,200 --> 00:56:04,000
to just be them answering the questions.

1276
00:56:01,359 --> 00:56:05,200
I I so I'm going to just um share a

1277
00:56:04,000 --> 00:56:07,280
concern that was brought to me yesterday

1278
00:56:05,200 --> 00:56:09,599
by a family member and it was really a

1279
00:56:07,280 --> 00:56:11,119
question about you know a person's their

1280
00:56:09,599 --> 00:56:12,799
own guardian and they didn't want any

1281
00:56:11,119 --> 00:56:17,119
family there. that's they're right and I

1282
00:56:12,799 --> 00:56:19,040
I point that um but their concern was

1283
00:56:17,119 --> 00:56:21,359
was the anere were the answers correct

1284
00:56:19,040 --> 00:56:23,599
right or were they accurate and and I

1285
00:56:21,359 --> 00:56:26,240
think some of the social potential

1286
00:56:23,599 --> 00:56:29,040
social

1287
00:56:26,240 --> 00:56:31,440
I think it's very common for anybody in

1288
00:56:29,040 --> 00:56:33,920
being asked very private questions to

1289
00:56:31,440 --> 00:56:36,319
not if be it in a doctor's office and

1290
00:56:33,920 --> 00:56:38,240
I'm sure some of these processes to

1291
00:56:36,319 --> 00:56:39,680
maybe not be truthful because of the

1292
00:56:38,240 --> 00:56:41,280
some of the social pressures related to

1293
00:56:39,680 --> 00:56:42,720
that and talking to a stranger so it's

1294
00:56:41,280 --> 00:56:45,359
totally totally makes sense depending on

1295
00:56:42,720 --> 00:56:48,240
how intimate those questions are. But so

1296
00:56:45,359 --> 00:56:50,480
I just wonder how that's being how that

1297
00:56:48,240 --> 00:56:51,839
affects the elbow level if somebody's

1298
00:56:50,480 --> 00:56:53,119
really not comfortable answering that

1299
00:56:51,839 --> 00:56:56,720
question. So maybe they'll answer it in

1300
00:56:53,119 --> 00:56:58,400
a more socially acceptable way. Um and

1301
00:56:56,720 --> 00:56:59,680
what's the consequence of that and is

1302
00:56:58,400 --> 00:57:02,319
this something that we need to help

1303
00:56:59,680 --> 00:57:04,319
people truly understand if there is a

1304
00:57:02,319 --> 00:57:06,079
potential consequence with and the

1305
00:57:04,319 --> 00:57:08,000
consequence being an elgo level that

1306
00:57:06,079 --> 00:57:09,520
maybe doesn't represent their need is

1307
00:57:08,000 --> 00:57:11,599
really you know maybe it's at a

1308
00:57:09,520 --> 00:57:12,720
different level. So, I don't know if we

1309
00:57:11,599 --> 00:57:15,440
have to we don't have to solve this.

1310
00:57:12,720 --> 00:57:17,200
Maybe this is on um on a parking lot

1311
00:57:15,440 --> 00:57:19,040
issue, but I think it's one of those big

1312
00:57:17,200 --> 00:57:21,040
topics that's worth us kind of

1313
00:57:19,040 --> 00:57:25,520
struggling with because it's going to as

1314
00:57:21,040 --> 00:57:27,760
that becomes a greater um uh gateway to

1315
00:57:25,520 --> 00:57:30,079
the levels of support or the types of

1316
00:57:27,760 --> 00:57:31,680
supports that you're able to access. We

1317
00:57:30,079 --> 00:57:33,680
need to make sure that's as accurate as

1318
00:57:31,680 --> 00:57:36,720
possible and that people are comfortable

1319
00:57:33,680 --> 00:57:39,440
sharing that their private information.

1320
00:57:36,720 --> 00:57:41,119
» Um it that's uncomfortable at times. So

1321
00:57:39,440 --> 00:57:46,799
anyway, that's all

1322
00:57:41,119 --> 00:57:49,839
» I I think what I'll add and um just to

1323
00:57:46,799 --> 00:57:51,839
step back a little bit is

1324
00:57:49,839 --> 00:57:55,440
that

1325
00:57:51,839 --> 00:57:58,079
prior to the utilization of this suite

1326
00:57:55,440 --> 00:58:01,520
of assessments, the level of care

1327
00:57:58,079 --> 00:58:04,480
conversation was a very basic level of

1328
00:58:01,520 --> 00:58:07,839
care conversation merely to establish

1329
00:58:04,480 --> 00:58:10,240
that minimum threshold for eligibility.

1330
00:58:07,839 --> 00:58:13,440
We didn't get into a lot of these other

1331
00:58:10,240 --> 00:58:15,359
conversations about what ultimately

1332
00:58:13,440 --> 00:58:17,920
lends itself to the service planning

1333
00:58:15,359 --> 00:58:22,240
piece. We're asking those questions now.

1334
00:58:17,920 --> 00:58:25,040
And I think those are helpful for

1335
00:58:22,240 --> 00:58:28,640
the team. I think it's also helpful for

1336
00:58:25,040 --> 00:58:30,880
us as a system to to Holly's earlier

1337
00:58:28,640 --> 00:58:33,200
point, minimize the number of encounters

1338
00:58:30,880 --> 00:58:36,480
that people have to have those kinds of

1339
00:58:33,200 --> 00:58:38,480
conversations with us. Um but I do think

1340
00:58:36,480 --> 00:58:42,960
it's an adjustment for people who have

1341
00:58:38,480 --> 00:58:45,760
been used to that annual um routine of

1342
00:58:42,960 --> 00:58:47,599
the level of care conversation and the

1343
00:58:45,760 --> 00:58:50,160
service planning being an entirely

1344
00:58:47,599 --> 00:58:52,640
different conversation that we have.

1345
00:58:50,160 --> 00:58:55,760
They're completely in our system today

1346
00:58:52,640 --> 00:58:59,920
very separate processes. There's maybe

1347
00:58:55,760 --> 00:59:01,760
some overlap. Um but it has to be to a

1348
00:58:59,920 --> 00:59:03,920
certain extent

1349
00:59:01,760 --> 00:59:06,880
previously very disjointed in the way in

1350
00:59:03,920 --> 00:59:10,400
which those conversations unfolded. Now

1351
00:59:06,880 --> 00:59:13,040
it does probably feel like now I'm

1352
00:59:10,400 --> 00:59:14,960
unpacking everything all at once and

1353
00:59:13,040 --> 00:59:18,799
that is certainly I think an adjustment

1354
00:59:14,960 --> 00:59:20,319
for people. Um but hopefully as as the

1355
00:59:18,799 --> 00:59:22,799
system

1356
00:59:20,319 --> 00:59:26,079
evolves in this waiver reset space and

1357
00:59:22,799 --> 00:59:28,559
people see how that information is being

1358
00:59:26,079 --> 00:59:30,880
utilized um both from the eligibility

1359
00:59:28,559 --> 00:59:33,839
standpoint but also to Holly's point in

1360
00:59:30,880 --> 00:59:37,440
the service planning. We now don't have

1361
00:59:33,839 --> 00:59:39,520
to come back to them and have another

1362
00:59:37,440 --> 00:59:41,599
engagement around le the service

1363
00:59:39,520 --> 00:59:43,200
planning unless there's a change unless

1364
00:59:41,599 --> 00:59:47,359
something it looks different than it did

1365
00:59:43,200 --> 00:59:49,280
before then yes. Um, so I do think this

1366
00:59:47,359 --> 00:59:51,119
is a maybe a little bit of a culture

1367
00:59:49,280 --> 00:59:53,280
shock or a shock to the system for

1368
00:59:51,119 --> 00:59:56,720
people to be like, there's a lot of

1369
00:59:53,280 --> 00:59:59,520
questions here. Um, and I and I do think

1370
00:59:56,720 --> 01:00:02,880
that that's um

1371
00:59:59,520 --> 01:00:06,880
the new norm. Um, I think for for lack

1372
01:00:02,880 --> 01:00:09,760
of a better term, as people adjust to um

1373
01:00:06,880 --> 01:00:11,520
the types of questions being asked, I

1374
01:00:09,760 --> 01:00:14,480
think to your point, it's up to us to

1375
01:00:11,520 --> 01:00:17,280
also educate people as to why there's

1376
01:00:14,480 --> 01:00:19,520
value in engaging in that and being

1377
01:00:17,280 --> 01:00:21,040
authentic and honest in in what's

1378
01:00:19,520 --> 01:00:24,319
working, what's not working for the

1379
01:00:21,040 --> 01:00:26,319
person. um so that we don't have to come

1380
01:00:24,319 --> 01:00:28,240
back again or circle back on those areas

1381
01:00:26,319 --> 01:00:30,400
where they felt I have to be socially

1382
01:00:28,240 --> 01:00:32,480
acceptable in my response or I have to

1383
01:00:30,400 --> 01:00:34,240
answer this because I really like my

1384
01:00:32,480 --> 01:00:36,400
team and I don't you know I don't want

1385
01:00:34,240 --> 01:00:37,760
to let them down so I better uh they've

1386
01:00:36,400 --> 01:00:39,520
been helping me with this particular

1387
01:00:37,760 --> 01:00:41,280
area so I better tell people I can do

1388
01:00:39,520 --> 01:00:42,960
this now even though maybe I can't.

1389
01:00:41,280 --> 01:00:45,599
Those types of things I think are things

1390
01:00:42,960 --> 01:00:48,559
that we're um just going to have to be

1391
01:00:45,599 --> 01:00:51,359
um supportive to our assessors in

1392
01:00:48,559 --> 01:00:53,280
navigating and making sure that the

1393
01:00:51,359 --> 01:00:57,040
information that we're we're gathering

1394
01:00:53,280 --> 01:00:59,359
has um is valid and that we have other

1395
01:00:57,040 --> 01:01:01,440
ways to either triangulate some

1396
01:00:59,359 --> 01:01:04,480
information or tell us that what we're

1397
01:01:01,440 --> 01:01:07,599
hearing is is accurate. But um certainly

1398
01:01:04,480 --> 01:01:10,400
I think we're just we're in a bit of a

1399
01:01:07,599 --> 01:01:13,200
growing space right now as far as how

1400
01:01:10,400 --> 01:01:14,640
people are adjusting to how that

1401
01:01:13,200 --> 01:01:16,400
assessment just looks and feels

1402
01:01:14,640 --> 01:01:18,480
different than what we've been used to.

1403
01:01:16,400 --> 01:01:20,640
» Well, and I think I think it's I think

1404
01:01:18,480 --> 01:01:24,559
the culture changes. Yes, absolutely.

1405
01:01:20,640 --> 01:01:27,119
And I think that's a big change and

1406
01:01:24,559 --> 01:01:29,760
but the connectivity of these of this

1407
01:01:27,119 --> 01:01:32,640
exercise with the not just eligibility

1408
01:01:29,760 --> 01:01:34,640
but the algo level is essential and I

1409
01:01:32,640 --> 01:01:37,440
think connecting it is I so this is such

1410
01:01:34,640 --> 01:01:39,200
an important role and I I I I think it

1411
01:01:37,440 --> 01:01:41,359
makes sense and I think it's a really

1412
01:01:39,200 --> 01:01:44,079
important direction especially if the

1413
01:01:41,359 --> 01:01:45,520
int as the intention is to be to

1414
01:01:44,079 --> 01:01:47,599
actually get services that people need

1415
01:01:45,520 --> 01:01:49,200
when they need it rather than saying and

1416
01:01:47,599 --> 01:01:51,920
this is what you get because we ask you

1417
01:01:49,200 --> 01:01:53,760
these these questions and sorry, I don't

1418
01:01:51,920 --> 01:01:56,000
know if you need it or don't. So, I

1419
01:01:53,760 --> 01:01:58,240
think I think that is spot on and I

1420
01:01:56,000 --> 01:01:59,599
think this is part of that evolution and

1421
01:01:58,240 --> 01:02:01,760
I think for all of us, I think the

1422
01:01:59,599 --> 01:02:05,359
culture change we need to help folks

1423
01:02:01,760 --> 01:02:08,160
» And I'm loving the microphone. Um it um

1424
01:02:05,359 --> 01:02:11,920
I think also to keep in mind

1425
01:02:08,160 --> 01:02:13,520
particularly the I mean for the

1426
01:02:11,920 --> 01:02:15,520
intellectual developmental disability

1427
01:02:13,520 --> 01:02:18,000
side

1428
01:02:15,520 --> 01:02:19,520
what we've been doing is assessing for

1429
01:02:18,000 --> 01:02:24,160
most people for that family support

1430
01:02:19,520 --> 01:02:27,119
waiver which service planning is

1431
01:02:24,160 --> 01:02:28,880
not absent from that but

1432
01:02:27,119 --> 01:02:31,040
you get a certain amount of money and

1433
01:02:28,880 --> 01:02:34,079
that's the allocation. And so the focus

1434
01:02:31,040 --> 01:02:35,920
on gathering information to build out

1435
01:02:34,079 --> 01:02:38,880
sort of the service array and supports

1436
01:02:35,920 --> 01:02:39,920
that somebody would need um I don't

1437
01:02:38,880 --> 01:02:42,079
think there's the right amount of

1438
01:02:39,920 --> 01:02:44,960
attention being placed on it because of

1439
01:02:42,079 --> 01:02:47,040
the way in which that waiver is been set

1440
01:02:44,960 --> 01:02:48,880
up to serve as many people as we

1441
01:02:47,040 --> 01:02:51,760
possibly can with what money we have and

1442
01:02:48,880 --> 01:02:54,000
that's doesn't lend itself to good

1443
01:02:51,760 --> 01:02:56,480
service planning discussion as part of

1444
01:02:54,000 --> 01:02:59,040
that level of care. Right? So I I think

1445
01:02:56,480 --> 01:03:01,520
that we'll get to a better space um for

1446
01:02:59,040 --> 01:03:03,200
for those folks who maybe this is a

1447
01:03:01,520 --> 01:03:05,280
feels very new because we're getting

1448
01:03:03,200 --> 01:03:07,119
we're getting definitely into more of

1449
01:03:05,280 --> 01:03:08,960
the nuts and bolts of their lives than

1450
01:03:07,119 --> 01:03:11,839
we were previously.

1451
01:03:08,960 --> 01:03:13,839
» Sorry. I think oh Tia I was gonna say

1452
01:03:11,839 --> 01:03:17,200
one thing that struck me when you said

1453
01:03:13,839 --> 01:03:18,559
it's not so much maybe I mean your

1454
01:03:17,200 --> 01:03:21,839
experience of what you were asked which

1455
01:03:18,559 --> 01:03:23,599
I'm not but maybe better preparing you

1456
01:03:21,839 --> 01:03:25,280
right like I think that's what I heard

1457
01:03:23,599 --> 01:03:26,400
too is I think may and I'm not saying it

1458
01:03:25,280 --> 01:03:27,839
wouldn't have made you uncomfortable I

1459
01:03:26,400 --> 01:03:29,920
don't mean to say that but I think

1460
01:03:27,839 --> 01:03:33,039
sounds like you weren't prepared

1461
01:03:29,920 --> 01:03:34,559
necessarily to know so I think going in

1462
01:03:33,039 --> 01:03:36,000
maybe that's just something we're and I

1463
01:03:34,559 --> 01:03:37,200
think you should have been I'm not but I

1464
01:03:36,000 --> 01:03:38,400
think it should because if you were I

1465
01:03:37,200 --> 01:03:39,119
think maybe you wouldn't have been I'm

1466
01:03:38,400 --> 01:03:41,039
not saying you wouldn't have been

1467
01:03:39,119 --> 01:03:44,640
uncomfortable I'm just saying this is my

1468
01:03:41,039 --> 01:03:48,079
first assessment I ever sat in on. And

1469
01:03:44,640 --> 01:03:49,520
that's the thing like my mom would use

1470
01:03:48,079 --> 01:03:50,559
» It. Still if you were better prepared,

1471
01:03:49,520 --> 01:03:52,000
you know what I mean? To have a

1472
01:03:50,559 --> 01:03:54,160
conversation. Hey, this is because I

1473
01:03:52,000 --> 01:03:55,440
think then you would have maybe know

1474
01:03:54,160 --> 01:03:56,880
known more of hey I don't want this

1475
01:03:55,440 --> 01:03:59,520
person here or not. So I think it just

1476
01:03:56,880 --> 01:04:00,960
that's what I hear too is I think you it

1477
01:03:59,520 --> 01:04:02,240
would have helped to make sure you know

1478
01:04:00,960 --> 01:04:03,599
we want to make sure people are

1479
01:04:02,240 --> 01:04:04,319
supported and knowing what's going to

1480
01:04:03,599 --> 01:04:07,359
happen. I guess

1481
01:04:04,319 --> 01:04:09,920
» Greatly supported. It's just I didn't

1482
01:04:07,359 --> 01:04:11,359
like the questions. It made me feel

1483
01:04:09,920 --> 01:04:11,760
really uncomfortable.

1484
01:04:11,359 --> 01:04:13,680
» Okay.

1485
01:04:11,760 --> 01:04:14,880
» And and I just

1486
01:04:13,680 --> 01:04:17,839
» Yeah, that's fair.

1487
01:04:14,880 --> 01:04:20,880
» I just felt like they were prying into

1488
01:04:17,839 --> 01:04:23,760
my daily life, which they need to know

1489
01:04:20,880 --> 01:04:25,039
how I feel and stuff, but like one

1490
01:04:23,760 --> 01:04:27,039
question was like, "How's your

1491
01:04:25,039 --> 01:04:29,920
relationship with your family?" I said,

1492
01:04:27,039 --> 01:04:32,720
"It's poorly because one, me and my mom

1493
01:04:29,920 --> 01:04:35,760
don't get always get along and I

1494
01:04:32,720 --> 01:04:39,200
struggle with that like

1495
01:04:35,760 --> 01:04:40,960
She nitpicks and then like I snap or get

1496
01:04:39,200 --> 01:04:42,880
an attitude and

1497
01:04:40,960 --> 01:04:46,079
» But I think maybe knowing

1498
01:04:42,880 --> 01:04:47,359
» I go to zero and 100 and I'm like wait I

1499
01:04:46,079 --> 01:04:47,839
shouldn't have done that but I

1500
01:04:47,359 --> 01:04:49,520
apologize.

1501
01:04:47,839 --> 01:04:51,119
» Yeah. Yeah. But maybe under helping you

1502
01:04:49,520 --> 01:04:52,559
understand why those are being asked

1503
01:04:51,119 --> 01:04:53,839
because I think because sometimes I

1504
01:04:52,559 --> 01:04:54,960
think if we're just going and I'm not

1505
01:04:53,839 --> 01:04:56,400
saying this is what happened but if I

1506
01:04:54,960 --> 01:04:59,039
just go in and I start with a list like

1507
01:04:56,400 --> 01:05:00,400
Holly said it shouldn't be hey Ty do you

1508
01:04:59,039 --> 01:05:01,520
know do you like your family? I'm not

1509
01:05:00,400 --> 01:05:04,240
saying that's what happened, but I think

1510
01:05:01,520 --> 01:05:06,319
to know why we're asking it because I

1511
01:05:04,240 --> 01:05:07,920
think if if you don't and I'm not I

1512
01:05:06,319 --> 01:05:08,960
think if I was me too and someone just

1513
01:05:07,920 --> 01:05:10,880
started asking me questions, I'd be

1514
01:05:08,960 --> 01:05:12,880
like, "What the heck? Why?" But I think

1515
01:05:10,880 --> 01:05:15,119
to know why you're being asked that it's

1516
01:05:12,880 --> 01:05:16,319
not here's why. And I think that's

1517
01:05:15,119 --> 01:05:18,799
probably not always happening.

1518
01:05:16,319 --> 01:05:22,000
» Yeah, I would like that because honestly

1519
01:05:18,799 --> 01:05:23,920
then I'd be okay like answering, but

1520
01:05:22,000 --> 01:05:24,640
still it's going to be a struggle for me

1521
01:05:23,920 --> 01:05:25,599
to do.

1522
01:05:24,640 --> 01:05:26,960
» I'm not saying it's not going to be

1523
01:05:25,599 --> 01:05:28,720
uncomfortable, but it might better give

1524
01:05:26,960 --> 01:05:30,960
you a sense of why it's being asked,

1525
01:05:28,720 --> 01:05:30,960
» Right?

1526
01:05:31,280 --> 01:05:32,160
Sorry.

1527
01:05:31,760 --> 01:05:32,480
» Yeah.

1528
01:05:32,160 --> 01:05:34,000
» Yeah.

1529
01:05:32,480 --> 01:05:34,720
» Uh I think she had a question over

1530
01:05:34,000 --> 01:05:36,000
there.

1531
01:05:34,720 --> 01:05:36,799
» Thank you so much.

1532
01:05:36,000 --> 01:05:38,480
» You're welcome.

1533
01:05:36,799 --> 01:05:40,400
» We have to finish.

1534
01:05:38,480 --> 01:05:41,760
» You know, I'm not ignoring you, right? I

1535
01:05:40,400 --> 01:05:42,799
just need to finish.

1536
01:05:41,760 --> 01:05:45,119
» I know.

1537
01:05:42,799 --> 01:05:46,799
» So, and

1538
01:05:45,119 --> 01:05:48,880
» It's just to Jessica's point was all I

1539
01:05:46,799 --> 01:05:51,119
will be I will be so brief if if that's

1540
01:05:48,880 --> 01:05:53,599
okay. And then you can move to wherever.

1541
01:05:51,119 --> 01:05:56,799
» Um I'm I'm gonna go ahead. I'm sorry. Go

1542
01:05:53,599 --> 01:05:58,559
ahead. Um, so I think this points to a

1543
01:05:56,799 --> 01:06:00,799
couple of things that we see at the

1544
01:05:58,559 --> 01:06:03,680
council. One is that advanced

1545
01:06:00,799 --> 01:06:06,400
preparation and is really a support tool

1546
01:06:03,680 --> 01:06:08,319
for people with ID, but also as a

1547
01:06:06,400 --> 01:06:10,240
sibling who has and a parent who's

1548
01:06:08,319 --> 01:06:13,359
navigating this system.

1549
01:06:10,240 --> 01:06:16,240
» I've seen the communications that come

1550
01:06:13,359 --> 01:06:19,359
and they are very thorough,

1551
01:06:16,240 --> 01:06:22,480
» But also it's not necessarily plain

1552
01:06:19,359 --> 01:06:27,119
language and it's definitely not easy

1553
01:06:22,480 --> 01:06:29,680
read. And so maybe uh one recommendation

1554
01:06:27,119 --> 01:06:33,440
is to work with a group of self-

1555
01:06:29,680 --> 01:06:37,760
advocates um who can help put materials

1556
01:06:33,440 --> 01:06:40,880
into plain language and easy read using

1557
01:06:37,760 --> 01:06:42,640
images. Um you know that's I think

1558
01:06:40,880 --> 01:06:45,520
that's going to help a lot of people

1559
01:06:42,640 --> 01:06:49,680
better understand and prepare for what

1560
01:06:45,520 --> 01:06:52,400
is in that tool. And also I would if

1561
01:06:49,680 --> 01:06:56,640
it's possible maybe a peer-to-peer

1562
01:06:52,400 --> 01:06:58,559
training or if if people are more

1563
01:06:56,640 --> 01:07:01,920
comfortable answering those types of

1564
01:06:58,559 --> 01:07:05,920
very personal questions uh with a peer

1565
01:07:01,920 --> 01:07:08,000
rather than their I mean if there's a a

1566
01:07:05,920 --> 01:07:10,319
poor relationship with the case manager

1567
01:07:08,000 --> 01:07:14,000
or any other team members

1568
01:07:10,319 --> 01:07:15,359
» Then I can see how any any way you

1569
01:07:14,000 --> 01:07:18,160
deploy that

1570
01:07:15,359 --> 01:07:21,680
» Tool is not going to be well received.

1571
01:07:18,160 --> 01:07:23,760
So, if there's a way to have a peer

1572
01:07:21,680 --> 01:07:26,240
relationship that helps somebody prepare

1573
01:07:23,760 --> 01:07:29,440
to answer those regardless of the

1574
01:07:26,240 --> 01:07:32,000
relationship with the case manager, um

1575
01:07:29,440 --> 01:07:34,640
that might be another tool, another

1576
01:07:32,000 --> 01:07:38,480
approach to supporting people.

1577
01:07:34,640 --> 01:07:41,280
» Um I know you probably can't have a peer

1578
01:07:38,480 --> 01:07:42,799
conduct or deploy that instrument with

1579
01:07:41,280 --> 01:07:45,839
that person.

1580
01:07:42,799 --> 01:07:47,920
» It has to be the case manager. Um, but I

1581
01:07:45,839 --> 01:07:49,760
think letting individuals know what

1582
01:07:47,920 --> 01:07:51,920
their rights are if they want a friend

1583
01:07:49,760 --> 01:07:55,200
with them when they're answering. I

1584
01:07:51,920 --> 01:07:56,480
think that's a very reasonable thing to

1585
01:07:55,200 --> 01:08:00,640
communicate to people.

1586
01:07:56,480 --> 01:08:04,160
» And then they can also help communicate

1587
01:08:00,640 --> 01:08:06,559
with seeing how they're doing too, you

1588
01:08:04,160 --> 01:08:08,799
know, like maybe they are struggling.

1589
01:08:06,559 --> 01:08:12,880
And like I struggle every day, but like

1590
01:08:08,799 --> 01:08:14,640
I it's just it's hard to answer those

1591
01:08:12,880 --> 01:08:18,960
questions

1592
01:08:14,640 --> 01:08:21,359
personally when I just answered them

1593
01:08:18,960 --> 01:08:24,000
like truthfully. Like you do have to

1594
01:08:21,359 --> 01:08:26,799
answer them truthfully cuz like if you

1595
01:08:24,000 --> 01:08:29,759
don't then it butts you bites you in the

1596
01:08:26,799 --> 01:08:34,239
ass at the end. But

1597
01:08:29,759 --> 01:08:36,560
I mean I I just it's just whatever. Um

1598
01:08:34,239 --> 01:08:38,560
to your point who spoke whoever spoke

1599
01:08:36,560 --> 01:08:41,759
before Tilly um

1600
01:08:38,560 --> 01:08:43,839
» And now I can't remember oh uh not to

1601
01:08:41,759 --> 01:08:46,560
speak for the whole SAI board but I

1602
01:08:43,839 --> 01:08:49,040
think like the peer-to-peer or creating

1603
01:08:46,560 --> 01:08:53,199
documents in plain language is something

1604
01:08:49,040 --> 01:08:56,880
that um you who um somebody could

1605
01:08:53,199 --> 01:09:01,520
approach self- advocates of Indiana on

1606
01:08:56,880 --> 01:09:05,040
as a board um because you know that's

1607
01:09:01,520 --> 01:09:08,080
something you know We we do and

1608
01:09:05,040 --> 01:09:10,799
typically and we're not to not to brag

1609
01:09:08,080 --> 01:09:12,159
but we're pretty good at it. So we're

1610
01:09:10,799 --> 01:09:15,199
you know not to speak for the whole

1611
01:09:12,159 --> 01:09:17,199
board SAI board but I think typically

1612
01:09:15,199 --> 01:09:19,920
we'd be willing to help with things like

1613
01:09:17,199 --> 01:09:20,960
that to an extent. So

1614
01:09:19,920 --> 01:09:25,120
» Okay go ahead.

1615
01:09:20,960 --> 01:09:28,319
» Thanks. Um I agree the preparation is is

1616
01:09:25,120 --> 01:09:29,679
really huge um because some individuals

1617
01:09:28,319 --> 01:09:32,719
are having assessments for different

1618
01:09:29,679 --> 01:09:34,640
systems. Um, just an example, I we

1619
01:09:32,719 --> 01:09:36,560
getting my son reevaluated at school and

1620
01:09:34,640 --> 01:09:38,159
we were sent I was sent an email from

1621
01:09:36,560 --> 01:09:39,520
the school psychologist who I had never

1622
01:09:38,159 --> 01:09:42,400
talked to and she said, "Please complete

1623
01:09:39,520 --> 01:09:45,359
this eval this evaluation, whatever."

1624
01:09:42,400 --> 01:09:47,120
And it was almost 200 questions that I

1625
01:09:45,359 --> 01:09:49,600
was really emotional answering at the

1626
01:09:47,120 --> 01:09:51,520
end because I was not prepared to answer

1627
01:09:49,600 --> 01:09:53,600
200 questions about his deficits at that

1628
01:09:51,520 --> 01:09:56,159
moment. And so I think the preparation

1629
01:09:53,600 --> 01:09:59,120
is key and I I'm encouraged that case

1630
01:09:56,159 --> 01:10:00,719
managers are being told to do these

1631
01:09:59,120 --> 01:10:02,239
things conversationally because I think

1632
01:10:00,719 --> 01:10:04,080
that's different and having a

1633
01:10:02,239 --> 01:10:06,000
conversation where it is tough to still

1634
01:10:04,080 --> 01:10:06,880
answer those questions but I'm not faced

1635
01:10:06,000 --> 01:10:09,520
with

1636
01:10:06,880 --> 01:10:12,000
» 200 questions of the same thing over and

1637
01:10:09,520 --> 01:10:14,480
over. So I think that that preparation

1638
01:10:12,000 --> 01:10:15,360
will be helpful. And again, and I think

1639
01:10:14,480 --> 01:10:16,719
we've talked about this in other

1640
01:10:15,360 --> 01:10:18,400
meetings for different things, like

1641
01:10:16,719 --> 01:10:19,760
setting the expectation of knowing what

1642
01:10:18,400 --> 01:10:22,480
they're walking into when they're doing

1643
01:10:19,760 --> 01:10:25,120
it because for that school evaluation,

1644
01:10:22,480 --> 01:10:26,560
that wasn't it. Um, and it's different.

1645
01:10:25,120 --> 01:10:28,000
You know, my art case manager has said,

1646
01:10:26,560 --> 01:10:29,600
you know, his evaluation will come up

1647
01:10:28,000 --> 01:10:31,679
next month. You know, we have a little

1648
01:10:29,600 --> 01:10:34,480
preparation. I'm prepared because I'm

1649
01:10:31,679 --> 01:10:36,080
here. Um, but I think in general

1650
01:10:34,480 --> 01:10:39,679
» That those extra steps really make a

1651
01:10:36,080 --> 01:10:43,600
difference. I agree with you because

1652
01:10:39,679 --> 01:10:47,199
like I it's just hard

1653
01:10:43,600 --> 01:10:52,560
to express myself

1654
01:10:47,199 --> 01:10:54,640
to others. But I cuz I'm a little shy or

1655
01:10:52,560 --> 01:10:57,920
you know going through something. But

1656
01:10:54,640 --> 01:11:01,600
like I will say this, Sunday I went to

1657
01:10:57,920 --> 01:11:04,880
church and I loved it because I felt the

1658
01:11:01,600 --> 01:11:09,199
presence of God and Jesus on a certain

1659
01:11:04,880 --> 01:11:14,320
hymn like a song. It's called it is well

1660
01:11:09,199 --> 01:11:18,640
and I felt sad and then joy and it it

1661
01:11:14,320 --> 01:11:21,520
reminds me of like doing self advocates

1662
01:11:18,640 --> 01:11:25,679
to help other individuals express what

1663
01:11:21,520 --> 01:11:30,080
they need. But when I express things,

1664
01:11:25,679 --> 01:11:31,920
sometimes it doesn't go forward and it's

1665
01:11:30,080 --> 01:11:35,280
just frustrating.

1666
01:11:31,920 --> 01:11:37,120
» So I I'd like to add um one thought to

1667
01:11:35,280 --> 01:11:40,880
this and and it kind of goes along with

1668
01:11:37,120 --> 01:11:43,199
what Dr. Nord said about um you know

1669
01:11:40,880 --> 01:11:45,280
having a having a wholesome conversation

1670
01:11:43,199 --> 01:11:47,199
about this. They call me doctor. I

1671
01:11:45,280 --> 01:11:49,040
figured nobody nobody calls me anything

1672
01:11:47,199 --> 01:11:51,440
but you

1673
01:11:49,040 --> 01:11:54,880
» That that was what that was. And I also

1674
01:11:51,440 --> 01:11:55,840
didn't press the mute button. Um,

1675
01:11:54,880 --> 01:11:57,920
» Yes.

1676
01:11:55,840 --> 01:11:59,199
» So, uh,

1677
01:11:57,920 --> 01:12:01,040
you know, the stakes are really high

1678
01:11:59,199 --> 01:12:03,520
when you get into I I mean, I get the

1679
01:12:01,040 --> 01:12:05,600
level of care where you're establishing

1680
01:12:03,520 --> 01:12:08,080
eligibility, but if you we get into

1681
01:12:05,600 --> 01:12:11,360
whatever a new Oasis or a new ALGO or

1682
01:12:08,080 --> 01:12:17,040
what whatever the new iteration of um

1683
01:12:11,360 --> 01:12:18,880
figuring out how this um translates into

1684
01:12:17,040 --> 01:12:20,239
uh you know, support needs and budgets

1685
01:12:18,880 --> 01:12:22,960
and all that kind of thing. the stakes

1686
01:12:20,239 --> 01:12:26,080
are very very high and one concern I

1687
01:12:22,960 --> 01:12:28,800
have is um the the time frame of three

1688
01:12:26,080 --> 01:12:30,640
days which in the inter eye over and

1689
01:12:28,800 --> 01:12:34,400
over and over again it's has this

1690
01:12:30,640 --> 01:12:38,400
occurred in the last three days so

1691
01:12:34,400 --> 01:12:41,120
I you know first of all for a lot of

1692
01:12:38,400 --> 01:12:42,719
things like if you're kind of sad you

1693
01:12:41,120 --> 01:12:44,480
have kind of depression there's a good

1694
01:12:42,719 --> 01:12:46,480
chance that that probably has manifested

1695
01:12:44,480 --> 01:12:50,400
itself in the last three days but there

1696
01:12:46,480 --> 01:12:52,880
are a lot of um highly acute who, you

1697
01:12:50,400 --> 01:12:55,360
know, very problematic behaviors that

1698
01:12:52,880 --> 01:12:56,719
may occur once in a blue moon. I mean,

1699
01:12:55,360 --> 01:12:57,600
some people it's like around Christmas

1700
01:12:56,719 --> 01:12:59,840
and all of a sudden they're

1701
01:12:57,600 --> 01:13:01,840
hospitalized. That person has a little

1702
01:12:59,840 --> 01:13:04,239
bit different support need than somebody

1703
01:13:01,840 --> 01:13:06,000
who absolutely never ever ever is

1704
01:13:04,239 --> 01:13:09,760
hospitalized, right?

1705
01:13:06,000 --> 01:13:13,520
» Um, and the one thing I would I would

1706
01:13:09,760 --> 01:13:15,840
really encourage you to consider is how

1707
01:13:13,520 --> 01:13:16,960
um an appeal can work. And I, you know,

1708
01:13:15,840 --> 01:13:19,199
I'm not talking about every single

1709
01:13:16,960 --> 01:13:21,120
person goes, "Oh, I lost a tiny bit of

1710
01:13:19,199 --> 01:13:23,120
budget and every every everybody's going

1711
01:13:21,120 --> 01:13:24,320
to appeal to get more and more and more,

1712
01:13:23,120 --> 01:13:27,040
but there are going to be some people

1713
01:13:24,320 --> 01:13:30,239
who this upends their budget or this

1714
01:13:27,040 --> 01:13:32,800
upends something in their support in

1715
01:13:30,239 --> 01:13:34,719
their support um the supports they're

1716
01:13:32,800 --> 01:13:37,760
provided." And I I'm just very concerned

1717
01:13:34,719 --> 01:13:40,719
about that three days aspect. Um, you

1718
01:13:37,760 --> 01:13:43,440
know, made positive statements. I mean,

1719
01:13:40,719 --> 01:13:45,840
sometimes I go three days without that.

1720
01:13:43,440 --> 01:13:47,280
You know, I there there are other ones

1721
01:13:45,840 --> 01:13:49,120
where you're talking about more

1722
01:13:47,280 --> 01:13:50,320
explosive behavior and aggression and

1723
01:13:49,120 --> 01:13:52,480
that kind of thing. Even the most

1724
01:13:50,320 --> 01:13:54,800
aggressive person is not aggressive

1725
01:13:52,480 --> 01:13:56,800
every week, you know, and so you might

1726
01:13:54,800 --> 01:13:59,600
have somebody who has physical

1727
01:13:56,800 --> 01:14:01,600
aggression, property destruction, and

1728
01:13:59,600 --> 01:14:03,280
sometimes it's big enough where some,

1729
01:14:01,600 --> 01:14:04,800
you know, law enforcement's involved,

1730
01:14:03,280 --> 01:14:06,880
but that happened last week, so I give

1731
01:14:04,800 --> 01:14:10,080
it a no. And that's going to really

1732
01:14:06,880 --> 01:14:11,679
affect what your supports

1733
01:14:10,080 --> 01:14:13,920
» Assessment is. And so I'm always

1734
01:14:11,679 --> 01:14:16,159
concerned when we kind of give up the

1735
01:14:13,920 --> 01:14:20,159
human aspect to say here it's a

1736
01:14:16,159 --> 01:14:22,320
checklist. And I I encourage you to give

1737
01:14:20,159 --> 01:14:24,880
» Some thought to how that appeal process

1738
01:14:22,320 --> 01:14:26,719
can work, especially in cases where

1739
01:14:24,880 --> 01:14:29,199
everybody knows it's obvious this person

1740
01:14:26,719 --> 01:14:33,280
shouldn't have, you know, dropped half

1741
01:14:29,199 --> 01:14:36,640
his budget because of the inter eye.

1742
01:14:33,280 --> 01:14:39,040
» So no, I I appreciate that um and

1743
01:14:36,640 --> 01:14:40,960
appreciate your comments, Jim. I think

1744
01:14:39,040 --> 01:14:43,920
what I will go back to is these

1745
01:14:40,960 --> 01:14:47,679
assessments are are very comprehensive.

1746
01:14:43,920 --> 01:14:50,159
Um, and yeah, there's there is certain

1747
01:14:47,679 --> 01:14:53,840
look back periods for certain items, but

1748
01:14:50,159 --> 01:14:56,320
that's not every item. And it also asks

1749
01:14:53,840 --> 01:14:58,480
things like how often and not just in

1750
01:14:56,320 --> 01:15:00,719
the last three days. So, without getting

1751
01:14:58,480 --> 01:15:04,400
into too many details, I I hear your

1752
01:15:00,719 --> 01:15:06,719
concern and I appreciate it. Um I think

1753
01:15:04,400 --> 01:15:08,960
um and I alluded to this before, there's

1754
01:15:06,719 --> 01:15:11,440
a reason we have case managers doing

1755
01:15:08,960 --> 01:15:14,159
these, right? Because they know the

1756
01:15:11,440 --> 01:15:15,440
individual. They also and if in the

1757
01:15:14,159 --> 01:15:18,640
event that they don't, let's say it's a

1758
01:15:15,440 --> 01:15:21,840
newer case manager, right? They have

1759
01:15:18,640 --> 01:15:23,360
that individual's file as well, right?

1760
01:15:21,840 --> 01:15:25,520
All their information about their

1761
01:15:23,360 --> 01:15:27,840
progress towards, you know, in various

1762
01:15:25,520 --> 01:15:29,440
services and and all of that

1763
01:15:27,840 --> 01:15:31,199
information.

1764
01:15:29,440 --> 01:15:33,440
um so that when they're doing that

1765
01:15:31,199 --> 01:15:35,679
assessment, if something doesn't quite

1766
01:15:33,440 --> 01:15:37,360
ring true, they can dig in a little

1767
01:15:35,679 --> 01:15:40,400
deeper in that conversation and find

1768
01:15:37,360 --> 01:15:42,000
out. We expect that people would grow in

1769
01:15:40,400 --> 01:15:43,920
their skills as a result of our

1770
01:15:42,000 --> 01:15:45,840
services, right?

1771
01:15:43,920 --> 01:15:48,080
um that growth will look different

1772
01:15:45,840 --> 01:15:49,840
depending on the person in the area, but

1773
01:15:48,080 --> 01:15:51,840
you know, we want to make space for

1774
01:15:49,840 --> 01:15:54,640
people to actually gain skills and to

1775
01:15:51,840 --> 01:15:58,400
recognize that as well as when

1776
01:15:54,640 --> 01:16:02,320
individuals maybe um I'll choose this

1777
01:15:58,400 --> 01:16:05,199
because it's it's me. Um as they age,

1778
01:16:02,320 --> 01:16:08,239
sometimes we lose some skills, right? Or

1779
01:16:05,199 --> 01:16:12,159
or our our strength areas change. So

1780
01:16:08,239 --> 01:16:14,080
these tools are sensitive enough um that

1781
01:16:12,159 --> 01:16:16,480
I think it will or we believe it will

1782
01:16:14,080 --> 01:16:18,239
pick up on all those things. I also want

1783
01:16:16,480 --> 01:16:20,159
to mention because of all the great

1784
01:16:18,239 --> 01:16:23,120
conversation around kind of setting the

1785
01:16:20,159 --> 01:16:25,600
stage and and those conversations to

1786
01:16:23,120 --> 01:16:27,040
help prepare individuals for these

1787
01:16:25,600 --> 01:16:29,520
assessments because they are very

1788
01:16:27,040 --> 01:16:33,040
different um than what we have been

1789
01:16:29,520 --> 01:16:34,640
doing for um a number of years.

1790
01:16:33,040 --> 01:16:36,719
There is we have a learning

1791
01:16:34,640 --> 01:16:39,520
collaborative for those assessors, the

1792
01:16:36,719 --> 01:16:41,199
mentor assessors. Um and all of this

1793
01:16:39,520 --> 01:16:43,520
information we can take back to that

1794
01:16:41,199 --> 01:16:46,239
learning collaborative. Um and talk

1795
01:16:43,520 --> 01:16:48,880
through what you know what what are some

1796
01:16:46,239 --> 01:16:51,440
maybe some individuals are doing that

1797
01:16:48,880 --> 01:16:53,280
preparation a certain way. You know, how

1798
01:16:51,440 --> 01:16:55,360
can we share that information and that

1799
01:16:53,280 --> 01:16:57,280
best practice to better position

1800
01:16:55,360 --> 01:17:01,120
individuals and families to be ready for

1801
01:16:57,280 --> 01:17:03,920
these assessments? So um those your

1802
01:17:01,120 --> 01:17:06,239
comments around um preparation and

1803
01:17:03,920 --> 01:17:08,400
setting that stage is is very much

1804
01:17:06,239 --> 01:17:09,920
appreciated and we will share that.

1805
01:17:08,400 --> 01:17:12,560
» Thank you.

1806
01:17:09,920 --> 01:17:15,600
» I um I I suspect this is maybe your last

1807
01:17:12,560 --> 01:17:18,560
bullet so I'll I'll um I'll just preempt

1808
01:17:15,600 --> 01:17:21,199
it. Um

1809
01:17:18,560 --> 01:17:22,640
I'm only I'm I'm asking these questions

1810
01:17:21,199 --> 01:17:24,000
mostly because I I think there's a

1811
01:17:22,640 --> 01:17:25,760
broader community with these questions.

1812
01:17:24,000 --> 01:17:28,080
I was in a conversation with a family

1813
01:17:25,760 --> 01:17:30,000
member yesterday and kind of three

1814
01:17:28,080 --> 01:17:32,320
things that came up. So, I figure this

1815
01:17:30,000 --> 01:17:33,840
is a great time because I can say it,

1816
01:17:32,320 --> 01:17:36,159
but I think it's more important that

1817
01:17:33,840 --> 01:17:38,719
they hear and and Holly, I think you and

1818
01:17:36,159 --> 01:17:41,360
I have had we we chatted about this last

1819
01:17:38,719 --> 01:17:44,239
week. Um,

1820
01:17:41,360 --> 01:17:46,719
there's a perception or or there's

1821
01:17:44,239 --> 01:17:48,640
there's conversation out there that

1822
01:17:46,719 --> 01:17:51,199
people have lost their waiver through

1823
01:17:48,640 --> 01:17:53,760
because of these assessments. That's the

1824
01:17:51,199 --> 01:17:56,400
first. The second is the denial pending

1825
01:17:53,760 --> 01:17:58,800
language in the review process for those

1826
01:17:56,400 --> 01:18:02,800
that and that language and what does

1827
01:17:58,800 --> 01:18:05,440
that mean? And then um the third is

1828
01:18:02,800 --> 01:18:06,960
appeal process. Those weren't even

1829
01:18:05,440 --> 01:18:09,760
phrases questions, but I'm just going to

1830
01:18:06,960 --> 01:18:12,800
throw those really volatile words out

1831
01:18:09,760 --> 01:18:14,239
and let you manage what comes next.

1832
01:18:12,800 --> 01:18:16,560
» Well, thank you for preempting it

1833
01:18:14,239 --> 01:18:20,960
because that's the perfect segue, Derek.

1834
01:18:16,560 --> 01:18:24,400
Um so yes so we um have been doing these

1835
01:18:20,960 --> 01:18:28,080
assessments now since February. Um very

1836
01:18:24,400 --> 01:18:31,120
few um

1837
01:18:28,080 --> 01:18:34,159
finalized denials have been issued and

1838
01:18:31,120 --> 01:18:38,560
there is a reason for that. Um these are

1839
01:18:34,159 --> 01:18:41,600
new tools as we all know these are um in

1840
01:18:38,560 --> 01:18:43,760
many cases not all because we have been

1841
01:18:41,600 --> 01:18:45,440
using the interrise suite of instruments

1842
01:18:43,760 --> 01:18:48,960
on the nursing facility level of care

1843
01:18:45,440 --> 01:18:53,280
side but for some case managers

1844
01:18:48,960 --> 01:18:54,560
um particularly in the space of uh

1845
01:18:53,280 --> 01:18:56,560
individuals with intellectual and

1846
01:18:54,560 --> 01:19:00,960
developmental disabilities these may be

1847
01:18:56,560 --> 01:19:02,960
completely new tools to them right so um

1848
01:19:00,960 --> 01:19:07,280
as a result of that we've got new tools

1849
01:19:02,960 --> 01:19:11,920
new assessors. We are taking um a lot of

1850
01:19:07,280 --> 01:19:14,400
care in reviewing any assessment that is

1851
01:19:11,920 --> 01:19:17,520
flagged for us to review because that is

1852
01:19:14,400 --> 01:19:19,679
case managers can do that. Um but also

1853
01:19:17,520 --> 01:19:22,800
any assessment that appears to be

1854
01:19:19,679 --> 01:19:24,560
borderline on eligibility, right? And

1855
01:19:22,800 --> 01:19:25,840
when I say we're reviewing it, we're not

1856
01:19:24,560 --> 01:19:28,640
just looking at it and going, "Oh,

1857
01:19:25,840 --> 01:19:31,120
okay." Right? And clicking a button.

1858
01:19:28,640 --> 01:19:33,520
We're looking at it for that individual.

1859
01:19:31,120 --> 01:19:35,360
And does that Is that assessment

1860
01:19:33,520 --> 01:19:37,760
consistent with what we see in the

1861
01:19:35,360 --> 01:19:41,199
individual's records?

1862
01:19:37,760 --> 01:19:43,520
Right? Um as a way to validate on an

1863
01:19:41,199 --> 01:19:45,280
individual level that okay, this

1864
01:19:43,520 --> 01:19:46,960
assessment

1865
01:19:45,280 --> 01:19:49,440
looks to be accurate based on the

1866
01:19:46,960 --> 01:19:52,640
information we have and the the actual

1867
01:19:49,440 --> 01:19:57,440
assessment. So um we are taking all that

1868
01:19:52,640 --> 01:19:59,600
very seriously obviously because um we

1869
01:19:57,440 --> 01:20:01,679
and we've talked about this but we know

1870
01:19:59,600 --> 01:20:04,159
we need to get the right services to the

1871
01:20:01,679 --> 01:20:07,120
right people.

1872
01:20:04,159 --> 01:20:09,360
Um we also know that there are

1873
01:20:07,120 --> 01:20:12,080
individuals in services who are not

1874
01:20:09,360 --> 01:20:13,600
going to continue to meet level of care.

1875
01:20:12,080 --> 01:20:15,920
Um

1876
01:20:13,600 --> 01:20:20,000
and that's hard.

1877
01:20:15,920 --> 01:20:22,960
That's hard for them. Um, it's hard for

1878
01:20:20,000 --> 01:20:25,280
uh the case manager to deliver that.

1879
01:20:22,960 --> 01:20:27,360
It's hard for bead staff, right? It's

1880
01:20:25,280 --> 01:20:29,679
just it's a a space we haven't been in

1881
01:20:27,360 --> 01:20:32,640
in a really really really long time

1882
01:20:29,679 --> 01:20:36,719
approving 99% of people that come in the

1883
01:20:32,640 --> 01:20:38,719
door. So, we are um working with case

1884
01:20:36,719 --> 01:20:41,120
managers

1885
01:20:38,719 --> 01:20:43,199
um about what that looks like, how those

1886
01:20:41,120 --> 01:20:47,199
conversations can be had and should be

1887
01:20:43,199 --> 01:20:50,400
had and how we're connecting people to

1888
01:20:47,199 --> 01:20:54,000
um to other resources. Um but we are

1889
01:20:50,400 --> 01:20:55,600
taking great care in any of those uh

1890
01:20:54,000 --> 01:20:58,800
reviewing any of those assessments that

1891
01:20:55,600 --> 01:21:00,320
appear to be result in denial as we

1892
01:20:58,800 --> 01:21:03,320
should.

1893
01:21:00,320 --> 01:21:03,320
um

1894
01:21:03,520 --> 01:21:09,360
the appeals process. Glad you brought

1895
01:21:05,360 --> 01:21:11,920
that up. Thank you. Um that as with

1896
01:21:09,360 --> 01:21:14,560
anything um any adverse action,

1897
01:21:11,920 --> 01:21:18,400
individuals will get written notice of

1898
01:21:14,560 --> 01:21:21,840
the decision with their appeal rights.

1899
01:21:18,400 --> 01:21:24,560
Um so the due process will is in place

1900
01:21:21,840 --> 01:21:28,560
and will will remain in place through

1901
01:21:24,560 --> 01:21:33,199
through um this entire um process.

1902
01:21:28,560 --> 01:21:35,520
individuals that are um determined not

1903
01:21:33,199 --> 01:21:37,040
to meet level of care, whether that's

1904
01:21:35,520 --> 01:21:40,000
people walking in our doors at the

1905
01:21:37,040 --> 01:21:41,600
district office, so to speak, um you

1906
01:21:40,000 --> 01:21:43,199
know, part of what we do today is

1907
01:21:41,600 --> 01:21:47,120
connecting them with other things,

1908
01:21:43,199 --> 01:21:49,120
right? Um because very few individuals

1909
01:21:47,120 --> 01:21:51,120
walk into a bead's office, apply for

1910
01:21:49,120 --> 01:21:53,440
services, and immediately get services,

1911
01:21:51,120 --> 01:21:56,239
right? That doesn't happen. Um, so we're

1912
01:21:53,440 --> 01:21:58,080
in uh we've been referring folks for

1913
01:21:56,239 --> 01:22:00,000
other and connecting them with other

1914
01:21:58,080 --> 01:22:02,960
resources for some time in that in those

1915
01:22:00,000 --> 01:22:05,280
situations. For individuals in services,

1916
01:22:02,960 --> 01:22:08,080
there will be a transition period if if

1917
01:22:05,280 --> 01:22:10,800
they lose um eligibility or level of

1918
01:22:08,080 --> 01:22:12,400
care. Um, and during that time, the case

1919
01:22:10,800 --> 01:22:15,920
manager will work with the individual

1920
01:22:12,400 --> 01:22:18,000
and the team on a transition plan, what

1921
01:22:15,920 --> 01:22:19,600
that looks like, and what other

1922
01:22:18,000 --> 01:22:22,800
resources that person needs to be

1923
01:22:19,600 --> 01:22:25,600
connected to. Um,

1924
01:22:22,800 --> 01:22:28,800
as an example, if if uh we're talking

1925
01:22:25,600 --> 01:22:31,040
about maybe a 40-year-old individual

1926
01:22:28,800 --> 01:22:34,080
who's been in services,

1927
01:22:31,040 --> 01:22:36,000
um, is working a job,

1928
01:22:34,080 --> 01:22:37,840
um, gets,

1929
01:22:36,000 --> 01:22:39,679
let's just say the person's on the CI

1930
01:22:37,840 --> 01:22:41,360
gets residential HAB, some behavior

1931
01:22:39,679 --> 01:22:47,360
supports,

1932
01:22:41,360 --> 01:22:49,040
um, and, uh, extended services. Um,

1933
01:22:47,360 --> 01:22:50,880
you know, what what's that look like?

1934
01:22:49,040 --> 01:22:53,280
what's that transition plan for that

1935
01:22:50,880 --> 01:22:55,679
individual. It might be, it depends on

1936
01:22:53,280 --> 01:22:57,199
the person certainly, but it might be a

1937
01:22:55,679 --> 01:23:01,120
referral to the Center for Independent

1938
01:22:57,199 --> 01:23:03,120
Living. Um, if they need some just

1939
01:23:01,120 --> 01:23:04,639
connections, right? Or maybe some

1940
01:23:03,120 --> 01:23:06,480
centers for independent living, they all

1941
01:23:04,639 --> 01:23:07,920
do things a little different, right?

1942
01:23:06,480 --> 01:23:12,080
They're all a little different in what

1943
01:23:07,920 --> 01:23:14,239
they offer. Um, it might be rep payee or

1944
01:23:12,080 --> 01:23:15,760
that might be a local bank, right?

1945
01:23:14,239 --> 01:23:20,000
Depending on the community and the

1946
01:23:15,760 --> 01:23:23,120
person. Um it may be um

1947
01:23:20,000 --> 01:23:26,320
uh a referral for or a discussion around

1948
01:23:23,120 --> 01:23:29,360
state plan services. It might be a

1949
01:23:26,320 --> 01:23:33,280
connection with um some sort of support

1950
01:23:29,360 --> 01:23:36,080
group or a CHC perhaps or you know uh

1951
01:23:33,280 --> 01:23:39,199
whatever whatever might support that

1952
01:23:36,080 --> 01:23:42,480
person. Um but we're not here to say

1953
01:23:39,199 --> 01:23:44,800
you're no longer eligible and uh next

1954
01:23:42,480 --> 01:23:46,960
week we're terminating your services.

1955
01:23:44,800 --> 01:23:48,480
Right? services will remain in place

1956
01:23:46,960 --> 01:23:52,400
through the appeal process if people

1957
01:23:48,480 --> 01:23:55,600
appeal. But I will say this and this

1958
01:23:52,400 --> 01:23:58,800
will date me too like 30 years or

1959
01:23:55,600 --> 01:24:01,199
whatever or 20 something years. Um, if a

1960
01:23:58,800 --> 01:24:02,880
person is determined not to meet level

1961
01:24:01,199 --> 01:24:05,280
of care and launches an appeal, that

1962
01:24:02,880 --> 01:24:07,520
team, that case manager needs still to

1963
01:24:05,280 --> 01:24:10,960
be having those very real conversations

1964
01:24:07,520 --> 01:24:14,400
about, you know, if

1965
01:24:10,960 --> 01:24:16,320
this appeal results in a denial of level

1966
01:24:14,400 --> 01:24:17,040
of care. Um,

1967
01:24:16,320 --> 01:24:18,639
» We need to be ready.

1968
01:24:17,040 --> 01:24:20,320
» We need to be planning for that and we

1969
01:24:18,639 --> 01:24:22,800
need to position them to be ready for

1970
01:24:20,320 --> 01:24:24,960
that. If that makes sense.

1971
01:24:22,800 --> 01:24:27,520
» I want to just circle back really

1972
01:24:24,960 --> 01:24:30,639
quickly to

1973
01:24:27,520 --> 01:24:33,280
this conversation around level of care

1974
01:24:30,639 --> 01:24:36,560
with the NRI suite of tools. Obviously,

1975
01:24:33,280 --> 01:24:39,360
I think and maybe this bears reminding I

1976
01:24:36,560 --> 01:24:42,000
think our system is working to or toward

1977
01:24:39,360 --> 01:24:44,000
a place where

1978
01:24:42,000 --> 01:24:46,960
we can

1979
01:24:44,000 --> 01:24:49,280
hopefully have one encounter

1980
01:24:46,960 --> 01:24:51,440
and identify the right waiver for the

1981
01:24:49,280 --> 01:24:53,120
right person at the right time with with

1982
01:24:51,440 --> 01:24:54,800
the array of tools that we are

1983
01:24:53,120 --> 01:24:57,600
operationalizing.

1984
01:24:54,800 --> 01:25:00,239
and also be in a position to have that

1985
01:24:57,600 --> 01:25:02,000
service planning happen essentially

1986
01:25:00,239 --> 01:25:05,199
simultaneously.

1987
01:25:02,000 --> 01:25:07,120
Um, and I know there are some

1988
01:25:05,199 --> 01:25:09,360
concerns around how some of the

1989
01:25:07,120 --> 01:25:12,800
questions are framed and time look back

1990
01:25:09,360 --> 01:25:16,480
periods and

1991
01:25:12,800 --> 01:25:18,880
we have seen some communications around

1992
01:25:16,480 --> 01:25:23,040
people being advised to go into that

1993
01:25:18,880 --> 01:25:25,920
assessment and share their worst day and

1994
01:25:23,040 --> 01:25:29,040
that that be the lens through which they

1995
01:25:25,920 --> 01:25:32,480
answer those assessment questions. Share

1996
01:25:29,040 --> 01:25:34,960
your worst day in the last 30 days and

1997
01:25:32,480 --> 01:25:38,320
the last 60 days, whatever that may be.

1998
01:25:34,960 --> 01:25:45,000
It needs to be your worst day.

1999
01:25:38,320 --> 01:25:45,000
And I would just say we can't do that.

2000
01:25:45,360 --> 01:25:52,400
And I would really I would really

2001
01:25:48,320 --> 01:25:55,360
put forth to this council that if we are

2002
01:25:52,400 --> 01:25:59,120
doing service planning based on

2003
01:25:55,360 --> 01:26:01,920
someone's worst day and we do that for

2004
01:25:59,120 --> 01:26:07,159
50,000 people,

2005
01:26:01,920 --> 01:26:07,159
we are going to be in a very tough spot.

2006
01:26:07,199 --> 01:26:12,560
Service planning conversations can

2007
01:26:09,199 --> 01:26:14,159
happen at any point in time, even after

2008
01:26:12,560 --> 01:26:16,719
their service plan budget has been

2009
01:26:14,159 --> 01:26:18,880
issued. If something changes, that

2010
01:26:16,719 --> 01:26:21,920
service plan should change to reflect

2011
01:26:18,880 --> 01:26:24,719
that. So, I just encourage folks to be

2012
01:26:21,920 --> 01:26:26,639
thinking about we do we do not want to

2013
01:26:24,719 --> 01:26:29,360
move forward

2014
01:26:26,639 --> 01:26:32,080
with a deficit-based mindset about the

2015
01:26:29,360 --> 01:26:34,000
people that we are supporting. We do

2016
01:26:32,080 --> 01:26:36,960
want to move forward with a dynamic

2017
01:26:34,000 --> 01:26:39,040
system that can adjust

2018
01:26:36,960 --> 01:26:42,000
to be respondent to that person's

2019
01:26:39,040 --> 01:26:43,760
changing needs over time.

2020
01:26:42,000 --> 01:26:45,679
» Thanks, Kathy. Yeah, Tom,

2021
01:26:43,760 --> 01:26:48,000
» Just question on the back to the appeal

2022
01:26:45,679 --> 01:26:51,360
question. Um, if someone is appealing

2023
01:26:48,000 --> 01:26:52,960
their denial of eligibility, if the NRI

2024
01:26:51,360 --> 01:26:54,560
suite of tools is utilized for that

2025
01:26:52,960 --> 01:26:56,400
determination, do they get any

2026
01:26:54,560 --> 01:26:59,040
information about their assessment from

2027
01:26:56,400 --> 01:27:01,600
NRI for the purpose of their appeal?

2028
01:26:59,040 --> 01:27:03,360
» Oh, sure. the the actual assessment like

2029
01:27:01,600 --> 01:27:04,800
their their responses and stuff they

2030
01:27:03,360 --> 01:27:08,239
» Utilize. Okay. So they they'll they'll

2031
01:27:04,800 --> 01:27:08,880
receive that for the appeal process. Uh

2032
01:27:08,239 --> 01:27:10,080
if they

2033
01:27:08,880 --> 01:27:14,480
» Receive the reason.

2034
01:27:10,080 --> 01:27:16,320
» Yes, they'll receive the reason. Um

2035
01:27:14,480 --> 01:27:19,679
ask me your question again, Tom, because

2036
01:27:16,320 --> 01:27:22,639
I don't think it's I don't think it's

2037
01:27:19,679 --> 01:27:25,960
» Just what

2038
01:27:22,639 --> 01:27:25,960
» Lawyers arguing.

2039
01:27:26,239 --> 01:27:29,520
» So the the actual assessment is being

2040
01:27:28,159 --> 01:27:31,760
utilized to make a determination for

2041
01:27:29,520 --> 01:27:33,840
eligibility. So that's what is being

2042
01:27:31,760 --> 01:27:36,639
relied upon. So, if someone's going to

2043
01:27:33,840 --> 01:27:38,719
appeal that denial of eligibility, what

2044
01:27:36,639 --> 01:27:40,800
information from that assessment are

2045
01:27:38,719 --> 01:27:42,080
they going to have access to to argue

2046
01:27:40,800 --> 01:27:43,520
their appeal?

2047
01:27:42,080 --> 01:27:46,000
» They will they will have their

2048
01:27:43,520 --> 01:27:47,679
determination letter and they can have a

2049
01:27:46,000 --> 01:27:48,159
copy of their assessment.

2050
01:27:47,679 --> 01:27:48,560
» Okay.

2051
01:27:48,159 --> 01:27:52,040
» Yeah.

2052
01:27:48,560 --> 01:27:52,040
» Okay. Thank you.

2053
01:27:57,440 --> 01:28:01,760
» I I do have one question. This is Kate

2054
01:27:59,679 --> 01:28:05,120
on the example you gave with somebody

2055
01:28:01,760 --> 01:28:06,560
who seems to is on the CI waiver and

2056
01:28:05,120 --> 01:28:09,040
they're getting lots of residential

2057
01:28:06,560 --> 01:28:11,760
support but they're successfully

2058
01:28:09,040 --> 01:28:14,639
employed and have living their good

2059
01:28:11,760 --> 01:28:16,560
life, their vision of a good life. Is

2060
01:28:14,639 --> 01:28:18,560
there a mechanism for you all to

2061
01:28:16,560 --> 01:28:21,040
determine whether or not those supports

2062
01:28:18,560 --> 01:28:24,159
are what is leading to that person's

2063
01:28:21,040 --> 01:28:25,920
success? like maybe they are employed

2064
01:28:24,159 --> 01:28:28,719
because they have the level of care

2065
01:28:25,920 --> 01:28:30,159
support that they that are receiving. Is

2066
01:28:28,719 --> 01:28:33,920
there do you understand what I'm trying

2067
01:28:30,159 --> 01:28:37,199
to ask? And is there I I just worry

2068
01:28:33,920 --> 01:28:41,040
about going from a CIH waiver level of

2069
01:28:37,199 --> 01:28:43,520
care down to community referrals if

2070
01:28:41,040 --> 01:28:46,080
there's a possibility that a family

2071
01:28:43,520 --> 01:28:48,639
support waiver structure with still some

2072
01:28:46,080 --> 01:28:50,480
of those things in place could continue

2073
01:28:48,639 --> 01:28:52,000
to support that person to live

2074
01:28:50,480 --> 01:28:54,639
independently

2075
01:28:52,000 --> 01:28:56,560
with the right level of support uh

2076
01:28:54,639 --> 01:28:59,440
rather than just going down to all

2077
01:28:56,560 --> 01:29:01,600
community based services. So,

2078
01:28:59,440 --> 01:29:03,440
» And that's just based on your example.

2079
01:29:01,600 --> 01:29:06,239
» Yes. No, that's that's a good question.

2080
01:29:03,440 --> 01:29:08,239
I I I do want to clarify that if someone

2081
01:29:06,239 --> 01:29:13,120
doesn't meet level of care, they would

2082
01:29:08,239 --> 01:29:15,920
not have access to CI or family support

2083
01:29:13,120 --> 01:29:18,159
because it's the same eligibility for

2084
01:29:15,920 --> 01:29:21,400
those two waiverss in terms of the level

2085
01:29:18,159 --> 01:29:21,400
of care.

2086
01:29:21,520 --> 01:29:28,800
So, we would again work with what are

2087
01:29:24,800 --> 01:29:31,199
the person's needs today, right? and how

2088
01:29:28,800 --> 01:29:35,199
can we connect them with other resources

2089
01:29:31,199 --> 01:29:38,639
outside of HCBS to address those needs.

2090
01:29:35,199 --> 01:29:41,440
» And I think to your I wanted to clarify

2091
01:29:38,639 --> 01:29:44,719
something you said because you talked

2092
01:29:41,440 --> 01:29:46,719
about CI level people

2093
01:29:44,719 --> 01:29:49,440
and

2094
01:29:46,719 --> 01:29:52,080
the folks on that waiver are a heavy

2095
01:29:49,440 --> 01:29:54,320
mix. There are some people who have some

2096
01:29:52,080 --> 01:29:55,760
truly exceptional needs on that waiver

2097
01:29:54,320 --> 01:29:58,639
and there are individuals who have

2098
01:29:55,760 --> 01:30:00,880
transitioned out of a group home to the

2099
01:29:58,639 --> 01:30:04,320
CI waiver or they've met some other

2100
01:30:00,880 --> 01:30:07,440
priority criteria at some point in time.

2101
01:30:04,320 --> 01:30:09,920
So their budget may not reflect and

2102
01:30:07,440 --> 01:30:12,000
their service need not reflect an

2103
01:30:09,920 --> 01:30:13,360
emergent need at the time that they are

2104
01:30:12,000 --> 01:30:15,120
assessed.

2105
01:30:13,360 --> 01:30:17,199
» So that's a I think just an important

2106
01:30:15,120 --> 01:30:18,719
clarification for people. I think what

2107
01:30:17,199 --> 01:30:22,480
you mean is those folks who are

2108
01:30:18,719 --> 01:30:25,760
currently getting a a a higher level of

2109
01:30:22,480 --> 01:30:27,760
support from our system and then are

2110
01:30:25,760 --> 01:30:30,480
determined at some point to no longer

2111
01:30:27,760 --> 01:30:34,159
meet our level of care. Uh and I do

2112
01:30:30,480 --> 01:30:37,280
think that's where we need um I mean

2113
01:30:34,159 --> 01:30:40,639
truly suggestions, input from this group

2114
01:30:37,280 --> 01:30:43,679
on how best to maybe walk somebody

2115
01:30:40,639 --> 01:30:45,440
through that transition to um kind of

2116
01:30:43,679 --> 01:30:47,520
offboard them off of that waiver.

2117
01:30:45,440 --> 01:30:49,920
because to your point, we wouldn't be

2118
01:30:47,520 --> 01:30:52,800
able to offer them a lesser amount of

2119
01:30:49,920 --> 01:30:54,639
services or an alternate waiver

2120
01:30:52,800 --> 01:30:59,120
because they wouldn't meet that criteria

2121
01:30:54,639 --> 01:31:02,560
either. So, it's really thinking about

2122
01:30:59,120 --> 01:31:04,400
forcing the system to have conversations

2123
01:31:02,560 --> 01:31:07,120
all along someone's journey in the

2124
01:31:04,400 --> 01:31:08,960
system about transitioning down or

2125
01:31:07,120 --> 01:31:11,040
stepping down from services and supports

2126
01:31:08,960 --> 01:31:12,560
when they don't need them. Um,

2127
01:31:11,040 --> 01:31:16,560
obviously, we don't want to create a

2128
01:31:12,560 --> 01:31:18,000
cliff for anyone. Um, but I certainly

2129
01:31:16,560 --> 01:31:20,320
also don't, and I think I've said this

2130
01:31:18,000 --> 01:31:23,920
at other meetings, I don't want people

2131
01:31:20,320 --> 01:31:26,159
to wait until that level of care to to

2132
01:31:23,920 --> 01:31:27,600
figure out that someone's that we kind

2133
01:31:26,159 --> 01:31:29,040
of already know maybe that somebody's

2134
01:31:27,600 --> 01:31:31,520
not going to meet that eligibility

2135
01:31:29,040 --> 01:31:33,199
criteria um before we start talking

2136
01:31:31,520 --> 01:31:34,880
about this isn't going to work and we

2137
01:31:33,199 --> 01:31:37,199
can't continue to offer this this level

2138
01:31:34,880 --> 01:31:39,120
of service. I can't think of an example

2139
01:31:37,199 --> 01:31:43,920
of somebody who would have those higher

2140
01:31:39,120 --> 01:31:46,400
need waiver supports who it may may be

2141
01:31:43,920 --> 01:31:48,400
impacted by that to be honest, but that

2142
01:31:46,400 --> 01:31:51,400
doesn't mean that there there isn't any.

2143
01:31:48,400 --> 01:31:51,400
So,

2144
01:31:51,600 --> 01:31:55,760
» I just want I just want to add I think

2145
01:31:53,280 --> 01:31:57,360
it comes down to the case managers um

2146
01:31:55,760 --> 01:32:00,400
because they're the ones in the homes

2147
01:31:57,360 --> 01:32:02,159
and seeing it. And for the case managers

2148
01:32:00,400 --> 01:32:04,159
to have the best training in

2149
01:32:02,159 --> 01:32:06,800
communication because they're the ones

2150
01:32:04,159 --> 01:32:09,040
that are going to be seeing it coming

2151
01:32:06,800 --> 01:32:11,199
» More than a piece of paper.

2152
01:32:09,040 --> 01:32:12,320
» Yeah, good point. Okay, I'm gonna Lexi,

2153
01:32:11,199 --> 01:32:14,719
I'm going to go to you and then we need

2154
01:32:12,320 --> 01:32:16,239
to keep moving. So, um and then we'll

2155
01:32:14,719 --> 01:32:18,639
take after your question, we'll take a

2156
01:32:16,239 --> 01:32:21,679
break. you know.

2157
01:32:18,639 --> 01:32:23,440
» Okay. Awesome. Thank you. Um I think I

2158
01:32:21,679 --> 01:32:24,880
want to go like I want to go back a

2159
01:32:23,440 --> 01:32:28,000
minute. It's been a minute since it's

2160
01:32:24,880 --> 01:32:32,080
been mentioned, but we talked about um

2161
01:32:28,000 --> 01:32:34,719
Holly talked about uh the good thing is

2162
01:32:32,080 --> 01:32:38,800
like the case managers that are the

2163
01:32:34,719 --> 01:32:40,880
assessors, they know most likely

2164
01:32:38,800 --> 01:32:44,639
um probably more often than not, they

2165
01:32:40,880 --> 01:32:48,239
know the individual being assessed um or

2166
01:32:44,639 --> 01:32:50,000
they know their file. Um, but I think

2167
01:32:48,239 --> 01:32:52,320
kind of the elephant in the room,

2168
01:32:50,000 --> 01:32:57,040
something people are a lot of people are

2169
01:32:52,320 --> 01:32:59,920
concerned about, um, is will there when

2170
01:32:57,040 --> 01:33:03,440
Waverista happens be a transition to

2171
01:32:59,920 --> 01:33:06,400
Maximus because Maximus assesses

2172
01:33:03,440 --> 01:33:08,239
individuals and knows pretty much

2173
01:33:06,400 --> 01:33:11,120
nothing about it. And we're seeing an

2174
01:33:08,239 --> 01:33:14,480
issue with that a lot on um, health and

2175
01:33:11,120 --> 01:33:17,360
wellness, TBI, stuff like that. So I

2176
01:33:14,480 --> 01:33:21,040
think a lot of people receiving ICF ID

2177
01:33:17,360 --> 01:33:23,360
services are very concerned that Maximus

2178
01:33:21,040 --> 01:33:28,800
is also going to be those doing those

2179
01:33:23,360 --> 01:33:30,960
ICC or ICF ID level of care assessments.

2180
01:33:28,800 --> 01:33:35,440
» Yeah, that's a good question, Lexi, but

2181
01:33:30,960 --> 01:33:38,480
currently there are no um no plans to to

2182
01:33:35,440 --> 01:33:42,080
um move those eligibility or level of

2183
01:33:38,480 --> 01:33:43,600
care assessments for ICFD.

2184
01:33:42,080 --> 01:33:45,440
That's good news because I'm one of the

2185
01:33:43,600 --> 01:33:47,840
people that was concerned about it and I

2186
01:33:45,440 --> 01:33:48,560
think a lot of people were. So,

2187
01:33:47,840 --> 01:33:49,679
» All right.

2188
01:33:48,560 --> 01:33:51,520
» Thank you.

2189
01:33:49,679 --> 01:33:55,120
» Thanks, Lexi. Okay, we are going to take

2190
01:33:51,520 --> 01:33:57,440
a This is exactly on time. It's crazy.

2191
01:33:55,120 --> 01:33:59,040
Okay. Um

2192
01:33:57,440 --> 01:34:01,199
uh 10:05. We're going to take a

2193
01:33:59,040 --> 01:34:03,360
10-minute break. So, we will be back at

2194
01:34:01,199 --> 01:34:05,440
10:15.

2195
01:34:03,360 --> 01:34:07,600
» That's okay.

2196
01:34:05,440 --> 01:34:09,600
» 11:15. Okay.

2197
01:34:07,600 --> 01:34:10,800
» Question. Hold on one second to just

2198
01:34:09,600 --> 01:34:14,159
because it's loud.

2199
01:34:10,800 --> 01:34:14,560
» Gota get people. Okay, go ahead.

2200
01:34:14,159 --> 01:34:15,840
» Sorry.

2201
01:34:14,560 --> 01:34:20,159
» Just start talking.

2202
01:34:15,840 --> 01:34:21,520
» So, I have a question. So, like,

2203
01:34:20,159 --> 01:34:24,000
» Hey guys, we're gonna go ahead and get

2204
01:34:21,520 --> 01:34:26,320
started just so we can get through it.

2205
01:34:24,000 --> 01:34:26,880
I'm not holding you guys. Um, okay. Go

2206
01:34:26,320 --> 01:34:29,920
ahead.

2207
01:34:26,880 --> 01:34:31,679
» I have a question. So, like say,

2208
01:34:29,920 --> 01:34:33,360
» Is this related? Sorry. Just I just want

2209
01:34:31,679 --> 01:34:35,440
to make sure is same same. Okay. I just

2210
01:34:33,360 --> 01:34:38,480
want to make sure in case it was Okay.

2211
01:34:35,440 --> 01:34:40,639
» No, you're fine. Go. know how people get

2212
01:34:38,480 --> 01:34:42,000
money for assistance

2213
01:34:40,639 --> 01:34:43,440
for their bills.

2214
01:34:42,000 --> 01:34:45,520
» They get what? I'm sorry.

2215
01:34:43,440 --> 01:34:46,639
» Money assistance for their bills.

2216
01:34:45,520 --> 01:34:49,040
» Yeah.

2217
01:34:46,639 --> 01:34:51,600
» Let's just say,

2218
01:34:49,040 --> 01:34:54,960
well, for me, I was trying to get for

2219
01:34:51,600 --> 01:34:59,760
the energy assistance and I got denied.

2220
01:34:54,960 --> 01:35:03,199
But what's frustrating on that is I have

2221
01:34:59,760 --> 01:35:06,000
a lot of bills, but I don't I don't know

2222
01:35:03,199 --> 01:35:08,480
how to put it any of them. Oh, I think

2223
01:35:06,000 --> 01:35:10,239
just she was mentioning that it can be

2224
01:35:08,480 --> 01:35:13,040
for people that were referring to that

2225
01:35:10,239 --> 01:35:15,360
as a as a support. It is not consistent

2226
01:35:13,040 --> 01:35:16,239
and who gets approved for that kind of

2227
01:35:15,360 --> 01:35:19,120
support.

2228
01:35:16,239 --> 01:35:20,320
» So, just more of a I think FYI for

2229
01:35:19,120 --> 01:35:20,880
» Okay, thanks.

2230
01:35:20,320 --> 01:35:23,840
» Thank you.

2231
01:35:20,880 --> 01:35:28,520
» Okay. Thanks. Okay, we're going to move

2232
01:35:23,840 --> 01:35:28,520
on here. Let me get my

2233
01:35:29,360 --> 01:35:34,239
get here. Okay, so we're going to move

2234
01:35:31,360 --> 01:35:37,120
on to uh waiver amendments. Moving on

2235
01:35:34,239 --> 01:35:39,440
with Holly.

2236
01:35:37,120 --> 01:35:42,159
» Me again. All right.

2237
01:35:39,440 --> 01:35:45,920
» Right. Um, good thing I got a strong

2238
01:35:42,159 --> 01:35:48,639
voice here. Um, so just a reminder that

2239
01:35:45,920 --> 01:35:50,480
we do have waiver amendments for all of

2240
01:35:48,639 --> 01:35:53,120
the beads administered waiverss as well

2241
01:35:50,480 --> 01:35:56,000
as and that's not on here, but the the

2242
01:35:53,120 --> 01:35:58,800
pathways for aging waiverss um are at

2243
01:35:56,000 --> 01:36:01,520
CMS with a planned effective date of

2244
01:35:58,800 --> 01:36:03,679
August 1st. That includes, of course,

2245
01:36:01,520 --> 01:36:07,199
the the case management that we've been

2246
01:36:03,679 --> 01:36:09,040
talking about um as well as some other

2247
01:36:07,199 --> 01:36:12,800
um

2248
01:36:09,040 --> 01:36:16,800
components that we've discussed uh uh in

2249
01:36:12,800 --> 01:36:18,800
previous meetings. Um but those are at

2250
01:36:16,800 --> 01:36:21,840
CMS under review and we anticipate

2251
01:36:18,800 --> 01:36:23,920
having those back um in July. I can't

2252
01:36:21,840 --> 01:36:26,159
give a date because I'm not sure when

2253
01:36:23,920 --> 01:36:29,360
that will be, but we expect them um to

2254
01:36:26,159 --> 01:36:32,480
come in in July. So just wanted to

2255
01:36:29,360 --> 01:36:34,880
provide that update

2256
01:36:32,480 --> 01:36:37,920
and then wanted to talk um some more

2257
01:36:34,880 --> 01:36:41,520
about waiver reset just to ensure that

2258
01:36:37,920 --> 01:36:43,120
we um that we are providing information

2259
01:36:41,520 --> 01:36:44,880
to you all so that you all can kind of

2260
01:36:43,120 --> 01:36:47,520
track what's happening with regard to

2261
01:36:44,880 --> 01:36:50,800
waiver reset and that we continue to

2262
01:36:47,520 --> 01:36:55,920
focus on um the goals and understanding

2263
01:36:50,800 --> 01:36:57,840
the why behind um the reset. So,

2264
01:36:55,920 --> 01:36:59,760
um, and you've seen this slide before,

2265
01:36:57,840 --> 01:37:02,560
you're probably going to be tired of it,

2266
01:36:59,760 --> 01:37:05,600
so I'll apologize in advance, but, um,

2267
01:37:02,560 --> 01:37:07,679
the goals of the waiver reset, um, have

2268
01:37:05,600 --> 01:37:10,800
been steady throughout this process. And

2269
01:37:07,679 --> 01:37:13,040
one is simplifying the system. Um, it's

2270
01:37:10,800 --> 01:37:16,159
not news to anyone that the system can

2271
01:37:13,040 --> 01:37:18,960
be difficult to navigate and confusing

2272
01:37:16,159 --> 01:37:20,800
um, for individuals and families. So,

2273
01:37:18,960 --> 01:37:23,520
um, we know that as part of waiver

2274
01:37:20,800 --> 01:37:25,920
reset, we want to make our system more

2275
01:37:23,520 --> 01:37:27,760
understandable. Um, we already talked

2276
01:37:25,920 --> 01:37:30,719
about reducing the number of assessments

2277
01:37:27,760 --> 01:37:33,360
that individuals have to go through. Um,

2278
01:37:30,719 --> 01:37:35,600
and then also updating the services that

2279
01:37:33,360 --> 01:37:38,639
are offered again based on feedback

2280
01:37:35,600 --> 01:37:40,560
we've received um, from those that we

2281
01:37:38,639 --> 01:37:42,400
support

2282
01:37:40,560 --> 01:37:46,080
and those individuals that we will

2283
01:37:42,400 --> 01:37:49,920
likely one day support. um we know that

2284
01:37:46,080 --> 01:37:52,400
our services um need to be updated um

2285
01:37:49,920 --> 01:37:54,480
and we need to to reexamine kind of what

2286
01:37:52,400 --> 01:37:55,920
we offer and how that's how those

2287
01:37:54,480 --> 01:37:57,520
services are delivered in some

2288
01:37:55,920 --> 01:37:59,600
situations.

2289
01:37:57,520 --> 01:38:01,440
We also know we need to improve support

2290
01:37:59,600 --> 01:38:03,199
coordination. I think we've heard a lot

2291
01:38:01,440 --> 01:38:05,600
about that this morning when we were

2292
01:38:03,199 --> 01:38:07,920
talking about the assessments and those

2293
01:38:05,600 --> 01:38:11,840
conversations that are taking place or

2294
01:38:07,920 --> 01:38:15,679
should be taking place. Um, we know that

2295
01:38:11,840 --> 01:38:18,560
uh in in the coordination of of services

2296
01:38:15,679 --> 01:38:21,119
and supports that those case managers

2297
01:38:18,560 --> 01:38:23,600
need to know what's out there and

2298
01:38:21,119 --> 01:38:27,119
available and they need to um be able to

2299
01:38:23,600 --> 01:38:29,440
connect individuals um with other

2300
01:38:27,119 --> 01:38:32,159
services, paid and unpaid, and actually

2301
01:38:29,440 --> 01:38:33,920
help them maximize um all of those

2302
01:38:32,159 --> 01:38:37,040
resources they may have available to

2303
01:38:33,920 --> 01:38:39,600
them. That's not new. Um we've been

2304
01:38:37,040 --> 01:38:42,320
talking about that for years. Um and

2305
01:38:39,600 --> 01:38:46,239
that is unrelated to an individual's

2306
01:38:42,320 --> 01:38:48,400
eligibility status, right? Um it really

2307
01:38:46,239 --> 01:38:50,320
um all of our services should be focused

2308
01:38:48,400 --> 01:38:53,360
on connecting people so that they're

2309
01:38:50,320 --> 01:38:55,840
more included in their communities,

2310
01:38:53,360 --> 01:38:58,159
whatever that looks like for them. um

2311
01:38:55,840 --> 01:39:01,119
enhancing quality outcomes. You know,

2312
01:38:58,159 --> 01:39:04,960
how can we um as part of waiver reset

2313
01:39:01,119 --> 01:39:06,480
offer quality services and then support

2314
01:39:04,960 --> 01:39:08,320
providers

2315
01:39:06,480 --> 01:39:10,159
um

2316
01:39:08,320 --> 01:39:13,679
in ways that they can provide those

2317
01:39:10,159 --> 01:39:18,159
services. Um and you know, I think the

2318
01:39:13,679 --> 01:39:21,280
the quality uh piece is part of that

2319
01:39:18,159 --> 01:39:23,760
valuebased purchasing or paying for

2320
01:39:21,280 --> 01:39:26,239
outcomes, whatever whatever terminology

2321
01:39:23,760 --> 01:39:29,600
we want to use. It really is how do we

2322
01:39:26,239 --> 01:39:32,480
support those providers of services

2323
01:39:29,600 --> 01:39:34,639
um to aggressively work with individuals

2324
01:39:32,480 --> 01:39:40,480
and families to to help them reach the

2325
01:39:34,639 --> 01:39:41,199
outcomes um they need from our services.

2326
01:39:40,480 --> 01:39:44,159
» Polly,

2327
01:39:41,199 --> 01:39:46,800
» Yes. Um I I know that the the whole idea

2328
01:39:44,159 --> 01:39:48,480
of um paying for quality and the value

2329
01:39:46,800 --> 01:39:50,080
based payments and all that that's a

2330
01:39:48,480 --> 01:39:51,840
that's something that we're all getting

2331
01:39:50,080 --> 01:39:53,199
kind of used to that terminology and

2332
01:39:51,840 --> 01:39:55,440
feeling like that's some that's a

2333
01:39:53,199 --> 01:39:57,760
direction that we're heading in. Right.

2334
01:39:55,440 --> 01:40:00,560
» Um can you give any salient examples

2335
01:39:57,760 --> 01:40:03,920
from other states that you've learned or

2336
01:40:00,560 --> 01:40:06,320
just that that beads that DAR is

2337
01:40:03,920 --> 01:40:08,159
thinking of in what what direction are

2338
01:40:06,320 --> 01:40:10,159
we going with this? I mean if you look

2339
01:40:08,159 --> 01:40:11,760
at the value based pay payments that

2340
01:40:10,159 --> 01:40:13,199
were in that one slide for case

2341
01:40:11,760 --> 01:40:17,280
management I think we already discussed

2342
01:40:13,199 --> 01:40:21,440
that being primary primarily compliance

2343
01:40:17,280 --> 01:40:23,440
what might be a good quality metric that

2344
01:40:21,440 --> 01:40:25,520
you would pay for or what are you guys

2345
01:40:23,440 --> 01:40:27,119
thinking? Well, I think, you know,

2346
01:40:25,520 --> 01:40:28,960
that's a great question, Jim, and I

2347
01:40:27,119 --> 01:40:30,560
don't have any um other states in my

2348
01:40:28,960 --> 01:40:32,480
back pocket that I would speak to just

2349
01:40:30,560 --> 01:40:34,800
because I don't think I could

2350
01:40:32,480 --> 01:40:37,360
necessarily adequately represent another

2351
01:40:34,800 --> 01:40:39,760
state without, you know, making sure um

2352
01:40:37,360 --> 01:40:42,480
and reviewing it recently. But we have

2353
01:40:39,760 --> 01:40:44,800
and we'll continue to look at um what's

2354
01:40:42,480 --> 01:40:47,920
happening in other states around this

2355
01:40:44,800 --> 01:40:50,320
valuebased purchasing um

2356
01:40:47,920 --> 01:40:54,320
so that that can inform any decisions we

2357
01:40:50,320 --> 01:40:56,400
make. Um, I think one of the things that

2358
01:40:54,320 --> 01:40:58,639
is important,

2359
01:40:56,400 --> 01:41:02,080
um, from my perspective when we're

2360
01:40:58,639 --> 01:41:05,040
thinking about paying for outcomes is,

2361
01:41:02,080 --> 01:41:06,719
you know, not just saying, okay, we're

2362
01:41:05,040 --> 01:41:08,560
going to pay for this, but we really do

2363
01:41:06,719 --> 01:41:10,159
have to build to it. And I think Derek

2364
01:41:08,560 --> 01:41:12,080
kind of alluded to this. We kind of

2365
01:41:10,159 --> 01:41:14,560
start with

2366
01:41:12,080 --> 01:41:17,679
gathering that data, looking at those

2367
01:41:14,560 --> 01:41:20,159
compliance matters, getting that nailed

2368
01:41:17,679 --> 01:41:22,800
down and in place and then build from

2369
01:41:20,159 --> 01:41:25,360
there. Um, but I think the outcomes

2370
01:41:22,800 --> 01:41:27,679
would differ depending on the service,

2371
01:41:25,360 --> 01:41:30,239
right? I mean we have music therapy,

2372
01:41:27,679 --> 01:41:32,639
recreck therapy that are therapeutic

2373
01:41:30,239 --> 01:41:35,280
services and then we have things like

2374
01:41:32,639 --> 01:41:37,679
today and this is we're talking waiver

2375
01:41:35,280 --> 01:41:39,920
reset so things will look differently

2376
01:41:37,679 --> 01:41:42,080
but then we're thinking about like

2377
01:41:39,920 --> 01:41:44,400
participant assistance and care or pack

2378
01:41:42,080 --> 01:41:47,920
in attendant care those outcomes would

2379
01:41:44,400 --> 01:41:49,520
look very different right and and so I

2380
01:41:47,920 --> 01:41:52,639
think it would depend on the service but

2381
01:41:49,520 --> 01:41:54,480
certainly we can take that back um and

2382
01:41:52,639 --> 01:41:57,600
um perhaps carve out some time in a

2383
01:41:54,480 --> 01:42:00,639
future meeting about how we might

2384
01:41:57,600 --> 01:42:03,360
consider uh valuebased payment for some

2385
01:42:00,639 --> 01:42:05,280
of the services. So I think that's a

2386
01:42:03,360 --> 01:42:06,960
great question

2387
01:42:05,280 --> 01:42:08,719
» And and I appreciate your answer because

2388
01:42:06,960 --> 01:42:11,119
that that's a basically I think that's

2389
01:42:08,719 --> 01:42:13,760
sort of the stepping stones that you you

2390
01:42:11,119 --> 01:42:17,040
need to get to to get to where we are. I

2391
01:42:13,760 --> 01:42:19,199
got to say that when when um in your

2392
01:42:17,040 --> 01:42:20,800
comment about like wreck therapy and

2393
01:42:19,199 --> 01:42:22,719
music therapy, those are therapeutic

2394
01:42:20,800 --> 01:42:26,000
surf ser services and they're going to

2395
01:42:22,719 --> 01:42:27,679
look different than pack. I mean, I can

2396
01:42:26,000 --> 01:42:29,840
see from a compliance standpoint where

2397
01:42:27,679 --> 01:42:33,119
there are some similarities, but like on

2398
01:42:29,840 --> 01:42:35,040
quality, I I guess maybe I'm just like

2399
01:42:33,119 --> 01:42:37,440
lacking imagination because it's really

2400
01:42:35,040 --> 01:42:39,360
hard for me to come up with specifics

2401
01:42:37,440 --> 01:42:40,880
that I'm thinking, oh, okay, here's

2402
01:42:39,360 --> 01:42:43,920
something that would be a quality metric

2403
01:42:40,880 --> 01:42:47,199
that the state would pay for in lie of

2404
01:42:43,920 --> 01:42:49,280
um unit space system and the quantity.

2405
01:42:47,199 --> 01:42:50,960
you know,

2406
01:42:49,280 --> 01:42:53,199
simply saying we're going to move away

2407
01:42:50,960 --> 01:42:55,840
from units and we're going to move away

2408
01:42:53,199 --> 01:42:58,480
from quantity and we're going to move to

2409
01:42:55,840 --> 01:43:01,679
quality. I don't think anybody would

2410
01:42:58,480 --> 01:43:04,159
disagree with that as a as a goal. The

2411
01:43:01,679 --> 01:43:06,080
devil's in the details though and and it

2412
01:43:04,159 --> 01:43:08,400
seems difficult if you're designing a

2413
01:43:06,080 --> 01:43:11,199
new system and then the payment

2414
01:43:08,400 --> 01:43:13,679
structure is based on this thing that we

2415
01:43:11,199 --> 01:43:17,199
are even having a hard time discussing

2416
01:43:13,679 --> 01:43:18,719
or or putting a putting our finger on

2417
01:43:17,199 --> 01:43:20,400
that gives me a little bit of

2418
01:43:18,719 --> 01:43:22,159
trepidation going into the future of

2419
01:43:20,400 --> 01:43:25,679
like well what is this going to look

2420
01:43:22,159 --> 01:43:28,639
like? Um, so I and I think I'll probably

2421
01:43:25,679 --> 01:43:30,960
I'll try to hone my imagination skills

2422
01:43:28,639 --> 01:43:33,040
in the future to be able to come up with

2423
01:43:30,960 --> 01:43:35,920
something because I you know it's it's

2424
01:43:33,040 --> 01:43:38,159
really difficult to really you know it's

2425
01:43:35,920 --> 01:43:39,679
everybody knows quality when you see it.

2426
01:43:38,159 --> 01:43:41,440
How do you measure it and how do you put

2427
01:43:39,679 --> 01:43:43,760
that forward into something that then

2428
01:43:41,440 --> 01:43:46,719
becomes a billable service?

2429
01:43:43,760 --> 01:43:49,520
» Yep. No, I think we're I I agree with

2430
01:43:46,719 --> 01:43:53,280
you and we are always open to feedback

2431
01:43:49,520 --> 01:43:56,719
if you uh do come up with suggestions um

2432
01:43:53,280 --> 01:44:00,480
for um value based payment or paying for

2433
01:43:56,719 --> 01:44:04,080
outcomes. But um I'll just speak to I

2434
01:44:00,480 --> 01:44:06,880
think um

2435
01:44:04,080 --> 01:44:09,199
we've talked ad nauseium with this group

2436
01:44:06,880 --> 01:44:11,440
about employment.

2437
01:44:09,199 --> 01:44:13,920
I think we've emphasized at the advisory

2438
01:44:11,440 --> 01:44:16,800
council quite a bit outcomes around

2439
01:44:13,920 --> 01:44:19,440
employment that will be an area of focus

2440
01:44:16,800 --> 01:44:21,840
more than likely

2441
01:44:19,440 --> 01:44:24,639
» The degree to which the services being

2442
01:44:21,840 --> 01:44:27,119
provided are leading to toward someone's

2443
01:44:24,639 --> 01:44:29,280
employment outcomes

2444
01:44:27,119 --> 01:44:32,159
will be looked at and evaluated as far

2445
01:44:29,280 --> 01:44:35,119
as how can we incentivize

2446
01:44:32,159 --> 01:44:36,880
services that that get someone

2447
01:44:35,119 --> 01:44:38,719
successfully toward an employment

2448
01:44:36,880 --> 01:44:40,000
outcome or the outcome that they are

2449
01:44:38,719 --> 01:44:42,880
working toward.

2450
01:44:40,000 --> 01:44:45,520
» Um, and that could be something that's

2451
01:44:42,880 --> 01:44:47,840
not employment, but in that same kind of

2452
01:44:45,520 --> 01:44:50,320
realm, I think I'm that one's coming to

2453
01:44:47,840 --> 01:44:52,320
mind again because we've talked about it

2454
01:44:50,320 --> 01:44:54,880
so heavily at the with this group, but

2455
01:44:52,320 --> 01:44:57,600
also because

2456
01:44:54,880 --> 01:44:59,920
the origin of us talking about it at

2457
01:44:57,600 --> 01:45:01,840
this group have been self- advocates

2458
01:44:59,920 --> 01:45:04,880
saying we want competitive integrated

2459
01:45:01,840 --> 01:45:07,040
employment. Um and so I think at least

2460
01:45:04,880 --> 01:45:09,280
from my perspective

2461
01:45:07,040 --> 01:45:12,239
and this is where you all you know are

2462
01:45:09,280 --> 01:45:14,159
welcome to bring forth successful ideas

2463
01:45:12,239 --> 01:45:16,560
or innovative ideas from other states

2464
01:45:14,159 --> 01:45:18,960
where who have implemented a valuebased

2465
01:45:16,560 --> 01:45:22,080
payment model around employment supports

2466
01:45:18,960 --> 01:45:24,880
or employment outcomes that

2467
01:45:22,080 --> 01:45:27,520
either for a particular service or for a

2468
01:45:24,880 --> 01:45:29,440
team um to to share in a valuebased

2469
01:45:27,520 --> 01:45:31,199
payment because they were collectively

2470
01:45:29,440 --> 01:45:33,760
able to work together to get somebody

2471
01:45:31,199 --> 01:45:36,960
that outcome. Um those are that's a just

2472
01:45:33,760 --> 01:45:38,960
a high very high level example and to

2473
01:45:36,960 --> 01:45:41,760
your point Jim the devil's always in the

2474
01:45:38,960 --> 01:45:45,119
details about how you execute that but

2475
01:45:41,760 --> 01:45:47,760
that's probably where the most attention

2476
01:45:45,119 --> 01:45:50,400
or emphasis has been internally for our

2477
01:45:47,760 --> 01:45:53,199
team um because of just some of the work

2478
01:45:50,400 --> 01:45:55,920
that has been occurring um with the

2479
01:45:53,199 --> 01:45:59,679
innovation pilot projects and some of

2480
01:45:55,920 --> 01:46:02,239
the um other uh APA related um

2481
01:45:59,679 --> 01:46:03,600
initiatives that we undertook um a

2482
01:46:02,239 --> 01:46:04,800
couple years ago.

2483
01:46:03,600 --> 01:46:07,440
» Yeah, I was going to I was going to say

2484
01:46:04,800 --> 01:46:09,040
that Kathy, I think that um and Melissa

2485
01:46:07,440 --> 01:46:11,119
has a lot of experience in this too, I

2486
01:46:09,040 --> 01:46:13,760
think, with employment, but right, if if

2487
01:46:11,119 --> 01:46:15,440
there is an employment goal and again it

2488
01:46:13,760 --> 01:46:17,119
can't just be does a person want a job

2489
01:46:15,440 --> 01:46:18,719
or not, you had the conversation, you

2490
01:46:17,119 --> 01:46:21,440
get paid, right? That's not going to

2491
01:46:18,719 --> 01:46:23,040
fly, right? So, if if if you've

2492
01:46:21,440 --> 01:46:26,639
discussed employment and it's an

2493
01:46:23,040 --> 01:46:28,800
obstacle, what have what are you doing

2494
01:46:26,639 --> 01:46:30,719
to either address that obstacle, right?

2495
01:46:28,800 --> 01:46:32,560
And so I think that for employment, it's

2496
01:46:30,719 --> 01:46:34,320
not just is there an employment goal,

2497
01:46:32,560 --> 01:46:37,760
you get money, right? You've you've

2498
01:46:34,320 --> 01:46:38,880
reached the outcome because that's not

2499
01:46:37,760 --> 01:46:40,639
what's going to happen. Someone's going

2500
01:46:38,880 --> 01:46:42,800
to write an employment goal so they can

2501
01:46:40,639 --> 01:46:43,840
get that extra $20. Let's a lot of times

2502
01:46:42,800 --> 01:46:46,080
unfortunately that's what's going to

2503
01:46:43,840 --> 01:46:49,440
happen, right? So how do we build it so

2504
01:46:46,080 --> 01:46:52,320
that it's actually um there's things in

2505
01:46:49,440 --> 01:46:54,000
place that's uh

2506
01:46:52,320 --> 01:46:56,560
you know incentivizing more than just

2507
01:46:54,000 --> 01:46:59,760
maybe checking the boxes sometimes. So,

2508
01:46:56,560 --> 01:47:01,119
um, but employment's like Kathy I was

2509
01:46:59,760 --> 01:47:03,119
going to say is what's coming to mind

2510
01:47:01,119 --> 01:47:04,639
because I think there's I don't know all

2511
01:47:03,119 --> 01:47:06,639
the research on valuebased, but I think

2512
01:47:04,639 --> 01:47:09,520
that's probably the Melissa could jump

2513
01:47:06,639 --> 01:47:11,360
in. Probably the most

2514
01:47:09,520 --> 01:47:12,960
probably the mo most used right now or

2515
01:47:11,360 --> 01:47:14,480
at least being explored at least

2516
01:47:12,960 --> 01:47:17,440
nationally, I would think. Do you think

2517
01:47:14,480 --> 01:47:19,040
that's accurate? Maybe. Maybe not. I

2518
01:47:17,440 --> 01:47:20,159
don't know. Am I putting you on the

2519
01:47:19,040 --> 01:47:22,159
spot? I don't know.

2520
01:47:20,159 --> 01:47:22,719
» No, that's fine. Am I

2521
01:47:22,159 --> 01:47:23,840
» I don't know if

2522
01:47:22,719 --> 01:47:26,400
» Yeah, you're okay. Just don't hit the

2523
01:47:23,840 --> 01:47:28,000
button like Derek. Don't mess up

2524
01:47:26,400 --> 01:47:31,000
everything like Derek did.

2525
01:47:28,000 --> 01:47:31,000
» All right.

2526
01:47:32,159 --> 01:47:36,000
» Yeah.

2527
01:47:33,199 --> 01:47:38,400
» So, you know, when you think about

2528
01:47:36,000 --> 01:47:41,840
values-based outcomes,

2529
01:47:38,400 --> 01:47:43,600
there's almost two different types of of

2530
01:47:41,840 --> 01:47:45,840
outcomes based things. There's there's

2531
01:47:43,600 --> 01:47:48,080
services that are meant to teach a skill

2532
01:47:45,840 --> 01:47:50,800
and services that are meant to help a

2533
01:47:48,080 --> 01:47:54,719
person achieve a an independence goal or

2534
01:47:50,800 --> 01:47:56,639
an ability to um increase their their uh

2535
01:47:54,719 --> 01:47:58,480
proficiency at doing something. And so

2536
01:47:56,639 --> 01:48:00,480
the outcome for that might be the

2537
01:47:58,480 --> 01:48:02,480
attainment or progression towards that

2538
01:48:00,480 --> 01:48:05,280
goal. But then there's other services

2539
01:48:02,480 --> 01:48:06,800
that are more uh filling a need that the

2540
01:48:05,280 --> 01:48:09,520
person may not be able to meet

2541
01:48:06,800 --> 01:48:12,000
themselves. transportation,

2542
01:48:09,520 --> 01:48:14,400
um, feeding,

2543
01:48:12,000 --> 01:48:18,560
um,

2544
01:48:14,400 --> 01:48:20,960
whatever ADLs, whatever that is. And so

2545
01:48:18,560 --> 01:48:23,119
the outcome measures for those types of

2546
01:48:20,960 --> 01:48:27,600
services might look a lot different

2547
01:48:23,119 --> 01:48:30,159
because those um are more based on the

2548
01:48:27,600 --> 01:48:32,239
quality of the service provided, the the

2549
01:48:30,159 --> 01:48:34,639
deliverability of it. So for example, if

2550
01:48:32,239 --> 01:48:37,600
it's transportation, is was the person

2551
01:48:34,639 --> 01:48:41,040
on time? Did they, you know, get picked

2552
01:48:37,600 --> 01:48:42,880
up within a reasonable um, you know,

2553
01:48:41,040 --> 01:48:44,400
distance from where they were were

2554
01:48:42,880 --> 01:48:45,920
going? And I'm just using transportation

2555
01:48:44,400 --> 01:48:49,280
because that's kind of a very concrete

2556
01:48:45,920 --> 01:48:52,159
one, but versus something like an

2557
01:48:49,280 --> 01:48:53,600
employment or um like a behavior goal

2558
01:48:52,159 --> 01:48:56,159
where it's like we're going to reduce

2559
01:48:53,600 --> 01:48:58,480
the number of self-injurious incidents

2560
01:48:56,159 --> 01:49:00,880
or reduce the number of aggressions. you

2561
01:48:58,480 --> 01:49:04,400
can objectively measure are we working

2562
01:49:00,880 --> 01:49:08,480
towards that goal versus you know um

2563
01:49:04,400 --> 01:49:10,800
we've got a a tedicare or or pack or

2564
01:49:08,480 --> 01:49:15,040
something that is you know helping the

2565
01:49:10,800 --> 01:49:17,360
person um feed themselves the person may

2566
01:49:15,040 --> 01:49:19,040
never be able to feed themselves due to

2567
01:49:17,360 --> 01:49:21,360
their disability but we can still

2568
01:49:19,040 --> 01:49:24,239
determine quality metrics

2569
01:49:21,360 --> 01:49:25,920
» From that based on um just looking at it

2570
01:49:24,239 --> 01:49:27,440
but I agree there's not going to be a

2571
01:49:25,920 --> 01:49:28,960
reversal

2572
01:49:27,440 --> 01:49:30,239
» Quality metric.

2573
01:49:28,960 --> 01:49:31,760
» So, so I'm not going to try to get

2574
01:49:30,239 --> 01:49:33,440
totally down the rabbit. Sorry, sorry,

2575
01:49:31,760 --> 01:49:35,920
K. This is just to follow up on kind of

2576
01:49:33,440 --> 01:49:40,480
what I was already saying. So, not to

2577
01:49:35,920 --> 01:49:42,880
just go totally rabbit hole on this, but

2578
01:49:40,480 --> 01:49:44,880
um like I bill for my agency and it

2579
01:49:42,880 --> 01:49:47,440
there's a certain way that you bill. You

2580
01:49:44,880 --> 01:49:49,360
go into the ICP portal and then you like

2581
01:49:47,440 --> 01:49:51,360
put in people's names and all this stuff

2582
01:49:49,360 --> 01:49:53,119
and their their Medicaid number and then

2583
01:49:51,360 --> 01:49:54,400
you get down to like what's the service

2584
01:49:53,119 --> 01:49:56,239
you're providing and what are the number

2585
01:49:54,400 --> 01:49:58,239
of units.

2586
01:49:56,239 --> 01:50:02,080
It's hard for me while I'm sitting at my

2587
01:49:58,239 --> 01:50:04,560
computer doing this to think, okay, for

2588
01:50:02,080 --> 01:50:09,040
this particular

2589
01:50:04,560 --> 01:50:11,679
uh this particular um BC visiting this

2590
01:50:09,040 --> 01:50:13,920
person, they took the this uh this guy

2591
01:50:11,679 --> 01:50:15,920
to Goodwill and that part of it was they

2592
01:50:13,920 --> 01:50:18,960
went and talked to somebody about it and

2593
01:50:15,920 --> 01:50:21,040
person's got a VR referral. They're they

2594
01:50:18,960 --> 01:50:22,800
they they don't have a job coach yet. So

2595
01:50:21,040 --> 01:50:24,480
the BC is kind of doing a little bit of

2596
01:50:22,800 --> 01:50:26,639
exploration which you know a couple

2597
01:50:24,480 --> 01:50:29,760
years ago you all added to be behavior

2598
01:50:26,639 --> 01:50:32,159
support as a as an appropriate um way

2599
01:50:29,760 --> 01:50:34,239
for BC to interact with an individual.

2600
01:50:32,159 --> 01:50:37,040
How do I bill for that? I mean do I look

2601
01:50:34,239 --> 01:50:39,280
into an individual service note and say

2602
01:50:37,040 --> 01:50:42,560
oh on this particular occasion they were

2603
01:50:39,280 --> 01:50:45,280
doing something that was relevant to to

2604
01:50:42,560 --> 01:50:46,719
um employment. They did a little bit of

2605
01:50:45,280 --> 01:50:49,119
exploration. They talked about it. Maybe

2606
01:50:46,719 --> 01:50:51,280
they talked to an employee. I don't know

2607
01:50:49,119 --> 01:50:52,400
how to I mean I agree that that's

2608
01:50:51,280 --> 01:50:54,560
quality

2609
01:50:52,400 --> 01:50:56,800
» But compared to being able to say and

2610
01:50:54,560 --> 01:50:59,040
they spent an hour and a half doing it

2611
01:50:56,800 --> 01:51:00,560
and so that's six units you know and I'm

2612
01:50:59,040 --> 01:51:02,239
not saying

2613
01:51:00,560 --> 01:51:07,280
» You know we have to keep unit I just

2614
01:51:02,239 --> 01:51:07,520
can't and again it may be my deficit in

2615
01:51:07,280 --> 01:51:08,960
um

2616
01:51:07,520 --> 01:51:10,960
» Well I think you're looking you're

2617
01:51:08,960 --> 01:51:15,840
looking maybe for the

2618
01:51:10,960 --> 01:51:18,239
» The howto way before process defined

2619
01:51:15,840 --> 01:51:19,840
» I think it is hard to envision because

2620
01:51:18,239 --> 01:51:21,840
that's that's kind of the struggle we

2621
01:51:19,840 --> 01:51:24,480
have is we can't envision it. Yeah.

2622
01:51:21,840 --> 01:51:26,960
» Um at the same time I will say and and

2623
01:51:24,480 --> 01:51:30,560
and because we haven't done it

2624
01:51:26,960 --> 01:51:32,719
» Ever, right? Um and right but I do think

2625
01:51:30,560 --> 01:51:34,159
here and here's the opportunity is and I

2626
01:51:32,719 --> 01:51:37,440
think employment's a really good example

2627
01:51:34,159 --> 01:51:40,560
is whatever that quality outcome is

2628
01:51:37,440 --> 01:51:43,040
isn't necessarily I would argue it's not

2629
01:51:40,560 --> 01:51:45,599
about what I as the provider did every

2630
01:51:43,040 --> 01:51:47,440
every minute of the day because every

2631
01:51:45,599 --> 01:51:49,520
minute of the day might be I had to work

2632
01:51:47,440 --> 01:51:51,679
I had to help the the employer

2633
01:51:49,520 --> 01:51:54,639
understand what their responsibility was

2634
01:51:51,679 --> 01:51:57,040
and I I had to provide support to the

2635
01:51:54,639 --> 01:51:59,119
individual. It's a big kind of holistic

2636
01:51:57,040 --> 01:52:02,080
that isn't just about me as the employ

2637
01:51:59,119 --> 01:52:04,239
as the provider that in other words the

2638
01:52:02,080 --> 01:52:06,880
outcome isn't just because of me and

2639
01:52:04,239 --> 01:52:09,679
what I did. The outcome is this whole

2640
01:52:06,880 --> 01:52:11,760
ecology or ecosystem around a person and

2641
01:52:09,679 --> 01:52:13,760
and how we set up the supports that

2642
01:52:11,760 --> 01:52:15,520
isn't just about what we deliver to them

2643
01:52:13,760 --> 01:52:17,119
but about what the community also

2644
01:52:15,520 --> 01:52:18,639
delivers. And I think I think that's a

2645
01:52:17,119 --> 01:52:20,480
really important and powerful

2646
01:52:18,639 --> 01:52:22,400
opportunity because at the end of the

2647
01:52:20,480 --> 01:52:24,960
day a quality employment outcome in the

2648
01:52:22,400 --> 01:52:27,280
community isn't I and having worked as

2649
01:52:24,960 --> 01:52:28,639
an vocational service provider it's not

2650
01:52:27,280 --> 01:52:30,719
because of me

2651
01:52:28,639 --> 01:52:32,639
» It's because the individual and those

2652
01:52:30,719 --> 01:52:35,119
around and yes of course we are

2653
01:52:32,639 --> 01:52:37,760
facilitators of that and those supports

2654
01:52:35,119 --> 01:52:40,320
but if if the outcome is is only because

2655
01:52:37,760 --> 01:52:42,800
of me and that's a failure I think and I

2656
01:52:40,320 --> 01:52:45,199
think so I just say I I really commend

2657
01:52:42,800 --> 01:52:47,040
it. Is that complex? Abs. Absolutely.

2658
01:52:45,199 --> 01:52:48,800
That's complex

2659
01:52:47,040 --> 01:52:51,199
and there's not going to be a metric in

2660
01:52:48,800 --> 01:52:53,119
the very traditional and how do I bill

2661
01:52:51,199 --> 01:52:55,760
for that? And I I do think that's an

2662
01:52:53,119 --> 01:52:58,239
important thing because it gets me away

2663
01:52:55,760 --> 01:52:59,840
from being the responsible party for

2664
01:52:58,239 --> 01:53:01,760
every outcome in this person's life and

2665
01:52:59,840 --> 01:53:03,520
realize that my my responsibility is

2666
01:53:01,760 --> 01:53:05,119
much bigger. That's hard to do. That's

2667
01:53:03,520 --> 01:53:06,400
going to be some big changes. I commend

2668
01:53:05,119 --> 01:53:08,000
it. It's going to be hard.

2669
01:53:06,400 --> 01:53:10,159
» It's be hard for us to struggle with

2670
01:53:08,000 --> 01:53:12,320
because we've got a long legacy. And I

2671
01:53:10,159 --> 01:53:14,800
mean that not as a not as a critique.

2672
01:53:12,320 --> 01:53:15,599
It's not a critique. This is I think

2673
01:53:14,800 --> 01:53:20,280
it's pretty

2674
01:53:15,599 --> 01:53:20,280
» Just to talk about employment. Sorry.

2675
01:53:20,480 --> 01:53:22,960
» Sorry, Katie. Do you want to go before

2676
01:53:22,320 --> 01:53:24,000
me?

2677
01:53:22,960 --> 01:53:26,560
» Yeah.

2678
01:53:24,000 --> 01:53:30,000
» Okay. Um, just to talk about employment,

2679
01:53:26,560 --> 01:53:34,239
like I just recently got a job, but it's

2680
01:53:30,000 --> 01:53:38,080
through the company I'm with, the LEAL

2681
01:53:34,239 --> 01:53:41,119
Foundation. I love it because they

2682
01:53:38,080 --> 01:53:44,880
look towards

2683
01:53:41,119 --> 01:53:48,480
people and other people with or without

2684
01:53:44,880 --> 01:53:51,679
intellectual disabilities. So that's my

2685
01:53:48,480 --> 01:53:54,880
main thing. Like most of the jobs that I

2686
01:53:51,679 --> 01:53:58,080
applied to didn't hire me because I put

2687
01:53:54,880 --> 01:54:00,000
I have an a disability. And I think

2688
01:53:58,080 --> 01:54:02,480
that's criticism.

2689
01:54:00,000 --> 01:54:05,119
I think it's discrimination.

2690
01:54:02,480 --> 01:54:09,280
It's not fair to us that we want to work

2691
01:54:05,119 --> 01:54:11,520
at Kroger, Walmart, Target, wherever.

2692
01:54:09,280 --> 01:54:14,000
They don't want to hire people with

2693
01:54:11,520 --> 01:54:18,080
disabilities anymore. It's frustrating.

2694
01:54:14,000 --> 01:54:21,119
So, I just went with the job that I feel

2695
01:54:18,080 --> 01:54:23,280
like that I love now. It's called

2696
01:54:21,119 --> 01:54:26,080
Feeling Fine. It's off of Massav. that's

2697
01:54:23,280 --> 01:54:29,360
pretty close to here. But,

2698
01:54:26,080 --> 01:54:33,199
um, it's a cute boutique and I just love

2699
01:54:29,360 --> 01:54:36,800
working there. And I feel like as if I

2700
01:54:33,199 --> 01:54:40,320
if I had a mental breakdown here in a

2701
01:54:36,800 --> 01:54:43,199
week or so, just for example, and I was

2702
01:54:40,320 --> 01:54:45,360
working at a different job that they

2703
01:54:43,199 --> 01:54:47,520
didn't understand, they would have fired

2704
01:54:45,360 --> 01:54:49,679
me on the spot.

2705
01:54:47,520 --> 01:54:51,520
Let's just let's just put it that point

2706
01:54:49,679 --> 01:54:53,440
in perspective because that's what

2707
01:54:51,520 --> 01:54:56,080
people do.

2708
01:54:53,440 --> 01:54:58,639
they don't care about our mental health.

2709
01:54:56,080 --> 01:55:00,800
» So, I think uh this is Kate for those of

2710
01:54:58,639 --> 01:55:03,920
you who are online, just so we can have

2711
01:55:00,800 --> 01:55:05,520
that for the transcript, too. Um I

2712
01:55:03,920 --> 01:55:07,760
really appreciate you sharing that

2713
01:55:05,520 --> 01:55:10,719
because I think when from the council's

2714
01:55:07,760 --> 01:55:13,040
perspective, we hear very often that

2715
01:55:10,719 --> 01:55:16,560
mental health and support for people

2716
01:55:13,040 --> 01:55:18,560
with ID who are also experiencing mental

2717
01:55:16,560 --> 01:55:21,360
health challenges is really important.

2718
01:55:18,560 --> 01:55:24,000
And it's not just, you know, getting

2719
01:55:21,360 --> 01:55:27,119
mental health services like therapy.

2720
01:55:24,000 --> 01:55:30,639
It's also having access to the words to

2721
01:55:27,119 --> 01:55:33,119
be able to describe how you're feeling

2722
01:55:30,639 --> 01:55:35,599
and share that experience so you can get

2723
01:55:33,119 --> 01:55:38,239
the help that you need. That's really

2724
01:55:35,599 --> 01:55:40,719
important. And it sounds to me like

2725
01:55:38,239 --> 01:55:45,119
there also is a need on the employment

2726
01:55:40,719 --> 01:55:48,880
side to do more training for um hiring

2727
01:55:45,119 --> 01:55:50,800
managers and in the community about like

2728
01:55:48,880 --> 01:55:53,280
you said you love your job and you work

2729
01:55:50,800 --> 01:55:55,760
at a boutique and I I would love to

2730
01:55:53,280 --> 01:55:58,560
visit your boutique because that sounds

2731
01:55:55,760 --> 01:56:01,520
amazing but I also saw your face light

2732
01:55:58,560 --> 01:56:04,960
up when you were talking about how much

2733
01:56:01,520 --> 01:56:08,159
you love your job and happiness. It's

2734
01:56:04,960 --> 01:56:11,199
not a goal that we work into care plans.

2735
01:56:08,159 --> 01:56:14,800
But ultimately, life is about being

2736
01:56:11,199 --> 01:56:16,960
happy. And you can't do that if the

2737
01:56:14,800 --> 01:56:19,119
things around you are not supporting you

2738
01:56:16,960 --> 01:56:19,920
to be happy and what you want for

2739
01:56:19,119 --> 01:56:22,560
yourself.

2740
01:56:19,920 --> 01:56:25,599
» Right? So, when I was doing job

2741
01:56:22,560 --> 01:56:27,599
applications with my job coach and I

2742
01:56:25,599 --> 01:56:29,119
wouldn't receive anything back, I'm

2743
01:56:27,599 --> 01:56:31,920
like,

2744
01:56:29,119 --> 01:56:36,560
"These jobs don't want to hire people."

2745
01:56:31,920 --> 01:56:39,760
» So, the L Yeah. And the LEO Foundation,

2746
01:56:36,560 --> 01:56:42,320
Home Services Foundation, is the company

2747
01:56:39,760 --> 01:56:46,880
I'm with. And Darlene, she's back there

2748
01:56:42,320 --> 01:56:50,239
beautiful and everything. But she she

2749
01:56:46,880 --> 01:56:53,760
going she put it out there that like,

2750
01:56:50,239 --> 01:56:54,880
"Hey, we have this new boutique opening.

2751
01:56:53,760 --> 01:56:56,400
Would you like to work there?" I was

2752
01:56:54,880 --> 01:56:59,199
like, "Yeah."

2753
01:56:56,400 --> 01:57:03,520
But it took quite a while for me to get

2754
01:56:59,199 --> 01:57:06,320
the job, but I was still patient.

2755
01:57:03,520 --> 01:57:09,760
So I I wanted to just comment on some of

2756
01:57:06,320 --> 01:57:11,040
the valuebased services. It's because it

2757
01:57:09,760 --> 01:57:12,880
sounds like there's two com

2758
01:57:11,040 --> 01:57:14,960
conversations here. What are the value

2759
01:57:12,880 --> 01:57:17,199
based services that you're looking to

2760
01:57:14,960 --> 01:57:20,960
integrate into waiver redesign or waiver

2761
01:57:17,199 --> 01:57:23,360
reset? Sorry, wrong word. Um and how

2762
01:57:20,960 --> 01:57:25,199
will you measure it is those are the two

2763
01:57:23,360 --> 01:57:26,960
things and I know some of those

2764
01:57:25,199 --> 01:57:30,320
measurement pieces come out of national

2765
01:57:26,960 --> 01:57:33,360
core indicators. Um, when we look at

2766
01:57:30,320 --> 01:57:35,840
that data, I always wonder if there's a

2767
01:57:33,360 --> 01:57:38,560
way to increase the response rate to

2768
01:57:35,840 --> 01:57:41,280
that those number of people that are on

2769
01:57:38,560 --> 01:57:43,040
those waiverss versus how many people

2770
01:57:41,280 --> 01:57:46,159
actually respond to national core

2771
01:57:43,040 --> 01:57:48,960
indicators seems relatively low. Um,

2772
01:57:46,159 --> 01:57:51,440
that might be one thing to consider in

2773
01:57:48,960 --> 01:57:56,800
is how do you increase that? Um, the

2774
01:57:51,440 --> 01:57:59,679
other thing uh I would look at is um

2775
01:57:56,800 --> 01:58:02,800
self- advocacy as a service, a value

2776
01:57:59,679 --> 01:58:05,199
added service. Um, the ver there's a few

2777
01:58:02,800 --> 01:58:08,560
states that have self- advocacy

2778
01:58:05,199 --> 01:58:10,639
integrated into their waiver system. Um,

2779
01:58:08,560 --> 01:58:13,119
I don't know how well that works or what

2780
01:58:10,639 --> 01:58:15,199
that entails, but I know that it's on

2781
01:58:13,119 --> 01:58:17,199
it's a service provision. That might be

2782
01:58:15,199 --> 01:58:20,320
something when we're talking about

2783
01:58:17,199 --> 01:58:22,800
self-determination and HCBS helping

2784
01:58:20,320 --> 01:58:25,199
people live in the community.

2785
01:58:22,800 --> 01:58:28,560
Something like self- advocacy

2786
01:58:25,199 --> 01:58:32,000
to build those skill sets uh for better

2787
01:58:28,560 --> 01:58:35,920
community living would be a value added.

2788
01:58:32,000 --> 01:58:39,239
» Thank you. I think Katie had No. Okay.

2789
01:58:35,920 --> 01:58:39,239
Oh, okay.

2790
01:58:39,679 --> 01:58:44,320
» Okay.

2791
01:58:41,920 --> 01:58:47,440
» Yeah. All right. Um, thank you guys for

2792
01:58:44,320 --> 01:58:50,719
the good conversation. Um,

2793
01:58:47,440 --> 01:58:53,040
so you're fine. It's good conversation.

2794
01:58:50,719 --> 01:58:54,320
Um, so lastly, oh, you switched.

2795
01:58:53,040 --> 01:58:57,840
» Were you ready? I'm sorry.

2796
01:58:54,320 --> 01:58:59,679
» That's okay. I think, um, yeah, just the

2797
01:58:57,840 --> 01:59:01,520
last goal of course is implementing the

2798
01:58:59,679 --> 01:59:04,320
sustainable service delivery system and

2799
01:59:01,520 --> 01:59:06,880
we have talked about that as well. So,

2800
01:59:04,320 --> 01:59:08,560
let's go ahead. Um,

2801
01:59:06,880 --> 01:59:10,239
I don't know what the music is. Sounds

2802
01:59:08,560 --> 01:59:15,199
like the ice cream truck. If anyone

2803
01:59:10,239 --> 01:59:16,960
remembers any pizza, too. I did too.

2804
01:59:15,199 --> 01:59:21,639
» Actually, I can't wait.

2805
01:59:16,960 --> 01:59:21,639
» I want the Superman ice cream, please.

2806
01:59:22,960 --> 01:59:28,400
» Um, so um, as we think about a

2807
01:59:26,400 --> 01:59:30,480
sustainable framework, I want to just

2808
01:59:28,400 --> 01:59:33,119
quickly go through those three levers

2809
01:59:30,480 --> 01:59:36,239
we've talked about before. Um, one is

2810
01:59:33,119 --> 01:59:40,400
the support needs tiers. That is again

2811
01:59:36,239 --> 01:59:45,040
where individuals um those interi

2812
01:59:40,400 --> 01:59:47,040
assessments, right? Those will inform

2813
01:59:45,040 --> 01:59:49,199
support level tiers that are in

2814
01:59:47,040 --> 01:59:52,080
development. Okay, those aren't done

2815
01:59:49,199 --> 01:59:53,599
yet. We are gathering all that data um

2816
01:59:52,080 --> 01:59:55,520
from the assessments that have been

2817
01:59:53,599 --> 01:59:57,440
completed.

2818
01:59:55,520 --> 02:00:00,000
Um somebody does have an ice cream truck

2819
01:59:57,440 --> 02:00:02,320
somewhere in this building. Um and then

2820
02:00:00,000 --> 02:00:04,320
we'll be looking at developing or are

2821
02:00:02,320 --> 02:00:08,560
developing support level tiers. those

2822
02:00:04,320 --> 02:00:11,280
those tiers will be individuals who have

2823
02:00:08,560 --> 02:00:13,920
similar needs will be grouped

2824
02:00:11,280 --> 02:00:15,679
um together, right? And according to

2825
02:00:13,920 --> 02:00:17,760
their need and that's what we're

2826
02:00:15,679 --> 02:00:21,040
referring to when we talk about support

2827
02:00:17,760 --> 02:00:22,800
levels or support need tiers. That's

2828
02:00:21,040 --> 02:00:25,840
what we're talking about. That's in

2829
02:00:22,800 --> 02:00:27,599
development from that. Once we have

2830
02:00:25,840 --> 02:00:29,840
those developed, there will be a model

2831
02:00:27,599 --> 02:00:32,480
service mix. And I know we we've talked

2832
02:00:29,840 --> 02:00:35,280
about this before or a model service or

2833
02:00:32,480 --> 02:00:38,960
a combination of services that one would

2834
02:00:35,280 --> 02:00:42,880
typically expect an individual with that

2835
02:00:38,960 --> 02:00:45,520
need level to utilize.

2836
02:00:42,880 --> 02:00:46,880
It's not telling people what services

2837
02:00:45,520 --> 02:00:49,119
they should get and saying here you're

2838
02:00:46,880 --> 02:00:50,560
in this support level. This these are

2839
02:00:49,119 --> 02:00:52,320
the services you get and this is how

2840
02:00:50,560 --> 02:00:54,800
much. That's not the intent. is just to

2841
02:00:52,320 --> 02:00:57,360
give some kind of some parameters for

2842
02:00:54,800 --> 02:00:59,520
teams so they can think about you know

2843
02:00:57,360 --> 02:01:03,679
what that might what a service mix might

2844
02:00:59,520 --> 02:01:06,719
look like um with the individual.

2845
02:01:03,679 --> 02:01:10,400
Then there's support budget tiers and

2846
02:01:06,719 --> 02:01:13,840
those budget tiers will be um determined

2847
02:01:10,400 --> 02:01:16,400
based on available resources the

2848
02:01:13,840 --> 02:01:19,520
Medicaid appropriation right and they

2849
02:01:16,400 --> 02:01:21,840
will be connected if you will to these

2850
02:01:19,520 --> 02:01:24,960
are the support level support need

2851
02:01:21,840 --> 02:01:27,440
levels these are the budget levels and

2852
02:01:24,960 --> 02:01:29,360
there'll be a relationship there but

2853
02:01:27,440 --> 02:01:30,800
they are two separate things I do want

2854
02:01:29,360 --> 02:01:34,000
to stress they are two separate

2855
02:01:30,800 --> 02:01:37,280
» Does that the Medicaid

2856
02:01:34,000 --> 02:01:40,159
Does that mean like a Medicaid um

2857
02:01:37,280 --> 02:01:42,880
redetermination or what

2858
02:01:40,159 --> 02:01:44,239
» To the amount of funds you know to

2859
02:01:42,880 --> 02:01:46,159
believe how we've kind of talked about

2860
02:01:44,239 --> 02:01:47,199
pie that we have of funding that's what

2861
02:01:46,159 --> 02:01:50,320
I'm talking about okay

2862
02:01:47,199 --> 02:01:53,280
» Is that overall kind of pie of funding

2863
02:01:50,320 --> 02:01:56,320
that gets divided with support level

2864
02:01:53,280 --> 02:01:58,639
framework more equitably across the

2865
02:01:56,320 --> 02:02:01,520
individuals and services

2866
02:01:58,639 --> 02:02:03,280
» So my question is is like do they do

2867
02:02:01,520 --> 02:02:04,400
Medicaid determination

2868
02:02:03,280 --> 02:02:06,960
do or no?

2869
02:02:04,400 --> 02:02:08,800
» No, that is that will remain with the

2870
02:02:06,960 --> 02:02:09,199
division of family resources as it is

2871
02:02:08,800 --> 02:02:10,719
now.

2872
02:02:09,199 --> 02:02:12,880
» Okay, that was my question.

2873
02:02:10,719 --> 02:02:14,880
» No, that's a good question. Um, and I

2874
02:02:12,880 --> 02:02:17,920
think the other piece is when we think

2875
02:02:14,880 --> 02:02:19,679
about the budget tiers, we're also

2876
02:02:17,920 --> 02:02:21,679
looking at some things other than the

2877
02:02:19,679 --> 02:02:25,199
assessment that would include living

2878
02:02:21,679 --> 02:02:28,800
arrangement and age and even what are

2879
02:02:25,199 --> 02:02:31,760
those other long-term ser LTSS or

2880
02:02:28,800 --> 02:02:34,560
long-term services and supports um,

2881
02:02:31,760 --> 02:02:36,400
expenses or costs for that individual?

2882
02:02:34,560 --> 02:02:39,040
what are they receiving not just in

2883
02:02:36,400 --> 02:02:40,639
waiver or what are their needs not just

2884
02:02:39,040 --> 02:02:43,119
from a waiver perspective but more

2885
02:02:40,639 --> 02:02:45,679
holistically what are an individual's

2886
02:02:43,119 --> 02:02:48,800
needs and then what are those resources

2887
02:02:45,679 --> 02:02:51,520
that are being used or needed across

2888
02:02:48,800 --> 02:02:53,280
waiver and state plan to address those

2889
02:02:51,520 --> 02:02:55,040
needs

2890
02:02:53,280 --> 02:02:58,400
um and then of course the sustainable

2891
02:02:55,040 --> 02:03:00,239
framework number and type of waivers um

2892
02:02:58,400 --> 02:03:03,040
simplification of the service array and

2893
02:03:00,239 --> 02:03:04,480
and the budget tiers and then the slots

2894
02:03:03,040 --> 02:03:08,960
assigned per waiver

2895
02:03:04,480 --> 02:03:10,960
once we have um the waivers designed or

2896
02:03:08,960 --> 02:03:13,520
or the number of waiverss determined.

2897
02:03:10,960 --> 02:03:15,199
Next slide,

2898
02:03:13,520 --> 02:03:16,719
» Please.

2899
02:03:15,199 --> 02:03:17,679
» Speaking of mental health, maybe we need

2900
02:03:16,719 --> 02:03:20,159
to go over there.

2901
02:03:17,679 --> 02:03:23,520
» Yeah, maybe.

2902
02:03:20,159 --> 02:03:26,400
» Um so, I did want to um just also kind

2903
02:03:23,520 --> 02:03:29,119
of put in one list, if you will, those

2904
02:03:26,400 --> 02:03:31,520
things that we're doing um related to

2905
02:03:29,119 --> 02:03:35,440
waiver reset. Um, we could call them

2906
02:03:31,520 --> 02:03:37,920
phases. Um, but waiver reset is big as

2907
02:03:35,440 --> 02:03:40,560
you guys know. Um, and everything that

2908
02:03:37,920 --> 02:03:44,080
we're doing is working towards

2909
02:03:40,560 --> 02:03:46,239
that final full waiver reset, right? So,

2910
02:03:44,080 --> 02:03:49,040
we've done stakeholder engagement. We we

2911
02:03:46,239 --> 02:03:51,119
will continue to do that. Um, we have

2912
02:03:49,040 --> 02:03:55,440
the support budget community advisory

2913
02:03:51,119 --> 02:03:58,639
board. I didn't name it. um the SB CAB

2914
02:03:55,440 --> 02:04:01,199
um that is meeting monthly um around

2915
02:03:58,639 --> 02:04:03,119
waiver reset. We have the intri

2916
02:04:01,199 --> 02:04:06,560
implementation which you can see how

2917
02:04:03,119 --> 02:04:10,000
that um utilizing those tools across all

2918
02:04:06,560 --> 02:04:12,880
the beads waiverss supports

2919
02:04:10,000 --> 02:04:16,320
that future look at support levels and

2920
02:04:12,880 --> 02:04:17,840
and developing those support levels.

2921
02:04:16,320 --> 02:04:20,560
We have the case management, the

2922
02:04:17,840 --> 02:04:24,320
selective contracting. Um we know with

2923
02:04:20,560 --> 02:04:28,880
waiver reset um however that ends up

2924
02:04:24,320 --> 02:04:30,719
looking right um in 2028, we need case

2925
02:04:28,880 --> 02:04:32,239
managers in place that are well trained

2926
02:04:30,719 --> 02:04:34,880
and well informed so that they can

2927
02:04:32,239 --> 02:04:37,440
adequately support individuals and

2928
02:04:34,880 --> 02:04:39,760
families through those changes.

2929
02:04:37,440 --> 02:04:43,199
Um and then the transition planning of

2930
02:04:39,760 --> 02:04:46,080
course um for individuals on waiverss

2931
02:04:43,199 --> 02:04:48,000
today um that will transition at the

2932
02:04:46,080 --> 02:04:50,400
time of waiver reset. We can't start

2933
02:04:48,000 --> 02:04:53,360
that too soon. And then of course we

2934
02:04:50,400 --> 02:04:57,840
have talked um I believe last month

2935
02:04:53,360 --> 02:05:01,520
about um our pursuit for a youth waiver.

2936
02:04:57,840 --> 02:05:05,280
Um we have heard um for uh quite some

2937
02:05:01,520 --> 02:05:08,159
time that there is a desire um for a

2938
02:05:05,280 --> 02:05:10,880
youth waiver. ch needs of children are

2939
02:05:08,159 --> 02:05:14,880
significantly different than those of

2940
02:05:10,880 --> 02:05:18,400
adults. Um so we are um looking at

2941
02:05:14,880 --> 02:05:21,119
pursuing a youth waiver um likely in

2942
02:05:18,400 --> 02:05:25,440
advance a little bit in advance of the

2943
02:05:21,119 --> 02:05:27,520
full waiver reset. So um I know that's a

2944
02:05:25,440 --> 02:05:29,280
lot. If we have questions we can

2945
02:05:27,520 --> 02:05:30,800
certainly talk through those. But this

2946
02:05:29,280 --> 02:05:32,800
surprise this will not be the last time

2947
02:05:30,800 --> 02:05:34,480
you hear about waiver reset. We'll

2948
02:05:32,800 --> 02:05:37,520
continue to have those conversations.

2949
02:05:34,480 --> 02:05:40,400
So, next slide.

2950
02:05:37,520 --> 02:05:42,239
Um, I won't go through this slide. You

2951
02:05:40,400 --> 02:05:43,840
all have seen it before. It just

2952
02:05:42,239 --> 02:05:47,360
provides a little more information on

2953
02:05:43,840 --> 02:05:50,480
the support budgets. Um,

2954
02:05:47,360 --> 02:05:53,360
but just wanted to call that out. Also

2955
02:05:50,480 --> 02:05:55,599
wanted to include the slide. Yes, that

2956
02:05:53,360 --> 02:05:58,639
talks about why we're pursuing support

2957
02:05:55,599 --> 02:06:02,400
budgets. Again, I think you know um I

2958
02:05:58,639 --> 02:06:04,639
will I will confess um I am steeped

2959
02:06:02,400 --> 02:06:07,760
enough in waiver reset that that I have

2960
02:06:04,639 --> 02:06:11,119
to remind myself to talk about the why,

2961
02:06:07,760 --> 02:06:14,800
right? Why are we doing this? Um why are

2962
02:06:11,119 --> 02:06:17,760
we pursuing um waiver reset and why are

2963
02:06:14,800 --> 02:06:20,239
we pursuing this different model of of

2964
02:06:17,760 --> 02:06:23,440
support level needs or support needs

2965
02:06:20,239 --> 02:06:26,719
levels and support budgets?

2966
02:06:23,440 --> 02:06:30,400
Um, at the end of the day, um, we're

2967
02:06:26,719 --> 02:06:33,400
doing it, um, we're pursuing it because,

2968
02:06:30,400 --> 02:06:33,400
um,

2969
02:06:33,599 --> 02:06:40,560
today there isn't, um, there is perhaps

2970
02:06:37,679 --> 02:06:43,840
a lack of lack of equity in in resources

2971
02:06:40,560 --> 02:06:46,320
individuals can access through HCBS,

2972
02:06:43,840 --> 02:06:48,960
right? It's dependent some on the waiver

2973
02:06:46,320 --> 02:06:51,840
you're on and and some other factors.

2974
02:06:48,960 --> 02:06:56,239
And the support level framework um

2975
02:06:51,840 --> 02:06:58,880
allows us to um objectively identify an

2976
02:06:56,239 --> 02:07:02,000
individual's needs.

2977
02:06:58,880 --> 02:07:04,719
And then the support budget allows us a

2978
02:07:02,000 --> 02:07:07,360
way to objectively say people with this

2979
02:07:04,719 --> 02:07:08,960
level of need should have access to this

2980
02:07:07,360 --> 02:07:11,199
level of funds.

2981
02:07:08,960 --> 02:07:13,679
» So on the waiver reset, are you talking

2982
02:07:11,199 --> 02:07:16,719
about all the waivers? Are you gonna

2983
02:07:13,679 --> 02:07:20,560
like like go through all the waivers and

2984
02:07:16,719 --> 02:07:21,599
see which need which waivers need more

2985
02:07:20,560 --> 02:07:25,040
budget?

2986
02:07:21,599 --> 02:07:27,760
» No, the actual the full waiver reset,

2987
02:07:25,040 --> 02:07:30,639
right, is when we will sunset

2988
02:07:27,760 --> 02:07:33,360
» The waivers we have today

2989
02:07:30,639 --> 02:07:37,199
» And they will be replaced and we will

2990
02:07:33,360 --> 02:07:40,079
stand up new waivers completely new.

2991
02:07:37,199 --> 02:07:42,639
» Um there will be a transition period,

2992
02:07:40,079 --> 02:07:46,159
right? So, individuals in all likelihood

2993
02:07:42,639 --> 02:07:49,760
will transition when their annual

2994
02:07:46,159 --> 02:07:53,280
» Um plan is due. Okay. Right. Um but the

2995
02:07:49,760 --> 02:07:55,679
waiverss as we know them today

2996
02:07:53,280 --> 02:07:57,040
» Won't be here. That's 2028 probably.

2997
02:07:55,679 --> 02:07:59,360
» Okay. Cool. Yeah. So, we're still

2998
02:07:57,040 --> 02:08:01,760
» It's not tomorrow. So, it's okay.

2999
02:07:59,360 --> 02:08:04,320
» That's what I was wondering.

3000
02:08:01,760 --> 02:08:07,040
» If it was tomorrow, all hair on my head

3001
02:08:04,320 --> 02:08:08,239
would be gray. But it's not. It's 25.

3002
02:08:07,040 --> 02:08:11,040
Me, too.

3003
02:08:08,239 --> 02:08:11,599
» So, it's all right.

3004
02:08:11,040 --> 02:08:13,440
Yeah,

3005
02:08:11,599 --> 02:08:16,400
» It it does. It feels like it's next

3006
02:08:13,440 --> 02:08:17,040
month around 2028, but but but we have

3007
02:08:16,400 --> 02:08:18,320
some time

3008
02:08:17,040 --> 02:08:19,360
» In two years.

3009
02:08:18,320 --> 02:08:22,719
» Holly,

3010
02:08:19,360 --> 02:08:24,480
» Yes. Has it completely like because I

3011
02:08:22,719 --> 02:08:26,480
know at one point we were talking like

3012
02:08:24,480 --> 02:08:28,400
late 2027.

3013
02:08:26,480 --> 02:08:30,960
Has it completely changed to the

3014
02:08:28,400 --> 02:08:32,880
transition period being 2028? And the

3015
02:08:30,960 --> 02:08:35,760
reason I asked this is I believe my

3016
02:08:32,880 --> 02:08:37,599
annual meeting is typically in December.

3017
02:08:35,760 --> 02:08:39,679
So, would I start transitioning in

3018
02:08:37,599 --> 02:08:42,000
December of 2027 or would I have to wait

3019
02:08:39,679 --> 02:08:43,920
till December of 2028?

3020
02:08:42,000 --> 02:08:48,079
» So, I can't give you a firm answer on

3021
02:08:43,920 --> 02:08:51,679
that right now, Lexi. Um, you know, we

3022
02:08:48,079 --> 02:08:53,360
we would we are full steam ahead. I want

3023
02:08:51,679 --> 02:08:56,880
to be clear about that. But we also want

3024
02:08:53,360 --> 02:08:59,679
to be very thoughtful and I do feel like

3025
02:08:56,880 --> 02:09:02,400
um previously we had talked about 2027.

3026
02:08:59,679 --> 02:09:04,320
I do feel like we are sliding into early

3027
02:09:02,400 --> 02:09:07,679
2028.

3028
02:09:04,320 --> 02:09:09,840
Um so um but we will keep you all

3029
02:09:07,679 --> 02:09:13,119
apprised of kind of where we are on that

3030
02:09:09,840 --> 02:09:15,599
timeline. Um

3031
02:09:13,119 --> 02:09:19,280
but we we again we're full speed ahead

3032
02:09:15,599 --> 02:09:21,679
but we want to make sure that um we

3033
02:09:19,280 --> 02:09:23,920
don't we want to be very thoughtful and

3034
02:09:21,679 --> 02:09:25,280
intentional in the process. So

3035
02:09:23,920 --> 02:09:27,199
» Understandable.

3036
02:09:25,280 --> 02:09:29,199
» Yeah. Yeah. But we'll keep you all I

3037
02:09:27,199 --> 02:09:30,480
mean we'll we'll be talking about this a

3038
02:09:29,199 --> 02:09:32,560
lot. You're going to have to hear from

3039
02:09:30,480 --> 02:09:34,960
me a lot more. I'm sorry.

3040
02:09:32,560 --> 02:09:35,920
» No problem. I like hearing about this

3041
02:09:34,960 --> 02:09:38,320
stuff, so it's cool.

3042
02:09:35,920 --> 02:09:39,599
» Okay. Thank you,

3043
02:09:38,320 --> 02:09:41,679
» So then go ahead.

3044
02:09:39,599 --> 02:09:44,560
» Sorry. I was gonna say, um, with the

3045
02:09:41,679 --> 02:09:49,119
youth waiver being a possibility, will

3046
02:09:44,560 --> 02:09:52,960
there be any kind of, um, I guess

3047
02:09:49,119 --> 02:09:56,159
movement forward to

3048
02:09:52,960 --> 02:10:00,480
coordinating how that might uh, work

3049
02:09:56,159 --> 02:10:04,639
with the schools or with the um, IdoE as

3050
02:10:00,480 --> 02:10:09,840
well? Yeah, that's a a a great question.

3051
02:10:04,639 --> 02:10:13,520
Um yes, I think um as we get further in

3052
02:10:09,840 --> 02:10:17,360
with the youth waiver, I do think it's

3053
02:10:13,520 --> 02:10:20,560
important um that we engage with

3054
02:10:17,360 --> 02:10:25,599
Department of Education. Um, I I will

3055
02:10:20,560 --> 02:10:27,599
say, and I know you know this, um,

3056
02:10:25,599 --> 02:10:31,040
a family's experience with the

3057
02:10:27,599 --> 02:10:33,520
educational system often is related

3058
02:10:31,040 --> 02:10:36,480
almost solely to their local school

3059
02:10:33,520 --> 02:10:40,079
district. Um

3060
02:10:36,480 --> 02:10:42,320
so um but yes I think that's an

3061
02:10:40,079 --> 02:10:45,280
important call out is and we do need to

3062
02:10:42,320 --> 02:10:47,520
account for again those entitlement

3063
02:10:45,280 --> 02:10:50,239
services for youth and how do we support

3064
02:10:47,520 --> 02:10:53,920
them in accessing those

3065
02:10:50,239 --> 02:10:56,079
in an appropriate way. Yeah good call

3066
02:10:53,920 --> 02:10:57,679
» With the youth waiver um possible

3067
02:10:56,079 --> 02:11:00,000
transition before like is there an idea

3068
02:10:57,679 --> 02:11:02,639
of how much sooner that that transition

3069
02:11:00,000 --> 02:11:05,760
would start than the full waiver reset?

3070
02:11:02,639 --> 02:11:08,880
Um, not right now. I think we would like

3071
02:11:05,760 --> 02:11:10,880
to I think if we we need to get it we

3072
02:11:08,880 --> 02:11:14,480
would need to to work through the youth

3073
02:11:10,880 --> 02:11:17,840
waiver um and get it implemented in 2027

3074
02:11:14,480 --> 02:11:20,800
probably early to mid 2027.

3075
02:11:17,840 --> 02:11:23,520
Um if we're going to do it before waiver

3076
02:11:20,800 --> 02:11:26,960
reset and that that is next week by the

3077
02:11:23,520 --> 02:11:29,040
way. Um not really but um but yeah

3078
02:11:26,960 --> 02:11:30,800
that's that's kind of in discuss or that

3079
02:11:29,040 --> 02:11:32,639
is in discussion right now as well is

3080
02:11:30,800 --> 02:11:36,159
watching that timeline.

3081
02:11:32,639 --> 02:11:38,159
» Holly is the envision that if youth only

3082
02:11:36,159 --> 02:11:39,360
on like only on that waiver and not on

3083
02:11:38,159 --> 02:11:41,040
the other waivers. So if they're youth

3084
02:11:39,360 --> 02:11:41,520
are on that waiver only that waiver.

3085
02:11:41,040 --> 02:11:42,480
» Yeah.

3086
02:11:41,520 --> 02:11:45,480
» Okay.

3087
02:11:42,480 --> 02:11:45,480
» Yep.

3088
02:11:46,159 --> 02:11:51,199
» Um let's see. Oh, and another thing on

3089
02:11:49,360 --> 02:11:53,920
here that I just want to want to note is

3090
02:11:51,199 --> 02:11:56,800
the supports budget does promote some

3091
02:11:53,920 --> 02:12:00,159
transparency there so that individuals

3092
02:11:56,800 --> 02:12:03,119
will know um walking into their annual

3093
02:12:00,159 --> 02:12:04,960
meeting so to speak what resources they

3094
02:12:03,119 --> 02:12:08,880
have available through state uh not

3095
02:12:04,960 --> 02:12:12,880
through state plan through the waiver um

3096
02:12:08,880 --> 02:12:14,880
in terms of in in consideration of also

3097
02:12:12,880 --> 02:12:16,719
what other services they may be

3098
02:12:14,880 --> 02:12:18,639
accessing through state plan and other

3099
02:12:16,719 --> 02:12:21,520
resources.

3100
02:12:18,639 --> 02:12:24,159
And again, it allows us to predict

3101
02:12:21,520 --> 02:12:27,599
predict predict I've been talking for

3102
02:12:24,159 --> 02:12:31,280
way too long today. Um spending

3103
02:12:27,599 --> 02:12:34,400
um both for people on the wait list as

3104
02:12:31,280 --> 02:12:36,079
well as um individuals and services. So

3105
02:12:34,400 --> 02:12:36,960
yeah, we can go ahead and go to the next

3106
02:12:36,079 --> 02:12:39,040
one.

3107
02:12:36,960 --> 02:12:40,800
» One more question. The the requirement

3108
02:12:39,040 --> 02:12:42,079
um from last legislative session to

3109
02:12:40,800 --> 02:12:43,280
create an assisted living waiver, how

3110
02:12:42,079 --> 02:12:44,320
does that interplay with the waiver

3111
02:12:43,280 --> 02:12:46,560
reset?

3112
02:12:44,320 --> 02:12:47,679
» I'm so sorry. living.

3113
02:12:46,560 --> 02:12:50,639
» Oh. Oh,

3114
02:12:47,679 --> 02:12:52,560
» The assisted living waiver is 460 plus.

3115
02:12:50,639 --> 02:12:53,679
» Okay. No implications just on that.

3116
02:12:52,560 --> 02:12:54,560
Okay.

3117
02:12:53,679 --> 02:12:57,840
» Good question though.

3118
02:12:54,560 --> 02:12:58,639
» That would fall under

3119
02:12:57,840 --> 02:13:01,040
» OMP.

3120
02:12:58,639 --> 02:13:03,760
» Yeah.

3121
02:13:01,040 --> 02:13:05,760
» Yep. Um I won't go through this again.

3122
02:13:03,760 --> 02:13:08,480
I'm wanted to include it though. If we

3123
02:13:05,760 --> 02:13:12,239
can go to the next slide. I've updated

3124
02:13:08,480 --> 02:13:14,880
this next slide and graphic. Please note

3125
02:13:12,239 --> 02:13:18,320
that those uh participant counts are

3126
02:13:14,880 --> 02:13:21,360
current um as of

3127
02:13:18,320 --> 02:13:22,480
» April. April. As of April um

3128
02:13:21,360 --> 02:13:25,040
» Say current people say

3129
02:13:22,480 --> 02:13:27,520
» Yeah I know um

3130
02:13:25,040 --> 02:13:29,040
» The devil's in the details as Jim said.

3131
02:13:27,520 --> 02:13:30,560
Yes. Okay. I can add that

3132
02:13:29,040 --> 02:13:33,920
» Just in because people will say

3133
02:13:30,560 --> 02:13:35,599
» Yes. So I've added in the youth waiver

3134
02:13:33,920 --> 02:13:36,960
there that you can see that is a

3135
02:13:35,599 --> 02:13:38,880
difference from the last time you saw

3136
02:13:36,960 --> 02:13:40,480
this slide as well. We have the case

3137
02:13:38,880 --> 02:13:42,400
management and the youth waiver. And

3138
02:13:40,480 --> 02:13:45,280
then that green is more representative

3139
02:13:42,400 --> 02:13:48,320
of the new waiver structure that would

3140
02:13:45,280 --> 02:13:51,719
that we would be in um at the time of

3141
02:13:48,320 --> 02:13:51,719
waiver reset.

3142
02:13:52,800 --> 02:13:58,000
» Um let's go ahead and

3143
02:13:56,480 --> 02:13:59,040
» Can you maybe just go back?

3144
02:13:58,000 --> 02:14:01,679
» Yes, please go back.

3145
02:13:59,040 --> 02:14:04,320
» I just want to highlight on that because

3146
02:14:01,679 --> 02:14:06,800
I think you did this intentionally.

3147
02:14:04,320 --> 02:14:09,760
» Oh, I did. Um,

3148
02:14:06,800 --> 02:14:11,679
Holly appears to have bolded

3149
02:14:09,760 --> 02:14:14,400
the kid numbers.

3150
02:14:11,679 --> 02:14:17,040
» Um, and I I I just wanted to call out

3151
02:14:14,400 --> 02:14:22,040
the numbers of kids that we are serving

3152
02:14:17,040 --> 02:14:22,040
is now outnumbering the adults.

3153
02:14:23,599 --> 02:14:27,599
» Thank you, Kathy.

3154
02:14:25,520 --> 02:14:29,920
» I mean,

3155
02:14:27,599 --> 02:14:32,239
» Yeah. So, lots of use.

3156
02:14:29,920 --> 02:14:34,560
» So, the bold ones mean kids.

3157
02:14:32,239 --> 02:14:36,239
» Yeah. The bold ones like the 10,000

3158
02:14:34,560 --> 02:14:41,119
There are some that are

3159
02:14:36,239 --> 02:14:44,800
» So basically 10,000 FS is 0 to 17 I mean

3160
02:14:41,119 --> 02:14:50,639
over 10 you know then 18 to 26 is 7,000

3161
02:14:44,800 --> 02:14:56,199
27 to 56 and then H&W 2000

3162
02:14:50,639 --> 02:14:56,199
to 17 798 18 to 26 okay

3163
02:14:56,560 --> 02:15:02,800
» Yes and our ages on the family support

3164
02:14:58,960 --> 02:15:05,920
waiver weight list very much

3165
02:15:02,800 --> 02:15:08,400
um correlate with this as well um in

3166
02:15:05,920 --> 02:15:10,880
terms of the age of of individuals on

3167
02:15:08,400 --> 02:15:12,239
the FS weight list. So Jory, just

3168
02:15:10,880 --> 02:15:13,840
quickly, I saw your face. So it's

3169
02:15:12,239 --> 02:15:15,599
interesting because I think you probably

3170
02:15:13,840 --> 02:15:17,360
didn't realize. It's interesting. I just

3171
02:15:15,599 --> 02:15:19,760
was because I think we are noticing

3172
02:15:17,360 --> 02:15:21,679
people don't necessarily real I mean we

3173
02:15:19,760 --> 02:15:23,520
say it sometimes but I don't think it's

3174
02:15:21,679 --> 02:15:25,280
I not to call you out. I just saw your

3175
02:15:23,520 --> 02:15:27,440
face was like oh

3176
02:15:25,280 --> 02:15:29,679
» My so I'm assistant special ed director

3177
02:15:27,440 --> 02:15:31,119
in the district and I think that's very

3178
02:15:29,679 --> 02:15:32,880
reflective though of the needs that

3179
02:15:31,119 --> 02:15:35,920
we're seeing in schools. the school

3180
02:15:32,880 --> 02:15:38,560
needs are significant and the I oversee

3181
02:15:35,920 --> 02:15:41,280
the uh developmental preschool program

3182
02:15:38,560 --> 02:15:42,719
as well as the my board of our

3183
02:15:41,280 --> 02:15:45,360
classrooms for students who have more

3184
02:15:42,719 --> 02:15:49,360
intense needs and just the level of the

3185
02:15:45,360 --> 02:15:52,400
growth in those needs is startling um

3186
02:15:49,360 --> 02:15:55,520
and then how are we providing it's very

3187
02:15:52,400 --> 02:15:57,840
passionate topic because it is this the

3188
02:15:55,520 --> 02:15:59,840
classrooms um we are adding a fourth

3189
02:15:57,840 --> 02:16:01,280
classroom our development preschool

3190
02:15:59,840 --> 02:16:03,679
classrooms are exploding and we're a

3191
02:16:01,280 --> 02:16:05,440
smaller district um some of the larger

3192
02:16:03,679 --> 02:16:07,040
districts and these are we have students

3193
02:16:05,440 --> 02:16:09,599
I mean every we've tried to figure out

3194
02:16:07,040 --> 02:16:11,119
how do we catch these kids as two or

3195
02:16:09,599 --> 02:16:13,119
three or four year olds who already have

3196
02:16:11,119 --> 02:16:15,920
the identified disability versus like a

3197
02:16:13,119 --> 02:16:17,520
developmental delay how do we catch them

3198
02:16:15,920 --> 02:16:19,760
get them on the waiting list for the

3199
02:16:17,520 --> 02:16:21,280
waiver um so we've just added little

3200
02:16:19,760 --> 02:16:23,360
bits to like our case conference

3201
02:16:21,280 --> 02:16:25,280
templates and things to ask but the

3202
02:16:23,360 --> 02:16:26,880
number of students that are not on the

3203
02:16:25,280 --> 02:16:28,800
wait list yet that haven't even signed

3204
02:16:26,880 --> 02:16:30,320
up and then match the number of kids

3205
02:16:28,800 --> 02:16:32,000
that are on it and just knowing in my

3206
02:16:30,320 --> 02:16:33,760
head like the conferences that in with

3207
02:16:32,000 --> 02:16:35,920
11 year olds or 15 year olds that are

3208
02:16:33,760 --> 02:16:38,000
still that have not been caught.

3209
02:16:35,920 --> 02:16:38,559
» It's just I think it's very reflective

3210
02:16:38,000 --> 02:16:42,399
kind of

3211
02:16:38,559 --> 02:16:45,359
» I think what they should do is like have

3212
02:16:42,399 --> 02:16:47,920
someone test them and then figure it out

3213
02:16:45,359 --> 02:16:50,160
because that's what my mom had me do was

3214
02:16:47,920 --> 02:16:53,359
be tested every year to see where I

3215
02:16:50,160 --> 02:16:55,920
struggle at and then they could help

3216
02:16:53,359 --> 02:16:58,920
them get on there. And these are

3217
02:16:55,920 --> 02:16:58,920
students.

3218
02:16:59,359 --> 02:17:03,760
» Even if they weren't evaluated, they

3219
02:17:01,359 --> 02:17:05,200
should still test them, you know.

3220
02:17:03,760 --> 02:17:06,719
» And I think to your point, Jo, I think

3221
02:17:05,200 --> 02:17:08,719
that's where the youth waiver comes in

3222
02:17:06,719 --> 02:17:12,719
because the services and supports that

3223
02:17:08,719 --> 02:17:14,240
are offered, right? I mean, aren't um I

3224
02:17:12,719 --> 02:17:16,719
I think about this as my first day on

3225
02:17:14,240 --> 02:17:18,399
the job years ago is what are you

3226
02:17:16,719 --> 02:17:20,399
waiting for? Because the problem is I

3227
02:17:18,399 --> 02:17:22,880
think people are waiting but it's it's

3228
02:17:20,399 --> 02:17:24,800
what services are on that array right

3229
02:17:22,880 --> 02:17:26,160
for a child and there's other services

3230
02:17:24,800 --> 02:17:28,639
that the school system provides right

3231
02:17:26,160 --> 02:17:31,439
that is not a waiver service and so I

3232
02:17:28,639 --> 02:17:34,800
think that's you know the the movement

3233
02:17:31,439 --> 02:17:36,080
is because what you know what what are

3234
02:17:34,800 --> 02:17:39,200
you wait I mean you know because a lot

3235
02:17:36,080 --> 02:17:41,679
of times it's not it the services that

3236
02:17:39,200 --> 02:17:42,960
are there other DOE's you know what I

3237
02:17:41,679 --> 02:17:44,000
mean there's other services and supports

3238
02:17:42,960 --> 02:17:46,160
that are already in place that are

3239
02:17:44,000 --> 02:17:47,599
helping that so it's kind of

3240
02:17:46,160 --> 02:17:49,920
» Can I throw something out there about

3241
02:17:47,599 --> 02:17:51,599
the numbers. This is Lexi.

3242
02:17:49,920 --> 02:17:56,160
» Um,

3243
02:17:51,599 --> 02:17:58,479
so I think so I found out I got on I was

3244
02:17:56,160 --> 02:18:00,160
got on the A andd waiver originally.

3245
02:17:58,479 --> 02:18:02,960
I've been on the waiver for almost 10

3246
02:18:00,160 --> 02:18:06,399
years and h about half of that was A&D

3247
02:18:02,960 --> 02:18:08,880
um which is now health and wellness. Um,

3248
02:18:06,399 --> 02:18:10,800
and I found out from my doctor, believe

3249
02:18:08,880 --> 02:18:13,120
it or not, which I heard is rare to find

3250
02:18:10,800 --> 02:18:15,920
out about the waiver from your doctor.

3251
02:18:13,120 --> 02:18:18,639
Um I think we're seeing more kids on the

3252
02:18:15,920 --> 02:18:21,359
waiver, more youth on the wa on the

3253
02:18:18,639 --> 02:18:24,559
waiver or on the waiting list now than

3254
02:18:21,359 --> 02:18:27,519
historically is because um and I see

3255
02:18:24,559 --> 02:18:29,760
this a lot on but on social media

3256
02:18:27,519 --> 02:18:32,559
especially Facebook and stuff there's a

3257
02:18:29,760 --> 02:18:34,880
lot of peer-to-peer support for families

3258
02:18:32,559 --> 02:18:36,719
like parents are supporting parents and

3259
02:18:34,880 --> 02:18:38,960
caregivers are supporting caregivers

3260
02:18:36,719 --> 02:18:41,280
their you know Facebook groups for stuff

3261
02:18:38,960 --> 02:18:42,960
like that and I think more parents are

3262
02:18:41,280 --> 02:18:44,960
hearing about the waiver honestly ly

3263
02:18:42,960 --> 02:18:48,240
through other parents through social

3264
02:18:44,960 --> 02:18:50,880
media um than historic, you know, that

3265
02:18:48,240 --> 02:18:53,040
wasn't a thing. That wasn't even as much

3266
02:18:50,880 --> 02:18:56,800
of a thing when I got on the waiver 10

3267
02:18:53,040 --> 02:18:59,120
years ago. But, um I think historically

3268
02:18:56,800 --> 02:19:00,719
for people my age, schools weren't

3269
02:18:59,120 --> 02:19:02,960
talking about it. Doctors weren't

3270
02:19:00,719 --> 02:19:04,719
talking about it. And now parents are

3271
02:19:02,960 --> 02:19:07,200
seeing other parents with their kids on

3272
02:19:04,719 --> 02:19:08,479
it on social media and finding out from

3273
02:19:07,200 --> 02:19:10,399
parents. And there's just so much

3274
02:19:08,479 --> 02:19:13,280
peer-to-peer support, especially with

3275
02:19:10,399 --> 02:19:15,359
social media.

3276
02:19:13,280 --> 02:19:15,840
Yeah, good point, Lexi.

3277
02:19:15,359 --> 02:19:17,519
» Thank you.

3278
02:19:15,840 --> 02:19:19,519
» Thank you, Kathy. Thanks for bringing us

3279
02:19:17,519 --> 02:19:21,120
back to point that out. No, I appreciate

3280
02:19:19,519 --> 02:19:24,719
it. I'm glad you did.

3281
02:19:21,120 --> 02:19:26,800
» I'm glad you did. Um, just want to note

3282
02:19:24,719 --> 02:19:29,599
we've already talked about most of this.

3283
02:19:26,800 --> 02:19:33,200
Um, but do want to just reiterate that

3284
02:19:29,599 --> 02:19:36,800
we are um analyzing that data from the

3285
02:19:33,200 --> 02:19:38,319
interrise now. Um and then um if we can

3286
02:19:36,800 --> 02:19:40,880
move to the next slide, I want to

3287
02:19:38,319 --> 02:19:43,439
provide an update on

3288
02:19:40,880 --> 02:19:46,080
some of the activities that we're in

3289
02:19:43,439 --> 02:19:50,479
process of or have completed already um

3290
02:19:46,080 --> 02:19:53,439
with regards to waiver reset. Um HSRI,

3291
02:19:50,479 --> 02:19:56,880
human services research institute is a

3292
02:19:53,439 --> 02:19:59,600
contracted entity with beads. um they

3293
02:19:56,880 --> 02:20:03,200
now have two years of Medicaid claims

3294
02:19:59,600 --> 02:20:05,439
data that includes the waiver, the HCBS

3295
02:20:03,200 --> 02:20:07,520
data as well as state plan data. So

3296
02:20:05,439 --> 02:20:11,120
we're looking again at that holistic

3297
02:20:07,520 --> 02:20:14,640
approach right um and they are cleaning

3298
02:20:11,120 --> 02:20:18,160
that right from a data perspective um

3299
02:20:14,640 --> 02:20:21,040
and then uh working on that analysis. We

3300
02:20:18,160 --> 02:20:23,760
have also and this is not we bees. This

3301
02:20:21,040 --> 02:20:25,359
is one of our internal partners in FSSA

3302
02:20:23,760 --> 02:20:27,520
our uh friends over at office of

3303
02:20:25,359 --> 02:20:29,359
Medicaid policy and planning have

3304
02:20:27,520 --> 02:20:31,040
launched an internal workg group

3305
02:20:29,359 --> 02:20:34,560
exploring state plan home health

3306
02:20:31,040 --> 02:20:36,720
services um and we are a part of that.

3307
02:20:34,560 --> 02:20:39,200
Um we've held some initial meetings on

3308
02:20:36,720 --> 02:20:40,880
the plans and goals for waiver reset

3309
02:20:39,200 --> 02:20:45,520
with our cross system partners that

3310
02:20:40,880 --> 02:20:48,960
includes um our friends at um DMHA of

3311
02:20:45,520 --> 02:20:54,640
course our our family now in the Bureau

3312
02:20:48,960 --> 02:20:58,960
of Better Aging um as well as OMP.

3313
02:20:54,640 --> 02:21:01,120
We have also um completed an in-depth

3314
02:20:58,960 --> 02:21:03,840
review of our current service

3315
02:21:01,120 --> 02:21:05,520
definitions across all four of the beads

3316
02:21:03,840 --> 02:21:08,800
waivers. I think we've talked about

3317
02:21:05,520 --> 02:21:11,040
before um we have a lot of services that

3318
02:21:08,800 --> 02:21:12,240
we offer and how can we simplify that,

3319
02:21:11,040 --> 02:21:14,399
right?

3320
02:21:12,240 --> 02:21:18,319
um how can we kind of consolidate

3321
02:21:14,399 --> 02:21:21,520
services or combine services or in in

3322
02:21:18,319 --> 02:21:23,439
some way make that system that's those

3323
02:21:21,520 --> 02:21:27,200
that that service array a little easier

3324
02:21:23,439 --> 02:21:31,280
to understand. Um while also keeping

3325
02:21:27,200 --> 02:21:33,920
that eye on on quality services. Um so

3326
02:21:31,280 --> 02:21:36,399
we have completed that. Um we have

3327
02:21:33,920 --> 02:21:38,560
completed round one of research into

3328
02:21:36,399 --> 02:21:41,680
some promising practices in other states

3329
02:21:38,560 --> 02:21:43,280
on all things waiver reset. Right. Um

3330
02:21:41,680 --> 02:21:47,439
all different topics there. And then we

3331
02:21:43,280 --> 02:21:49,200
begin um or began some additional um

3332
02:21:47,439 --> 02:21:52,000
research into promising practices

3333
02:21:49,200 --> 02:21:54,240
earlier this month. We have a

3334
02:21:52,000 --> 02:21:57,200
preliminary service array recommendation

3335
02:21:54,240 --> 02:21:59,359
from HSRI or No, I'm sorry. We don't

3336
02:21:57,200 --> 02:22:04,920
have it yet, but it's in process of

3337
02:21:59,359 --> 02:22:04,920
being um developed for us to review.

3338
02:22:05,439 --> 02:22:12,000
And then um Yes. Oh, I'm sorry. You're

3339
02:22:09,280 --> 02:22:14,000
fine. We're fine. Um on that preliminary

3340
02:22:12,000 --> 02:22:18,319
service array recommendations, is that

3341
02:22:14,000 --> 02:22:20,399
going to be uh discussed with the SB?

3342
02:22:18,319 --> 02:22:22,000
» Probably. So I'm not sure the timeline

3343
02:22:20,399 --> 02:22:24,720
for it yet, but I would think we will

3344
02:22:22,000 --> 02:22:25,520
talk about that with the SB group. Yes.

3345
02:22:24,720 --> 02:22:28,319
Thank you.

3346
02:22:25,520 --> 02:22:31,359
» Good question.

3347
02:22:28,319 --> 02:22:35,680
We have also provided weight list data

3348
02:22:31,359 --> 02:22:37,600
um to HSRI um because as we talk about

3349
02:22:35,680 --> 02:22:40,720
the launch of a youth waiver and waiver

3350
02:22:37,600 --> 02:22:44,479
reset um we know we've got multiple

3351
02:22:40,720 --> 02:22:46,080
waiting lists now for HCBS. So we need

3352
02:22:44,479 --> 02:22:49,600
to be looking at that and deciding how

3353
02:22:46,080 --> 02:22:50,560
that's going to work moving forward.

3354
02:22:49,600 --> 02:22:51,280
Um and then

3355
02:22:50,560 --> 02:22:54,399
» Sorry Holly.

3356
02:22:51,280 --> 02:22:56,720
» Oh yeah sure. Well, Kate left, so

3357
02:22:54,399 --> 02:23:00,560
somebody asked that question, but you

3358
02:22:56,720 --> 02:23:02,560
know, she she passed it on to me. Um,

3359
02:23:00,560 --> 02:23:07,120
that weight list data, is that kind of

3360
02:23:02,560 --> 02:23:09,760
demographic data, age? Okay, so it's not

3361
02:23:07,120 --> 02:23:11,920
um level of care, nothing like that.

3362
02:23:09,760 --> 02:23:14,720
Okay.

3363
02:23:11,920 --> 02:23:16,640
» Well, let me rephrase that. That waiting

3364
02:23:14,720 --> 02:23:19,200
list data would include what level of

3365
02:23:16,640 --> 02:23:21,439
care was met by the person, right?

3366
02:23:19,200 --> 02:23:22,880
because we have different we have the

3367
02:23:21,439 --> 02:23:25,200
nursing facility level of care and the

3368
02:23:22,880 --> 02:23:26,479
ICF ID level of care. So,

3369
02:23:25,200 --> 02:23:28,880
» Does that make sense?

3370
02:23:26,479 --> 02:23:31,120
» Yes, it does. It's you're not looking at

3371
02:23:28,880 --> 02:23:32,399
you're not looking at NRI data

3372
02:23:31,120 --> 02:23:33,760
essentially.

3373
02:23:32,399 --> 02:23:34,720
» We're looking at the level of care.

3374
02:23:33,760 --> 02:23:37,200
» Got it. Thank you.

3375
02:23:34,720 --> 02:23:39,920
» Yeah.

3376
02:23:37,200 --> 02:23:41,840
All right. Good questions. Um and then

3377
02:23:39,920 --> 02:23:43,760
again, need to update this because the

3378
02:23:41,840 --> 02:23:46,640
final awards um for the new case

3379
02:23:43,760 --> 02:23:48,720
management contracts have been made. So

3380
02:23:46,640 --> 02:23:50,880
um and we've talked quite a bit about

3381
02:23:48,720 --> 02:23:53,200
case management and also the data

3382
02:23:50,880 --> 02:23:55,600
analysis for the budget framework um

3383
02:23:53,200 --> 02:23:57,680
development has begun. So while we're

3384
02:23:55,600 --> 02:24:00,160
working on the identifying the support

3385
02:23:57,680 --> 02:24:03,439
levels

3386
02:24:00,160 --> 02:24:04,720
um for individuals um and what that will

3387
02:24:03,439 --> 02:24:07,200
look like or the support level

3388
02:24:04,720 --> 02:24:10,240
framework, we're also analyzing that

3389
02:24:07,200 --> 02:24:12,720
data or HSRI is analyzing the data uh

3390
02:24:10,240 --> 02:24:15,280
regard regarding the budget framework

3391
02:24:12,720 --> 02:24:18,240
which again considers

3392
02:24:15,280 --> 02:24:20,800
HCBS and state planning. So, it's all of

3393
02:24:18,240 --> 02:24:23,800
the long-term services and supports

3394
02:24:20,800 --> 02:24:23,800
data.

3395
02:24:26,319 --> 02:24:31,359
Okay.

3396
02:24:27,840 --> 02:24:33,439
Okay. Going to shift just a little

3397
02:24:31,359 --> 02:24:36,640
shift. Any questions? I'm going to reset

3398
02:24:33,439 --> 02:24:38,000
before I jump in here. Okay. Okay. So,

3399
02:24:36,640 --> 02:24:41,120
the home and community support

3400
02:24:38,000 --> 02:24:43,280
professionals uh statistics. So, we have

3401
02:24:41,120 --> 02:24:46,720
a reporting period. This is the the

3402
02:24:43,280 --> 02:24:48,960
training registry that the HCSP

3403
02:24:46,720 --> 02:24:52,640
um training registry that we've

3404
02:24:48,960 --> 02:24:54,720
launched. Um the total number of

3405
02:24:52,640 --> 02:24:58,560
learning path certificates granted since

3406
02:24:54,720 --> 02:25:02,000
July is over almost 37,000

3407
02:24:58,560 --> 02:25:06,800
which is really good. Um total time

3408
02:25:02,000 --> 02:25:09,840
spent learning is um about 188,000

3409
02:25:06,800 --> 02:25:11,840
hours. Uh Wednesday appears to be the

3410
02:25:09,840 --> 02:25:12,880
day that most people do their training.

3411
02:25:11,840 --> 02:25:16,080
Huh.

3412
02:25:12,880 --> 02:25:18,399
» Yeah, that is interesting. Um, it's

3413
02:25:16,080 --> 02:25:20,240
middle of the week and then the user

3414
02:25:18,399 --> 02:25:23,280
device description just talks about what

3415
02:25:20,240 --> 02:25:27,600
device people are using, right, for um

3416
02:25:23,280 --> 02:25:32,319
for the training. So, um, again, we've

3417
02:25:27,600 --> 02:25:34,080
had really positive, uh, feedback on the

3418
02:25:32,319 --> 02:25:37,040
HCSP training.

3419
02:25:34,080 --> 02:25:40,319
» Is that is the this

3420
02:25:37,040 --> 02:25:44,000
professional stats like the tests that

3421
02:25:40,319 --> 02:25:44,960
people have to take to be a caregiver or

3422
02:25:44,000 --> 02:25:48,640
anything?

3423
02:25:44,960 --> 02:25:51,760
» So, is the the HCSP training, right,

3424
02:25:48,640 --> 02:25:53,760
includes th that competency testing.

3425
02:25:51,760 --> 02:25:56,000
» Okay. So get the certificate. You

3426
02:25:53,760 --> 02:25:58,399
correct me if I'm mistake. Um

3427
02:25:56,000 --> 02:26:00,160
» When you say caregiver

3428
02:25:58,399 --> 02:26:00,479
» I don't know to what you're

3429
02:26:00,160 --> 02:26:01,439
» Like

3430
02:26:00,479 --> 02:26:02,720
» You know what I mean

3431
02:26:01,439 --> 02:26:05,120
» Support staff.

3432
02:26:02,720 --> 02:26:08,880
» Yes like Yes. I just want to make sure

3433
02:26:05,120 --> 02:26:10,080
because it's not all service like but I

3434
02:26:08,880 --> 02:26:12,080
Yes. Traditional

3435
02:26:10,080 --> 02:26:14,160
» Is CI on it or Okay.

3436
02:26:12,080 --> 02:26:16,000
» Yes. But like a music therapist which I

3437
02:26:14,160 --> 02:26:17,520
know you wouldn't call it is not

3438
02:26:16,000 --> 02:26:18,880
considered a home but yes but

3439
02:26:17,520 --> 02:26:19,760
traditionally the what you're thinking

3440
02:26:18,880 --> 02:26:21,760
of is Yes.

3441
02:26:19,760 --> 02:26:22,160
» Yes. CI. Yeah.

3442
02:26:21,760 --> 02:26:24,800
» Yeah.

3443
02:26:22,160 --> 02:26:28,080
» Yeah. DS

3444
02:26:24,800 --> 02:26:31,120
» Or day programs day programs. Okay.

3445
02:26:28,080 --> 02:26:33,120
Cool. Thanks.

3446
02:26:31,120 --> 02:26:35,760
» We had really positive feedback. We've

3447
02:26:33,120 --> 02:26:37,280
been very pleased with how

3448
02:26:35,760 --> 02:26:40,240
» Yeah. And we're going to provide the

3449
02:26:37,280 --> 02:26:43,760
reertification is coming up um in terms

3450
02:26:40,240 --> 02:26:45,040
of um folks. And then also the med admin

3451
02:26:43,760 --> 02:26:47,040
we're still working on. It's taking a

3452
02:26:45,040 --> 02:26:48,640
little bit longer. The the providers are

3453
02:26:47,040 --> 02:26:50,640
obviously able to still use their own,

3454
02:26:48,640 --> 02:26:52,720
right? they're not being penalized for

3455
02:26:50,640 --> 02:26:54,640
um anything. So um yeah, so it's going

3456
02:26:52,720 --> 02:26:56,479
pretty well. We're going to share u much

3457
02:26:54,640 --> 02:26:58,640
more information and we're also coming

3458
02:26:56,479 --> 02:27:01,520
up on a year. So we're going to be able

3459
02:26:58,640 --> 02:27:02,880
it's hard because we didn't have data on

3460
02:27:01,520 --> 02:27:04,479
direct support professionals prior to

3461
02:27:02,880 --> 02:27:07,680
this. So we don't have anything to

3462
02:27:04,479 --> 02:27:10,000
compare it to much. I mean we have some

3463
02:27:07,680 --> 02:27:13,840
obviously national um you know surveys

3464
02:27:10,000 --> 02:27:15,840
that are done but um so but now that

3465
02:27:13,840 --> 02:27:19,200
we're almost at a year we can really

3466
02:27:15,840 --> 02:27:20,640
look at um you know some things and I

3467
02:27:19,200 --> 02:27:21,920
think it's going to be interesting as

3468
02:27:20,640 --> 02:27:24,720
we're moving forward. So we will be

3469
02:27:21,920 --> 02:27:27,920
presenting at the quarterly

3470
02:27:24,720 --> 02:27:29,520
MFR which is what?

3471
02:27:27,920 --> 02:27:31,280
Yeah. When is that? August. I don't

3472
02:27:29,520 --> 02:27:33,680
remember when the next one is. Um sorry

3473
02:27:31,280 --> 02:27:36,240
I'm blanking but we will be providing

3474
02:27:33,680 --> 02:27:38,640
details on this. Um just some more data

3475
02:27:36,240 --> 02:27:40,479
and everything. So it's exciting stuff.

3476
02:27:38,640 --> 02:27:42,560
» We all have brain farts sometimes.

3477
02:27:40,479 --> 02:27:45,560
» I know I can't.

3478
02:27:42,560 --> 02:27:45,560
Yeah.

3479
02:27:46,240 --> 02:27:49,240
» Yeah.

3480
02:27:49,600 --> 02:27:53,439
» Okay. We have about I mean 20 minutes.

3481
02:27:51,920 --> 02:27:56,640
Obviously not going to hold you here and

3482
02:27:53,439 --> 02:27:58,240
to stare at each other, but if

3483
02:27:56,640 --> 02:28:01,560
Oh yeah,

3484
02:27:58,240 --> 02:28:01,560
» I know.

3485
02:28:04,240 --> 02:28:07,280
» Good job.

3486
02:28:05,359 --> 02:28:10,319
» Wait, we've got 20 minutes worth of

3487
02:28:07,280 --> 02:28:13,319
questions. Go.

3488
02:28:10,319 --> 02:28:13,319
» So,

3489
02:28:13,680 --> 02:28:19,439
» We need Kate We need Kate back.

3490
02:28:16,720 --> 02:28:23,520
I'm just going to um add since we do

3491
02:28:19,439 --> 02:28:26,560
have some time and we um obviously I

3492
02:28:23,520 --> 02:28:28,640
mentioned earlier around sort of the

3493
02:28:26,560 --> 02:28:31,600
questions related to the valuebased

3494
02:28:28,640 --> 02:28:33,920
payment or purchasing our interest in

3495
02:28:31,600 --> 02:28:37,120
the employment space uh competitive

3496
02:28:33,920 --> 02:28:39,359
integrated employment space. Um and

3497
02:28:37,120 --> 02:28:42,560
that's an area that we've continued to

3498
02:28:39,359 --> 02:28:48,000
to work toward making incremental

3499
02:28:42,560 --> 02:28:52,160
progress. Um, but as of I think this

3500
02:28:48,000 --> 02:28:55,520
week, and you two correct me if I'm if I

3501
02:28:52,160 --> 02:28:58,319
can't read clearly, apparently, um, we

3502
02:28:55,520 --> 02:29:00,399
have less than 500 subminimum wage

3503
02:28:58,319 --> 02:29:01,439
workers in the state of Indiana right

3504
02:29:00,399 --> 02:29:04,880
now.

3505
02:29:01,439 --> 02:29:08,319
» Um, and that is a significant decrease

3506
02:29:04,880 --> 02:29:10,160
from where we started um, I don't know,

3507
02:29:08,319 --> 02:29:14,560
feels like yesterday, but it was a

3508
02:29:10,160 --> 02:29:17,840
couple years ago. Um and so for for us

3509
02:29:14,560 --> 02:29:20,640
that continue when I said that earlier

3510
02:29:17,840 --> 02:29:22,800
it's because we have um we have a a

3511
02:29:20,640 --> 02:29:25,680
desire here to make some meaningful

3512
02:29:22,800 --> 02:29:28,880
progress um in Indiana and I think we

3513
02:29:25,680 --> 02:29:32,800
are very much on the right track. Um, we

3514
02:29:28,880 --> 02:29:35,200
do still have a number of 14C entities,

3515
02:29:32,800 --> 02:29:38,640
but those a number of those are working

3516
02:29:35,200 --> 02:29:42,399
at um transitioning out uh or phasing

3517
02:29:38,640 --> 02:29:45,840
out their 14C's uh even so later this

3518
02:29:42,399 --> 02:29:48,080
year. So, um I I want to just

3519
02:29:45,840 --> 02:29:51,920
acknowledge the work that everyone has

3520
02:29:48,080 --> 02:29:53,760
has done in that front, but we are that

3521
02:29:51,920 --> 02:29:55,680
don't feel like that's an opportunity to

3522
02:29:53,760 --> 02:29:58,240
let up on the gas at this point, which

3523
02:29:55,680 --> 02:30:01,359
is why we're talking about valuebased

3524
02:29:58,240 --> 02:30:04,080
payment as a mechanism to help forward

3525
02:30:01,359 --> 02:30:06,080
um the employment um outcomes for people

3526
02:30:04,080 --> 02:30:08,319
even further. So, I just I wanted to

3527
02:30:06,080 --> 02:30:11,600
take a minute to share some of that

3528
02:30:08,319 --> 02:30:14,560
data. Didn't totally fit into the agenda

3529
02:30:11,600 --> 02:30:16,960
um today. And I certainly will have some

3530
02:30:14,560 --> 02:30:21,200
more information to to share with you at

3531
02:30:16,960 --> 02:30:24,720
future uh advisory meetings. But um I I

3532
02:30:21,200 --> 02:30:27,359
I because you all have been so invested

3533
02:30:24,720 --> 02:30:29,200
and involved in these conversations and

3534
02:30:27,359 --> 02:30:32,240
some of the work that we've laid forth

3535
02:30:29,200 --> 02:30:34,800
in our plan. Um I I wanted to take just

3536
02:30:32,240 --> 02:30:38,240
take an opportunity to to to put that in

3537
02:30:34,800 --> 02:30:42,640
front of folks and uh share that update.

3538
02:30:38,240 --> 02:30:45,760
» Yep. So in that 500 does it is it with

3539
02:30:42,640 --> 02:30:47,439
people with intellectual disabilities or

3540
02:30:45,760 --> 02:30:51,200
that

3541
02:30:47,439 --> 02:30:53,600
because they can't have a job or

3542
02:30:51,200 --> 02:30:56,560
the person

3543
02:30:53,600 --> 02:31:00,479
wants a job but

3544
02:30:56,560 --> 02:31:02,479
the com the base the jobs like Target,

3545
02:31:00,479 --> 02:31:05,120
Walmart, Kroger,

3546
02:31:02,479 --> 02:31:08,160
Goodwill. I I know Goodwill hires

3547
02:31:05,120 --> 02:31:11,680
people, but I don't preferly like

3548
02:31:08,160 --> 02:31:16,240
working there. But

3549
02:31:11,680 --> 02:31:19,439
um is that because the 500 is because

3550
02:31:16,240 --> 02:31:23,560
jobs now these days are not accepting

3551
02:31:19,439 --> 02:31:23,560
people with intellectual disabilities?

3552
02:31:24,479 --> 02:31:28,560
» You feel free to to jump in. Um I

3553
02:31:26,720 --> 02:31:31,760
there's actually it's a number of

3554
02:31:28,560 --> 02:31:34,240
reasons why they're they haven't and and

3555
02:31:31,760 --> 02:31:36,479
some of it is at this point either they

3556
02:31:34,240 --> 02:31:38,960
they haven't had those conversations and

3557
02:31:36,479 --> 02:31:40,800
been planning around competitive

3558
02:31:38,960 --> 02:31:42,880
integrated employment. They're just at

3559
02:31:40,800 --> 02:31:46,080
different places and spaces depending on

3560
02:31:42,880 --> 02:31:48,399
their own um kind of trajectory kind of

3561
02:31:46,080 --> 02:31:51,280
how long have they been in a subminimum

3562
02:31:48,399 --> 02:31:53,359
wage scenario. And um obviously

3563
02:31:51,280 --> 02:31:56,080
sometimes it's harder for folks to

3564
02:31:53,359 --> 02:31:58,560
transition away from that. um there

3565
02:31:56,080 --> 02:32:00,319
there's a lot of forces at play for some

3566
02:31:58,560 --> 02:32:04,000
some of those people for maybe why

3567
02:32:00,319 --> 02:32:08,240
that's the case. Um but knowing that

3568
02:32:04,000 --> 02:32:10,399
that number I think is a much more um a

3569
02:32:08,240 --> 02:32:14,319
number that's much better I guess from

3570
02:32:10,399 --> 02:32:17,120
tackling those very um individualized

3571
02:32:14,319 --> 02:32:19,920
issues on an individual basis um to be

3572
02:32:17,120 --> 02:32:21,920
able to help them work through that or

3573
02:32:19,920 --> 02:32:23,760
navigate look at a trajectory of where

3574
02:32:21,920 --> 02:32:26,399
they're headed and how to get there.

3575
02:32:23,760 --> 02:32:27,200
Holly or Jess, anything else you would

3576
02:32:26,399 --> 02:32:29,520
ask?

3577
02:32:27,200 --> 02:32:31,520
» Yeah, no, I think that was a great

3578
02:32:29,520 --> 02:32:34,640
response. I would I would also add that

3579
02:32:31,520 --> 02:32:36,720
I think um some of the individuals um

3580
02:32:34,640 --> 02:32:40,240
that are maybe still in those settings

3581
02:32:36,720 --> 02:32:42,560
too may just have lots of questions

3582
02:32:40,240 --> 02:32:45,600
about competitive integrated employment.

3583
02:32:42,560 --> 02:32:47,680
And I think um I'll I'll be selfish here

3584
02:32:45,600 --> 02:32:49,359
and make a little plug for a couple of

3585
02:32:47,680 --> 02:32:51,439
the newer services, the career

3586
02:32:49,359 --> 02:32:53,200
exploration and planning and and also

3587
02:32:51,439 --> 02:32:55,040
that benefits

3588
02:32:53,200 --> 02:32:59,760
» Those benefit discussions because I

3589
02:32:55,040 --> 02:33:02,720
think um those are opportunities to um

3590
02:32:59,760 --> 02:33:05,280
for our system to engage with those

3591
02:33:02,720 --> 02:33:07,120
individuals and their families about

3592
02:33:05,280 --> 02:33:10,240
what other what are the other

3593
02:33:07,120 --> 02:33:12,640
possibilities, you know, right? Um, I

3594
02:33:10,240 --> 02:33:15,280
think my mom's supposed to do my

3595
02:33:12,640 --> 02:33:18,560
benefits review with someone, but they

3596
02:33:15,280 --> 02:33:23,600
haven't reached back out. So, then

3597
02:33:18,560 --> 02:33:26,479
my um VR counselor and I met yesterday

3598
02:33:23,600 --> 02:33:28,800
with my mom and Darlene and she said,

3599
02:33:26,479 --> 02:33:32,240
"We're thinking about taking you to the

3600
02:33:28,800 --> 02:33:34,000
next step and closing your case."

3601
02:33:32,240 --> 02:33:37,280
because they couldn't really work with

3602
02:33:34,000 --> 02:33:41,680
me because my case manager is in Johnson

3603
02:33:37,280 --> 02:33:43,920
County and I work in Marian. Um, but I

3604
02:33:41,680 --> 02:33:47,920
would have I like the job where I'm at

3605
02:33:43,920 --> 02:33:49,760
because it's just easier. They love

3606
02:33:47,920 --> 02:33:53,120
people with intellectual disabilities

3607
02:33:49,760 --> 02:33:56,240
and they want us to succeed and move on

3608
02:33:53,120 --> 02:33:59,680
from what what's going on right now.

3609
02:33:56,240 --> 02:34:01,760
Like, you know, like I get it. It's hard

3610
02:33:59,680 --> 02:34:05,520
to

3611
02:34:01,760 --> 02:34:09,920
like my like if I was looking for a job

3612
02:34:05,520 --> 02:34:14,240
like let's say 5 years ago which I I did

3613
02:34:09,920 --> 02:34:18,800
have a job but then

3614
02:34:14,240 --> 02:34:24,479
it's harder these days to get a job

3615
02:34:18,800 --> 02:34:27,680
because of all the changes in the state

3616
02:34:24,479 --> 02:34:29,439
and with the government and sorry I have

3617
02:34:27,680 --> 02:34:35,280
to say his name even though I don't like

3618
02:34:29,439 --> 02:34:38,560
him. Trump's stuff, but I just I don't

3619
02:34:35,280 --> 02:34:41,200
understand why he's doing this to people

3620
02:34:38,560 --> 02:34:44,640
with an abilities.

3621
02:34:41,200 --> 02:34:46,960
But my point is like he doesn't know how

3622
02:34:44,640 --> 02:34:49,120
well we succeed. He doesn't know

3623
02:34:46,960 --> 02:34:51,760
anything. And he has someone with a

3624
02:34:49,120 --> 02:34:57,040
disability and he probably disown them

3625
02:34:51,760 --> 02:34:59,280
like crazily, but I don't like them. So,

3626
02:34:57,040 --> 02:35:00,960
» Well, again, I think as as you mentioned

3627
02:34:59,280 --> 02:35:03,200
though, you know your possibilities,

3628
02:35:00,960 --> 02:35:05,120
right? And I think we have we likely

3629
02:35:03,200 --> 02:35:06,399
have some individuals maybe who don't

3630
02:35:05,120 --> 02:35:08,000
and we need to be having those

3631
02:35:06,399 --> 02:35:11,680
conversations.

3632
02:35:08,000 --> 02:35:13,040
» They they need more support in it.

3633
02:35:11,680 --> 02:35:15,200
» Yeah.

3634
02:35:13,040 --> 02:35:16,560
» I'd also like to make a statement and

3635
02:35:15,200 --> 02:35:18,000
the two other lawyers in my room, they

3636
02:35:16,560 --> 02:35:19,840
can people cannot not hire you because

3637
02:35:18,000 --> 02:35:21,200
you have a disability. So, just

3638
02:35:19,840 --> 02:35:24,319
» We can have a we'll have a side

3639
02:35:21,200 --> 02:35:26,160
conversation that is not okay. So just

3640
02:35:24,319 --> 02:35:27,920
just making that public statement.

3641
02:35:26,160 --> 02:35:31,040
Someone cannot hire you. That's

3642
02:35:27,920 --> 02:35:32,720
discrimination. So anyway, um but uh

3643
02:35:31,040 --> 02:35:34,800
okay. So I think did you have a

3644
02:35:32,720 --> 02:35:36,560
question, Lexi? And then I know Katie

3645
02:35:34,800 --> 02:35:38,000
has a question as well.

3646
02:35:36,560 --> 02:35:40,319
» Oh,

3647
02:35:38,000 --> 02:35:44,160
» Um yeah, I had a question. Um actually I

3648
02:35:40,319 --> 02:35:47,680
have a couple. So um

3649
02:35:44,160 --> 02:35:50,319
I was asked by an individual uh two

3650
02:35:47,680 --> 02:35:53,200
questions. So the first was how do you

3651
02:35:50,319 --> 02:35:54,960
plan on targeting the weight list for

3652
02:35:53,200 --> 02:35:57,760
FSWC

3653
02:35:54,960 --> 02:36:00,000
health and wellness and TVI? And my

3654
02:35:57,760 --> 02:36:05,120
second question is um it's kind of a

3655
02:36:00,000 --> 02:36:09,200
two-parter. uh like when when kind of

3656
02:36:05,120 --> 02:36:11,439
when slots open up in on July 1st,

3657
02:36:09,200 --> 02:36:14,479
uh how do you plan to target the FSW

3658
02:36:11,439 --> 02:36:18,080
weight list and kind of what's the plan

3659
02:36:14,479 --> 02:36:18,640
for addressing CI

3660
02:36:18,080 --> 02:36:21,200
» Questions?

3661
02:36:18,640 --> 02:36:23,120
» Yeah. And Lexi, I'm sorry I didn't get a

3662
02:36:21,200 --> 02:36:24,880
response out to you until this morning

3663
02:36:23,120 --> 02:36:26,720
that I'll I'll follow up with you on

3664
02:36:24,880 --> 02:36:28,800
that. I think those are

3665
02:36:26,720 --> 02:36:31,200
» Yeah, that's those are those are that's

3666
02:36:28,800 --> 02:36:32,720
a longer conversation than today and I

3667
02:36:31,200 --> 02:36:34,560
um but I can follow up with you for

3668
02:36:32,720 --> 02:36:36,160
sure. Those are good questions.

3669
02:36:34,560 --> 02:36:37,520
» Okay, thank you. Sorry, I haven't been

3670
02:36:36,160 --> 02:36:39,359
on my email so I haven't seen

3671
02:36:37,520 --> 02:36:40,960
» No, believe me, I understand. I will

3672
02:36:39,359 --> 02:36:43,040
never criticize someone for not reading

3673
02:36:40,960 --> 02:36:43,840
their email immediately. Okay, you're

3674
02:36:43,040 --> 02:36:46,000
good.

3675
02:36:43,840 --> 02:36:48,160
» Okay, thank you.

3676
02:36:46,000 --> 02:36:50,720
» Katie, you had a question. I think

3677
02:36:48,160 --> 02:36:54,600
» Is there a timeline on the updated

3678
02:36:50,720 --> 02:36:54,600
living caregiver bulletin?

3679
02:36:54,880 --> 02:37:00,160
the amended one. Yes. Um I don't have a

3680
02:36:58,000 --> 02:37:01,840
date that we will be able to issue that,

3681
02:37:00,160 --> 02:37:04,000
but we are working to get that out as

3682
02:37:01,840 --> 02:37:07,120
soon as we can. I'll let you know

3683
02:37:04,000 --> 02:37:09,040
» Soon as we have that. Thank you.

3684
02:37:07,120 --> 02:37:12,319
I was just going to ask if in the future

3685
02:37:09,040 --> 02:37:14,960
at a meeting maybe we could have um

3686
02:37:12,319 --> 02:37:16,720
conversation about choice and how that

3687
02:37:14,960 --> 02:37:18,560
since it is serving families under 60

3688
02:37:16,720 --> 02:37:21,760
and how that intersects with then the

3689
02:37:18,560 --> 02:37:24,960
beads HCBS and how someone might find

3690
02:37:21,760 --> 02:37:26,560
themselves on one path or the other just

3691
02:37:24,960 --> 02:37:28,560
since we have someone here now that can

3692
02:37:26,560 --> 02:37:29,359
speak to that I would love to to learn

3693
02:37:28,560 --> 02:37:34,040
more about

3694
02:37:29,359 --> 02:37:34,040
» We can watch that PDA video again right

3695
02:37:37,359 --> 02:37:42,560
I have one kind of um follow-up comment

3696
02:37:40,399 --> 02:37:45,200
from last uh from our last meeting which

3697
02:37:42,560 --> 02:37:47,040
I believe was our March meeting. Um at

3698
02:37:45,200 --> 02:37:49,760
that time, Holly, you had you had

3699
02:37:47,040 --> 02:37:53,359
expressed the um opportunity for NABC

3700
02:37:49,760 --> 02:37:55,760
members to provide you um and beads with

3701
02:37:53,359 --> 02:37:57,439
um claims issues from December. And

3702
02:37:55,760 --> 02:37:59,520
these were these were issues that

3703
02:37:57,439 --> 02:38:01,280
happened because no nobody did anything

3704
02:37:59,520 --> 02:38:03,920
like intentionally wrong, but there were

3705
02:38:01,280 --> 02:38:06,160
some autogenerated budgets in January

3706
02:38:03,920 --> 02:38:08,640
that then ended up where there was some

3707
02:38:06,160 --> 02:38:11,120
shortfall in December and we were having

3708
02:38:08,640 --> 02:38:14,640
difficulty finding traction to get those

3709
02:38:11,120 --> 02:38:17,600
those um legitimate claims paid. And um

3710
02:38:14,640 --> 02:38:19,439
NABC, all the members, we really

3711
02:38:17,600 --> 02:38:23,840
appreciate the way that beads partnered

3712
02:38:19,439 --> 02:38:26,000
with us to look at over 500 claims. Um,

3713
02:38:23,840 --> 02:38:27,040
and I mean, and it took a minute. I

3714
02:38:26,000 --> 02:38:30,160
don't think that you were expecting it

3715
02:38:27,040 --> 02:38:32,880
to be quite that big a number. Um, but

3716
02:38:30,160 --> 02:38:35,680
you know, a lot of members of NABC have

3717
02:38:32,880 --> 02:38:37,760
expressed to me gratitude um, for your

3718
02:38:35,680 --> 02:38:39,359
willingness to to do that. And I I think

3719
02:38:37,760 --> 02:38:41,680
that it's um, it's important. I mean,

3720
02:38:39,359 --> 02:38:43,120
you brought it up uh, two months ago

3721
02:38:41,680 --> 02:38:44,399
that you were willing to do this and you

3722
02:38:43,120 --> 02:38:46,800
followed through and we really do

3723
02:38:44,399 --> 02:38:48,560
appreciate it.

3724
02:38:46,800 --> 02:38:50,880
» No problem at all. We're all in this

3725
02:38:48,560 --> 02:38:52,080
together, so

3726
02:38:50,880 --> 02:38:54,640
through things together.

3727
02:38:52,080 --> 02:38:54,640
» Thank you.

3728
02:38:55,200 --> 02:39:01,120
Okay. Uh, next meeting July 15th here at

3729
02:38:58,399 --> 02:39:04,720
the government center in room B and BRS

3730
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Teresa Kazar um will be giving an update

3731
02:39:04,720 --> 02:39:08,720
from BRS.

3732
02:39:06,960 --> 02:39:09,680
All right. Thank you everyone. Thanks

3733
02:39:08,720 --> 02:39:12,960
everyone online.

3734
02:39:09,680 --> 02:39:12,960
» Thanks. Thanks everyone.