[0:00] All right, we're going to go ahead and
[0:00] get started. I think we're missing a few
[0:02] folks. Um, but I know with the rain and
[0:05] who knows what's going on out there in
[0:07] the parking lot. Um, I am going to go
[0:10] ahead and um do roll call and we've got
[0:14] um possibly two folks I can't see all
[0:17] the way at the end of the table who are
[0:18] joining us as new members um that I will
[0:21] have introduced themselves. But I'm
[0:22] going to go ahead. Lexi is online. So
[0:24] Lexi, I'll go ahead and um see who's
[0:27] here just because it's easier for me
[0:28] obviously being in the room. Um so Kelly
[0:31] Mitchell I know is absent, so I will
[0:33] just say absent for her. Um Dr. Jim
[0:36] Wiltz
[0:37] » Here.
[0:38] » Uh Katie Stafford Cunningham
[0:40] » Here.
[0:41] » Uh Ty Clark
[0:42] » Here.
[0:43] » Uh Lexi Westerfield
[0:47] » Here.
[0:47] » Here.
[0:48] » Uh Laura Fe
[0:50] » Here.
[0:50] » Uh Kate Barro
[0:52] » Here.
[0:52] » I always forget. Do I pronounce that
[0:54] right? Kate Barrow. Bar. Okay, that
[0:57] helps me. Sorry, I I've been pronouncing
[0:58] it wrong. Uh Kim Dodson.
[1:04] Uh Melissa Keys here. Um and then we
[1:08] have Nicole Hicks. Nicole, would you
[1:10] mind um introducing yourself and who
[1:12] you're representing?
[1:14] » Sorry. Yeah, you and if you can just
[1:16] remember to speak into the microphone or
[1:18] you'll get a yell from me just because
[1:21] uh it is if you do not folks online
[1:24] cannot hear so.
[1:26] » Sure. I'm Nicole Hicks. I'm representing
[1:28] insource.
[1:28] » Great. Can do you mind telling us just
[1:30] about yourself? I know I introduced just
[1:32] » Sure. Um uh I have four children. I have
[1:35] one with special needs. He is uh going
[1:37] to be 30 in uh November and we are
[1:40] navigating um you know the adult world
[1:43] with his uh layers that he is requiring
[1:46] which is fun. So um and I've worked for
[1:48] insource for going on 14 years. I am the
[1:51] supervisor of the north team. So I
[1:53] supervise the whole north side of the
[1:55] state. Um
[1:58] that's me. Great. Thank you. Appreciate
[2:00] it. Welcome. Um we're excited to have
[2:02] you.
[2:03] » Um let's see Derek Nord. I'm here.
[2:07] » Uh Carrie Lee
[2:08] » Here.
[2:09] » Ann Titus
[2:10] » Here.
[2:11] » Um Kim Han, I know she had messaged me
[2:13] that she was unable to make it, but
[2:15] she'll be um watching either online or
[2:16] watch the recording. And uh Jory Zulman,
[2:20] I don't think she's here. Trying to
[2:21] look. Um she is our um new family
[2:24] representative who is joining us. So um
[2:27] she might be having some traffic issues,
[2:29] but um she should be joining us. And
[2:30] I'll have her introduce herself um uh
[2:34] after she gets here. Okay, I am going to
[2:38] tee up this video. Um, and this is
[2:41] timely and I know Erin is very excited
[2:44] that I'm sharing this with her in the
[2:45] room. Um,
[2:46] » Yes, you might be too. So, uh, this, uh,
[2:49] this is Aaron Wright, um, is the, uh,
[2:51] director of, um, the Bureau of Better
[2:53] Aging. And as you guys, um, over the
[2:56] course of gosh, I don't know, eight
[2:57] months, I think, since, um, maybe a
[2:59] year, has it been a year since aging,
[3:02] um, you know, was the name change as
[3:05] well as, um, we were lucky to have them
[3:07] join the DD ARS family. So, um, I'm
[3:11] going to share the video, um, that we,
[3:13] as you guys know, over the last couple
[3:14] meetings, we've been sharing the videos
[3:16] that we created, um, about the bureaus
[3:18] that we're excited about and are great
[3:20] videos. Um, and I'm going to share this
[3:22] and then, uh, Aaron is going to, um, I
[3:26] know obviously most of you know what BBA
[3:29] is, but, they've had, um, some
[3:31] structural changes, um, nothing, you
[3:33] know, crazy improvements um, if you
[3:35] will, but just uh, in the way that BBA
[3:37] is structured. So, she's going to
[3:38] introduce some of that. So, I'm going to
[3:40] share the video and crossing fingers
[3:42] people online can hear and tech is
[3:44] working this morning.
[3:50] See, I just changed it. Hold on. And
[3:52] then they leave the room and it's not
[3:54] going to work.
[3:54] » Where's Scott?
[3:56] » Hold on. Let me see. Let me try
[3:57] something. And if not, Erin, I might
[3:58] just have you go and then we can share.
[4:00] I should have
[4:04] » Well,
[4:05] » I know, but it's not. No,
[4:08] » I can't do I know. Sorry, Erin. And then
[4:10] you're like, really? No, because then it
[4:12] it doesn't
[4:18] » I can't do that because then it
[4:20] » I know what I need to do. Hold on. Talks
[4:22] amongst yourself. Hold on.
[4:24] » I gotta I gotta hit You have to go on
[4:26] here and hit share. Share sound.
[4:34] » Says share sound. Hold on. And I didn't
[4:36] click it.
[4:39] Does anyone remember where share sound
[4:40] is? There's like a button on Zoom that
[4:42] has share sound.
[4:46] Do you know what I'm talking about?
[4:49] » Erin, just go ahead. Do you mind go
[4:51] ahead and starting and I'll mess with
[4:53] it.
[4:54] » It's there's a button on here and I just
[4:56] never remember where it is and you have
[4:58] to hit it every single time. So, I'm
[4:59] going to wait. Go ahead. I don't want to
[5:01] hold people up and have everyone staring
[5:02] at you and me as we're trying to figure
[5:04] this out. So, um I'll go ahead and uh
[5:07] just we'll work on the slides and we'll
[5:08] work on it as you're talking um you know
[5:11] just sharing about um BBA.
[5:15] » Hi, I'm Aaron Wright. I am the director
[5:17] of Bureau of Better Aging. I have been
[5:20] with aging for about eight and a half
[5:24] years. Before I assumed this role, I
[5:28] oversaw our state and federal grant-f
[5:30] funed programs for home and community
[5:33] based services, our functions as the
[5:36] state unit on aging, and also the aging
[5:39] and disability resource centers.
[5:43] So, the Bureau of Better Aging really
[5:46] works to help individuals access
[5:49] resources, supports, and home and
[5:52] community based services. We
[5:55] are designated as I mentioned as the
[5:58] state unit on aging under the federal
[6:00] older Americans act. And with that comes
[6:03] the responsibility to designate local
[6:06] organizations to really serve as focal
[6:09] points and resources for older adults
[6:11] and caregivers in their communities.
[6:15] About 67%
[6:17] of our grant funds go to these local
[6:22] area agencies on aging. We also
[6:25] administer other programs such as adult
[6:28] protective services, some limited
[6:30] guardianship programs, residential care
[6:33] assessment programs. with our transition
[6:37] to being a standalone division to part
[6:41] of the ARS. Now we really are trying to
[6:49] kind of reident re
[6:52] determine our priorities while really
[6:55] staying true to our role as the state
[6:59] unit on aging.
[7:02] Um we have gone through a recent
[7:05] restructure prior to our merger with
[7:10] DBRS. We operated very much in
[7:14] programmatic silos. So we have tried to
[7:19] restructure ourselves to better support
[7:22] the programs and services that we
[7:24] administer. We can go to the next.
[7:25] » Okay. Sorry, that's what I was trying to
[7:27] read you.
[7:28] » By
[7:30] creating a centralized program and
[7:33] policy team with provider and vendor
[7:36] relations and quality and outcomes kind
[7:38] of wrapping around those core programs
[7:41] and services that we administer. We've
[7:44] been very fortunate to be able to grow
[7:46] our team in the last couple of months to
[7:51] increase our capacity to improve the
[7:56] programs and services that we deliver.
[7:58] So this is our hidden organizational
[8:01] structure. If you had seen it before, it
[8:03] was almost like a straight line. So
[8:05] we've really tried to move towards a
[8:08] very collaborative
[8:10] integrated
[8:12] but also functional structure.
[8:15] » Next
[8:18] with our transition we are really
[8:22] focused on improving our internal
[8:26] policies and procedures. As I mentioned
[8:29] just trying to settle into our new
[8:33] identity. We are really focused on
[8:38] trying to integrate with now DDARS.
[8:43] I will say I've been very welcomed and
[8:45] supported as our we've become one of the
[8:49] four bureaus within um DDRs.
[8:54] We are um
[8:57] with our new structure really trying to
[9:00] champion
[9:02] our multis- sector plan for aging called
[9:06] age forward together. This was a
[9:09] collaborative initiative
[9:12] that's
[9:14] started and I guess was approved in the
[9:18] end of calendar year 2024. It is a
[9:22] 10-year forwardthinking plan that was
[9:26] really focused on aging within Indiana.
[9:30] It centers around age friendly
[9:32] communities, reducing barriers to
[9:35] accessing services.
[9:37] There's a focus on civic engagement,
[9:40] employment,
[9:42] volunteerism, which really ties into
[9:45] some of the work that DBRS have been
[9:48] doing with SEM and around community
[9:53] integrated
[9:55] employment. So have that collaboration
[9:58] and tie in there.
[10:01] And then another component of the multis
[10:04] sector plan for aging is around
[10:07] reframing aging and trying to combat
[10:10] agism. Not looking at aging as a disease
[10:15] or a disability but just a process
[10:18] in life.
[10:22] Um, as part of our responsibility as a
[10:25] state unit on aging, we complete a state
[10:29] plan on aging every four years that we
[10:32] submit to the federal um health and
[10:34] human services administration for
[10:37] community living. We are in the process
[10:39] of drafting our next state plan on
[10:41] aging. We currently are in the public
[10:43] comment period. So I hope um we are
[10:48] holding a series of listening sessions
[10:51] or stakeholder feedback sessions. The
[10:53] first one is today up in South Bend. We
[10:57] have one in Indianapolis next week, one
[11:01] in Evansville, and then we will be doing
[11:03] a virtual one next week as well. If
[11:06] anyone would like a copy of the state
[11:08] plan, email DA comments or let me know
[11:11] and I will send it. Um the public
[11:15] comment period ends on the 30th.
[11:21] We also have a dementia strategic plan
[11:24] and we've really been trying to focus to
[11:27] ensure there's alignment between all of
[11:29] these different plans. Um, an initiative
[11:32] that we are working on relates to
[11:36] legislation that was passed last year
[11:39] about um, conducting a study and
[11:42] preparing a report around realigning and
[11:46] consolidating the area agencies on aging
[11:48] map. Here's our current map. We
[11:51] currently have 16 different areas. These
[11:55] were
[11:57] introduced in the mid 1970s
[12:01] and
[12:02] there has not been a change in the
[12:05] structure of the map since that time.
[12:09] So we are looking at the map to see if
[12:13] there may be
[12:15] areas that can be consolidated,
[12:19] realigned to better support
[12:21] administrative efficiencies and also
[12:24] just recognizing that the landscape of
[12:27] aging and long-term services and
[12:29] supports has changed significantly in
[12:31] the last 50 years. So we're using this
[12:35] opportunity to just kind of take a step
[12:38] back and say does this structure make
[12:40] sense?
[12:42] There are federal and state processes we
[12:44] have to follow if we are going to make
[12:48] any changes to the map. There. First is
[12:52] the structure about the map itself and
[12:56] then the next part of the process is
[13:00] designating local entities to serve as
[13:05] the area agencies on aging for those
[13:08] specific service areas. So in
[13:12] redesigning the map, it's not
[13:15] really the focus is not on the agencies
[13:19] that are serving as the area agency, but
[13:22] it's really the structure of the service
[13:25] areas. Are there counties that would
[13:27] make more sense to be in an aligned
[13:30] service region? Does it make sense to
[13:33] focus more on a smaller
[13:37] urban area and change the boundaries of
[13:40] rural areas? There's a lot of
[13:43] demographic data that we're reviewing.
[13:45] We're having conversations with the area
[13:48] agencies about this. We had a dayong
[13:51] visioning session yesterday.
[13:55] Our goal is Oh, Jessica, go next. Um,
[14:00] » Hold on. Sorry.
[14:01] » Oh, that's it was just the timeline
[14:03] which is probably yeah more detailed
[14:05] than anyone wants to know, but um we're
[14:09] really focused on coming up with the
[14:11] recommendations and part of that is the
[14:15] funding formula that we'll use to
[14:17] distribute funds to each of the areas
[14:20] which has to be approved by our federal
[14:23] funer. Um, if there are any changes that
[14:26] come from this process, we wouldn't be
[14:28] looking at really implementing the
[14:31] changes with new a new structure and new
[14:35] grants to local organizations until
[14:37] October of 2018.
[14:44] » There any questions?
[14:51] » It's too easy. Were you able to get the
[14:53] video?
[14:54] » I was. And
[14:58] » Nope. Kathy's not going to let that go.
[15:01] » I have a question. Sorry, Jess.
[15:03] » Oh, yeah. Go ahead. Yeah, Lexi.
[15:05] » Um, so
[15:06] » I'll get rid of it.
[15:07] » What's going to be the BBA's
[15:09] relationship with Pathways then? Because
[15:11] I didn't hear you mention Pathways.
[15:16] » So, currently we
[15:18] » Hey, Erin. Sorry. Oh, I don't think I
[15:21] was talking to Mike at all. Um,
[15:26] in the current state, the
[15:30] we work with both pathways and beads
[15:33] related to our role as the aging
[15:36] supporting the aging and disability
[15:38] resource centers. The ADRC's have a role
[15:43] in waiting list management. So, um,
[15:47] helping with that process as well as
[15:50] really helping to navigate and support
[15:54] individuals when they have questions
[15:56] just around how does LTSS work in
[15:59] Indiana. We don't currently have any
[16:03] direct oversight or involvement in the
[16:07] delivery of pathways waiver or even the
[16:10] pathways managed care services. That's
[16:12] all.
[16:18] » Thank you.
[16:20] » Thanks, Lexi. Okay, I do have it
[16:23] working. So, hold on one second. I got
[16:24] to go back.
[16:26] Cross your fingers. Someone chatted me
[16:28] to fix it. See if it works.
[16:36] Dang it. I did what she told me to do.
[16:41] It looks like it's muted in the top
[16:42] right hand.
[16:43] » I know. I don't know if it's weird
[16:45] because then it'll then it plays from my
[16:51] » Well, I did it. I wonder if it's changed
[16:53] because I did what she told me to do and
[16:54] I
[16:55] » Primarily
[16:58] But we also provide services and
[17:02] » Fourth fifth times a term.
[17:06] BBA stands for Bureau of Better Aging.
[17:09] BBA primarily supports older adults and
[17:12] their caregivers, but we also provide
[17:14] services and supports for individuals
[17:17] with disabilities. Livestream is one of
[17:20] 15 agencies in Indiana serving as an
[17:22] area agency on aging. And as an area
[17:25] agency on aging, we provide a variety of
[17:28] programs and resources to help older
[17:30] adults live their best lives. EVA
[17:32] provides an array of services. We fund
[17:36] local agencies and support local
[17:38] communities to operate everything from
[17:42] senior centers to home delivered meal
[17:44] programs to inhome services such as help
[17:48] with bathing, dressing, cooking. Those
[17:52] services that can help older adults
[17:54] remain independent and in the community.
[17:56] Various agencies on aging such as
[17:58] liveream provide a lot of different
[18:00] services for older users. We provide
[18:03] everything from basic information and
[18:05] assistance. Where can I get energy
[18:07] assistance? Where can I get tax help to
[18:11] more involved options counseling? What
[18:13] are my options for long-term services
[18:15] and supports? Care management which is
[18:18] help coordinating those services and
[18:19] supports. There is a whole network of
[18:22] local service providers that help
[18:26] individuals wherever they are on their
[18:30] journey through long-term services and
[18:32] support. So, an individual can go to a
[18:35] senior center and get a nutritionally
[18:38] balanced meal and socialize, or an
[18:41] individual can have somebody come to
[18:43] their home and help them get ready for
[18:46] the day or take them to the doctor.
[18:48] those types of services. One of the
[18:51] things that we do is we help people with
[18:53] all kinds of resources and information.
[18:55] For example, their medications they're
[18:57] on. How can they afford them? What are
[18:59] some programs that can help them better
[19:01] afford their medications? So, we make
[19:03] sure that they are taking the
[19:04] medications their physicians have have
[19:06] ordered for them so they can manage
[19:08] those chronic conditions better. So,
[19:10] what brings me joy in my work with the
[19:12] Bureau of Better Aging is knowing on a
[19:15] daily basis that I'm making a difference
[19:18] in my community and helping older adults
[19:21] to age in the manner of their choosing.
[19:24] I feel like doing this work, I have seen
[19:26] the impact of systems and systems change
[19:29] and how we can make things better and
[19:32] how we can make the world better in
[19:34] Indiana better for older adults who want
[19:36] to age in their home and have services
[19:39] and programs available to help them do
[19:40] that. So, I think it's a win-win. The
[19:42] person gets to stay where their friends
[19:44] and the people they know are, and it's
[19:47] supporting the community.
[19:51] Awesome.
[19:57] » Thank you. I think you did a good job,
[19:59] Erin.
[20:00] » Maybe you should watch it a second time.
[20:02] » Do you want to watch it one more time or
[20:03] do you want me to freeze it for the
[20:05] entire time when you're
[20:07] um Thank you. Uh yeah,
[20:10] » So what's the age limit on the age
[20:15] living?
[20:16] So the majority of our programs are for
[20:20] individuals 60 and over. Okay. We do
[20:23] have state funded home and community
[20:25] based services program called choice
[20:27] that can serve individuals under 60 with
[20:31] disability.
[20:32] » Thank you.
[20:34] » Thank you. Okay. And if you guys have
[20:36] any questions, if you think of
[20:37] something, put it on your little parking
[20:39] lot sticker um for Aaron. She'll be here
[20:41] the whole time. Okay. I'm going to have
[20:43] Jory. Do you mind introducing yourself?
[20:45] feel like a grand entrance. No. Um Jory
[20:48] Zulman is our um we have the pleasure of
[20:51] having her as our newest family member
[20:53] representative. Um and so do you mind
[20:55] just introducing yourself a little bit
[20:57] about yourself as well?
[20:59] » You just if you can use the microphone
[21:03] » Maybe a little closer. It's kind of
[21:05] There you go. Perfect.
[21:06] » I'm Jory. Sorry I'm late. I parked at
[21:08] Idol Jore because I couldn't find it was
[21:09] so then I went to South.
[21:12] So anyway, I made it. But um I am I have
[21:15] a 47 year old brother with significant
[21:17] disabilities. Um he lives in a group
[21:19] home in Northwest Indiana, Opportunity
[21:21] Enterprises, the Sheffield House. Um my
[21:24] parents live up there. They're 80 and
[21:26] 82. Um and so just kind of three boys, a
[21:30] 21 year 21 year old and two 18 year olds
[21:32] are getting ready to graduate and a
[21:34] husband English he's an English teacher.
[21:36] I've been a special education teacher
[21:37] and social worker my whole life. So that
[21:40] » Thank you. Yeah. No, great. Thank you.
[21:42] not to put you on the spot right when
[21:43] you
[21:45] » Um Okay, we're going to move right along
[21:47] here to um Holly who will be presenting
[21:52] most of the rest of the agenda. Um
[21:54] follow along. We'll probably take a
[21:55] break. Um just as you guys know, three
[21:57] hours I need a break. Most of us
[21:59] probably do. So, um I will turn it over
[22:01] to Holly and try to follow her lead with
[22:03] her slides.
[22:07] » Thank you. Um Jess,
[22:10] » Are you guys hearing in the back? Okay.
[22:12] Okay. Because I can't tell if it's
[22:13] working or not.
[22:14] » I think it is. I think it is because
[22:16] Lexi could hear us earlier. So,
[22:18] » Doesn't feel like it's
[22:19] » Yeah,
[22:25] » Okay. Okay. I'll have them check.
[22:27] » All right. Um well, hello everyone. Uh
[22:30] good to see everybody. Um hope everybody
[22:33] made it through the rain.
[22:35] » Yes, that's good because it was raining
[22:37] quite a bit on my drive-in this morning.
[22:39] So I want to start with an update on
[22:42] case management. Um as we have discussed
[22:46] um we have waiver amendments at CMS
[22:49] right now to move to the selective
[22:51] contracting model for case management
[22:53] for the beads administered waiverss. Um
[22:57] the slide here is slightly inaccurate.
[22:59] It says preliminary awards but yesterday
[23:01] the final awards were uh notice was
[23:04] posted. So um but we had already sent
[23:06] these out. So, um, just wanted to call
[23:10] that out. Um, the, uh, final awards, uh,
[23:14] were to IPMG, Aging and Inhome Services,
[23:18] Unity, Inspire, and Columbus. Um, again,
[23:23] those are the entities that had the
[23:24] preliminary awards, and the final award
[23:26] notice went out yesterday.
[23:29] Um,
[23:32] » Does that mean, sorry to interrupt,
[23:34] you're fine.
[23:34] » Does that mean that like Those
[23:38] are the case managements
[23:41] for everyone now or is there others?
[23:43] » No, that's a great question. We're going
[23:45] to talk some through that. That means
[23:47] that as of August 1st, individuals, the
[23:51] only entities that can provide case
[23:54] management on the family support, CI,
[23:56] health and wellness, and TBI waiverss
[23:58] are one of these five.
[24:00] » I already have inspired so I'm good.
[24:01] » Okay. All right. Very good. Um but we'll
[24:04] talk through kind of that process
[24:06] because I think that's that's important.
[24:08] So um so we are moving from um slightly
[24:13] over
[24:14] uh 30 case management entities today um
[24:19] to five. So I wanted to just spend a few
[24:22] minutes um and that's meant to be
[24:24] demonstrated there with the uh the
[24:26] graphic you see. So while we are seeing
[24:28] a decrease or will see a decrease in the
[24:31] number of case management entities, we
[24:34] anticipate we will see an increase in
[24:36] the number of case managers. Um and um
[24:39] when we went to selective contracting
[24:42] before on the FS and CI um what we saw
[24:46] largely were case managers continued in
[24:48] the field. Um I think you all have heard
[24:50] me say before that was the funnest job I
[24:52] ever had.
[24:54] Kathy, don't listen. Um but um case
[24:58] management was yeah fun job. But anyway
[25:01] um it also has uh case management has a
[25:03] lot of individuals in that work that
[25:06] have a heart for what we do. Um so we
[25:09] anticipate a lot of the case managers
[25:11] the bulk of them um will continue to
[25:13] provide case management services. We do
[25:16] expect as I mentioned an increase in the
[25:18] number of case managers um as we move to
[25:21] the selective contracting because of the
[25:22] case load
[25:24] uh parameters involved in the contract
[25:27] um which is 47 no more than 47 across
[25:31] all CA an average of 47 across all case
[25:33] manage full-time case managers. So, um,
[25:38] we know that we have some, um, case
[25:41] managers currently supporting
[25:43] individuals on the health and wellness
[25:44] and traumatic brain injury waiverss that
[25:47] have pretty pretty significant case
[25:49] loads above that. So, um, that's why we
[25:52] believe we will see an increase in in
[25:54] the number of case managers.
[25:57] So, um, these five case management
[25:59] entities are um, actively recruiting. Um
[26:04] so uh if you follow any of them on
[26:06] Facebook you you will see that um so
[26:09] they are gearing up um for the um the
[26:14] change.
[26:16] So as uh Ty pointed out um everyone
[26:21] currently supported on our waiverss will
[26:23] need to choose one of these five
[26:25] entities if they have not already. Um
[26:29] and all five are going to provide case
[26:32] management statewide
[26:34] as well. If we can move to the next
[26:37] slide, please.
[26:41] So, one of the things that um we have
[26:44] already done is send a letter to
[26:46] everyone supported through those four
[26:49] home and community based service
[26:51] waiverss um making them aware of um this
[26:56] change in model coming forward and the
[26:59] uh
[27:01] case management entities that will be
[27:03] providing case management um as of
[27:06] August 1st.
[27:08] those letters um went to everyone even
[27:11] if they had a case management entity
[27:14] that currently that is one of those five
[27:17] because we again wanted to ensure
[27:19] awareness. We have also been um working
[27:22] with the existing case management
[27:24] entities um and have provided them with
[27:27] toolkits that are on our website um to
[27:30] support their conversations with
[27:33] individuals that they work with and
[27:35] their families about this transition and
[27:39] what this looks like and what decisions
[27:41] they may need to make um depending on
[27:44] their situation and what their options
[27:46] are. um that is tied to the case
[27:50] management uh monthly reimbursement for
[27:53] those current case management entities
[27:55] right now. So they have to do those
[27:57] things in order to be able to bill. Um
[28:00] and we have gotten some um positive
[28:04] feedback about how that's going. Um and
[28:08] um
[28:10] we know that some case managers are
[28:12] texting
[28:14] families with all the things we've asked
[28:17] them to to cover. Um even if for example
[28:21] if someone has um IPMG today um IPMG is
[28:29] still required to reach out to them and
[28:30] make sure they're aware of this. make
[28:32] sure they know that as of August 1st
[28:34] these are the providing entities and you
[28:38] can stay with IPMG or I can offer you
[28:41] choice of another. So, everyone, all the
[28:45] case managers are handling this in the
[28:47] same way. And we are seeing phone calls
[28:50] being made, text messages. Um, and I was
[28:53] smiling at Carrie because she was a
[28:55] recipient of one of those text messages
[28:58] um from one of her current case managers
[29:00] and um um she shared that and it was it
[29:05] was spot on. They case manager did
[29:07] exactly what we needed them to do. So,
[29:10] um, so as of now, case managers are
[29:14] talking with individuals, um, and
[29:17] offering making sure there's awareness
[29:20] and families can start choosing now what
[29:22] case management organization they want
[29:24] to go with. I do want to note that um,
[29:28] the choice list for case management with
[29:31] those five entities working across all
[29:33] the four waiverss um, will be updated
[29:36] for June 1st. So, a family may say, "I
[29:39] want provider A." Um, and the choice
[29:43] list may not be updated yet if they're
[29:44] on the family support waiver for
[29:46] provider A. So, that case manager will
[29:49] follow up with them to get them that
[29:51] choice list um come June 1st and then
[29:53] we'll move it we'll we'll move that
[29:56] situation forward.
[29:58] » Hey, Holly.
[29:58] » Yes.
[29:59] » Lexi, is your do you want to ask your
[30:01] question now? Is it really does it
[30:03] pertinent to this? Um, I'd like to ask
[30:05] you before we get too far. Um,
[30:08] » Okay. Go ahead. Go ahead.
[30:10] » So, you went over the waiverss that will
[30:14] be under these new um that will have
[30:17] these new five well not new but like the
[30:20] updated 5CMOs. Um, my question is when
[30:24] you look at the DDRS or the Ark of
[30:29] Indiana or any of those websites that
[30:31] lists like the information about it, it
[30:35] talks about um also pathways fee for
[30:39] service and money follows the person. um
[30:42] not to confuse anybody but from what I
[30:46] understood especially with pathways is
[30:48] that they weren't like case management
[30:51] uh CMOs weren't involved it was like
[30:54] through the MCE but from what I
[30:56] understand fee for service means like
[30:58] traditional Medicaid but I thought all
[31:00] pathways recipients were under an MCE
[31:03] sorry that was a lot but
[31:05] » No Lexi no that's a great question and
[31:08] you are correct um this does case
[31:11] management also does um impact the money
[31:15] follows the person. Um it also does
[31:18] include a very small number of
[31:21] individuals in pathways fee for service
[31:24] and it's a really really small number
[31:26] but those those individuals um on
[31:30] pathways fee for service operate much
[31:34] more similarly to the uh individuals on
[31:37] the health and wellness waiver today as
[31:39] an example. they actually have a case
[31:41] manager. So, um that works with them
[31:44] because they're not managed care. So,
[31:47] again, very small number. People um meet
[31:51] very specific uh detailed situations
[31:54] that that can allow them to opt into the
[31:57] managed care for pathways, but it's it's
[32:00] again it's a very small number, but this
[32:02] does impact them as well.
[32:06] » Great question.
[32:07] » Thank you.
[32:07] » Thank you.
[32:08] » Thank you.
[32:10] So, um, we are also, um, hosting meet
[32:14] and greets both in person and virtual.
[32:16] We had our first one last night in
[32:18] Evansville. Uh, we had 26 different
[32:21] families show up to that, which I think
[32:23] was really good for the first
[32:25] » That's awesome.
[32:26] » For the first one. Um, we have a virtual
[32:29] one today. Um but um those are scheduled
[32:33] and have been announced and and are um
[32:37] have been published and we are getting
[32:40] um we are getting people to attend. So
[32:43] that is that is great and we do I want
[32:46] to shout out to um our partners uh our
[32:49] external partners for sharing those as
[32:52] well um and helping us get the word out
[32:54] um to individuals and families. So, um,
[32:58] and those meet and greets, if you have
[32:59] never been to one, I will just give a
[33:01] real brief description. Each of the CMOs
[33:05] has a table there. Um, and they are just
[33:08] there to answer questions um, and for
[33:11] individuals and families to have that
[33:13] opportunity to meet them and ask them,
[33:16] you know, some of the questions that
[33:17] they would ask a case manager um, when
[33:20] they were interviewing a case manager,
[33:22] for example. So, um, and they have some
[33:25] of their swag there, too. Um, but, uh,
[33:29] but yeah, they're they're uh it went
[33:31] very well last night and, um, we got
[33:34] some positive feedback from the families
[33:36] that that attended. So, um,
[33:39] » And the virtual tonight.
[33:40] » There is a virtual today. There's
[33:42] several virtuals. Um, but the first one
[33:44] is today. I believe it's at two o'clock,
[33:46] but
[33:47] » Just make sure you're um, we put those
[33:50] out through our list serve, too. So, um
[33:53] hopefully everyone in this room is
[33:54] signed up for our list serve. Um but, uh
[33:57] make sure if you're not, you know, sh
[33:59] that's where a lot of this information I
[34:00] mean multiple ways is being shared, but
[34:02] » It's also
[34:04] » Um it's a so um I can put it in the
[34:07] chat. The uh DDRS for to get updates. I
[34:10] don't even know what it's called, a list
[34:11] serve. You can subscribe to it and then
[34:14] you get um emails with updates.
[34:17] » Yeah, I send you the link. You just need
[34:19] an email basically and it's and it's
[34:21] multiple updates. It's not just about
[34:22] beads, but um it's a good way. Yeah.
[34:25] Yeah. Yeah. And anyone can sign up. It
[34:28] doesn't have to you don't have to be in
[34:29] the way. I mean, it's just information.
[34:31] So, thank you.
[34:32] » Welcome.
[34:34] » And we are keeping um updated
[34:36] information on the waiver reset page
[34:38] that has all this information about case
[34:40] management as well. So, um, we do have
[34:44] to because case management is a required
[34:47] service for HCBS, we do have to ensure
[34:49] there's a case manager
[34:52] from one of those five entities on board
[34:54] with every single person August 1. So,
[34:58] if individuals and families have not
[35:00] made a choice by July 15th, we will auto
[35:03] assign them. Um, they will retain the
[35:06] ability to make a choice after August
[35:08] 1st, right? if they want to go with
[35:10] someone else, that's that is absolutely
[35:13] um fine, but we need to make sure that
[35:16] there's a case manager in place on
[35:17] August 1. So, if a choice hasn't been
[35:20] made by the 15th after, you know, our
[35:24] efforts, um we're sending additional
[35:26] letters out in May, we'll be making
[35:28] phone calls to people who do not make a
[35:30] choice. Um then we will auto assign.
[35:35] We are um monitoring on a weekly basis
[35:38] the movement um of individuals who need
[35:41] to make a change in case management um
[35:44] by July 15th. Um we are monitoring that
[35:47] on a weekly basis. Um as you can imagine
[35:50] right now there hasn't been a lot of
[35:52] movement. There's been a some
[35:53] individuals who have have made a choice
[35:55] already to um to change um but we still
[36:00] um the bulk have not. We anticipate
[36:03] we'll see a spike due one because those
[36:05] conversations are being had now.
[36:07] » Have caps.
[36:08] » I'm sorry.
[36:09] » Do any of the providers have caps? Like
[36:11] we can only take so many.
[36:12] » No.
[36:13] » Okay.
[36:13] » No, they in fact that is part of the
[36:15] contract. They have to be positioned to
[36:17] accept uh individuals. Yep.
[36:20] » On a statewide basis.
[36:23] » Yeah, good question.
[36:26] Next slide, please.
[36:31] So the other thing that we are
[36:33] introducing in this um contract uh for
[36:38] the case management is our value based
[36:41] payment or value based purchasing. Um
[36:44] what that essentially means is that
[36:46] we're um
[36:48] going to be paying for certain outcomes
[36:51] with case management. This is just I I
[36:54] want to reiterate this. This is just the
[36:56] beginning. It's pretty basic as you can
[36:58] tell. It's um pretty complianceoriented
[37:02] at this point on um timely completion of
[37:05] the PCISPs and the level of care um
[37:10] completion or timely completion on
[37:12] incident reporting and responding to
[37:14] CAPS. um that uh for followup, mortality
[37:19] review, case load size um and then
[37:22] trainings for case managers outside of
[37:26] state state trainings included with
[37:27] that. So again, this is a start u for
[37:30] the first uh contract year. Um but we
[37:34] will be growing that uh element in case
[37:38] management as we move forward.
[37:40] » Yes. So m maybe this can go on the
[37:42] parking lot um and be addressed at an
[37:45] future meeting. I would love to see what
[37:48] those value uh services, value added
[37:51] services are and what your expectations
[37:54] are for those quality indicators just as
[37:57] part of that advisory piece so we have a
[38:00] good idea of what to look for.
[38:01] » Sure.
[38:02] » Especially when our our constituents are
[38:05] calling us and asking questions.
[38:08] » No, that's great. question.
[38:11] » Yes.
[38:11] » So,
[38:13] you guys know I I'm Ty Clark, but I have
[38:16] a disability, but
[38:19] I have struggled with case management
[38:21] issues
[38:23] for the past
[38:25] seven years, I think. I don't know how
[38:28] long, but I have a new case manager.
[38:31] She's sweet. But what I struggle with is
[38:34] when a case manager takes my case and
[38:39] then it becomes too stressful or
[38:42] whatever,
[38:44] they drop me and then I have to have
[38:47] someone fill in. So that's frustrating.
[38:50] So does this mean like they need to
[38:56] what would happen if they keep doing
[38:58] that?
[39:00] » Yeah, I think that's a good question. we
[39:01] can kind of talk about specifics. Um,
[39:04] but you know, ultimately, um, when
[39:07] individuals or families receiving case
[39:09] management services have concerns,
[39:11] similar concerns, what we want them to
[39:14] do is reach out to us and we will work
[39:15] with them on an individual basis.
[39:18] » Sounds good to resolve.
[39:19] » I I met my new case manager at my last
[39:22] quarterly meeting. Um, I had to do the
[39:28] waiver reset stuff. So, the questions
[39:31] were very personal and I kind of like
[39:34] didn't like them because my mom used to
[39:37] do them, but I have to sit in that. And
[39:41] Darlene and I were playing with my
[39:43] Neidato and it helped me calm down, but
[39:47] I was like very emotional and frustrated
[39:51] because
[39:54] of the questions they had to ask. I
[39:56] didn't really like them cuz they were
[39:59] too they were like
[40:03] personal too personal and I felt like
[40:09] I yes I struggle with things on a daily
[40:12] basis like depression and anxiety
[40:16] and mental health but it's like
[40:20] I don't think every time they need to
[40:23] ask that cuz that
[40:25] makes me feel a certain way and I feel
[40:30] like it's it puts me it sets me back
[40:34] basically.
[40:35] » Okay,
[40:37] » Thanks for sharing that. I think I know
[40:39] what you're referencing.
[40:41] » Thanks.
[40:43] » It is good feedback. Um
[40:46] so with regard to the uh value based
[40:49] purchasing or value based payment um
[40:52] like I mentioned there these are and to
[40:54] your point Kate these are very much
[40:57] compliance as we move forward um with
[41:03] this model of case management across all
[41:05] our waiverss. We will be looking at how
[41:07] to infuse more quality measures over and
[41:10] above just mere compliance. Right? So,
[41:14] um, did want to note that. All right,
[41:17] next slide.
[41:19] » Can I ask one more question? U, just as
[41:22] a recommendation, when it comes to those
[41:24] valuebased uh, payments and those value
[41:26] based services, how is the department or
[41:30] the division planning on um,
[41:33] communicating those to our community
[41:36] members who are receiving services? So
[41:39] there's a broad understanding of what
[41:42] value based services means
[41:45] » Because I think that could mean a lot of
[41:46] things to different people.
[41:48] » It can it boils down to the metrics that
[41:50] are that are being used to incentivize,
[41:54] » Right? So yes, and this is again sharing
[41:58] that we don't have I mean we have some
[42:01] of this data but starting fresh August
[42:03] first when we're talking about sorry
[42:06] when we're talking about a much larger
[42:09] um pool of individuals with varying
[42:12] needs um the data may look a little
[42:14] different than it does today. So we will
[42:16] be sharing that that information with
[42:18] this committee
[42:19] » Just how that it it is
[42:22] » Good these like you said are compliance
[42:25] focus and I get it and I think I'm not
[42:27] suggesting that these don't have a
[42:30] I don't want that problem
[42:32] » Sure
[42:32] » But it's it's a bit different this is
[42:34] about pushing providers to to be very
[42:37] and I think that's a really good thing
[42:39] » It's a good opportunity though to test
[42:42] some internal processes
[42:45] um how do you communicate this out to
[42:47] individual people receiving services
[42:50] » Because if this is step one where I
[42:53] would imagine some of these value based
[42:55] will be much more about individual
[42:57] potenti I'm assuming individual outcomes
[43:00] um that's going to affect them much more
[43:03] acutely than you know u training of case
[43:06] managers and I I realize that that
[43:08] affects but it's just it the
[43:10] responsibility the impact is felt far
[43:12] more so this might provide a good kind
[43:14] of a low entry way to how do we
[43:17] communicate this and get this message
[43:18] out because two or later on to a value
[43:23] base that's really about needing a
[43:25] service
[43:26] » Right
[43:26] » I'm already in the house so just just a
[43:29] thought
[43:30] » No I no I appreciate that Derek and I
[43:32] think we are completely aligned on that
[43:34] right this is our first kind of foray
[43:36] into it it's very basic it's very
[43:38] compliance driven but
[43:42] we will grow that right like we have to
[43:44] grow our system to be able to to really
[43:47] look at what quality measures are
[43:49] important, true quality, and how do we
[43:52] measure those and then how do we
[43:54] incentivize providers, case managers or
[43:56] whomever, right? To
[44:00] um to provide high quality services that
[44:03] results in the outcomes that people are
[44:05] needing.
[44:05] » Yeah.
[44:06] » Right. Yeah. I feel like this is
[44:09] something we'll be talking about more um
[44:12] because we have um identified as part of
[44:15] waiver reset that we really want
[44:18] » To be more focused on the outcomes of
[44:21] services and supports for people. What's
[44:23] really meaningful? Are people getting
[44:25] something meaningful from our services?
[44:27] And what what does that look like? And
[44:31] how do we how do we you know pat those
[44:34] providers on the back that are doing
[44:36] that, right? that are resulting in the
[44:38] outcomes. Yeah. Yep.
[44:42] » Yes.
[44:43] » Do you need to like literally go like
[44:45] this? I mean, how close do like how
[44:47] close? Okay. So, dearly, you guys
[44:49] literally have to be up on this cuz it's
[44:52] not I don't know. People are texting and
[44:55] messaging me that they're not hearing
[44:57] you guys. I don't know. They're telling
[44:59] me it's working. So, I mean, I would
[45:00] just get up into the microphone. They're
[45:03] hearing you, but I don't know. So, um,
[45:06] but yeah, I would just talk as direct as
[45:08] you can into it. I know it's kind of
[45:10] annoying. Um, but just not as productive
[45:13] because I think it's multiple people are
[45:14] messaging me that they can't hear. So,
[45:16] trying to fix it.
[45:18] » So, be very love the microphone today.
[45:21] Okay.
[45:24] » Love it.
[45:27] » Hopefully no one's sick of that.
[45:30] » What you do? What' you say?
[45:32] » Yeah. Love that microphone.
[45:35] » I mean, I have a loud voice, so I don't
[45:36] have that problem.
[45:37] » Yeah.
[45:37] » Okay.
[45:37] » All right. Let's go ahead and move the
[45:39] next slide, please.
[45:41] » All right. Um, want to spend some time
[45:45] around level of care in our uh
[45:47] assessment tools, but want to start with
[45:51] just some level setting on level of care
[45:54] requirements for ICF, right? Um, this is
[45:58] not new. This is in federal code. um we
[46:03] address it. We define developmental
[46:05] disability in Indiana code um but wanted
[46:09] to review it um because and again stress
[46:11] that has not changed. We have not
[46:13] changed the eligibility requirement. So
[46:16] that is an intellectual developmental
[46:18] disability um or related condition that
[46:22] manifests before the age of 22
[46:25] that is likely to continue indefinitely
[46:28] um and then results in and this is key
[46:31] here substantial functional limitations
[46:33] in three of six major life areas that's
[46:36] mobility um self-care understanding and
[46:39] use of language learning self-direction
[46:42] and capacity for independent living. So
[46:45] again, that has not changed. Um, but
[46:48] wanted to include that here. Um, because
[46:50] I do think sometimes there is um some
[46:54] confusion around if a person has a
[46:58] developmental disability,
[47:01] they meet level of care. And that's not
[47:04] that's not accurate. There has to be
[47:06] » It's not completely true because
[47:08] everyone
[47:09] has different levels.
[47:11] » That's true. That's true. Right. And
[47:13] it's really about functional need,
[47:15] » Right?
[47:16] » Yep. Good point. All right, next slide.
[47:20] No, you're fine. You're fine. Just use
[47:22] the microphone. Okay,
[47:24] » I will.
[47:25] » Love it. Love it.
[47:27] » Love it. Goodness.
[47:31] » Um, so I did want to provide an update,
[47:34] a bit of an update. So um we have of
[47:38] course implemented new tools to assess
[47:40] individuals for ICF level of care from
[47:43] the enter suite of instruments which is
[47:46] also used for assessing nursing facility
[47:49] level of care different tools in that
[47:52] suite of instruments but but tools um
[47:55] all from the same suite um and all from
[47:59] interi
[48:00] right now we are using those tools it's
[48:04] the um interi DD for adults, the interi
[48:11] chime DD for youth for and 4 to 17 and
[48:16] then the inry early years um for 0 to
[48:20] three or through three. Right now we use
[48:24] those tools for eligibility reasons,
[48:28] right? But future state they will be
[48:31] used um in support of the design of the
[48:34] support level framework. So um way way
[48:38] back way back to waiver redesign uh one
[48:42] of the things that we've heard very
[48:44] consistently from individuals and
[48:46] families is around the you know multiple
[48:48] assessments right um
[48:52] every time they turned around they felt
[48:55] like they were having yet another
[48:56] assessment. Maybe it was for
[48:57] eligibility, maybe it was for level of
[48:59] service, maybe it was for
[49:02] allocation, all kinds of different
[49:04] reasons. So, um, one of our goals was,
[49:08] um, to reduce the number of assessments
[49:09] that people have to quite frankly
[49:12] endure. Um, we can't we have to reassess
[49:15] level of care every year, but it's once
[49:18] a year. So,
[49:20] um, so these are the um, currently used
[49:23] for eligibility will be used in design
[49:24] of the support level framework. We'll
[49:26] talk a little bit more about that today.
[49:29] Um, I do want to note the ICF ID level
[49:33] of care assessments you utilization of
[49:35] those three tools I mentioned must be
[49:38] done in person.
[49:41] That is how assessors have been trained.
[49:43] Um, that is the expectation that they
[49:46] are done in person engaging with the
[49:48] individual.
[49:50] Um it is possible that uh
[49:56] the assessor who has been trained. Um
[50:01] there may be gaps if they're meeting
[50:03] with the individual and in or things
[50:05] that they want or need to verify and
[50:08] they may reach out to, you know, a
[50:10] direct support staff perhaps that knows
[50:12] the person or a family member that knows
[50:15] the person. Um, but that individual
[50:19] needs to be engaged and I think that's
[50:20] what you were referencing a moment ago
[50:22] is that you you sat and answered a lot
[50:25] of questions, right?
[50:26] » Yeah, it was with my team, too. So, like
[50:29] I I prefer to do it on my quarterly
[50:31] meeting because then they get to
[50:34] understand everything that I do,
[50:37] » But it I didn't like it.
[50:39] » Yeah. So um to your point there are
[50:42] these are very comprehensive tools and
[50:44] they are used um every question is not
[50:47] related to eligibility. Right. Right.
[50:51] » But they are related to the individual's
[50:53] needs and can support the team taking a
[50:56] more holistic approach about what are
[50:58] what what does Holly really need? Um and
[51:02] how can we connect her whether it's
[51:05] » Sister?
[51:06] » Yeah. whether it's waiver services or
[51:08] something different like
[51:11] um energy assistance,
[51:13] » Right,
[51:14] » Or repair affair for some home repairs
[51:17] that need to occur. So um so they're
[51:19] very comprehensive. Um they really
[51:21] should be administered more as a
[51:23] conversation than just a a whole list of
[51:26] questions. Um so we continue to work
[51:29] with assessors on um best practice um
[51:33] with those assessments. But to your
[51:36] point, individuals can choose to have
[51:38] other people present during the
[51:41] assessment, but it is not required. So
[51:44] sometimes those personal questions
[51:47] may feel a little easier to answer if
[51:50] it's just the assessor and
[51:52] » Definitely with like other people
[51:54] surrounded me, it made me feel better.
[51:58] But like my mom's my legal guardian and
[52:01] so
[52:03] I prefer to have her there too
[52:05] sometimes. It's just we all feel about
[52:10] our moms.
[52:11] » We but heads but it's like I love her
[52:14] but it's just what it is.
[52:20] » Kind of bouncing off um what Ty was
[52:23] talking about. Um, so
[52:27] I'm hearing you say if there's like gaps
[52:30] that a DSP or a family member might be
[52:34] reached out to. Um,
[52:37] excuse me, my throat got scratchy. I
[52:39] just want to um like make sure that when
[52:44] those conversations are being had with
[52:45] the family member of the DSP that if the
[52:48] individual wants to be included, they
[52:51] should definitely be asked first if they
[52:53] want to be included because they don't
[52:55] feel like things like that should be
[52:57] talked about without the individual just
[53:00] in case the individual kind of disagrees
[53:02] with what
[53:03] » The DSP or family members view is. They
[53:05] don't want inaccuracies
[53:08] um from because we our lived experience
[53:10] we know ourselves best right so yeah
[53:13] » You are absolutely right Lexi absolutely
[53:16] and those
[53:17] » Assessors whether that's a beads staff
[53:20] or a case manager should um would always
[53:24] be expected to make sure that's okay
[53:26] with the individual that they talk with
[53:28] someone else about them right or that
[53:31] they're actually engaged in that
[53:33] conversation. Absolutely.
[53:36] » Mine was with my case manager. So,
[53:38] » Yes.
[53:39] » Yeah, there's there's a reason um we uh
[53:43] have continued for uh with case managers
[53:46] doing those level of care assessments
[53:48] um for ICFID and and a lot of that is
[53:51] because those case managers know the
[53:53] individual, right? Um and um
[53:59] the expectation would be that there's
[54:00] some if something doesn't kind of ring
[54:03] true in that assessment that that case
[54:05] manager would be like, "Oh, I might we
[54:07] need to delve into that a little bit
[54:09] more in this conversation to make sure
[54:11] we're getting accurate accurately
[54:13] capturing things."
[54:14] » Can I just go on?
[54:17] » Okay. Um and apparently I was the
[54:20] problem here with the speaker with the
[54:21] microphone. Sorry everyone. Um
[54:24] this tool is being used for eligibility.
[54:28] It its intention is also to be used and
[54:30] maybe it already is um for the the kind
[54:33] of level of care as well. So I I I'm
[54:36] looking at these somewhat separately but
[54:37] I there and I realize they overlap. Is
[54:39] that help? Correct me because I'm
[54:41] looking at you right now and you're
[54:42] » So apparently you're it's better. So
[54:44] you're
[54:46] » Good job loving the microphone
[54:47] » Because I was pushing I was turning it
[54:48] off. Sorry.
[54:50] » Good job. Sorry, it says push. I pushed
[54:53] the button.
[54:54] » I did that one time, too, and then I'm
[54:56] like, "Oh, great. You don't push
[54:58] » This." It was really you.
[54:59] » It was I was the problem.
[55:01] » So,
[55:02] » All Derek's fault.
[55:04] » And I'm going to try to answer that, but
[55:06] I may not. Let me know if I don't answer
[55:08] your question. When I talk about
[55:10] eligibility and level of care, I'm kind
[55:12] of lumping those together. Okay? Right.
[55:14] level of care is the requirement that
[55:17] has to be met or the threshold that has
[55:19] to be met to be eligible for home and
[55:21] community based services.
[55:22] » Uh so elgo level how about that? Oh so
[55:26] so I'm sorry. So so at this point this
[55:29] isn't being folded into that but the
[55:32] intention the intention is to go that
[55:34] direction. So, so that that's one thing
[55:37] I wanted just to get out there and make
[55:38] sure I was So, then I think my my
[55:41] question is really about what we were
[55:42] just kind of talking about and and I
[55:45] think it the concerns that was expressed
[55:48] about these are very private questions.
[55:51] Um, and then the involvement of family
[55:54] members or just the individual
[55:56] themselves, they have they should have
[55:57] the right people should have the right
[55:59] to just be them answering the questions.
[56:01] I I so I'm going to just um share a
[56:04] concern that was brought to me yesterday
[56:05] by a family member and it was really a
[56:07] question about you know a person's their
[56:09] own guardian and they didn't want any
[56:11] family there. that's they're right and I
[56:12] I point that um but their concern was
[56:17] was the anere were the answers correct
[56:19] right or were they accurate and and I
[56:21] think some of the social potential
[56:23] social
[56:26] I think it's very common for anybody in
[56:29] being asked very private questions to
[56:31] not if be it in a doctor's office and
[56:33] I'm sure some of these processes to
[56:36] maybe not be truthful because of the
[56:38] some of the social pressures related to
[56:39] that and talking to a stranger so it's
[56:41] totally totally makes sense depending on
[56:42] how intimate those questions are. But so
[56:45] I just wonder how that's being how that
[56:48] affects the elbow level if somebody's
[56:50] really not comfortable answering that
[56:51] question. So maybe they'll answer it in
[56:53] a more socially acceptable way. Um and
[56:56] what's the consequence of that and is
[56:58] this something that we need to help
[56:59] people truly understand if there is a
[57:02] potential consequence with and the
[57:04] consequence being an elgo level that
[57:06] maybe doesn't represent their need is
[57:08] really you know maybe it's at a
[57:09] different level. So, I don't know if we
[57:11] have to we don't have to solve this.
[57:12] Maybe this is on um on a parking lot
[57:15] issue, but I think it's one of those big
[57:17] topics that's worth us kind of
[57:19] struggling with because it's going to as
[57:21] that becomes a greater um uh gateway to
[57:25] the levels of support or the types of
[57:27] supports that you're able to access. We
[57:30] need to make sure that's as accurate as
[57:31] possible and that people are comfortable
[57:33] sharing that their private information.
[57:36] » Um it that's uncomfortable at times. So
[57:39] anyway, that's all
[57:41] » I I think what I'll add and um just to
[57:46] step back a little bit is
[57:49] that
[57:51] prior to the utilization of this suite
[57:55] of assessments, the level of care
[57:58] conversation was a very basic level of
[58:01] care conversation merely to establish
[58:04] that minimum threshold for eligibility.
[58:07] We didn't get into a lot of these other
[58:10] conversations about what ultimately
[58:13] lends itself to the service planning
[58:15] piece. We're asking those questions now.
[58:17] And I think those are helpful for
[58:22] the team. I think it's also helpful for
[58:25] us as a system to to Holly's earlier
[58:28] point, minimize the number of encounters
[58:30] that people have to have those kinds of
[58:33] conversations with us. Um but I do think
[58:36] it's an adjustment for people who have
[58:38] been used to that annual um routine of
[58:42] the level of care conversation and the
[58:45] service planning being an entirely
[58:47] different conversation that we have.
[58:50] They're completely in our system today
[58:52] very separate processes. There's maybe
[58:55] some overlap. Um but it has to be to a
[58:59] certain extent
[59:01] previously very disjointed in the way in
[59:03] which those conversations unfolded. Now
[59:06] it does probably feel like now I'm
[59:10] unpacking everything all at once and
[59:13] that is certainly I think an adjustment
[59:14] for people. Um but hopefully as as the
[59:18] system
[59:20] evolves in this waiver reset space and
[59:22] people see how that information is being
[59:26] utilized um both from the eligibility
[59:28] standpoint but also to Holly's point in
[59:30] the service planning. We now don't have
[59:33] to come back to them and have another
[59:37] engagement around le the service
[59:39] planning unless there's a change unless
[59:41] something it looks different than it did
[59:43] before then yes. Um, so I do think this
[59:47] is a maybe a little bit of a culture
[59:49] shock or a shock to the system for
[59:51] people to be like, there's a lot of
[59:53] questions here. Um, and I and I do think
[59:56] that that's um
[59:59] the new norm. Um, I think for for lack
[1:00:02] of a better term, as people adjust to um
[1:00:06] the types of questions being asked, I
[1:00:09] think to your point, it's up to us to
[1:00:11] also educate people as to why there's
[1:00:14] value in engaging in that and being
[1:00:17] authentic and honest in in what's
[1:00:19] working, what's not working for the
[1:00:21] person. um so that we don't have to come
[1:00:24] back again or circle back on those areas
[1:00:26] where they felt I have to be socially
[1:00:28] acceptable in my response or I have to
[1:00:30] answer this because I really like my
[1:00:32] team and I don't you know I don't want
[1:00:34] to let them down so I better uh they've
[1:00:36] been helping me with this particular
[1:00:37] area so I better tell people I can do
[1:00:39] this now even though maybe I can't.
[1:00:41] Those types of things I think are things
[1:00:42] that we're um just going to have to be
[1:00:45] um supportive to our assessors in
[1:00:48] navigating and making sure that the
[1:00:51] information that we're we're gathering
[1:00:53] has um is valid and that we have other
[1:00:57] ways to either triangulate some
[1:00:59] information or tell us that what we're
[1:01:01] hearing is is accurate. But um certainly
[1:01:04] I think we're just we're in a bit of a
[1:01:07] growing space right now as far as how
[1:01:10] people are adjusting to how that
[1:01:13] assessment just looks and feels
[1:01:14] different than what we've been used to.
[1:01:16] » Well, and I think I think it's I think
[1:01:18] the culture changes. Yes, absolutely.
[1:01:20] And I think that's a big change and
[1:01:24] but the connectivity of these of this
[1:01:27] exercise with the not just eligibility
[1:01:29] but the algo level is essential and I
[1:01:32] think connecting it is I so this is such
[1:01:34] an important role and I I I I think it
[1:01:37] makes sense and I think it's a really
[1:01:39] important direction especially if the
[1:01:41] int as the intention is to be to
[1:01:44] actually get services that people need
[1:01:45] when they need it rather than saying and
[1:01:47] this is what you get because we ask you
[1:01:49] these these questions and sorry, I don't
[1:01:51] know if you need it or don't. So, I
[1:01:53] think I think that is spot on and I
[1:01:56] think this is part of that evolution and
[1:01:58] I think for all of us, I think the
[1:01:59] culture change we need to help folks
[1:02:01] » And I'm loving the microphone. Um it um
[1:02:05] I think also to keep in mind
[1:02:08] particularly the I mean for the
[1:02:11] intellectual developmental disability
[1:02:13] side
[1:02:15] what we've been doing is assessing for
[1:02:18] most people for that family support
[1:02:19] waiver which service planning is
[1:02:24] not absent from that but
[1:02:27] you get a certain amount of money and
[1:02:28] that's the allocation. And so the focus
[1:02:31] on gathering information to build out
[1:02:34] sort of the service array and supports
[1:02:35] that somebody would need um I don't
[1:02:38] think there's the right amount of
[1:02:39] attention being placed on it because of
[1:02:42] the way in which that waiver is been set
[1:02:44] up to serve as many people as we
[1:02:47] possibly can with what money we have and
[1:02:48] that's doesn't lend itself to good
[1:02:51] service planning discussion as part of
[1:02:54] that level of care. Right? So I I think
[1:02:56] that we'll get to a better space um for
[1:02:59] for those folks who maybe this is a
[1:03:01] feels very new because we're getting
[1:03:03] we're getting definitely into more of
[1:03:05] the nuts and bolts of their lives than
[1:03:07] we were previously.
[1:03:08] » Sorry. I think oh Tia I was gonna say
[1:03:11] one thing that struck me when you said
[1:03:13] it's not so much maybe I mean your
[1:03:17] experience of what you were asked which
[1:03:18] I'm not but maybe better preparing you
[1:03:21] right like I think that's what I heard
[1:03:23] too is I think may and I'm not saying it
[1:03:25] wouldn't have made you uncomfortable I
[1:03:26] don't mean to say that but I think
[1:03:27] sounds like you weren't prepared
[1:03:29] necessarily to know so I think going in
[1:03:33] maybe that's just something we're and I
[1:03:34] think you should have been I'm not but I
[1:03:36] think it should because if you were I
[1:03:37] think maybe you wouldn't have been I'm
[1:03:38] not saying you wouldn't have been
[1:03:39] uncomfortable I'm just saying this is my
[1:03:41] first assessment I ever sat in on. And
[1:03:44] that's the thing like my mom would use
[1:03:48] » It. Still if you were better prepared,
[1:03:49] you know what I mean? To have a
[1:03:50] conversation. Hey, this is because I
[1:03:52] think then you would have maybe know
[1:03:54] known more of hey I don't want this
[1:03:55] person here or not. So I think it just
[1:03:56] that's what I hear too is I think you it
[1:03:59] would have helped to make sure you know
[1:04:00] we want to make sure people are
[1:04:02] supported and knowing what's going to
[1:04:03] happen. I guess
[1:04:04] » Greatly supported. It's just I didn't
[1:04:07] like the questions. It made me feel
[1:04:09] really uncomfortable.
[1:04:11] » Okay.
[1:04:11] » And and I just
[1:04:13] » Yeah, that's fair.
[1:04:14] » I just felt like they were prying into
[1:04:17] my daily life, which they need to know
[1:04:20] how I feel and stuff, but like one
[1:04:23] question was like, "How's your
[1:04:25] relationship with your family?" I said,
[1:04:27] "It's poorly because one, me and my mom
[1:04:29] don't get always get along and I
[1:04:32] struggle with that like
[1:04:35] She nitpicks and then like I snap or get
[1:04:39] an attitude and
[1:04:40] » But I think maybe knowing
[1:04:42] » I go to zero and 100 and I'm like wait I
[1:04:46] shouldn't have done that but I
[1:04:47] apologize.
[1:04:47] » Yeah. Yeah. But maybe under helping you
[1:04:49] understand why those are being asked
[1:04:51] because I think because sometimes I
[1:04:52] think if we're just going and I'm not
[1:04:53] saying this is what happened but if I
[1:04:54] just go in and I start with a list like
[1:04:56] Holly said it shouldn't be hey Ty do you
[1:04:59] know do you like your family? I'm not
[1:05:00] saying that's what happened, but I think
[1:05:01] to know why we're asking it because I
[1:05:04] think if if you don't and I'm not I
[1:05:06] think if I was me too and someone just
[1:05:07] started asking me questions, I'd be
[1:05:08] like, "What the heck? Why?" But I think
[1:05:10] to know why you're being asked that it's
[1:05:12] not here's why. And I think that's
[1:05:15] probably not always happening.
[1:05:16] » Yeah, I would like that because honestly
[1:05:18] then I'd be okay like answering, but
[1:05:22] still it's going to be a struggle for me
[1:05:23] to do.
[1:05:24] » I'm not saying it's not going to be
[1:05:25] uncomfortable, but it might better give
[1:05:26] you a sense of why it's being asked,
[1:05:28] » Right?
[1:05:31] Sorry.
[1:05:31] » Yeah.
[1:05:32] » Yeah.
[1:05:32] » Uh I think she had a question over
[1:05:34] there.
[1:05:34] » Thank you so much.
[1:05:36] » You're welcome.
[1:05:36] » We have to finish.
[1:05:38] » You know, I'm not ignoring you, right? I
[1:05:40] just need to finish.
[1:05:41] » I know.
[1:05:42] » So, and
[1:05:45] » It's just to Jessica's point was all I
[1:05:46] will be I will be so brief if if that's
[1:05:48] okay. And then you can move to wherever.
[1:05:51] » Um I'm I'm gonna go ahead. I'm sorry. Go
[1:05:53] ahead. Um, so I think this points to a
[1:05:56] couple of things that we see at the
[1:05:58] council. One is that advanced
[1:06:00] preparation and is really a support tool
[1:06:03] for people with ID, but also as a
[1:06:06] sibling who has and a parent who's
[1:06:08] navigating this system.
[1:06:10] » I've seen the communications that come
[1:06:13] and they are very thorough,
[1:06:16] » But also it's not necessarily plain
[1:06:19] language and it's definitely not easy
[1:06:22] read. And so maybe uh one recommendation
[1:06:27] is to work with a group of self-
[1:06:29] advocates um who can help put materials
[1:06:33] into plain language and easy read using
[1:06:37] images. Um you know that's I think
[1:06:40] that's going to help a lot of people
[1:06:42] better understand and prepare for what
[1:06:45] is in that tool. And also I would if
[1:06:49] it's possible maybe a peer-to-peer
[1:06:52] training or if if people are more
[1:06:56] comfortable answering those types of
[1:06:58] very personal questions uh with a peer
[1:07:01] rather than their I mean if there's a a
[1:07:05] poor relationship with the case manager
[1:07:08] or any other team members
[1:07:10] » Then I can see how any any way you
[1:07:14] deploy that
[1:07:15] » Tool is not going to be well received.
[1:07:18] So, if there's a way to have a peer
[1:07:21] relationship that helps somebody prepare
[1:07:23] to answer those regardless of the
[1:07:26] relationship with the case manager, um
[1:07:29] that might be another tool, another
[1:07:32] approach to supporting people.
[1:07:34] » Um I know you probably can't have a peer
[1:07:38] conduct or deploy that instrument with
[1:07:41] that person.
[1:07:42] » It has to be the case manager. Um, but I
[1:07:45] think letting individuals know what
[1:07:47] their rights are if they want a friend
[1:07:49] with them when they're answering. I
[1:07:51] think that's a very reasonable thing to
[1:07:55] communicate to people.
[1:07:56] » And then they can also help communicate
[1:08:00] with seeing how they're doing too, you
[1:08:04] know, like maybe they are struggling.
[1:08:06] And like I struggle every day, but like
[1:08:08] I it's just it's hard to answer those
[1:08:12] questions
[1:08:14] personally when I just answered them
[1:08:18] like truthfully. Like you do have to
[1:08:21] answer them truthfully cuz like if you
[1:08:24] don't then it butts you bites you in the
[1:08:26] ass at the end. But
[1:08:29] I mean I I just it's just whatever. Um
[1:08:34] to your point who spoke whoever spoke
[1:08:36] before Tilly um
[1:08:38] » And now I can't remember oh uh not to
[1:08:41] speak for the whole SAI board but I
[1:08:43] think like the peer-to-peer or creating
[1:08:46] documents in plain language is something
[1:08:49] that um you who um somebody could
[1:08:53] approach self- advocates of Indiana on
[1:08:56] as a board um because you know that's
[1:09:01] something you know We we do and
[1:09:05] typically and we're not to not to brag
[1:09:08] but we're pretty good at it. So we're
[1:09:10] you know not to speak for the whole
[1:09:12] board SAI board but I think typically
[1:09:15] we'd be willing to help with things like
[1:09:17] that to an extent. So
[1:09:19] » Okay go ahead.
[1:09:20] » Thanks. Um I agree the preparation is is
[1:09:25] really huge um because some individuals
[1:09:28] are having assessments for different
[1:09:29] systems. Um, just an example, I we
[1:09:32] getting my son reevaluated at school and
[1:09:34] we were sent I was sent an email from
[1:09:36] the school psychologist who I had never
[1:09:38] talked to and she said, "Please complete
[1:09:39] this eval this evaluation, whatever."
[1:09:42] And it was almost 200 questions that I
[1:09:45] was really emotional answering at the
[1:09:47] end because I was not prepared to answer
[1:09:49] 200 questions about his deficits at that
[1:09:51] moment. And so I think the preparation
[1:09:53] is key and I I'm encouraged that case
[1:09:56] managers are being told to do these
[1:09:59] things conversationally because I think
[1:10:00] that's different and having a
[1:10:02] conversation where it is tough to still
[1:10:04] answer those questions but I'm not faced
[1:10:06] with
[1:10:06] » 200 questions of the same thing over and
[1:10:09] over. So I think that that preparation
[1:10:12] will be helpful. And again, and I think
[1:10:14] we've talked about this in other
[1:10:15] meetings for different things, like
[1:10:16] setting the expectation of knowing what
[1:10:18] they're walking into when they're doing
[1:10:19] it because for that school evaluation,
[1:10:22] that wasn't it. Um, and it's different.
[1:10:25] You know, my art case manager has said,
[1:10:26] you know, his evaluation will come up
[1:10:28] next month. You know, we have a little
[1:10:29] preparation. I'm prepared because I'm
[1:10:31] here. Um, but I think in general
[1:10:34] » That those extra steps really make a
[1:10:36] difference. I agree with you because
[1:10:39] like I it's just hard
[1:10:43] to express myself
[1:10:47] to others. But I cuz I'm a little shy or
[1:10:52] you know going through something. But
[1:10:54] like I will say this, Sunday I went to
[1:10:57] church and I loved it because I felt the
[1:11:01] presence of God and Jesus on a certain
[1:11:04] hymn like a song. It's called it is well
[1:11:09] and I felt sad and then joy and it it
[1:11:14] reminds me of like doing self advocates
[1:11:18] to help other individuals express what
[1:11:21] they need. But when I express things,
[1:11:25] sometimes it doesn't go forward and it's
[1:11:30] just frustrating.
[1:11:31] » So I I'd like to add um one thought to
[1:11:35] this and and it kind of goes along with
[1:11:37] what Dr. Nord said about um you know
[1:11:40] having a having a wholesome conversation
[1:11:43] about this. They call me doctor. I
[1:11:45] figured nobody nobody calls me anything
[1:11:47] but you
[1:11:49] » That that was what that was. And I also
[1:11:51] didn't press the mute button. Um,
[1:11:54] » Yes.
[1:11:55] » So, uh,
[1:11:57] you know, the stakes are really high
[1:11:59] when you get into I I mean, I get the
[1:12:01] level of care where you're establishing
[1:12:03] eligibility, but if you we get into
[1:12:05] whatever a new Oasis or a new ALGO or
[1:12:08] what whatever the new iteration of um
[1:12:11] figuring out how this um translates into
[1:12:17] uh you know, support needs and budgets
[1:12:18] and all that kind of thing. the stakes
[1:12:20] are very very high and one concern I
[1:12:22] have is um the the time frame of three
[1:12:26] days which in the inter eye over and
[1:12:28] over and over again it's has this
[1:12:30] occurred in the last three days so
[1:12:34] I you know first of all for a lot of
[1:12:38] things like if you're kind of sad you
[1:12:41] have kind of depression there's a good
[1:12:42] chance that that probably has manifested
[1:12:44] itself in the last three days but there
[1:12:46] are a lot of um highly acute who, you
[1:12:50] know, very problematic behaviors that
[1:12:52] may occur once in a blue moon. I mean,
[1:12:55] some people it's like around Christmas
[1:12:56] and all of a sudden they're
[1:12:57] hospitalized. That person has a little
[1:12:59] bit different support need than somebody
[1:13:01] who absolutely never ever ever is
[1:13:04] hospitalized, right?
[1:13:06] » Um, and the one thing I would I would
[1:13:09] really encourage you to consider is how
[1:13:13] um an appeal can work. And I, you know,
[1:13:15] I'm not talking about every single
[1:13:16] person goes, "Oh, I lost a tiny bit of
[1:13:19] budget and every every everybody's going
[1:13:21] to appeal to get more and more and more,
[1:13:23] but there are going to be some people
[1:13:24] who this upends their budget or this
[1:13:27] upends something in their support in
[1:13:30] their support um the supports they're
[1:13:32] provided." And I I'm just very concerned
[1:13:34] about that three days aspect. Um, you
[1:13:37] know, made positive statements. I mean,
[1:13:40] sometimes I go three days without that.
[1:13:43] You know, I there there are other ones
[1:13:45] where you're talking about more
[1:13:47] explosive behavior and aggression and
[1:13:49] that kind of thing. Even the most
[1:13:50] aggressive person is not aggressive
[1:13:52] every week, you know, and so you might
[1:13:54] have somebody who has physical
[1:13:56] aggression, property destruction, and
[1:13:59] sometimes it's big enough where some,
[1:14:01] you know, law enforcement's involved,
[1:14:03] but that happened last week, so I give
[1:14:04] it a no. And that's going to really
[1:14:06] affect what your supports
[1:14:10] » Assessment is. And so I'm always
[1:14:11] concerned when we kind of give up the
[1:14:13] human aspect to say here it's a
[1:14:16] checklist. And I I encourage you to give
[1:14:20] » Some thought to how that appeal process
[1:14:22] can work, especially in cases where
[1:14:24] everybody knows it's obvious this person
[1:14:26] shouldn't have, you know, dropped half
[1:14:29] his budget because of the inter eye.
[1:14:33] » So no, I I appreciate that um and
[1:14:36] appreciate your comments, Jim. I think
[1:14:39] what I will go back to is these
[1:14:40] assessments are are very comprehensive.
[1:14:43] Um, and yeah, there's there is certain
[1:14:47] look back periods for certain items, but
[1:14:50] that's not every item. And it also asks
[1:14:53] things like how often and not just in
[1:14:56] the last three days. So, without getting
[1:14:58] into too many details, I I hear your
[1:15:00] concern and I appreciate it. Um I think
[1:15:04] um and I alluded to this before, there's
[1:15:06] a reason we have case managers doing
[1:15:08] these, right? Because they know the
[1:15:11] individual. They also and if in the
[1:15:14] event that they don't, let's say it's a
[1:15:15] newer case manager, right? They have
[1:15:18] that individual's file as well, right?
[1:15:21] All their information about their
[1:15:23] progress towards, you know, in various
[1:15:25] services and and all of that
[1:15:27] information.
[1:15:29] um so that when they're doing that
[1:15:31] assessment, if something doesn't quite
[1:15:33] ring true, they can dig in a little
[1:15:35] deeper in that conversation and find
[1:15:37] out. We expect that people would grow in
[1:15:40] their skills as a result of our
[1:15:42] services, right?
[1:15:43] um that growth will look different
[1:15:45] depending on the person in the area, but
[1:15:48] you know, we want to make space for
[1:15:49] people to actually gain skills and to
[1:15:51] recognize that as well as when
[1:15:54] individuals maybe um I'll choose this
[1:15:58] because it's it's me. Um as they age,
[1:16:02] sometimes we lose some skills, right? Or
[1:16:05] or our our strength areas change. So
[1:16:08] these tools are sensitive enough um that
[1:16:12] I think it will or we believe it will
[1:16:14] pick up on all those things. I also want
[1:16:16] to mention because of all the great
[1:16:18] conversation around kind of setting the
[1:16:20] stage and and those conversations to
[1:16:23] help prepare individuals for these
[1:16:25] assessments because they are very
[1:16:27] different um than what we have been
[1:16:29] doing for um a number of years.
[1:16:33] There is we have a learning
[1:16:34] collaborative for those assessors, the
[1:16:36] mentor assessors. Um and all of this
[1:16:39] information we can take back to that
[1:16:41] learning collaborative. Um and talk
[1:16:43] through what you know what what are some
[1:16:46] maybe some individuals are doing that
[1:16:48] preparation a certain way. You know, how
[1:16:51] can we share that information and that
[1:16:53] best practice to better position
[1:16:55] individuals and families to be ready for
[1:16:57] these assessments? So um those your
[1:17:01] comments around um preparation and
[1:17:03] setting that stage is is very much
[1:17:06] appreciated and we will share that.
[1:17:08] » Thank you.
[1:17:09] » I um I I suspect this is maybe your last
[1:17:12] bullet so I'll I'll um I'll just preempt
[1:17:15] it. Um
[1:17:18] I'm only I'm I'm asking these questions
[1:17:21] mostly because I I think there's a
[1:17:22] broader community with these questions.
[1:17:24] I was in a conversation with a family
[1:17:25] member yesterday and kind of three
[1:17:28] things that came up. So, I figure this
[1:17:30] is a great time because I can say it,
[1:17:32] but I think it's more important that
[1:17:33] they hear and and Holly, I think you and
[1:17:36] I have had we we chatted about this last
[1:17:38] week. Um,
[1:17:41] there's a perception or or there's
[1:17:44] there's conversation out there that
[1:17:46] people have lost their waiver through
[1:17:48] because of these assessments. That's the
[1:17:51] first. The second is the denial pending
[1:17:53] language in the review process for those
[1:17:56] that and that language and what does
[1:17:58] that mean? And then um the third is
[1:18:02] appeal process. Those weren't even
[1:18:05] phrases questions, but I'm just going to
[1:18:06] throw those really volatile words out
[1:18:09] and let you manage what comes next.
[1:18:12] » Well, thank you for preempting it
[1:18:14] because that's the perfect segue, Derek.
[1:18:16] Um so yes so we um have been doing these
[1:18:20] assessments now since February. Um very
[1:18:24] few um
[1:18:28] finalized denials have been issued and
[1:18:31] there is a reason for that. Um these are
[1:18:34] new tools as we all know these are um in
[1:18:38] many cases not all because we have been
[1:18:41] using the interrise suite of instruments
[1:18:43] on the nursing facility level of care
[1:18:45] side but for some case managers
[1:18:48] um particularly in the space of uh
[1:18:53] individuals with intellectual and
[1:18:54] developmental disabilities these may be
[1:18:56] completely new tools to them right so um
[1:19:00] as a result of that we've got new tools
[1:19:02] new assessors. We are taking um a lot of
[1:19:07] care in reviewing any assessment that is
[1:19:11] flagged for us to review because that is
[1:19:14] case managers can do that. Um but also
[1:19:17] any assessment that appears to be
[1:19:19] borderline on eligibility, right? And
[1:19:22] when I say we're reviewing it, we're not
[1:19:24] just looking at it and going, "Oh,
[1:19:25] okay." Right? And clicking a button.
[1:19:28] We're looking at it for that individual.
[1:19:31] And does that Is that assessment
[1:19:33] consistent with what we see in the
[1:19:35] individual's records?
[1:19:37] Right? Um as a way to validate on an
[1:19:41] individual level that okay, this
[1:19:43] assessment
[1:19:45] looks to be accurate based on the
[1:19:46] information we have and the the actual
[1:19:49] assessment. So um we are taking all that
[1:19:52] very seriously obviously because um we
[1:19:57] and we've talked about this but we know
[1:19:59] we need to get the right services to the
[1:20:01] right people.
[1:20:04] Um we also know that there are
[1:20:07] individuals in services who are not
[1:20:09] going to continue to meet level of care.
[1:20:12] Um
[1:20:13] and that's hard.
[1:20:15] That's hard for them. Um, it's hard for
[1:20:20] uh the case manager to deliver that.
[1:20:22] It's hard for bead staff, right? It's
[1:20:25] just it's a a space we haven't been in
[1:20:27] in a really really really long time
[1:20:29] approving 99% of people that come in the
[1:20:32] door. So, we are um working with case
[1:20:36] managers
[1:20:38] um about what that looks like, how those
[1:20:41] conversations can be had and should be
[1:20:43] had and how we're connecting people to
[1:20:47] um to other resources. Um but we are
[1:20:50] taking great care in any of those uh
[1:20:54] reviewing any of those assessments that
[1:20:55] appear to be result in denial as we
[1:20:58] should.
[1:21:00] um
[1:21:03] the appeals process. Glad you brought
[1:21:05] that up. Thank you. Um that as with
[1:21:09] anything um any adverse action,
[1:21:11] individuals will get written notice of
[1:21:14] the decision with their appeal rights.
[1:21:18] Um so the due process will is in place
[1:21:21] and will will remain in place through
[1:21:24] through um this entire um process.
[1:21:28] individuals that are um determined not
[1:21:33] to meet level of care, whether that's
[1:21:35] people walking in our doors at the
[1:21:37] district office, so to speak, um you
[1:21:40] know, part of what we do today is
[1:21:41] connecting them with other things,
[1:21:43] right? Um because very few individuals
[1:21:47] walk into a bead's office, apply for
[1:21:49] services, and immediately get services,
[1:21:51] right? That doesn't happen. Um, so we're
[1:21:53] in uh we've been referring folks for
[1:21:56] other and connecting them with other
[1:21:58] resources for some time in that in those
[1:22:00] situations. For individuals in services,
[1:22:02] there will be a transition period if if
[1:22:05] they lose um eligibility or level of
[1:22:08] care. Um, and during that time, the case
[1:22:10] manager will work with the individual
[1:22:12] and the team on a transition plan, what
[1:22:15] that looks like, and what other
[1:22:18] resources that person needs to be
[1:22:19] connected to. Um,
[1:22:22] as an example, if if uh we're talking
[1:22:25] about maybe a 40-year-old individual
[1:22:28] who's been in services,
[1:22:31] um, is working a job,
[1:22:34] um, gets,
[1:22:36] let's just say the person's on the CI
[1:22:37] gets residential HAB, some behavior
[1:22:39] supports,
[1:22:41] um, and, uh, extended services. Um,
[1:22:47] you know, what what's that look like?
[1:22:49] what's that transition plan for that
[1:22:50] individual. It might be, it depends on
[1:22:53] the person certainly, but it might be a
[1:22:55] referral to the Center for Independent
[1:22:57] Living. Um, if they need some just
[1:23:01] connections, right? Or maybe some
[1:23:03] centers for independent living, they all
[1:23:04] do things a little different, right?
[1:23:06] They're all a little different in what
[1:23:07] they offer. Um, it might be rep payee or
[1:23:12] that might be a local bank, right?
[1:23:14] Depending on the community and the
[1:23:15] person. Um it may be um
[1:23:20] uh a referral for or a discussion around
[1:23:23] state plan services. It might be a
[1:23:26] connection with um some sort of support
[1:23:29] group or a CHC perhaps or you know uh
[1:23:33] whatever whatever might support that
[1:23:36] person. Um but we're not here to say
[1:23:39] you're no longer eligible and uh next
[1:23:42] week we're terminating your services.
[1:23:44] Right? services will remain in place
[1:23:46] through the appeal process if people
[1:23:48] appeal. But I will say this and this
[1:23:52] will date me too like 30 years or
[1:23:55] whatever or 20 something years. Um, if a
[1:23:58] person is determined not to meet level
[1:24:01] of care and launches an appeal, that
[1:24:02] team, that case manager needs still to
[1:24:05] be having those very real conversations
[1:24:07] about, you know, if
[1:24:10] this appeal results in a denial of level
[1:24:14] of care. Um,
[1:24:16] » We need to be ready.
[1:24:17] » We need to be planning for that and we
[1:24:18] need to position them to be ready for
[1:24:20] that. If that makes sense.
[1:24:22] » I want to just circle back really
[1:24:24] quickly to
[1:24:27] this conversation around level of care
[1:24:30] with the NRI suite of tools. Obviously,
[1:24:33] I think and maybe this bears reminding I
[1:24:36] think our system is working to or toward
[1:24:39] a place where
[1:24:42] we can
[1:24:44] hopefully have one encounter
[1:24:46] and identify the right waiver for the
[1:24:49] right person at the right time with with
[1:24:51] the array of tools that we are
[1:24:53] operationalizing.
[1:24:54] and also be in a position to have that
[1:24:57] service planning happen essentially
[1:25:00] simultaneously.
[1:25:02] Um, and I know there are some
[1:25:05] concerns around how some of the
[1:25:07] questions are framed and time look back
[1:25:09] periods and
[1:25:12] we have seen some communications around
[1:25:16] people being advised to go into that
[1:25:18] assessment and share their worst day and
[1:25:23] that that be the lens through which they
[1:25:25] answer those assessment questions. Share
[1:25:29] your worst day in the last 30 days and
[1:25:32] the last 60 days, whatever that may be.
[1:25:34] It needs to be your worst day.
[1:25:38] And I would just say we can't do that.
[1:25:45] And I would really I would really
[1:25:48] put forth to this council that if we are
[1:25:52] doing service planning based on
[1:25:55] someone's worst day and we do that for
[1:25:59] 50,000 people,
[1:26:01] we are going to be in a very tough spot.
[1:26:07] Service planning conversations can
[1:26:09] happen at any point in time, even after
[1:26:12] their service plan budget has been
[1:26:14] issued. If something changes, that
[1:26:16] service plan should change to reflect
[1:26:18] that. So, I just encourage folks to be
[1:26:21] thinking about we do we do not want to
[1:26:24] move forward
[1:26:26] with a deficit-based mindset about the
[1:26:29] people that we are supporting. We do
[1:26:32] want to move forward with a dynamic
[1:26:34] system that can adjust
[1:26:36] to be respondent to that person's
[1:26:39] changing needs over time.
[1:26:42] » Thanks, Kathy. Yeah, Tom,
[1:26:43] » Just question on the back to the appeal
[1:26:45] question. Um, if someone is appealing
[1:26:48] their denial of eligibility, if the NRI
[1:26:51] suite of tools is utilized for that
[1:26:52] determination, do they get any
[1:26:54] information about their assessment from
[1:26:56] NRI for the purpose of their appeal?
[1:26:59] » Oh, sure. the the actual assessment like
[1:27:01] their their responses and stuff they
[1:27:03] » Utilize. Okay. So they they'll they'll
[1:27:04] receive that for the appeal process. Uh
[1:27:08] if they
[1:27:08] » Receive the reason.
[1:27:10] » Yes, they'll receive the reason. Um
[1:27:14] ask me your question again, Tom, because
[1:27:16] I don't think it's I don't think it's
[1:27:19] » Just what
[1:27:22] » Lawyers arguing.
[1:27:26] » So the the actual assessment is being
[1:27:28] utilized to make a determination for
[1:27:29] eligibility. So that's what is being
[1:27:31] relied upon. So, if someone's going to
[1:27:33] appeal that denial of eligibility, what
[1:27:36] information from that assessment are
[1:27:38] they going to have access to to argue
[1:27:40] their appeal?
[1:27:42] » They will they will have their
[1:27:43] determination letter and they can have a
[1:27:46] copy of their assessment.
[1:27:47] » Okay.
[1:27:48] » Yeah.
[1:27:48] » Okay. Thank you.
[1:27:57] » I I do have one question. This is Kate
[1:27:59] on the example you gave with somebody
[1:28:01] who seems to is on the CI waiver and
[1:28:05] they're getting lots of residential
[1:28:06] support but they're successfully
[1:28:09] employed and have living their good
[1:28:11] life, their vision of a good life. Is
[1:28:14] there a mechanism for you all to
[1:28:16] determine whether or not those supports
[1:28:18] are what is leading to that person's
[1:28:21] success? like maybe they are employed
[1:28:24] because they have the level of care
[1:28:25] support that they that are receiving. Is
[1:28:28] there do you understand what I'm trying
[1:28:30] to ask? And is there I I just worry
[1:28:33] about going from a CIH waiver level of
[1:28:37] care down to community referrals if
[1:28:41] there's a possibility that a family
[1:28:43] support waiver structure with still some
[1:28:46] of those things in place could continue
[1:28:48] to support that person to live
[1:28:50] independently
[1:28:52] with the right level of support uh
[1:28:54] rather than just going down to all
[1:28:56] community based services. So,
[1:28:59] » And that's just based on your example.
[1:29:01] » Yes. No, that's that's a good question.
[1:29:03] I I I do want to clarify that if someone
[1:29:06] doesn't meet level of care, they would
[1:29:08] not have access to CI or family support
[1:29:13] because it's the same eligibility for
[1:29:15] those two waiverss in terms of the level
[1:29:18] of care.
[1:29:21] So, we would again work with what are
[1:29:24] the person's needs today, right? and how
[1:29:28] can we connect them with other resources
[1:29:31] outside of HCBS to address those needs.
[1:29:35] » And I think to your I wanted to clarify
[1:29:38] something you said because you talked
[1:29:41] about CI level people
[1:29:44] and
[1:29:46] the folks on that waiver are a heavy
[1:29:49] mix. There are some people who have some
[1:29:52] truly exceptional needs on that waiver
[1:29:54] and there are individuals who have
[1:29:55] transitioned out of a group home to the
[1:29:58] CI waiver or they've met some other
[1:30:00] priority criteria at some point in time.
[1:30:04] So their budget may not reflect and
[1:30:07] their service need not reflect an
[1:30:09] emergent need at the time that they are
[1:30:12] assessed.
[1:30:13] » So that's a I think just an important
[1:30:15] clarification for people. I think what
[1:30:17] you mean is those folks who are
[1:30:18] currently getting a a a higher level of
[1:30:22] support from our system and then are
[1:30:25] determined at some point to no longer
[1:30:27] meet our level of care. Uh and I do
[1:30:30] think that's where we need um I mean
[1:30:34] truly suggestions, input from this group
[1:30:37] on how best to maybe walk somebody
[1:30:40] through that transition to um kind of
[1:30:43] offboard them off of that waiver.
[1:30:45] because to your point, we wouldn't be
[1:30:47] able to offer them a lesser amount of
[1:30:49] services or an alternate waiver
[1:30:52] because they wouldn't meet that criteria
[1:30:54] either. So, it's really thinking about
[1:30:59] forcing the system to have conversations
[1:31:02] all along someone's journey in the
[1:31:04] system about transitioning down or
[1:31:07] stepping down from services and supports
[1:31:08] when they don't need them. Um,
[1:31:11] obviously, we don't want to create a
[1:31:12] cliff for anyone. Um, but I certainly
[1:31:16] also don't, and I think I've said this
[1:31:18] at other meetings, I don't want people
[1:31:20] to wait until that level of care to to
[1:31:23] figure out that someone's that we kind
[1:31:26] of already know maybe that somebody's
[1:31:27] not going to meet that eligibility
[1:31:29] criteria um before we start talking
[1:31:31] about this isn't going to work and we
[1:31:33] can't continue to offer this this level
[1:31:34] of service. I can't think of an example
[1:31:37] of somebody who would have those higher
[1:31:39] need waiver supports who it may may be
[1:31:43] impacted by that to be honest, but that
[1:31:46] doesn't mean that there there isn't any.
[1:31:48] So,
[1:31:51] » I just want I just want to add I think
[1:31:53] it comes down to the case managers um
[1:31:55] because they're the ones in the homes
[1:31:57] and seeing it. And for the case managers
[1:32:00] to have the best training in
[1:32:02] communication because they're the ones
[1:32:04] that are going to be seeing it coming
[1:32:06] » More than a piece of paper.
[1:32:09] » Yeah, good point. Okay, I'm gonna Lexi,
[1:32:11] I'm going to go to you and then we need
[1:32:12] to keep moving. So, um and then we'll
[1:32:14] take after your question, we'll take a
[1:32:16] break. you know.
[1:32:18] » Okay. Awesome. Thank you. Um I think I
[1:32:21] want to go like I want to go back a
[1:32:23] minute. It's been a minute since it's
[1:32:24] been mentioned, but we talked about um
[1:32:28] Holly talked about uh the good thing is
[1:32:32] like the case managers that are the
[1:32:34] assessors, they know most likely
[1:32:38] um probably more often than not, they
[1:32:40] know the individual being assessed um or
[1:32:44] they know their file. Um, but I think
[1:32:48] kind of the elephant in the room,
[1:32:50] something people are a lot of people are
[1:32:52] concerned about, um, is will there when
[1:32:57] Waverista happens be a transition to
[1:32:59] Maximus because Maximus assesses
[1:33:03] individuals and knows pretty much
[1:33:06] nothing about it. And we're seeing an
[1:33:08] issue with that a lot on um, health and
[1:33:11] wellness, TBI, stuff like that. So I
[1:33:14] think a lot of people receiving ICF ID
[1:33:17] services are very concerned that Maximus
[1:33:21] is also going to be those doing those
[1:33:23] ICC or ICF ID level of care assessments.
[1:33:28] » Yeah, that's a good question, Lexi, but
[1:33:30] currently there are no um no plans to to
[1:33:35] um move those eligibility or level of
[1:33:38] care assessments for ICFD.
[1:33:42] That's good news because I'm one of the
[1:33:43] people that was concerned about it and I
[1:33:45] think a lot of people were. So,
[1:33:47] » All right.
[1:33:48] » Thank you.
[1:33:49] » Thanks, Lexi. Okay, we are going to take
[1:33:51] a This is exactly on time. It's crazy.
[1:33:55] Okay. Um
[1:33:57] uh 10:05. We're going to take a
[1:33:59] 10-minute break. So, we will be back at
[1:34:01] 10:15.
[1:34:03] » That's okay.
[1:34:05] » 11:15. Okay.
[1:34:07] » Question. Hold on one second to just
[1:34:09] because it's loud.
[1:34:10] » Gota get people. Okay, go ahead.
[1:34:14] » Sorry.
[1:34:14] » Just start talking.
[1:34:15] » So, I have a question. So, like,
[1:34:20] » Hey guys, we're gonna go ahead and get
[1:34:21] started just so we can get through it.
[1:34:24] I'm not holding you guys. Um, okay. Go
[1:34:26] ahead.
[1:34:26] » I have a question. So, like say,
[1:34:29] » Is this related? Sorry. Just I just want
[1:34:31] to make sure is same same. Okay. I just
[1:34:33] want to make sure in case it was Okay.
[1:34:35] » No, you're fine. Go. know how people get
[1:34:38] money for assistance
[1:34:40] for their bills.
[1:34:42] » They get what? I'm sorry.
[1:34:43] » Money assistance for their bills.
[1:34:45] » Yeah.
[1:34:46] » Let's just say,
[1:34:49] well, for me, I was trying to get for
[1:34:51] the energy assistance and I got denied.
[1:34:54] But what's frustrating on that is I have
[1:34:59] a lot of bills, but I don't I don't know
[1:35:03] how to put it any of them. Oh, I think
[1:35:06] just she was mentioning that it can be
[1:35:08] for people that were referring to that
[1:35:10] as a as a support. It is not consistent
[1:35:13] and who gets approved for that kind of
[1:35:15] support.
[1:35:16] » So, just more of a I think FYI for
[1:35:19] » Okay, thanks.
[1:35:20] » Thank you.
[1:35:20] » Okay. Thanks. Okay, we're going to move
[1:35:23] on here. Let me get my
[1:35:29] get here. Okay, so we're going to move
[1:35:31] on to uh waiver amendments. Moving on
[1:35:34] with Holly.
[1:35:37] » Me again. All right.
[1:35:39] » Right. Um, good thing I got a strong
[1:35:42] voice here. Um, so just a reminder that
[1:35:45] we do have waiver amendments for all of
[1:35:48] the beads administered waiverss as well
[1:35:50] as and that's not on here, but the the
[1:35:53] pathways for aging waiverss um are at
[1:35:56] CMS with a planned effective date of
[1:35:58] August 1st. That includes, of course,
[1:36:01] the the case management that we've been
[1:36:03] talking about um as well as some other
[1:36:07] um
[1:36:09] components that we've discussed uh uh in
[1:36:12] previous meetings. Um but those are at
[1:36:16] CMS under review and we anticipate
[1:36:18] having those back um in July. I can't
[1:36:21] give a date because I'm not sure when
[1:36:23] that will be, but we expect them um to
[1:36:26] come in in July. So just wanted to
[1:36:29] provide that update
[1:36:32] and then wanted to talk um some more
[1:36:34] about waiver reset just to ensure that
[1:36:37] we um that we are providing information
[1:36:41] to you all so that you all can kind of
[1:36:43] track what's happening with regard to
[1:36:44] waiver reset and that we continue to
[1:36:47] focus on um the goals and understanding
[1:36:50] the why behind um the reset. So,
[1:36:55] um, and you've seen this slide before,
[1:36:57] you're probably going to be tired of it,
[1:36:59] so I'll apologize in advance, but, um,
[1:37:02] the goals of the waiver reset, um, have
[1:37:05] been steady throughout this process. And
[1:37:07] one is simplifying the system. Um, it's
[1:37:10] not news to anyone that the system can
[1:37:13] be difficult to navigate and confusing
[1:37:16] um, for individuals and families. So,
[1:37:18] um, we know that as part of waiver
[1:37:20] reset, we want to make our system more
[1:37:23] understandable. Um, we already talked
[1:37:25] about reducing the number of assessments
[1:37:27] that individuals have to go through. Um,
[1:37:30] and then also updating the services that
[1:37:33] are offered again based on feedback
[1:37:35] we've received um, from those that we
[1:37:38] support
[1:37:40] and those individuals that we will
[1:37:42] likely one day support. um we know that
[1:37:46] our services um need to be updated um
[1:37:49] and we need to to reexamine kind of what
[1:37:52] we offer and how that's how those
[1:37:54] services are delivered in some
[1:37:55] situations.
[1:37:57] We also know we need to improve support
[1:37:59] coordination. I think we've heard a lot
[1:38:01] about that this morning when we were
[1:38:03] talking about the assessments and those
[1:38:05] conversations that are taking place or
[1:38:07] should be taking place. Um, we know that
[1:38:11] uh in in the coordination of of services
[1:38:15] and supports that those case managers
[1:38:18] need to know what's out there and
[1:38:21] available and they need to um be able to
[1:38:23] connect individuals um with other
[1:38:27] services, paid and unpaid, and actually
[1:38:29] help them maximize um all of those
[1:38:32] resources they may have available to
[1:38:33] them. That's not new. Um we've been
[1:38:37] talking about that for years. Um and
[1:38:39] that is unrelated to an individual's
[1:38:42] eligibility status, right? Um it really
[1:38:46] um all of our services should be focused
[1:38:48] on connecting people so that they're
[1:38:50] more included in their communities,
[1:38:53] whatever that looks like for them. um
[1:38:55] enhancing quality outcomes. You know,
[1:38:58] how can we um as part of waiver reset
[1:39:01] offer quality services and then support
[1:39:04] providers
[1:39:06] um
[1:39:08] in ways that they can provide those
[1:39:10] services. Um and you know, I think the
[1:39:13] the quality uh piece is part of that
[1:39:18] valuebased purchasing or paying for
[1:39:21] outcomes, whatever whatever terminology
[1:39:23] we want to use. It really is how do we
[1:39:26] support those providers of services
[1:39:29] um to aggressively work with individuals
[1:39:32] and families to to help them reach the
[1:39:34] outcomes um they need from our services.
[1:39:40] » Polly,
[1:39:41] » Yes. Um I I know that the the whole idea
[1:39:44] of um paying for quality and the value
[1:39:46] based payments and all that that's a
[1:39:48] that's something that we're all getting
[1:39:50] kind of used to that terminology and
[1:39:51] feeling like that's some that's a
[1:39:53] direction that we're heading in. Right.
[1:39:55] » Um can you give any salient examples
[1:39:57] from other states that you've learned or
[1:40:00] just that that beads that DAR is
[1:40:03] thinking of in what what direction are
[1:40:06] we going with this? I mean if you look
[1:40:08] at the value based pay payments that
[1:40:10] were in that one slide for case
[1:40:11] management I think we already discussed
[1:40:13] that being primary primarily compliance
[1:40:17] what might be a good quality metric that
[1:40:21] you would pay for or what are you guys
[1:40:23] thinking? Well, I think, you know,
[1:40:25] that's a great question, Jim, and I
[1:40:27] don't have any um other states in my
[1:40:28] back pocket that I would speak to just
[1:40:30] because I don't think I could
[1:40:32] necessarily adequately represent another
[1:40:34] state without, you know, making sure um
[1:40:37] and reviewing it recently. But we have
[1:40:39] and we'll continue to look at um what's
[1:40:42] happening in other states around this
[1:40:44] valuebased purchasing um
[1:40:47] so that that can inform any decisions we
[1:40:50] make. Um, I think one of the things that
[1:40:54] is important,
[1:40:56] um, from my perspective when we're
[1:40:58] thinking about paying for outcomes is,
[1:41:02] you know, not just saying, okay, we're
[1:41:05] going to pay for this, but we really do
[1:41:06] have to build to it. And I think Derek
[1:41:08] kind of alluded to this. We kind of
[1:41:10] start with
[1:41:12] gathering that data, looking at those
[1:41:14] compliance matters, getting that nailed
[1:41:17] down and in place and then build from
[1:41:20] there. Um, but I think the outcomes
[1:41:22] would differ depending on the service,
[1:41:25] right? I mean we have music therapy,
[1:41:27] recreck therapy that are therapeutic
[1:41:30] services and then we have things like
[1:41:32] today and this is we're talking waiver
[1:41:35] reset so things will look differently
[1:41:37] but then we're thinking about like
[1:41:39] participant assistance and care or pack
[1:41:42] in attendant care those outcomes would
[1:41:44] look very different right and and so I
[1:41:47] think it would depend on the service but
[1:41:49] certainly we can take that back um and
[1:41:52] um perhaps carve out some time in a
[1:41:54] future meeting about how we might
[1:41:57] consider uh valuebased payment for some
[1:42:00] of the services. So I think that's a
[1:42:03] great question
[1:42:05] » And and I appreciate your answer because
[1:42:06] that that's a basically I think that's
[1:42:08] sort of the stepping stones that you you
[1:42:11] need to get to to get to where we are. I
[1:42:13] got to say that when when um in your
[1:42:17] comment about like wreck therapy and
[1:42:19] music therapy, those are therapeutic
[1:42:20] surf ser services and they're going to
[1:42:22] look different than pack. I mean, I can
[1:42:26] see from a compliance standpoint where
[1:42:27] there are some similarities, but like on
[1:42:29] quality, I I guess maybe I'm just like
[1:42:33] lacking imagination because it's really
[1:42:35] hard for me to come up with specifics
[1:42:37] that I'm thinking, oh, okay, here's
[1:42:39] something that would be a quality metric
[1:42:40] that the state would pay for in lie of
[1:42:43] um unit space system and the quantity.
[1:42:47] you know,
[1:42:49] simply saying we're going to move away
[1:42:50] from units and we're going to move away
[1:42:53] from quantity and we're going to move to
[1:42:55] quality. I don't think anybody would
[1:42:58] disagree with that as a as a goal. The
[1:43:01] devil's in the details though and and it
[1:43:04] seems difficult if you're designing a
[1:43:06] new system and then the payment
[1:43:08] structure is based on this thing that we
[1:43:11] are even having a hard time discussing
[1:43:13] or or putting a putting our finger on
[1:43:17] that gives me a little bit of
[1:43:18] trepidation going into the future of
[1:43:20] like well what is this going to look
[1:43:22] like? Um, so I and I think I'll probably
[1:43:25] I'll try to hone my imagination skills
[1:43:28] in the future to be able to come up with
[1:43:30] something because I you know it's it's
[1:43:33] really difficult to really you know it's
[1:43:35] everybody knows quality when you see it.
[1:43:38] How do you measure it and how do you put
[1:43:39] that forward into something that then
[1:43:41] becomes a billable service?
[1:43:43] » Yep. No, I think we're I I agree with
[1:43:46] you and we are always open to feedback
[1:43:49] if you uh do come up with suggestions um
[1:43:53] for um value based payment or paying for
[1:43:56] outcomes. But um I'll just speak to I
[1:44:00] think um
[1:44:04] we've talked ad nauseium with this group
[1:44:06] about employment.
[1:44:09] I think we've emphasized at the advisory
[1:44:11] council quite a bit outcomes around
[1:44:13] employment that will be an area of focus
[1:44:16] more than likely
[1:44:19] » The degree to which the services being
[1:44:21] provided are leading to toward someone's
[1:44:24] employment outcomes
[1:44:27] will be looked at and evaluated as far
[1:44:29] as how can we incentivize
[1:44:32] services that that get someone
[1:44:35] successfully toward an employment
[1:44:36] outcome or the outcome that they are
[1:44:38] working toward.
[1:44:40] » Um, and that could be something that's
[1:44:42] not employment, but in that same kind of
[1:44:45] realm, I think I'm that one's coming to
[1:44:47] mind again because we've talked about it
[1:44:50] so heavily at the with this group, but
[1:44:52] also because
[1:44:54] the origin of us talking about it at
[1:44:57] this group have been self- advocates
[1:44:59] saying we want competitive integrated
[1:45:01] employment. Um and so I think at least
[1:45:04] from my perspective
[1:45:07] and this is where you all you know are
[1:45:09] welcome to bring forth successful ideas
[1:45:12] or innovative ideas from other states
[1:45:14] where who have implemented a valuebased
[1:45:16] payment model around employment supports
[1:45:18] or employment outcomes that
[1:45:22] either for a particular service or for a
[1:45:24] team um to to share in a valuebased
[1:45:27] payment because they were collectively
[1:45:29] able to work together to get somebody
[1:45:31] that outcome. Um those are that's a just
[1:45:33] a high very high level example and to
[1:45:36] your point Jim the devil's always in the
[1:45:38] details about how you execute that but
[1:45:41] that's probably where the most attention
[1:45:45] or emphasis has been internally for our
[1:45:47] team um because of just some of the work
[1:45:50] that has been occurring um with the
[1:45:53] innovation pilot projects and some of
[1:45:55] the um other uh APA related um
[1:45:59] initiatives that we undertook um a
[1:46:02] couple years ago.
[1:46:03] » Yeah, I was going to I was going to say
[1:46:04] that Kathy, I think that um and Melissa
[1:46:07] has a lot of experience in this too, I
[1:46:09] think, with employment, but right, if if
[1:46:11] there is an employment goal and again it
[1:46:13] can't just be does a person want a job
[1:46:15] or not, you had the conversation, you
[1:46:17] get paid, right? That's not going to
[1:46:18] fly, right? So, if if if you've
[1:46:21] discussed employment and it's an
[1:46:23] obstacle, what have what are you doing
[1:46:26] to either address that obstacle, right?
[1:46:28] And so I think that for employment, it's
[1:46:30] not just is there an employment goal,
[1:46:32] you get money, right? You've you've
[1:46:34] reached the outcome because that's not
[1:46:37] what's going to happen. Someone's going
[1:46:38] to write an employment goal so they can
[1:46:40] get that extra $20. Let's a lot of times
[1:46:42] unfortunately that's what's going to
[1:46:43] happen, right? So how do we build it so
[1:46:46] that it's actually um there's things in
[1:46:49] place that's uh
[1:46:52] you know incentivizing more than just
[1:46:54] maybe checking the boxes sometimes. So,
[1:46:56] um, but employment's like Kathy I was
[1:46:59] going to say is what's coming to mind
[1:47:01] because I think there's I don't know all
[1:47:03] the research on valuebased, but I think
[1:47:04] that's probably the Melissa could jump
[1:47:06] in. Probably the most
[1:47:09] probably the mo most used right now or
[1:47:11] at least being explored at least
[1:47:12] nationally, I would think. Do you think
[1:47:14] that's accurate? Maybe. Maybe not. I
[1:47:17] don't know. Am I putting you on the
[1:47:19] spot? I don't know.
[1:47:20] » No, that's fine. Am I
[1:47:22] » I don't know if
[1:47:22] » Yeah, you're okay. Just don't hit the
[1:47:23] button like Derek. Don't mess up
[1:47:26] everything like Derek did.
[1:47:28] » All right.
[1:47:32] » Yeah.
[1:47:33] » So, you know, when you think about
[1:47:36] values-based outcomes,
[1:47:38] there's almost two different types of of
[1:47:41] outcomes based things. There's there's
[1:47:43] services that are meant to teach a skill
[1:47:45] and services that are meant to help a
[1:47:48] person achieve a an independence goal or
[1:47:50] an ability to um increase their their uh
[1:47:54] proficiency at doing something. And so
[1:47:56] the outcome for that might be the
[1:47:58] attainment or progression towards that
[1:48:00] goal. But then there's other services
[1:48:02] that are more uh filling a need that the
[1:48:05] person may not be able to meet
[1:48:06] themselves. transportation,
[1:48:09] um, feeding,
[1:48:12] um,
[1:48:14] whatever ADLs, whatever that is. And so
[1:48:18] the outcome measures for those types of
[1:48:20] services might look a lot different
[1:48:23] because those um are more based on the
[1:48:27] quality of the service provided, the the
[1:48:30] deliverability of it. So for example, if
[1:48:32] it's transportation, is was the person
[1:48:34] on time? Did they, you know, get picked
[1:48:37] up within a reasonable um, you know,
[1:48:41] distance from where they were were
[1:48:42] going? And I'm just using transportation
[1:48:44] because that's kind of a very concrete
[1:48:45] one, but versus something like an
[1:48:49] employment or um like a behavior goal
[1:48:52] where it's like we're going to reduce
[1:48:53] the number of self-injurious incidents
[1:48:56] or reduce the number of aggressions. you
[1:48:58] can objectively measure are we working
[1:49:00] towards that goal versus you know um
[1:49:04] we've got a a tedicare or or pack or
[1:49:08] something that is you know helping the
[1:49:10] person um feed themselves the person may
[1:49:15] never be able to feed themselves due to
[1:49:17] their disability but we can still
[1:49:19] determine quality metrics
[1:49:21] » From that based on um just looking at it
[1:49:24] but I agree there's not going to be a
[1:49:25] reversal
[1:49:27] » Quality metric.
[1:49:28] » So, so I'm not going to try to get
[1:49:30] totally down the rabbit. Sorry, sorry,
[1:49:31] K. This is just to follow up on kind of
[1:49:33] what I was already saying. So, not to
[1:49:35] just go totally rabbit hole on this, but
[1:49:40] um like I bill for my agency and it
[1:49:42] there's a certain way that you bill. You
[1:49:44] go into the ICP portal and then you like
[1:49:47] put in people's names and all this stuff
[1:49:49] and their their Medicaid number and then
[1:49:51] you get down to like what's the service
[1:49:53] you're providing and what are the number
[1:49:54] of units.
[1:49:56] It's hard for me while I'm sitting at my
[1:49:58] computer doing this to think, okay, for
[1:50:02] this particular
[1:50:04] uh this particular um BC visiting this
[1:50:09] person, they took the this uh this guy
[1:50:11] to Goodwill and that part of it was they
[1:50:13] went and talked to somebody about it and
[1:50:15] person's got a VR referral. They're they
[1:50:18] they they don't have a job coach yet. So
[1:50:21] the BC is kind of doing a little bit of
[1:50:22] exploration which you know a couple
[1:50:24] years ago you all added to be behavior
[1:50:26] support as a as an appropriate um way
[1:50:29] for BC to interact with an individual.
[1:50:32] How do I bill for that? I mean do I look
[1:50:34] into an individual service note and say
[1:50:37] oh on this particular occasion they were
[1:50:39] doing something that was relevant to to
[1:50:42] um employment. They did a little bit of
[1:50:45] exploration. They talked about it. Maybe
[1:50:46] they talked to an employee. I don't know
[1:50:49] how to I mean I agree that that's
[1:50:51] quality
[1:50:52] » But compared to being able to say and
[1:50:54] they spent an hour and a half doing it
[1:50:56] and so that's six units you know and I'm
[1:50:59] not saying
[1:51:00] » You know we have to keep unit I just
[1:51:02] can't and again it may be my deficit in
[1:51:07] um
[1:51:07] » Well I think you're looking you're
[1:51:08] looking maybe for the
[1:51:10] » The howto way before process defined
[1:51:15] » I think it is hard to envision because
[1:51:18] that's that's kind of the struggle we
[1:51:19] have is we can't envision it. Yeah.
[1:51:21] » Um at the same time I will say and and
[1:51:24] and because we haven't done it
[1:51:26] » Ever, right? Um and right but I do think
[1:51:30] here and here's the opportunity is and I
[1:51:32] think employment's a really good example
[1:51:34] is whatever that quality outcome is
[1:51:37] isn't necessarily I would argue it's not
[1:51:40] about what I as the provider did every
[1:51:43] every minute of the day because every
[1:51:45] minute of the day might be I had to work
[1:51:47] I had to help the the employer
[1:51:49] understand what their responsibility was
[1:51:51] and I I had to provide support to the
[1:51:54] individual. It's a big kind of holistic
[1:51:57] that isn't just about me as the employ
[1:51:59] as the provider that in other words the
[1:52:02] outcome isn't just because of me and
[1:52:04] what I did. The outcome is this whole
[1:52:06] ecology or ecosystem around a person and
[1:52:09] and how we set up the supports that
[1:52:11] isn't just about what we deliver to them
[1:52:13] but about what the community also
[1:52:15] delivers. And I think I think that's a
[1:52:17] really important and powerful
[1:52:18] opportunity because at the end of the
[1:52:20] day a quality employment outcome in the
[1:52:22] community isn't I and having worked as
[1:52:24] an vocational service provider it's not
[1:52:27] because of me
[1:52:28] » It's because the individual and those
[1:52:30] around and yes of course we are
[1:52:32] facilitators of that and those supports
[1:52:35] but if if the outcome is is only because
[1:52:37] of me and that's a failure I think and I
[1:52:40] think so I just say I I really commend
[1:52:42] it. Is that complex? Abs. Absolutely.
[1:52:45] That's complex
[1:52:47] and there's not going to be a metric in
[1:52:48] the very traditional and how do I bill
[1:52:51] for that? And I I do think that's an
[1:52:53] important thing because it gets me away
[1:52:55] from being the responsible party for
[1:52:58] every outcome in this person's life and
[1:52:59] realize that my my responsibility is
[1:53:01] much bigger. That's hard to do. That's
[1:53:03] going to be some big changes. I commend
[1:53:05] it. It's going to be hard.
[1:53:06] » It's be hard for us to struggle with
[1:53:08] because we've got a long legacy. And I
[1:53:10] mean that not as a not as a critique.
[1:53:12] It's not a critique. This is I think
[1:53:14] it's pretty
[1:53:15] » Just to talk about employment. Sorry.
[1:53:20] » Sorry, Katie. Do you want to go before
[1:53:22] me?
[1:53:22] » Yeah.
[1:53:24] » Okay. Um, just to talk about employment,
[1:53:26] like I just recently got a job, but it's
[1:53:30] through the company I'm with, the LEAL
[1:53:34] Foundation. I love it because they
[1:53:38] look towards
[1:53:41] people and other people with or without
[1:53:44] intellectual disabilities. So that's my
[1:53:48] main thing. Like most of the jobs that I
[1:53:51] applied to didn't hire me because I put
[1:53:54] I have an a disability. And I think
[1:53:58] that's criticism.
[1:54:00] I think it's discrimination.
[1:54:02] It's not fair to us that we want to work
[1:54:05] at Kroger, Walmart, Target, wherever.
[1:54:09] They don't want to hire people with
[1:54:11] disabilities anymore. It's frustrating.
[1:54:14] So, I just went with the job that I feel
[1:54:18] like that I love now. It's called
[1:54:21] Feeling Fine. It's off of Massav. that's
[1:54:23] pretty close to here. But,
[1:54:26] um, it's a cute boutique and I just love
[1:54:29] working there. And I feel like as if I
[1:54:33] if I had a mental breakdown here in a
[1:54:36] week or so, just for example, and I was
[1:54:40] working at a different job that they
[1:54:43] didn't understand, they would have fired
[1:54:45] me on the spot.
[1:54:47] Let's just let's just put it that point
[1:54:49] in perspective because that's what
[1:54:51] people do.
[1:54:53] they don't care about our mental health.
[1:54:56] » So, I think uh this is Kate for those of
[1:54:58] you who are online, just so we can have
[1:55:00] that for the transcript, too. Um I
[1:55:03] really appreciate you sharing that
[1:55:05] because I think when from the council's
[1:55:07] perspective, we hear very often that
[1:55:10] mental health and support for people
[1:55:13] with ID who are also experiencing mental
[1:55:16] health challenges is really important.
[1:55:18] And it's not just, you know, getting
[1:55:21] mental health services like therapy.
[1:55:24] It's also having access to the words to
[1:55:27] be able to describe how you're feeling
[1:55:30] and share that experience so you can get
[1:55:33] the help that you need. That's really
[1:55:35] important. And it sounds to me like
[1:55:38] there also is a need on the employment
[1:55:40] side to do more training for um hiring
[1:55:45] managers and in the community about like
[1:55:48] you said you love your job and you work
[1:55:50] at a boutique and I I would love to
[1:55:53] visit your boutique because that sounds
[1:55:55] amazing but I also saw your face light
[1:55:58] up when you were talking about how much
[1:56:01] you love your job and happiness. It's
[1:56:04] not a goal that we work into care plans.
[1:56:08] But ultimately, life is about being
[1:56:11] happy. And you can't do that if the
[1:56:14] things around you are not supporting you
[1:56:16] to be happy and what you want for
[1:56:19] yourself.
[1:56:19] » Right? So, when I was doing job
[1:56:22] applications with my job coach and I
[1:56:25] wouldn't receive anything back, I'm
[1:56:27] like,
[1:56:29] "These jobs don't want to hire people."
[1:56:31] » So, the L Yeah. And the LEO Foundation,
[1:56:36] Home Services Foundation, is the company
[1:56:39] I'm with. And Darlene, she's back there
[1:56:42] beautiful and everything. But she she
[1:56:46] going she put it out there that like,
[1:56:50] "Hey, we have this new boutique opening.
[1:56:53] Would you like to work there?" I was
[1:56:54] like, "Yeah."
[1:56:56] But it took quite a while for me to get
[1:56:59] the job, but I was still patient.
[1:57:03] So I I wanted to just comment on some of
[1:57:06] the valuebased services. It's because it
[1:57:09] sounds like there's two com
[1:57:11] conversations here. What are the value
[1:57:12] based services that you're looking to
[1:57:14] integrate into waiver redesign or waiver
[1:57:17] reset? Sorry, wrong word. Um and how
[1:57:20] will you measure it is those are the two
[1:57:23] things and I know some of those
[1:57:25] measurement pieces come out of national
[1:57:26] core indicators. Um, when we look at
[1:57:30] that data, I always wonder if there's a
[1:57:33] way to increase the response rate to
[1:57:35] that those number of people that are on
[1:57:38] those waiverss versus how many people
[1:57:41] actually respond to national core
[1:57:43] indicators seems relatively low. Um,
[1:57:46] that might be one thing to consider in
[1:57:48] is how do you increase that? Um, the
[1:57:51] other thing uh I would look at is um
[1:57:56] self- advocacy as a service, a value
[1:57:59] added service. Um, the ver there's a few
[1:58:02] states that have self- advocacy
[1:58:05] integrated into their waiver system. Um,
[1:58:08] I don't know how well that works or what
[1:58:10] that entails, but I know that it's on
[1:58:13] it's a service provision. That might be
[1:58:15] something when we're talking about
[1:58:17] self-determination and HCBS helping
[1:58:20] people live in the community.
[1:58:22] Something like self- advocacy
[1:58:25] to build those skill sets uh for better
[1:58:28] community living would be a value added.
[1:58:32] » Thank you. I think Katie had No. Okay.
[1:58:35] Oh, okay.
[1:58:39] » Okay.
[1:58:41] » Yeah. All right. Um, thank you guys for
[1:58:44] the good conversation. Um,
[1:58:47] so you're fine. It's good conversation.
[1:58:50] Um, so lastly, oh, you switched.
[1:58:53] » Were you ready? I'm sorry.
[1:58:54] » That's okay. I think, um, yeah, just the
[1:58:57] last goal of course is implementing the
[1:58:59] sustainable service delivery system and
[1:59:01] we have talked about that as well. So,
[1:59:04] let's go ahead. Um,
[1:59:06] I don't know what the music is. Sounds
[1:59:08] like the ice cream truck. If anyone
[1:59:10] remembers any pizza, too. I did too.
[1:59:15] » Actually, I can't wait.
[1:59:16] » I want the Superman ice cream, please.
[1:59:22] » Um, so um, as we think about a
[1:59:26] sustainable framework, I want to just
[1:59:28] quickly go through those three levers
[1:59:30] we've talked about before. Um, one is
[1:59:33] the support needs tiers. That is again
[1:59:36] where individuals um those interi
[1:59:40] assessments, right? Those will inform
[1:59:45] support level tiers that are in
[1:59:47] development. Okay, those aren't done
[1:59:49] yet. We are gathering all that data um
[1:59:52] from the assessments that have been
[1:59:53] completed.
[1:59:55] Um somebody does have an ice cream truck
[1:59:57] somewhere in this building. Um and then
[2:00:00] we'll be looking at developing or are
[2:00:02] developing support level tiers. those
[2:00:04] those tiers will be individuals who have
[2:00:08] similar needs will be grouped
[2:00:11] um together, right? And according to
[2:00:13] their need and that's what we're
[2:00:15] referring to when we talk about support
[2:00:17] levels or support need tiers. That's
[2:00:21] what we're talking about. That's in
[2:00:22] development from that. Once we have
[2:00:25] those developed, there will be a model
[2:00:27] service mix. And I know we we've talked
[2:00:29] about this before or a model service or
[2:00:32] a combination of services that one would
[2:00:35] typically expect an individual with that
[2:00:38] need level to utilize.
[2:00:42] It's not telling people what services
[2:00:45] they should get and saying here you're
[2:00:46] in this support level. This these are
[2:00:49] the services you get and this is how
[2:00:50] much. That's not the intent. is just to
[2:00:52] give some kind of some parameters for
[2:00:54] teams so they can think about you know
[2:00:57] what that might what a service mix might
[2:00:59] look like um with the individual.
[2:01:03] Then there's support budget tiers and
[2:01:06] those budget tiers will be um determined
[2:01:10] based on available resources the
[2:01:13] Medicaid appropriation right and they
[2:01:16] will be connected if you will to these
[2:01:19] are the support level support need
[2:01:21] levels these are the budget levels and
[2:01:24] there'll be a relationship there but
[2:01:27] they are two separate things I do want
[2:01:29] to stress they are two separate
[2:01:30] » Does that the Medicaid
[2:01:34] Does that mean like a Medicaid um
[2:01:37] redetermination or what
[2:01:40] » To the amount of funds you know to
[2:01:42] believe how we've kind of talked about
[2:01:44] pie that we have of funding that's what
[2:01:46] I'm talking about okay
[2:01:47] » Is that overall kind of pie of funding
[2:01:50] that gets divided with support level
[2:01:53] framework more equitably across the
[2:01:56] individuals and services
[2:01:58] » So my question is is like do they do
[2:02:01] Medicaid determination
[2:02:03] do or no?
[2:02:04] » No, that is that will remain with the
[2:02:06] division of family resources as it is
[2:02:08] now.
[2:02:09] » Okay, that was my question.
[2:02:10] » No, that's a good question. Um, and I
[2:02:12] think the other piece is when we think
[2:02:14] about the budget tiers, we're also
[2:02:17] looking at some things other than the
[2:02:19] assessment that would include living
[2:02:21] arrangement and age and even what are
[2:02:25] those other long-term ser LTSS or
[2:02:28] long-term services and supports um,
[2:02:31] expenses or costs for that individual?
[2:02:34] what are they receiving not just in
[2:02:36] waiver or what are their needs not just
[2:02:39] from a waiver perspective but more
[2:02:40] holistically what are an individual's
[2:02:43] needs and then what are those resources
[2:02:45] that are being used or needed across
[2:02:48] waiver and state plan to address those
[2:02:51] needs
[2:02:53] um and then of course the sustainable
[2:02:55] framework number and type of waivers um
[2:02:58] simplification of the service array and
[2:03:00] and the budget tiers and then the slots
[2:03:03] assigned per waiver
[2:03:04] once we have um the waivers designed or
[2:03:08] or the number of waiverss determined.
[2:03:10] Next slide,
[2:03:13] » Please.
[2:03:15] » Speaking of mental health, maybe we need
[2:03:16] to go over there.
[2:03:17] » Yeah, maybe.
[2:03:20] » Um so, I did want to um just also kind
[2:03:23] of put in one list, if you will, those
[2:03:26] things that we're doing um related to
[2:03:29] waiver reset. Um, we could call them
[2:03:31] phases. Um, but waiver reset is big as
[2:03:35] you guys know. Um, and everything that
[2:03:37] we're doing is working towards
[2:03:40] that final full waiver reset, right? So,
[2:03:44] we've done stakeholder engagement. We we
[2:03:46] will continue to do that. Um, we have
[2:03:49] the support budget community advisory
[2:03:51] board. I didn't name it. um the SB CAB
[2:03:55] um that is meeting monthly um around
[2:03:58] waiver reset. We have the intri
[2:04:01] implementation which you can see how
[2:04:03] that um utilizing those tools across all
[2:04:06] the beads waiverss supports
[2:04:10] that future look at support levels and
[2:04:12] and developing those support levels.
[2:04:16] We have the case management, the
[2:04:17] selective contracting. Um we know with
[2:04:20] waiver reset um however that ends up
[2:04:24] looking right um in 2028, we need case
[2:04:28] managers in place that are well trained
[2:04:30] and well informed so that they can
[2:04:32] adequately support individuals and
[2:04:34] families through those changes.
[2:04:37] Um and then the transition planning of
[2:04:39] course um for individuals on waiverss
[2:04:43] today um that will transition at the
[2:04:46] time of waiver reset. We can't start
[2:04:48] that too soon. And then of course we
[2:04:50] have talked um I believe last month
[2:04:53] about um our pursuit for a youth waiver.
[2:04:57] Um we have heard um for uh quite some
[2:05:01] time that there is a desire um for a
[2:05:05] youth waiver. ch needs of children are
[2:05:08] significantly different than those of
[2:05:10] adults. Um so we are um looking at
[2:05:14] pursuing a youth waiver um likely in
[2:05:18] advance a little bit in advance of the
[2:05:21] full waiver reset. So um I know that's a
[2:05:25] lot. If we have questions we can
[2:05:27] certainly talk through those. But this
[2:05:29] surprise this will not be the last time
[2:05:30] you hear about waiver reset. We'll
[2:05:32] continue to have those conversations.
[2:05:34] So, next slide.
[2:05:37] Um, I won't go through this slide. You
[2:05:40] all have seen it before. It just
[2:05:42] provides a little more information on
[2:05:43] the support budgets. Um,
[2:05:47] but just wanted to call that out. Also
[2:05:50] wanted to include the slide. Yes, that
[2:05:53] talks about why we're pursuing support
[2:05:55] budgets. Again, I think you know um I
[2:05:58] will I will confess um I am steeped
[2:06:02] enough in waiver reset that that I have
[2:06:04] to remind myself to talk about the why,
[2:06:07] right? Why are we doing this? Um why are
[2:06:11] we pursuing um waiver reset and why are
[2:06:14] we pursuing this different model of of
[2:06:17] support level needs or support needs
[2:06:20] levels and support budgets?
[2:06:23] Um, at the end of the day, um, we're
[2:06:26] doing it, um, we're pursuing it because,
[2:06:30] um,
[2:06:33] today there isn't, um, there is perhaps
[2:06:37] a lack of lack of equity in in resources
[2:06:40] individuals can access through HCBS,
[2:06:43] right? It's dependent some on the waiver
[2:06:46] you're on and and some other factors.
[2:06:48] And the support level framework um
[2:06:51] allows us to um objectively identify an
[2:06:56] individual's needs.
[2:06:58] And then the support budget allows us a
[2:07:02] way to objectively say people with this
[2:07:04] level of need should have access to this
[2:07:07] level of funds.
[2:07:08] » So on the waiver reset, are you talking
[2:07:11] about all the waivers? Are you gonna
[2:07:13] like like go through all the waivers and
[2:07:16] see which need which waivers need more
[2:07:20] budget?
[2:07:21] » No, the actual the full waiver reset,
[2:07:25] right, is when we will sunset
[2:07:27] » The waivers we have today
[2:07:30] » And they will be replaced and we will
[2:07:33] stand up new waivers completely new.
[2:07:37] » Um there will be a transition period,
[2:07:40] right? So, individuals in all likelihood
[2:07:42] will transition when their annual
[2:07:46] » Um plan is due. Okay. Right. Um but the
[2:07:49] waiverss as we know them today
[2:07:53] » Won't be here. That's 2028 probably.
[2:07:55] » Okay. Cool. Yeah. So, we're still
[2:07:57] » It's not tomorrow. So, it's okay.
[2:07:59] » That's what I was wondering.
[2:08:01] » If it was tomorrow, all hair on my head
[2:08:04] would be gray. But it's not. It's 25.
[2:08:07] Me, too.
[2:08:08] » So, it's all right.
[2:08:11] Yeah,
[2:08:11] » It it does. It feels like it's next
[2:08:13] month around 2028, but but but we have
[2:08:16] some time
[2:08:17] » In two years.
[2:08:18] » Holly,
[2:08:19] » Yes. Has it completely like because I
[2:08:22] know at one point we were talking like
[2:08:24] late 2027.
[2:08:26] Has it completely changed to the
[2:08:28] transition period being 2028? And the
[2:08:30] reason I asked this is I believe my
[2:08:32] annual meeting is typically in December.
[2:08:35] So, would I start transitioning in
[2:08:37] December of 2027 or would I have to wait
[2:08:39] till December of 2028?
[2:08:42] » So, I can't give you a firm answer on
[2:08:43] that right now, Lexi. Um, you know, we
[2:08:48] we would we are full steam ahead. I want
[2:08:51] to be clear about that. But we also want
[2:08:53] to be very thoughtful and I do feel like
[2:08:56] um previously we had talked about 2027.
[2:08:59] I do feel like we are sliding into early
[2:09:02] 2028.
[2:09:04] Um so um but we will keep you all
[2:09:07] apprised of kind of where we are on that
[2:09:09] timeline. Um
[2:09:13] but we we again we're full speed ahead
[2:09:15] but we want to make sure that um we
[2:09:19] don't we want to be very thoughtful and
[2:09:21] intentional in the process. So
[2:09:23] » Understandable.
[2:09:25] » Yeah. Yeah. But we'll keep you all I
[2:09:27] mean we'll we'll be talking about this a
[2:09:29] lot. You're going to have to hear from
[2:09:30] me a lot more. I'm sorry.
[2:09:32] » No problem. I like hearing about this
[2:09:34] stuff, so it's cool.
[2:09:35] » Okay. Thank you,
[2:09:38] » So then go ahead.
[2:09:39] » Sorry. I was gonna say, um, with the
[2:09:41] youth waiver being a possibility, will
[2:09:44] there be any kind of, um, I guess
[2:09:49] movement forward to
[2:09:52] coordinating how that might uh, work
[2:09:56] with the schools or with the um, IdoE as
[2:10:00] well? Yeah, that's a a a great question.
[2:10:04] Um yes, I think um as we get further in
[2:10:09] with the youth waiver, I do think it's
[2:10:13] important um that we engage with
[2:10:17] Department of Education. Um, I I will
[2:10:20] say, and I know you know this, um,
[2:10:25] a family's experience with the
[2:10:27] educational system often is related
[2:10:31] almost solely to their local school
[2:10:33] district. Um
[2:10:36] so um but yes I think that's an
[2:10:40] important call out is and we do need to
[2:10:42] account for again those entitlement
[2:10:45] services for youth and how do we support
[2:10:47] them in accessing those
[2:10:50] in an appropriate way. Yeah good call
[2:10:53] » With the youth waiver um possible
[2:10:56] transition before like is there an idea
[2:10:57] of how much sooner that that transition
[2:11:00] would start than the full waiver reset?
[2:11:02] Um, not right now. I think we would like
[2:11:05] to I think if we we need to get it we
[2:11:08] would need to to work through the youth
[2:11:10] waiver um and get it implemented in 2027
[2:11:14] probably early to mid 2027.
[2:11:17] Um if we're going to do it before waiver
[2:11:20] reset and that that is next week by the
[2:11:23] way. Um not really but um but yeah
[2:11:26] that's that's kind of in discuss or that
[2:11:29] is in discussion right now as well is
[2:11:30] watching that timeline.
[2:11:32] » Holly is the envision that if youth only
[2:11:36] on like only on that waiver and not on
[2:11:38] the other waivers. So if they're youth
[2:11:39] are on that waiver only that waiver.
[2:11:41] » Yeah.
[2:11:41] » Okay.
[2:11:42] » Yep.
[2:11:46] » Um let's see. Oh, and another thing on
[2:11:49] here that I just want to want to note is
[2:11:51] the supports budget does promote some
[2:11:53] transparency there so that individuals
[2:11:56] will know um walking into their annual
[2:12:00] meeting so to speak what resources they
[2:12:03] have available through state uh not
[2:12:04] through state plan through the waiver um
[2:12:08] in terms of in in consideration of also
[2:12:12] what other services they may be
[2:12:14] accessing through state plan and other
[2:12:16] resources.
[2:12:18] And again, it allows us to predict
[2:12:21] predict predict I've been talking for
[2:12:24] way too long today. Um spending
[2:12:27] um both for people on the wait list as
[2:12:31] well as um individuals and services. So
[2:12:34] yeah, we can go ahead and go to the next
[2:12:36] one.
[2:12:36] » One more question. The the requirement
[2:12:39] um from last legislative session to
[2:12:40] create an assisted living waiver, how
[2:12:42] does that interplay with the waiver
[2:12:43] reset?
[2:12:44] » I'm so sorry. living.
[2:12:46] » Oh. Oh,
[2:12:47] » The assisted living waiver is 460 plus.
[2:12:50] » Okay. No implications just on that.
[2:12:52] Okay.
[2:12:53] » Good question though.
[2:12:54] » That would fall under
[2:12:57] » OMP.
[2:12:58] » Yeah.
[2:13:01] » Yep. Um I won't go through this again.
[2:13:03] I'm wanted to include it though. If we
[2:13:05] can go to the next slide. I've updated
[2:13:08] this next slide and graphic. Please note
[2:13:12] that those uh participant counts are
[2:13:14] current um as of
[2:13:18] » April. April. As of April um
[2:13:21] » Say current people say
[2:13:22] » Yeah I know um
[2:13:25] » The devil's in the details as Jim said.
[2:13:27] Yes. Okay. I can add that
[2:13:29] » Just in because people will say
[2:13:30] » Yes. So I've added in the youth waiver
[2:13:33] there that you can see that is a
[2:13:35] difference from the last time you saw
[2:13:36] this slide as well. We have the case
[2:13:38] management and the youth waiver. And
[2:13:40] then that green is more representative
[2:13:42] of the new waiver structure that would
[2:13:45] that we would be in um at the time of
[2:13:48] waiver reset.
[2:13:52] » Um let's go ahead and
[2:13:56] » Can you maybe just go back?
[2:13:58] » Yes, please go back.
[2:13:59] » I just want to highlight on that because
[2:14:01] I think you did this intentionally.
[2:14:04] » Oh, I did. Um,
[2:14:06] Holly appears to have bolded
[2:14:09] the kid numbers.
[2:14:11] » Um, and I I I just wanted to call out
[2:14:14] the numbers of kids that we are serving
[2:14:17] is now outnumbering the adults.
[2:14:23] » Thank you, Kathy.
[2:14:25] » I mean,
[2:14:27] » Yeah. So, lots of use.
[2:14:29] » So, the bold ones mean kids.
[2:14:32] » Yeah. The bold ones like the 10,000
[2:14:34] There are some that are
[2:14:36] » So basically 10,000 FS is 0 to 17 I mean
[2:14:41] over 10 you know then 18 to 26 is 7,000
[2:14:44] 27 to 56 and then H&W 2000
[2:14:50] to 17 798 18 to 26 okay
[2:14:56] » Yes and our ages on the family support
[2:14:58] waiver weight list very much
[2:15:02] um correlate with this as well um in
[2:15:05] terms of the age of of individuals on
[2:15:08] the FS weight list. So Jory, just
[2:15:10] quickly, I saw your face. So it's
[2:15:12] interesting because I think you probably
[2:15:13] didn't realize. It's interesting. I just
[2:15:15] was because I think we are noticing
[2:15:17] people don't necessarily real I mean we
[2:15:19] say it sometimes but I don't think it's
[2:15:21] I not to call you out. I just saw your
[2:15:23] face was like oh
[2:15:25] » My so I'm assistant special ed director
[2:15:27] in the district and I think that's very
[2:15:29] reflective though of the needs that
[2:15:31] we're seeing in schools. the school
[2:15:32] needs are significant and the I oversee
[2:15:35] the uh developmental preschool program
[2:15:38] as well as the my board of our
[2:15:41] classrooms for students who have more
[2:15:42] intense needs and just the level of the
[2:15:45] growth in those needs is startling um
[2:15:49] and then how are we providing it's very
[2:15:52] passionate topic because it is this the
[2:15:55] classrooms um we are adding a fourth
[2:15:57] classroom our development preschool
[2:15:59] classrooms are exploding and we're a
[2:16:01] smaller district um some of the larger
[2:16:03] districts and these are we have students
[2:16:05] I mean every we've tried to figure out
[2:16:07] how do we catch these kids as two or
[2:16:09] three or four year olds who already have
[2:16:11] the identified disability versus like a
[2:16:13] developmental delay how do we catch them
[2:16:15] get them on the waiting list for the
[2:16:17] waiver um so we've just added little
[2:16:19] bits to like our case conference
[2:16:21] templates and things to ask but the
[2:16:23] number of students that are not on the
[2:16:25] wait list yet that haven't even signed
[2:16:26] up and then match the number of kids
[2:16:28] that are on it and just knowing in my
[2:16:30] head like the conferences that in with
[2:16:32] 11 year olds or 15 year olds that are
[2:16:33] still that have not been caught.
[2:16:35] » It's just I think it's very reflective
[2:16:38] kind of
[2:16:38] » I think what they should do is like have
[2:16:42] someone test them and then figure it out
[2:16:45] because that's what my mom had me do was
[2:16:47] be tested every year to see where I
[2:16:50] struggle at and then they could help
[2:16:53] them get on there. And these are
[2:16:55] students.
[2:16:59] » Even if they weren't evaluated, they
[2:17:01] should still test them, you know.
[2:17:03] » And I think to your point, Jo, I think
[2:17:05] that's where the youth waiver comes in
[2:17:06] because the services and supports that
[2:17:08] are offered, right? I mean, aren't um I
[2:17:12] I think about this as my first day on
[2:17:14] the job years ago is what are you
[2:17:16] waiting for? Because the problem is I
[2:17:18] think people are waiting but it's it's
[2:17:20] what services are on that array right
[2:17:22] for a child and there's other services
[2:17:24] that the school system provides right
[2:17:26] that is not a waiver service and so I
[2:17:28] think that's you know the the movement
[2:17:31] is because what you know what what are
[2:17:34] you wait I mean you know because a lot
[2:17:36] of times it's not it the services that
[2:17:39] are there other DOE's you know what I
[2:17:41] mean there's other services and supports
[2:17:42] that are already in place that are
[2:17:44] helping that so it's kind of
[2:17:46] » Can I throw something out there about
[2:17:47] the numbers. This is Lexi.
[2:17:49] » Um,
[2:17:51] so I think so I found out I got on I was
[2:17:56] got on the A andd waiver originally.
[2:17:58] I've been on the waiver for almost 10
[2:18:00] years and h about half of that was A&D
[2:18:02] um which is now health and wellness. Um,
[2:18:06] and I found out from my doctor, believe
[2:18:08] it or not, which I heard is rare to find
[2:18:10] out about the waiver from your doctor.
[2:18:13] Um I think we're seeing more kids on the
[2:18:15] waiver, more youth on the wa on the
[2:18:18] waiver or on the waiting list now than
[2:18:21] historically is because um and I see
[2:18:24] this a lot on but on social media
[2:18:27] especially Facebook and stuff there's a
[2:18:29] lot of peer-to-peer support for families
[2:18:32] like parents are supporting parents and
[2:18:34] caregivers are supporting caregivers
[2:18:36] their you know Facebook groups for stuff
[2:18:38] like that and I think more parents are
[2:18:41] hearing about the waiver honestly ly
[2:18:42] through other parents through social
[2:18:44] media um than historic, you know, that
[2:18:48] wasn't a thing. That wasn't even as much
[2:18:50] of a thing when I got on the waiver 10
[2:18:53] years ago. But, um I think historically
[2:18:56] for people my age, schools weren't
[2:18:59] talking about it. Doctors weren't
[2:19:00] talking about it. And now parents are
[2:19:02] seeing other parents with their kids on
[2:19:04] it on social media and finding out from
[2:19:07] parents. And there's just so much
[2:19:08] peer-to-peer support, especially with
[2:19:10] social media.
[2:19:13] Yeah, good point, Lexi.
[2:19:15] » Thank you.
[2:19:15] » Thank you, Kathy. Thanks for bringing us
[2:19:17] back to point that out. No, I appreciate
[2:19:19] it. I'm glad you did.
[2:19:21] » I'm glad you did. Um, just want to note
[2:19:24] we've already talked about most of this.
[2:19:26] Um, but do want to just reiterate that
[2:19:29] we are um analyzing that data from the
[2:19:33] interrise now. Um and then um if we can
[2:19:36] move to the next slide, I want to
[2:19:38] provide an update on
[2:19:40] some of the activities that we're in
[2:19:43] process of or have completed already um
[2:19:46] with regards to waiver reset. Um HSRI,
[2:19:50] human services research institute is a
[2:19:53] contracted entity with beads. um they
[2:19:56] now have two years of Medicaid claims
[2:19:59] data that includes the waiver, the HCBS
[2:20:03] data as well as state plan data. So
[2:20:05] we're looking again at that holistic
[2:20:07] approach right um and they are cleaning
[2:20:11] that right from a data perspective um
[2:20:14] and then uh working on that analysis. We
[2:20:18] have also and this is not we bees. This
[2:20:21] is one of our internal partners in FSSA
[2:20:23] our uh friends over at office of
[2:20:25] Medicaid policy and planning have
[2:20:27] launched an internal workg group
[2:20:29] exploring state plan home health
[2:20:31] services um and we are a part of that.
[2:20:34] Um we've held some initial meetings on
[2:20:36] the plans and goals for waiver reset
[2:20:39] with our cross system partners that
[2:20:40] includes um our friends at um DMHA of
[2:20:45] course our our family now in the Bureau
[2:20:48] of Better Aging um as well as OMP.
[2:20:54] We have also um completed an in-depth
[2:20:58] review of our current service
[2:21:01] definitions across all four of the beads
[2:21:03] waivers. I think we've talked about
[2:21:05] before um we have a lot of services that
[2:21:08] we offer and how can we simplify that,
[2:21:11] right?
[2:21:12] um how can we kind of consolidate
[2:21:14] services or combine services or in in
[2:21:18] some way make that system that's those
[2:21:21] that that service array a little easier
[2:21:23] to understand. Um while also keeping
[2:21:27] that eye on on quality services. Um so
[2:21:31] we have completed that. Um we have
[2:21:33] completed round one of research into
[2:21:36] some promising practices in other states
[2:21:38] on all things waiver reset. Right. Um
[2:21:41] all different topics there. And then we
[2:21:43] begin um or began some additional um
[2:21:47] research into promising practices
[2:21:49] earlier this month. We have a
[2:21:52] preliminary service array recommendation
[2:21:54] from HSRI or No, I'm sorry. We don't
[2:21:57] have it yet, but it's in process of
[2:21:59] being um developed for us to review.
[2:22:05] And then um Yes. Oh, I'm sorry. You're
[2:22:09] fine. We're fine. Um on that preliminary
[2:22:12] service array recommendations, is that
[2:22:14] going to be uh discussed with the SB?
[2:22:18] » Probably. So I'm not sure the timeline
[2:22:20] for it yet, but I would think we will
[2:22:22] talk about that with the SB group. Yes.
[2:22:24] Thank you.
[2:22:25] » Good question.
[2:22:28] We have also provided weight list data
[2:22:31] um to HSRI um because as we talk about
[2:22:35] the launch of a youth waiver and waiver
[2:22:37] reset um we know we've got multiple
[2:22:40] waiting lists now for HCBS. So we need
[2:22:44] to be looking at that and deciding how
[2:22:46] that's going to work moving forward.
[2:22:49] Um and then
[2:22:50] » Sorry Holly.
[2:22:51] » Oh yeah sure. Well, Kate left, so
[2:22:54] somebody asked that question, but you
[2:22:56] know, she she passed it on to me. Um,
[2:23:00] that weight list data, is that kind of
[2:23:02] demographic data, age? Okay, so it's not
[2:23:07] um level of care, nothing like that.
[2:23:09] Okay.
[2:23:11] » Well, let me rephrase that. That waiting
[2:23:14] list data would include what level of
[2:23:16] care was met by the person, right?
[2:23:19] because we have different we have the
[2:23:21] nursing facility level of care and the
[2:23:22] ICF ID level of care. So,
[2:23:25] » Does that make sense?
[2:23:26] » Yes, it does. It's you're not looking at
[2:23:28] you're not looking at NRI data
[2:23:31] essentially.
[2:23:32] » We're looking at the level of care.
[2:23:33] » Got it. Thank you.
[2:23:34] » Yeah.
[2:23:37] All right. Good questions. Um and then
[2:23:39] again, need to update this because the
[2:23:41] final awards um for the new case
[2:23:43] management contracts have been made. So
[2:23:46] um and we've talked quite a bit about
[2:23:48] case management and also the data
[2:23:50] analysis for the budget framework um
[2:23:53] development has begun. So while we're
[2:23:55] working on the identifying the support
[2:23:57] levels
[2:24:00] um for individuals um and what that will
[2:24:03] look like or the support level
[2:24:04] framework, we're also analyzing that
[2:24:07] data or HSRI is analyzing the data uh
[2:24:10] regard regarding the budget framework
[2:24:12] which again considers
[2:24:15] HCBS and state planning. So, it's all of
[2:24:18] the long-term services and supports
[2:24:20] data.
[2:24:26] Okay.
[2:24:27] Okay. Going to shift just a little
[2:24:31] shift. Any questions? I'm going to reset
[2:24:33] before I jump in here. Okay. Okay. So,
[2:24:36] the home and community support
[2:24:38] professionals uh statistics. So, we have
[2:24:41] a reporting period. This is the the
[2:24:43] training registry that the HCSP
[2:24:46] um training registry that we've
[2:24:48] launched. Um the total number of
[2:24:52] learning path certificates granted since
[2:24:54] July is over almost 37,000
[2:24:58] which is really good. Um total time
[2:25:02] spent learning is um about 188,000
[2:25:06] hours. Uh Wednesday appears to be the
[2:25:09] day that most people do their training.
[2:25:11] Huh.
[2:25:12] » Yeah, that is interesting. Um, it's
[2:25:16] middle of the week and then the user
[2:25:18] device description just talks about what
[2:25:20] device people are using, right, for um
[2:25:23] for the training. So, um, again, we've
[2:25:27] had really positive, uh, feedback on the
[2:25:32] HCSP training.
[2:25:34] » Is that is the this
[2:25:37] professional stats like the tests that
[2:25:40] people have to take to be a caregiver or
[2:25:44] anything?
[2:25:44] » So, is the the HCSP training, right,
[2:25:48] includes th that competency testing.
[2:25:51] » Okay. So get the certificate. You
[2:25:53] correct me if I'm mistake. Um
[2:25:56] » When you say caregiver
[2:25:58] » I don't know to what you're
[2:26:00] » Like
[2:26:00] » You know what I mean
[2:26:01] » Support staff.
[2:26:02] » Yes like Yes. I just want to make sure
[2:26:05] because it's not all service like but I
[2:26:08] Yes. Traditional
[2:26:10] » Is CI on it or Okay.
[2:26:12] » Yes. But like a music therapist which I
[2:26:14] know you wouldn't call it is not
[2:26:16] considered a home but yes but
[2:26:17] traditionally the what you're thinking
[2:26:18] of is Yes.
[2:26:19] » Yes. CI. Yeah.
[2:26:21] » Yeah.
[2:26:22] » Yeah. DS
[2:26:24] » Or day programs day programs. Okay.
[2:26:28] Cool. Thanks.
[2:26:31] » We had really positive feedback. We've
[2:26:33] been very pleased with how
[2:26:35] » Yeah. And we're going to provide the
[2:26:37] reertification is coming up um in terms
[2:26:40] of um folks. And then also the med admin
[2:26:43] we're still working on. It's taking a
[2:26:45] little bit longer. The the providers are
[2:26:47] obviously able to still use their own,
[2:26:48] right? they're not being penalized for
[2:26:50] um anything. So um yeah, so it's going
[2:26:52] pretty well. We're going to share u much
[2:26:54] more information and we're also coming
[2:26:56] up on a year. So we're going to be able
[2:26:58] it's hard because we didn't have data on
[2:27:01] direct support professionals prior to
[2:27:02] this. So we don't have anything to
[2:27:04] compare it to much. I mean we have some
[2:27:07] obviously national um you know surveys
[2:27:10] that are done but um so but now that
[2:27:13] we're almost at a year we can really
[2:27:15] look at um you know some things and I
[2:27:19] think it's going to be interesting as
[2:27:20] we're moving forward. So we will be
[2:27:21] presenting at the quarterly
[2:27:24] MFR which is what?
[2:27:27] Yeah. When is that? August. I don't
[2:27:29] remember when the next one is. Um sorry
[2:27:31] I'm blanking but we will be providing
[2:27:33] details on this. Um just some more data
[2:27:36] and everything. So it's exciting stuff.
[2:27:38] » We all have brain farts sometimes.
[2:27:40] » I know I can't.
[2:27:42] Yeah.
[2:27:46] » Yeah.
[2:27:49] » Okay. We have about I mean 20 minutes.
[2:27:51] Obviously not going to hold you here and
[2:27:53] to stare at each other, but if
[2:27:56] Oh yeah,
[2:27:58] » I know.
[2:28:04] » Good job.
[2:28:05] » Wait, we've got 20 minutes worth of
[2:28:07] questions. Go.
[2:28:10] » So,
[2:28:13] » We need Kate We need Kate back.
[2:28:16] I'm just going to um add since we do
[2:28:19] have some time and we um obviously I
[2:28:23] mentioned earlier around sort of the
[2:28:26] questions related to the valuebased
[2:28:28] payment or purchasing our interest in
[2:28:31] the employment space uh competitive
[2:28:33] integrated employment space. Um and
[2:28:37] that's an area that we've continued to
[2:28:39] to work toward making incremental
[2:28:42] progress. Um, but as of I think this
[2:28:48] week, and you two correct me if I'm if I
[2:28:52] can't read clearly, apparently, um, we
[2:28:55] have less than 500 subminimum wage
[2:28:58] workers in the state of Indiana right
[2:29:00] now.
[2:29:01] » Um, and that is a significant decrease
[2:29:04] from where we started um, I don't know,
[2:29:08] feels like yesterday, but it was a
[2:29:10] couple years ago. Um and so for for us
[2:29:14] that continue when I said that earlier
[2:29:17] it's because we have um we have a a
[2:29:20] desire here to make some meaningful
[2:29:22] progress um in Indiana and I think we
[2:29:25] are very much on the right track. Um, we
[2:29:28] do still have a number of 14C entities,
[2:29:32] but those a number of those are working
[2:29:35] at um transitioning out uh or phasing
[2:29:38] out their 14C's uh even so later this
[2:29:42] year. So, um I I want to just
[2:29:45] acknowledge the work that everyone has
[2:29:48] has done in that front, but we are that
[2:29:51] don't feel like that's an opportunity to
[2:29:53] let up on the gas at this point, which
[2:29:55] is why we're talking about valuebased
[2:29:58] payment as a mechanism to help forward
[2:30:01] um the employment um outcomes for people
[2:30:04] even further. So, I just I wanted to
[2:30:06] take a minute to share some of that
[2:30:08] data. Didn't totally fit into the agenda
[2:30:11] um today. And I certainly will have some
[2:30:14] more information to to share with you at
[2:30:16] future uh advisory meetings. But um I I
[2:30:21] I because you all have been so invested
[2:30:24] and involved in these conversations and
[2:30:27] some of the work that we've laid forth
[2:30:29] in our plan. Um I I wanted to take just
[2:30:32] take an opportunity to to to put that in
[2:30:34] front of folks and uh share that update.
[2:30:38] » Yep. So in that 500 does it is it with
[2:30:42] people with intellectual disabilities or
[2:30:45] that
[2:30:47] because they can't have a job or
[2:30:51] the person
[2:30:53] wants a job but
[2:30:56] the com the base the jobs like Target,
[2:31:00] Walmart, Kroger,
[2:31:02] Goodwill. I I know Goodwill hires
[2:31:05] people, but I don't preferly like
[2:31:08] working there. But
[2:31:11] um is that because the 500 is because
[2:31:16] jobs now these days are not accepting
[2:31:19] people with intellectual disabilities?
[2:31:24] » You feel free to to jump in. Um I
[2:31:26] there's actually it's a number of
[2:31:28] reasons why they're they haven't and and
[2:31:31] some of it is at this point either they
[2:31:34] they haven't had those conversations and
[2:31:36] been planning around competitive
[2:31:38] integrated employment. They're just at
[2:31:40] different places and spaces depending on
[2:31:42] their own um kind of trajectory kind of
[2:31:46] how long have they been in a subminimum
[2:31:48] wage scenario. And um obviously
[2:31:51] sometimes it's harder for folks to
[2:31:53] transition away from that. um there
[2:31:56] there's a lot of forces at play for some
[2:31:58] some of those people for maybe why
[2:32:00] that's the case. Um but knowing that
[2:32:04] that number I think is a much more um a
[2:32:08] number that's much better I guess from
[2:32:10] tackling those very um individualized
[2:32:14] issues on an individual basis um to be
[2:32:17] able to help them work through that or
[2:32:19] navigate look at a trajectory of where
[2:32:21] they're headed and how to get there.
[2:32:23] Holly or Jess, anything else you would
[2:32:26] ask?
[2:32:27] » Yeah, no, I think that was a great
[2:32:29] response. I would I would also add that
[2:32:31] I think um some of the individuals um
[2:32:34] that are maybe still in those settings
[2:32:36] too may just have lots of questions
[2:32:40] about competitive integrated employment.
[2:32:42] And I think um I'll I'll be selfish here
[2:32:45] and make a little plug for a couple of
[2:32:47] the newer services, the career
[2:32:49] exploration and planning and and also
[2:32:51] that benefits
[2:32:53] » Those benefit discussions because I
[2:32:55] think um those are opportunities to um
[2:32:59] for our system to engage with those
[2:33:02] individuals and their families about
[2:33:05] what other what are the other
[2:33:07] possibilities, you know, right? Um, I
[2:33:10] think my mom's supposed to do my
[2:33:12] benefits review with someone, but they
[2:33:15] haven't reached back out. So, then
[2:33:18] my um VR counselor and I met yesterday
[2:33:23] with my mom and Darlene and she said,
[2:33:26] "We're thinking about taking you to the
[2:33:28] next step and closing your case."
[2:33:32] because they couldn't really work with
[2:33:34] me because my case manager is in Johnson
[2:33:37] County and I work in Marian. Um, but I
[2:33:41] would have I like the job where I'm at
[2:33:43] because it's just easier. They love
[2:33:47] people with intellectual disabilities
[2:33:49] and they want us to succeed and move on
[2:33:53] from what what's going on right now.
[2:33:56] Like, you know, like I get it. It's hard
[2:33:59] to
[2:34:01] like my like if I was looking for a job
[2:34:05] like let's say 5 years ago which I I did
[2:34:09] have a job but then
[2:34:14] it's harder these days to get a job
[2:34:18] because of all the changes in the state
[2:34:24] and with the government and sorry I have
[2:34:27] to say his name even though I don't like
[2:34:29] him. Trump's stuff, but I just I don't
[2:34:35] understand why he's doing this to people
[2:34:38] with an abilities.
[2:34:41] But my point is like he doesn't know how
[2:34:44] well we succeed. He doesn't know
[2:34:46] anything. And he has someone with a
[2:34:49] disability and he probably disown them
[2:34:51] like crazily, but I don't like them. So,
[2:34:57] » Well, again, I think as as you mentioned
[2:34:59] though, you know your possibilities,
[2:35:00] right? And I think we have we likely
[2:35:03] have some individuals maybe who don't
[2:35:05] and we need to be having those
[2:35:06] conversations.
[2:35:08] » They they need more support in it.
[2:35:11] » Yeah.
[2:35:13] » I'd also like to make a statement and
[2:35:15] the two other lawyers in my room, they
[2:35:16] can people cannot not hire you because
[2:35:18] you have a disability. So, just
[2:35:19] » We can have a we'll have a side
[2:35:21] conversation that is not okay. So just
[2:35:24] just making that public statement.
[2:35:26] Someone cannot hire you. That's
[2:35:27] discrimination. So anyway, um but uh
[2:35:31] okay. So I think did you have a
[2:35:32] question, Lexi? And then I know Katie
[2:35:34] has a question as well.
[2:35:36] » Oh,
[2:35:38] » Um yeah, I had a question. Um actually I
[2:35:40] have a couple. So um
[2:35:44] I was asked by an individual uh two
[2:35:47] questions. So the first was how do you
[2:35:50] plan on targeting the weight list for
[2:35:53] FSWC
[2:35:54] health and wellness and TVI? And my
[2:35:57] second question is um it's kind of a
[2:36:00] two-parter. uh like when when kind of
[2:36:05] when slots open up in on July 1st,
[2:36:09] uh how do you plan to target the FSW
[2:36:11] weight list and kind of what's the plan
[2:36:14] for addressing CI
[2:36:18] » Questions?
[2:36:18] » Yeah. And Lexi, I'm sorry I didn't get a
[2:36:21] response out to you until this morning
[2:36:23] that I'll I'll follow up with you on
[2:36:24] that. I think those are
[2:36:26] » Yeah, that's those are those are that's
[2:36:28] a longer conversation than today and I
[2:36:31] um but I can follow up with you for
[2:36:32] sure. Those are good questions.
[2:36:34] » Okay, thank you. Sorry, I haven't been
[2:36:36] on my email so I haven't seen
[2:36:37] » No, believe me, I understand. I will
[2:36:39] never criticize someone for not reading
[2:36:40] their email immediately. Okay, you're
[2:36:43] good.
[2:36:43] » Okay, thank you.
[2:36:46] » Katie, you had a question. I think
[2:36:48] » Is there a timeline on the updated
[2:36:50] living caregiver bulletin?
[2:36:54] the amended one. Yes. Um I don't have a
[2:36:58] date that we will be able to issue that,
[2:37:00] but we are working to get that out as
[2:37:01] soon as we can. I'll let you know
[2:37:04] » Soon as we have that. Thank you.
[2:37:07] I was just going to ask if in the future
[2:37:09] at a meeting maybe we could have um
[2:37:12] conversation about choice and how that
[2:37:14] since it is serving families under 60
[2:37:16] and how that intersects with then the
[2:37:18] beads HCBS and how someone might find
[2:37:21] themselves on one path or the other just
[2:37:24] since we have someone here now that can
[2:37:26] speak to that I would love to to learn
[2:37:28] more about
[2:37:29] » We can watch that PDA video again right
[2:37:37] I have one kind of um follow-up comment
[2:37:40] from last uh from our last meeting which
[2:37:42] I believe was our March meeting. Um at
[2:37:45] that time, Holly, you had you had
[2:37:47] expressed the um opportunity for NABC
[2:37:49] members to provide you um and beads with
[2:37:53] um claims issues from December. And
[2:37:55] these were these were issues that
[2:37:57] happened because no nobody did anything
[2:37:59] like intentionally wrong, but there were
[2:38:01] some autogenerated budgets in January
[2:38:03] that then ended up where there was some
[2:38:06] shortfall in December and we were having
[2:38:08] difficulty finding traction to get those
[2:38:11] those um legitimate claims paid. And um
[2:38:14] NABC, all the members, we really
[2:38:17] appreciate the way that beads partnered
[2:38:19] with us to look at over 500 claims. Um,
[2:38:23] and I mean, and it took a minute. I
[2:38:26] don't think that you were expecting it
[2:38:27] to be quite that big a number. Um, but
[2:38:30] you know, a lot of members of NABC have
[2:38:32] expressed to me gratitude um, for your
[2:38:35] willingness to to do that. And I I think
[2:38:37] that it's um, it's important. I mean,
[2:38:39] you brought it up uh, two months ago
[2:38:41] that you were willing to do this and you
[2:38:43] followed through and we really do
[2:38:44] appreciate it.
[2:38:46] » No problem at all. We're all in this
[2:38:48] together, so
[2:38:50] through things together.
[2:38:52] » Thank you.
[2:38:55] Okay. Uh, next meeting July 15th here at
[2:38:58] the government center in room B and BRS
[2:39:01] Teresa Kazar um will be giving an update
[2:39:04] from BRS.
[2:39:06] All right. Thank you everyone. Thanks
[2:39:08] everyone online.
[2:39:09] » Thanks. Thanks everyone.