Rappahannock Rapidan Community Services Program Committee Meeting - - PDF document

Rappahannock Rapidan Community Services Program Committee Meeting September 24, 2019 at 1:00 PM MINUTES Members Present: Ann Baumgardner, Donalda Lovelace, Dawn Klemann, Jack Ledden, Valerie Ward Staff Present: Jim LaGraffe, Anna McFalls, Ryan Banks, Ray Parks, Paula Stone, Daisy Mills, Valerie Sparks, Jeanette Nord, Sheri Sobkowiak Others present: Robert Weigel, Demaris Miller

• 1. Call to order

Ann Baumgardner called the meeting to order at 1:01 pm.

• 2. Agenda Review

The committee consented to adopt the agenda.

• 3. Follow up on recent activities

Jim LaGraffe, Executive Director noted that, following up to the Board Planning day in August, Katie Snyder, executive coach and consultant, will be attending the October 8th Board Meeting to begin discussions on developing a long-term strategic plan for the organization. Additionally, he reported that the Oxford House in Warrenton is now off the table as there are current code compliance

• issues. He added, however, that PATH is still interested in it and asked members to keep an eye out

if anything becomes available in Fauquier County or northern Culpeper.

• 4. Quality Assurance Report

Anna McFalls, Director, Finance & Administrative Services Division, introduced Daisy Mills, Quality Analyst, after which Ms. Mills briefly described her experience. Valerie Sparks, Quality Analyst, discussed RRCS’ reporting requirements. She also briefly detailed recent program reviews and resulting action plans. Committee members talked about reports regarding client services.

• Closed Session – Discussion Relating to Medical Records

ACTION: Jack Ledden moved that the Board enter closed session for the purpose of discussing issues relating to medical and mental health records. This motion is made pursuant to Virginia Code Section 2.2-3711, Paragraph A, Subsection 16. After reconvening the open session, committee members were polled, "To the best of your knowledge, do each of you certify that only public business matters lawfully exempted from the open meeting requirements under existing Virginia law, and only such public business matters as were identified in

Program Committee – September 24, 2019 Page 2 the motion by which the closed session was convened were heard, discussed, or considered by the Committee in the closed session just held?" Each Board member present responded as follows: Ann Baumgardner Yes Donalda Lovelace Yes Dawn Klemann Yes Valerie Ward Yes Jack Ledden Yes Bob Weigel Yes Demaris Miller Yes Marcia Brose Yes

• 5. Presentation on Organizational Compliance with HCBS community Rule

Sheri Sobkowiak provided a presentation on Home and Community Based Services (HCBS), a copy of which is attached.

• 6. Discussion on Key Performance Indicators for FY20

Committee members consented to context-based presentations at the program committee meeting, while receiving the key performance indicator reports quarterly rather than monthly. There being no further business, the meeting adjourned at 2:27 pm.

RRCS De ve lo pme nta l Disa b ility Se rvic e s

9/ 24/ 19

Po ints T

• Co ve r

1) Re g ula to ry Ag e nc ie s

2) HCBS 3) F uture Bridg e s

DD Wa ive r Pro g ra ms Re g ula to ry Ag e nc ie s



DBHDS, Offic e o f L ic e nsing & Offic e o f Huma n Rig hts



Ce nte r fo r Me dic a id a nd Me dic a re Se rvic e s (CMS)

 Ho me a nd Co mmunity Ba se d Se rvic e s (HCBS)



De pa rtme nt o f Me dic a l Assista nc e Se rvic e s (DMAS) Virg inia 's Me dic a id pro g ra m



De pa rtme nt o f Justic e (DOJ)



De pa rtme nt o f Nursing



HUD (fo r 5 g ro up ho me s)

E xte rna l I nflue nc e s Re g ula to ry Sta nda rds

Ove ra ll, the re g ula to ry a g e nc ie s tha t pro vide c o mplia nc e sta nda rds a re a lig ne d, whic h e na b le s pro vide rs to pa ve a pa th to wa rds c o mmo n g o a ls.

DOJ ~ CMS ~ DMAS ~ HCBS ~ L ic e nsing ~ Huma n Rig hts

HCBS Re g ula tio ns

• T

he re q uire me nts a re de sig ne d to e nsure tha t pe o ple with disa b ilitie s living in the c o mmunity ha ve a c c e ss to the sa me kind o f c ho ic e a nd c o ntro l o ve r the ir o wn live s a s tho se no t re c e iving Me dic a id HCBS funding .

De ve lo pme nt o f HCBS Re g ula tio ns

Alig n with fe de ra l po lic y a nd le g isla tio n, suppo rting inc lusio n a nd inte g ra tio n

• f pe o ple with disa b ilitie s in the c o mmunity.



Ame ric a ns with Disa b ilitie s Ac t



Re ha b ilita tio n Ac t



De ve lo pme nta l Disa b ilitie s Ac t



I ndividua ls with Disa b ilitie s E duc a tio n Ac t



Ne w F re e do m I nitia tive a nd Ye a r o f Co mmunity L iving .

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HCBS

HCBS c o mplia nc e is re q uire d fo r pro vide rs who o ffe r Ho me a nd Co mmunity Ba se d Wa ive r se rvic e s, whic h a re lo ng te rm se rvic e s in the c o mmunity ra the r tha n in a n institutio n. Va lue s tha t a re e mb e dde d in the re g ula tio ns:

F ull Community Inc lusion Autonomy L ife Choic e s

HCBS - I nte rpre ta tio n o f Re g ula tio ns

Va lue b a se d re g ula tio ns: Cha lle ng ing : sig nific a nt va ria tio ns in wha t full c o mmunity inc lusio n, a uto no my, & ma king life c ho ic e s lo o ks like . A c o uple o f the HCBS re g ula tio ns a re c le a r c ut : E xa mple : individua ls will ha ve the a b ility to lo c k the ir b e dro o m do o rs fo r priva c y.

HCBS Re g ula tio ns

 T

he se tting is inte g ra te d in the g re a te r c o mmunity;

 Pro vide r suppo rts the individua l’ s full a c c e ss to the g re a te r

c o mmunity, inc luding o ppo rtunitie s to suppo rt pe o ple to se e k e mplo yme nt, wo rk in c o mpe titive inte g ra te d se tting s, e ng a g e in c o mmunity life ;

HCBS Re g ula tio ns

 Pe o ple a re in c o ntro l o f pe rso na l re so urc e s, a nd

re c e ive se rvic e s in the c o mmunity;

 T

he se tting s a re se le c te d b y the individua l fro m a mo ng diffe re nt se tting o ptio ns, inc luding no n- disa b ility spe c ific o ptio ns a nd a n o ptio n fo r a priva te unit in a re side ntia l se tting ;

HCBS Re g ula tio ns

 Pro vide r e nsure s a n individua l’ s rig hts to priva c y, dig nity,

re spe c t, a nd fre e do m fro m c o e rc io n a nd re stra int;

 Pro vide r o ptimize s individua l initia tive , a uto no my, a nd

inde pe nde nc e in ma king life c ho ic e s, inc luding da ily a c tivitie s, physic a l e nviro nme nt, a nd pe rso na l a sso c ia tio ns; a nd fa c ilita te s individua l c ho ic e re g a rding se rvic e s a nd suppo rts a nd who pro vide s the m.

HCBS Re g ula tio ns Additio na l fo r Re side ntia l



Ha ve a le a se o r o the r le g ally e nfo rc e a b le a g re e me nt pro viding simila r pro te c tio ns;



Ha ve priva c y in the ir unit, inc luding lo c ka ble do o rs, c ho ic e o f ro o mma te s a nd fre e do m to furnish o r de c o ra te the unit;



Ha ve the rig ht to c o ntro l his/ he r o wn sc he dule inc luding a c c e ss to fo o d a t a ny time ;



Ha ve the rig ht to visito rs a t a ny time ; a nd



Ha ve a se tting tha t is physic a lly a c c e ssib le .



E xc e ptio ns c a n b e ma de to the se re q uire me nts if suppo rte d b y a spe c ific ne e d tha t is justifie d in the individua l’ s pe rso n-c e nte re d se rvic e pla n – b ut this must re la te to the individua l, no t the fa c ility.

HCBS

Ac hie ving c o mplia nc e with b ro a dly sta te d re g ula tio ns 2015 sub mitte d 1st pro vide r se lf a sse ssme nt 2017 sub mitte d a n upda te d pro vide r se lf a sse ssme nt a fte r DMAS issue d g uida nc e in HCBS T

• o lkit do c ume nts.

2019 sub mitte d 3rd ro und o f pro vide r se lf a sse ssme nt.

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HCBS Co mplia nc e De a dline s

Sta te wide c o mplia nc e must b e me t b y 3/ 2022. Pro vide r c o mplia nc e must b e me t b y 3/ 2021.

HCBS L e ve ls o f Co mplia nc e F ull c o mplia nc e o r no n c o mplia nc e No in-b e twe e n

I f a pro vide r do e s no t me e t full o rg a niza tio na l a nd se tting s c o mplia nc e b y 3/ 2021, a ll o f the pe o ple re c e iving RRCS HCBS se rvic e s will ha ve 1 ye a r to tra nsitio n to a diffe re nt se rvic e pro vide r who ha s a c hie ve d full c o mplia nc e .

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HCBS Org a niza tio na l & Se tting s Co mplia nc e

Or ganizational:



T he o rg a niza tio n must ha ve po lic ie s a nd syste ms in pla c e tha t sho w HCBS c o mplia nc e .



F ull o rg a niza tio n c o mplia nc e is re q uire d b e fo re re vie w o f the se tting spe c ific c o mplia nc e c a n b e g in.

Se ttings:



E a c h pro g ra m lo c a tio n a nd a c c o mpa nying se rvic e s must me e t full c o mplia nc e .



RRCS – 8 g ro up ho me s a nd da y suppo rt se rvic e s.

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HCBS RRCS – Org a niza tio na l Co mplia nc e RRCS a c hie ve d full Org a niza tio na l Co mplia nc e in Aug ust, 2019.

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HCBS Se tting s

DMAS’ re vie w o f a n a g e nc y’ s se tting s b e g ins a fte r o rg a niza tio na l c o mplia nc e ha s b e e n a c hie ve d. Re vie w c o nsists o f:



Se lf a sse ssme nt na rra tive s a nd e vide nc e .



Re vie we rs visits pro g ra ms



I nte rvie ws with individua ls re c e iving se rvic e s



I nte rvie ws with o the r sta ke ho lde rs

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HCBS: RRCS F

• c us Gro ups

HCBS re g ula tio ns to uc h upo n mo st RRCS Divisio ns. I nte rna l fo c us g ro ups we re fo rme d to c o mple te pro je c ts to wa rds c o mplia nc e .



Upda te d a nd c re a te d a g e nc y a nd pro g ra m po lic ie s, pro c e dure s, a nd pro to c o ls.



Qua lity re vie w o f do c ume nta tio n a nd de mo nstra tio n o f c o mpe te nc y o f sta ff.



Upda te d jo b de sc riptio ns fo r DD sta ff



HCBS tra ining – a ll DD sta ff & pe o ple re c e iving se rvic e s



Pro g ra m / o rg a niza tio na l c ulture shift – o ng o ing .

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HCBS

COMPL I ANCE I S CRI T I CAL L Y I MPORT ANT F OR ……..

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Pe o ple L iving in RRCS Gro up Ho me s 8 Ho me s

Home T

• wn / County

# of pe ople living in the home

F

• xc ro ft

Wa rre nto n 4 Airlie Wa rre nto n 2 E ve rg re e n Re ming to n 4 Re ming to n Re ming to n 4 Hig hpo int * Culpe pe r 3 Ca nte rb ury Culpe pe r 4 L

• c ust Gro ve

L

• c ust Gro ve

5 Ora ng e Ora ng e 4

Pe o ple Re c e iving Da y Suppo rt Se rvic e s – Bridg e s

L

• c ation

# of pe ople e nr

• lle d in Br

idge s

E lkwo o d 90

County of r e side nc e # of pe ople e nr

• lle d in Br

idge s

Culpe pe r 37 F a uq uie r 30 Ma diso n 5 Ora ng e 18 Ra ppa ha nno c k

RRCS – T he Busine ss

DIR E CT SUPPOR T ST AF F Appr

• ximate ly 80 e mploye e s

BUDGE T Appr

• ximate ly $4,189,774

COMMUNIT Y Availability of se r vic e s

Ne xt Ste ps

I nfo rm sta ke ho lde rs o n HCBS re q uire me nts & impa c t o n RRCS DD pro g ra ms. Cre a te fo c us g ro ups to inc lude inte rna l a nd e xte rna l sta ke ho lde rs to pa rtic ipa te in pro g ra m e nha nc e me nt pro je c ts a nd a c tivitie s. Pro vide o ng o ing upda te s o n pro g re ss to wa rds c o mplia nc e De ve lo p a nd mo dify a s ne e de d, a tra nsitio n pla n fo r Bridg e s.

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Bridg e s

Why is the re a fo c us o n Bridg e s g o ing thro ug h a tra nsitio n?

“CMS ha s issue d g uida nc e o n wha t kinds o f se tting s fa ll into the c a te g o ry o f tho se tha t “ha ve the e ffe c t o f iso la ting individua ls re c e iving Me dic a id-funde d HCBS fro m the b ro a de r c o mmunity.” T he g uida nc e e xpla ins tha t the se se tting s a re typic a lly de sig ne d spe c ific a lly fo r pe o ple with disa b ilitie s (o r e ve n pe o ple with a c e rta in type o f disa b ility). I n suc h se tting s, the individua ls re siding within the m a re prima rily o r e xc lusive ly pe o ple with disa b ilitie s. T he y ma y b e de sig ne d to pro vide pe o ple with disa b ilitie s with ma ny se rvic e s a nd a c tivitie s

• n-site , a nd to o ffe r limite d, if a ny, inte ra c tio n with the b ro a de r c o mmunity.”

F

• r mo re info rma tio n, ple a se c o nta c t Aliso n Ba rko ff, Dire c to r o f Advo c a c y, a t the Ce nte r fo r Pub lic Re pre se nta tio n a t a b a rko ff@ c pr-us.o rg , o r Va nia L

e ve ille , Se nio r L e g isla tive Co unse l, a tvle ve ille @ ac lu.o rg . Yo u c a n a lso le a rn mo re a b o ut the Se tting s Rule a t https:/ / hc b sa dvo c ac y.o rg / .January 2018. HCBS to o lkit

Avo iding Pa ra lle l Wo rlds

Disa b ility life : Prima rily with pa id sta ff a nd disa b ility g ro ups - Gro up ho me , Da y suppo rt, Churc h g ro up fo r pe o ple with spe c ia l ne e ds, spe c ia l Olympic s, so me “c o mmunity visits” to fa st fo o d re sta ura nts, lib ra ry. L I F E T

• wnho use with b e st frie nd, wo rk a t c a r de a le rship, sing in Churc h Cho ir, lo c a l

g ym to lift we ig hts, pla y Bunko with ne ig hb o rs e ve ry F rida y nig ht.

I nc lusio n

“I nc lusio n is the na tura l sta te ; a nything e lse is a n a rtific ia l e nviro nme nt. Wha t c o uld ha ppe n if o ur hig he st g uiding princ iple wa s to e nsure the na tura l sta te

• f inc lusio n c o ntinue s thro ug ho ut a pe rso n’ s life . T

his wo uld re q uire us to ho ld inc lusio n a s a hig he r va lue tha n se rvic e s a nd inte rve ntio ns g e a re d to “he lp” the pe rso n”. “Ye s, ma ny pe o ple with disa b ilitie s ma y ne e d mo re o r diffe re nt, tha n tho se witho ut disa b ilitie s, b ut a s pre vio usly me ntio ne d, o ur c o mmunitie s a re ric h with g e ne ric (a nd inc lusive ) se rvic e s”.

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Bridg e s

T he te a m ha s do ne a n e xc e lle nt jo b c re a ting ma ny me a ning ful e xpe rie nc e s fo r pe o ple who re c e ive se rvic e s, b o th o n-site a nd in the c o mmunity. Ho we ve r, the re a lity is tha t the re a re a ppro xima te ly 90 pe o ple who g o to o ne b uilding lo c a tio n, whic h is a pro g ra m o nly fo r pe o ple with De ve lo pme nta l Disa b ilitie s.

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Bridg e s



T ra nsfo rma tio n fro m a pro g ra m to full inc lusio n; ra the r tha n b e ing a t a pro g ra m a nd simply visiting the c o mmunity.



Ha ve a c o uple o f b a se lo c a tio n in multiple c o untie s.



T he ma jo rity o f pe o ple will b e o ut a nd a b o ut, invo lve d in da ily life e xpe rie nc e s tha t a re me a ning ful to e a c h pe rso n a nd side b y side with

• the r me mb e rs o f the c o mmunity.

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Co mmunity Site s

So me pe o ple ma y re ma in a t a lo c a l c o mmunity lo c a tio n fo r the ma jo rity o f the da y b ut still ha ve

• ppo rtunitie s to a c tive ly

e ng a g e in the c o mmunity. Mo st pe o ple will use this sa me lo c a l c o mmunity lo c a tio n a s a sta rting a nd e nding po int o f the da y. Mo st o f the da y is spe nt a lo ng side o the r me mb e rs o f the c o mmunity.

Co mmunity L ife

Sta ff

Jo hnny Sa lly Pe tunia

L

• c a l Gym

L ib ra ry Vo lunte e r a t lo c a l ho spita l Mo rning c o ffe e a t lo c a l c o ffe e sho p

Da y Suppo rt Se rvic e T ype s

Gr

• up Day inc lude s skill-b uilding a nd suppo rt to g a in o r re ta in so c ia l skills, se lf-he lp skills

a nd o the r ne c e ssa ry skills to e nha nc e inde pe nde nc e a nd inc re a se c o mmunity inte g ra tio n. Ca n o c c ur in a c e nte r a nd the c o mmunity.

R e quir e d staff to c lie nt r atio: 1:7 Community E ngage me nt pro vide s a wide va rie ty o f o ppo rtunitie s to b uild re la tio nships

a nd na tura l suppo rts in the c o mmunity, while utilizing the c o mmunity a s a le a rning e nviro nme nt. Oc c urs in the c o mmunity.

Re quir e d staff to c lie nt r atio: 1:3

Bridg e s: Po ssib ilitie s

Gro up Da y fe we r pe o ple & sma lle r lo c a tio n Gro up Da y fe we r pe o ple & sma lle r lo c a tio n

2 o r 3 “mini pro g ra ms” fo r pe o ple who will prima ry re c e ive g ro up da y se rvic e s. We a re a t the b e g inning sta g e s o f ide ntifying lo c a tio ns o f mini pro g ra ms, with inte g ra tio n in mind. Pe o ple will still ha ve o ppo rtunitie s to g o into the c o mmunity.

Bridg e s: Po ssib ilitie s

We a re wo rking o n the mo de l fo r the re ma inde r o f pe o ple who will re c e ive se rvic e s in the c o mmunity.



Still ne e d me e ting po ints. Pe o ple a rrive a t the me e ting po ints in the mo rning . Sta ff a nd sma ll g ro up o f pe o ple (ide a lly no mo re tha n 3) a re the n o ut in the c o mmunity a ll da y.



Me e ting po ints unde r re vie w.

 Po ssib ly a c o uple o f pla c e s in the c o mmunity no t a sso c ia te d with RRCS  Use c urre nt RRCS pro g ra m lo c a tio ns a s the me e ting po int

Bridg e s T ra nsitio n – F ina nc ia l I mpa c t Pro je c t

T ie r 1 T ie r 2 T ie r 3 T ie r 4

Gro up Da y: ROS $8.60 $11.25 $13.31 $17.34 Gro up Da y: NOVA $10.01 $13.12 $15.55 $20.29 Co m. E ng a g e me nt ROS $14.29 $16.01 $18.38 $22.61 Co m. E ng a g e me nt NOVA $16.19 $18.21 $21.01 $25.98

Bridg e s T ra nsitio n – F ina nc ia l I mpa c t Pro je c t

Co nside ra tio ns



Re vie w o f e a c h pe rso n’ s se rvic e type : g ro up da y, c o mmunity e ng a g e me nt, o r c o mb ina tio n o f b o th.



De te rmining the numb e r o f sta ff ne e de d to tra nsitio n to ne w mo de l.



Pro je c tio n o f Me dic a id re ve nue b a se d o n the se rvic e s a nd va rio us re imb urse me nt ra te s.

I nte rde pa rtme nta l Co lla b o ra tio n

DD Pro g ra ms a nd b e yo nd So me e xa mple s

T r a nsit:



Ride s to a nd fro m pro g ra m lo c a tio ns / me e t up spo ts.



Use o f a g e nc y ve hic le s a s c o mmunity invo lve me nt inc re a se s.

IT :



Pho ne s



De vic e s fo r do c ume nta tio n purpo se s.



Cha ng e me tho ds to c a pture b illing



QA: Re vie w o f ne w po lic ie s



F inanc e : Budg e t impa c t o f c ha ng e s, b illing

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