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Meeting Materials (PDF) Open in new window AGENDA INARF Board of Directors Meeting Tuesday, March 12, 2013 3:00 p.m. – 5:00 p.m. Sheraton Indianapolis Hotel at Keystone Crossing 8787 Keystone Crossing, Woodfield Boardroom Indianapolis, IN I. Call to Order, Welcome and Introductions II. Modification to the Agenda III. Group Home Conversion Strategic Discussion - Current Draft Resolution - Member Feedback and Position(s) - Daily Rate Recommendation - Implications Given Identified Position - Communication to Members IV. Dialogue with David Fox V. Adjournment -- Board Minutes The INARF Board of Directors meeting was held on March 12, 2013 at the Sheraton Indianapolis Hotel at Keystone Crossing, 8787 Keystone Crossing, Indianapolis. Present: Jill Dunn, Chair Steve Sacksteder, Vice Chair Marie Dausch, Treasurer Clint Bolser, LOGAN Community Resources, Inc. Steve Cook, AWS Mark Draves, Carey Services, Inc. Bettye Dunham, Rauch, Inc. Dan Griffin, Dungarvin Indiana LLC Jane Wear, Cardinal Services, Inc. Pam Verbarg, Indiana MENTOR Absent: Jonathan Burlison, Secretary John Niederman, Pathfinder Services, Inc. Tom O’Neill, Passages, Inc. Susan Rinne, LifeDesigns, Inc. Guests (in Person): Bert Clemons, LifeDesigns, Inc. Tonya Hassinger, Developmental Service Alternatives, Inc. Sandy Wing, Pathfinder Services, Inc. Staff: Kim Opsahl, President/CEO Barbara Young, Vice President/CFO Keith Digman, Director - Member Support & Advocacy Elizabeth Patel, Coordinator - Communications & Advocacy I. Call to Order, Welcome and Introduction Jill Dunn, INARF Board Chair, welcomed those in attendance and called the meeting to order. II. Modification to the Agenda No modifications were made to the agenda. III. Group Home Conversion Strategic Discussion Kim Opsahl reviewed the most recent draft of the group home conversion Board resolution and discussed additional modifications that were made based upon member feedback. In terms of member feedback regarding the board resolution, it was noted that the majority of respondents supported conversion as a voluntary option, with a fair number of members remaining opposed to it. Effective messaging and clear communication will be vital components of the Association’s work to convey the Association’s ultimate position statement and explain the reasoning behind it. It was noted that as the administrative landscape changes, the provider landscape changes as well. INARF must take measured and strategic steps to ensure that the provider community has a seat at the table when critical discussions take place. Additionally, the Board discussed on-going concerns in cultivating a partnership with the Division of Disability and Rehabilitative Services (DDRS). This partnership is critical to having input and influence on important issues like health homes, transportation, and overall group home conversion task forces. The Board also discussed the impact of managed care, noting that there is no managed care product with an institutional funding model inside the managed care model. Lastly, the Board discussed how agencies have been forced to cut benefits in an effort to remain financially viable. As a result, the position statement emphasis on daily rates that reflect the cost of services delivered is critically important. After discussion, the Board determined that the Association will take a cautiously supportive position on group home conversion in general, and will include recommendations that that voluntary conversion is a better option than mandatory conversion. In support of this, Mark Draves proposed the following language for the final draft of the group home conversion Board resolution: “While INARF supports conversion, more work needs to be done regarding the long term implications of conversion on persons served and the service delivery system. A return to a policy of voluntary conversion will afford that opportunity.” MOTION 13:08 Mark Draves moved to approve amendments supporting conversion with a statement regarding preference for voluntary conversion in the group home resolution draft. Steve Sacksteder seconded and the motion carried. IV. Dialogue with David Fox Ms. Dunn welcomed David Fox, DDRS Director of Program Development. Mr. Fox began by providing a brief history of group home conversion starting with the Section 144 Report, which first advanced the idea of group home conversion as a voluntary process. In November 2012, a few willing providers participated on a pilot basis and at least the initial conversions appear to be successful. Mr. Fox then discussed the Balancing Incentives Program (BIP), which provides a 2% enhanced FMAP funding rate on Home and Community Based Services. It is hoped that by increasing state spending in Home and Community Based Services the state will realize an additional $78 million in Federal match through BIP. It is estimated that about $48 million of that amount will be available to DDRS over next three years. Of that approximately $30 million will be dedicated to helping consumers and providers convert group homes through risk mitigation grants. The risk mitigation grants were announced in January 2013, with a deadline of September 30, 2015, coinciding with end of the BIP grant period. Mr. Fox indicated that the decision to make conversion mandatory was due to a limited number of providers expressing interest in conversion and the upcoming expiration of the Administrative Code governing group homes. In response to group home conversion concerns, FSSA assembled a stakeholder task force including representatives from four INARF providers, Self-Advocates of Indiana, the Arc of Indiana, INARF, and family representatives. The first meeting took place last week and meeting minutes will be posted to the FSSA website. Mr. Fox reported that FSSA has met with or scheduled group home conversion meetings with 42 group home providers, with over 150 residents on track to convert to waiver homes. The risk mitigation grants are proving helpful throughout this transition. Ms. Dunn noted that continuation of care is an issue as local Division of Family Resources (DFR) offices offer slow to respond to changing consumer eligibility and level of care and as a result agencies are providing services without reimbursement for extended periods of time. Mr. Fox indicated that he would set up a meeting with DFR to review these issues. Board members noted that the group home reimbursement model offered a chance for rate change as the cost to provide services increases, but there is not corresponding mechanism on the waiver side. As a result, the Board expressed concerns that recruiting and retaining quality direct support professionals is very challenging. This challenge raises serious concerns about the quality and sustainability of care for those individuals currently in services, but may prove a serious obstacle to addressing the needs of those waiting for services. Mr. Fox heard the Board’s concerns and stated that these issues are on the FSSA radar and that the agency is committed to working collaboratively to improve the system. He stated that he believed providers will like the new quality rate reimbursement methodology: screenshots will be available in April and the program will roll out in June. The quality rate reimbursement program is a way for providers to increase margins through superior performance. Steve Sacksteder expressed support for daily rates, and other Board members echoed this position. Mr. Fox acknowledged that fee for service had high overhead and stated that there is an Office of Medicaid Planning & Policy (OMPP) group working on aged, blind, and disabled issues considering daily rates and other issues. He will research the group’s work and follow up with Ms. Opsahl. Ms. Opsahl and Ms. Dunn thanked Mr. Fox for bringing providers to the table and engaging them in the FSSA policymaking process. Ms. Opsahl stated that the Association is continuing work on conversion issues and urged Mr. Fox to share other relevant issues with INARF. V. Adjournment The next Member Forum and the Board of Directors Meeting will be held on April 26, 2013 at Easter Seals Crossroads, 4740 Kingsway Drive, Indianapolis from 10:00 a.m. – 11:00 a.m. and 11:00 a.m. – 12:30 p.m., respectively. Respectfully submitted, ___________________________________________ Jonathan Burlison, Secretary JB/ecp