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Meeting Materials (PDF) Open in new window AGENDA INARF Board of Directors Meeting Friday, June 28, 2013 11:00 a.m. – 12:30 p.m. Easter Seals Crossroads 4740 Kingsway Drive, Indianapolis I. Call to Order, Welcome and Introductions II. Modification to the Agenda III. Approval of Minutes IV. Board Dialogue with DDRS Director Nicole Norvell - Provider Community Observations V. Review of Financial Statements VI. Standing Committee Reports - Governmental Affairs Committee - Innovation & Systems Change Committee - Membership Support Committee - Training and Professional Development Committee - Industry Infrastructure Committee VII. Strategic Discussions and Feedback - Strategic Planning Update - Managed Care - Balancing Incentives Program/Group Home Conversion VIII. Adjournment -- Board Minutes The INARF Board of Directors Meeting and Member Forum was held on June 28, 2013 at Easter Seals Crossroads, 4740 Kingsway Drive in Indianapolis. The INARF Member Forum convened at 10:00 a.m. with the INARF Board of Directors meeting immediately afterwards. Present: Steve Sacksteder, Chair Dan Griffin, Vice-Chair Jill Dunn, Immediate Past Chair Jonathan Burlison, Secretary (via telephone) Debbie Bennett, Hillcroft Services, Inc. Clint Bolser, LOGAN Community Resources, Inc. Steve Cook, AWS, Inc. Jill Dunn, Bona Vista Programs, Inc. Dan Griffin, Dungarvin of Indiana, LLC Susan Rinne, LifeDesigns, Inc. Jane Wear, Cardinal Services, Inc. Absent: Marie Dausch, Treasurer Patrick Cockrum, Sycamore Services, Inc. Bettye Dunham, Rauch, Inc. John Niederman, Pathfinder Services, Inc. Holly Piggott, ResCare, Inc. Guests (in Person): Rick Adams, Dungarvin of Indiana, LLC Jim Allbaugh, Carey Services, Inc. Christine Beik, Indiana MENTOR Peter Bisbecos, Caregiver Homes of Indiana Connie Dillman, Tangram, Inc. Bob Coles, Meridian Health Services Doug Conrad, Indiana MENTOR Mark Draves, Carey Services, Inc. Jeff Frady, Damar Services, Inc. Leslie Green, Stone Belt Arc, Inc. Linda Johnson, Arc of Wabash County, Inc. Michael Lintner, Marshall-Starke Developmental Center, Inc. Kelly Mitchell, Southern Indiana Resource Solutions, Inc. Nicole Norvell, Division of Disability and Rehabilitative Services Jane Ruff, Hopewell Center Dick Rhoad, Wabash Center, Inc. Patrick Sandy, Easter Seals Crossroads Debra Seman, Arc Opportunities, Inc. Paula Shively, ADEC, Inc. Randy Soforenko, Occazio Pam Verbarg, Indiana MENTOR Julia Wicks, Houston Group Homes, Inc. Sandy Wing, Pathfinder Services, Inc. Guests (via Webinar): Donna Belusar, ADEC, Inc. Alicia Boyd, Alicia M. Boyd, CPA PC Amber Edmonson, Cardinal Services, Inc. Janessa Gerber, LifeDesigns, Inc. Herb Grulke, In-Pact, Inc. Megan Gumbel, MDC Goldenrod, Inc. Teressa Jackson, Rauch, Inc. David McDougle, Bona Vista Programs, Inc. Curtiss Quirin, Crossroads Industrial Services, Inc. Kelly Schneider, Easter Seals Rehabilitation Center, Inc. Melissa Steele, Tangram, Inc. Rich Stoller, Pasages, Inc. Ruth Ann Widman, Jay Randolph Developmental Services, Inc. Staff: Kim Opsahl, President/CEO Barb Young, Vice President/CFO Christiaan Campbell, Director – State Use Program Keith Digman, Director-Member Support & Advocacy Nanette Hagedorn, Director – Membership Engagement & Development Traycee Land, Coordinator – Operations Support Elizabeth Patel, Coordinator – Communications & Advocacy INARF Member Forum I. Call to Order, Welcome & Introductions Steve Sacksteder welcomed attendees and called the meeting to order at 10:00 a.m. He introduced Gavin Rose, Staff Attorney for the American Civil Liberties Union (ACLU) and the featured speaker for the INARF Member Forum. II. Overview: Karla Steimel v. Debra Minott, et al. Mr. Rose reported on Karla Steimel, et. al., v. Debra Minott, et. al. a recently filed suit challenging policy changes to Indiana’s Home and Community Based Waiver program. The policies in question involve changes in the eligibility criteria under the Aged & Disabled criteria and changing to a needs based approach under the Community Integration and Habilitation Waiver. The suit alleges that both changes violate the Americans with Disabilities Act integration mandate and place Ms. Steimel and those similarly situated at undue risk of institutionalization. III. Board Chair Report A. Strategic Planning Update Mr. Sacksteder reported that the Board has chosen Impact Strategies to facilitate the 2013 INARF strategic planning retreat. Earlier today, Mike Stone of Impact Strategies met with the Executive Committee to review objectives for the strategic planning session scheduled for July 30. Results from the soon to be released INARF Membership Survey which will be used to guide Mr. Stone’s work with strategic planning session participants. After being introduced, Mr. Stone discussed the intended strategic planning process. He noted that the industry has its own history and trajectory, and member agencies working within the framework of INARF have their own histories and priorities. These layers create a complex environment within which the strategic planning session participants will explore INARF to determine what role it should play to serve the needs of members. With this in mind, Mr. Stone identified three major questions to be explored during the strategic planning session, all centered around INARF’s needs. He encouraged the INARF Board and members to consider what the Association wants to be, what its members need it to be and what it can afford to be. Once these questions have been addressed, Mr. Stone and INARF will sketch out the overall vision for INARF and work through Association committees to accomplish identified goals. Mr. Sacksteder reminded members that the July Board meeting would be held in conjunction with the strategic planning meeting and would not include a member forum. Mr. Sacksteder wrapped up his report by noting that INARF is still seeking volunteer leaders for professional interest sections and committees. Interested parties may contact the INARF office for details. Lastly, Mr. Sacksteder reported that the INARF PAC has begun fundraising for 2013, and encouraged agencies to commit to the PAC goal of raising $20,000 this year. IV. President/CEO Report A. Interim Study Commissions Kim Opsahl reported that the Health Finance Commission held their first meeting last week and will meet monthly into early fall. The initial meeting featured an update from FSSA Secretary Debra Minott regarding the Healthy Indiana Plan and discussion regarding its renewal. FSSA met with the Centers for Medicare and Medicaid Services (CMS) a few weeks ago and hope to have an agreement in place by August, with clarification regarding cost sharing provisions. In addition to this update, the Commission received a high-level overview of Indiana’s waiver programs and a report on efforts to combat Medicaid fraud. The Commission learned that the Attorney General’s office recovered $60 million, while FSSA reported that few individuals had been prosecuted for Medicaid recipient fraud. Of note to INARF members, it was shared that the Attorney General’s office will soon begin using data mining strategies to identify Medicaid fraud and abuse. To support members in learning more about the Medicaid Fraud Control Unit (MFCU) in general and this issue in particular, staff will invite MFCU representatives to participate in the August 15th INARF Professional Interest Section meeting. Ms. Opsahl reported that the Commission on Developmental Disabilities is expected to convene in August. Chairwoman Pat Miller (R-Indianapolis) has been replaced by Senator Ron Grooms (R-Jeffersonville). In anticipation of upcoming DD Commission meetings, INARF and the Arc of Indiana are working collaboratively with the Division of Disability and Rehabilitative Services to ensure that Sen. Grooms is well-versed in the Commission’s history and current issues, including coordination of services for persons with dual diagnoses, proper treatment of incarcerated persons with disabilities, guardianship matters, and evaluation of Medicaid Waiver rates. Ms. Opsahl noted that the Innovation & Systems Change Committee has been researching issues related to serving individuals who are dually diagnosed and incarcerated individuals. Also, work will continue with the Governmental Affairs Committee’s Rate Reform work group relative to evaluating rates. The Arc of Indiana is anticipated to take the lead on guardianship. In closing, Ms. Opsahl encouraged all INARF members to submit additional issues of concern to INARF staff. B. FSSA/DDRS Update Ms. Opsahl reported she and Kelli Waggoner, KWK Management recently met with Secretary Minott and Ms. Norvell to thank them for restoring a portion of the group home rate reduction and to request a similar adjustments to the Medicaid Waiver rate for Residential Habilitation Supports (RHS), Respite and Individual Habilitation rates. Overall, the discussion was positive and we anticipate a response within the next few weeks During that meeting, there was a significant amount of discussion relative to the Medicaid Waiver rate structure. Ms. Norvell seemed keenly aware of concerns that billing for comprehensive services in one hour increments. She seemed equally interested in working to explore alternate rate structures. The Governmental Affairs Committee Rate Reform Workgroup has been developing potential options and will be previewing their initial recommendations with the INARF Board. Ms. Opsahl then addressed the topic of group home conversion, noting that the State of Indiana has evaluated the fiscal impact of this initiative. The data reflected a significant increase in spending when group homes convert to Waiver sites. Ms. Norvell will be submitting her final recommendations regarding group home conversion to Secretary Minott in the near future; it is anticipated that group home conversion will revert to a voluntary initiative. An official announcement is expected soon. Ms. Opsahl discussed managed care for the aged, blind and disabled population, which INARF has been researching in conjunction with Hoosiers for Options members. INARF approached Secretary Minott about this issue in conjunction with Hoosiers for Options and expect to meet with the Secretary in August for additional discussion. In addition, the Innovation & Systems Change Committee has been examining this issue and will draft an issue brief to use as the foundation of the Association’s 2014 position statement. Ms. Opsahl reviewed the latest information regarding health homes, noting that implementation is still on hold while FSSA addresses internal issues. Ms. Norvell is exploring funding options and considering policy alternatives. Ms. Opsahl closed with an operational update, introducing members to Traycee Lane, INARF’s Operations Support Coordinator. Traycee will work with INARF and State Use stakeholders on project research and development, order processing, accounting, and membership operations. Ms. Opsahl also shared information on upcoming INARF events include the Professional Interest Section meeting in August and the Technology Summit in September. The Association is pleased to host the second Technology Summit in partnership with the Illinois Association of Rehabilitation Facilities (IARF) and the Ohio Provider Resource Association (OPRA). All members are encouraged to attend and take advantage of upcoming events. INARF Board of Directors Meeting I. Call to Order, Welcome and Introduction Steve Sacksteder, INARF Board Chair, welcomed those in attendance. II. Modification to the Agenda There were no modifications to the agenda. III. Approval of Minutes The May 17 Board of Directors meeting minutes were presented and reviewed. MOTION 13:16 Susan Rinne moved to approve the May 17 meeting minutes as presented. Jill Dunn seconded and the motion carried. IV. Board Dialogue with DDRS Director Nicole Norvell Ms. Opsahl welcomed and introduced Division of Disabilities & Rehabilitative Services (DDRS) Director Nicole Norvell. During her short tenure with the Division, Ms. Norvell has visited several member agencies, having the opportunity to see a wide variety of programs and practices. Ms. Norvell was invited to join the Board to share her reflections on these visits in terms of things that appear to be going well and in terms of opportunities for improvement. Ms. Norvell reported that she had numerous successful meetings with INARF members and observed various approaches to serving the needs of persons with disabilities. Ms. Norvell and DDRS Chief of Staff Dawn Downer were surprised to learn that there was less usage of assistive technology than they had initially assumed. Jill Dunn and Susan Rinne noted that schools have more avenues and opportunities to fund the purchase of assistive technology devices, which often prove cost prohibitive in the adult services arena. Ms. Norvell expressed concern that there is a lack of continuity when students utilize assistive technology in high school and transition to young adulthood without such supports. She suggested that providers partner with school districts to purchase student-specific technology when possible. Ms. Rinne shared that her agency has participated in a successful pilot program to purchase technology tools from local school districts. Steve Cook stated that it was difficult for disability service providers to find technology experts outside of the educational environment. With a focus on program improvement, Ms. Norvell noted the need for consumers, providers, and DDRS to find a middle ground to determine the efficacy of programming with the intent of remaining focused on the needs of the consumer. She used Supported Employment Follow-Along (SEFA) as an example; stating that persons with disabilities may participate in SEFA services for many years with no way to determine whether the SEFA services have been effective. Her focus was on matching consumers with appropriate services and supports to prevent waste and promote independence. With an emphasis on sustainable services, Ms. Norvell encouraged the development of new ideas to supplement and complement less sustainable sources like state line item funding. Ms. Norvell shared that DDRS staff will be moving toward using data analysis to better understand how FSSA funds are being used and developing solutions based upon available data. She emphasized the need to identify geographic gaps in service, using southern Indiana as an example of an underserved area. In closing, Ms. Norvell thanked the Board for sharing their feedback and ideas. She and her staff recognize that additional resources are needed to identify service gaps and are in the process of hiring new staff members to address this problem. She asked the provider community for patience as she and her leadership team institute cultural changes at FSSA, with a focus on partnership with providers, consumers, and families. Ms. Norvell encouraged providers to contact her office with any concerns and expressed appreciation for the honest communication that has taken place to date. V. Review of Financial Statements Barb Young reported that May financial statements reflect a positive position of sixty-six thousand five hundred thirteen dollars ($66,513) from operations and thirteen thousand six hundred twenty-four dollars ($13,624) from an unrealized gain on investments for a total increase in net assets of eighty thousand one hundred thirty eight dollars ($80,138). MOTION 13:17 Jane Wear moved to approve the May financial statements be filed for audit. Debbie Bennett seconded and the motion carried. Ms. Young presented the Board with a proposal to migrate data and website design and hosting to a new vendor. Ms. Young explained that INARF has used the same vendor since 2006, noticing a steady decline in customer service and a lack of updates to INARF’s web capabilities. In response to these challenges, staff researched competing vendors and recommended a more robust association management software and content management system. The staff proposal recommends engaging Weblink, an Indiana-based company with a solid history of working with Chambers of Commerce and other membership organizations. Weblink provides enhanced features including data collection tools, collaborative workspaces, ecommerce and a web shopping cart, and member-managed profiles. The proposal was presented to the Board due to the fiscal impact involved; the first year of the contract would exceed the INARF consultant budget by $11,000. Subsequent years of the agreement would remain within the INARF budget. Due to upgrades being made to both Smart Partners Alliance (SPA) and INARF capabilities, the SPA Board has committed to sharing equally in the first years’ expenses. MOTION 13:18 Clint Bolser moved to approve staff engagement with Weblink, recognizing the $11,000 expenditure in excess of the Consultant/Technology budget. Jill Dunn seconded and the motion carried. VI. Standing Committee Reports A. Governmental Affairs Committee Keith Digman reported that the Governmental Affairs Committee has been reviewing recent federal issues and activities. The Committee reviewed issues relating Section 14(c) of the Fair Labor Standards Act, which has been negatively portrayed by media outlets including the now defunct Rock Center program. The Rock Center segment did not present a fair and balanced view of employment options for persons with disabilities. It is not prudent for INARF to respond to the Rock Center broadcast at this time. The Committee recommends incorporating Section 14(c) in the 2014 INARF position statement on employment as a means to develop consensus among the membership on this issue and to then advocate from that position. The Committee also reviewed the UN Convention on the Rights of Persons with Disabilities. The Arc of the United States is championing a campaign in support of US ratification of the Convention, with the Arc of Indiana slated to play a key role in this initiative. The Committee agreed that INARF would express support for the Convention but not play a key role in direct action. Lastly, the Committee discussed the Senate Resolution to recognize DSP recognition week, noting that the American Network for Community Options & Resources (ANCOR) was leading the effort to obtain a Congressional Resolution and that state associations of Direct Support Professionals would pursue gubernatorial proclamations in their respective states. INARF will work with the Direct Support Professionals of Indiana (DSPIN) to pursue a gubernatorial proclamation from Governor Pence and reach out to Senator Donnelly in an effort to build support for the Congressional Resolution. Steve Cook reported that the Rate Reform Work Group reviewed Residential Habilitation and Support (RHS) rates. The Group recommends that the rate for RHS services under 35 hours per week (RH1O) remain an hourly rate. However, the Group recommends that RHS services over 35 hours per week (RH2O) be converted to either a daily, weekly, and/or monthly rate, using the proposed reimbursement formula: [(OBA x Current Rate) + Transportation Amount] / 365 x .96 = RH2O Daily Rate. To achieve a weekly or monthly rate, the formula would be divided by 52 or 12, respectively. Ms. Opsahl and Mr. Cook acknowledge that the sufficiency of the underlying rate remains an issue, but for strategic purposes the Work Group has focused its efforts on methodology, while INARF pursues rate restoration parity directly with Secretary Minott and Ms. Norvell. With this in mind, Ms. Opsahl noted that , assuming there is no objection by the Board, this concept will be shared with DDRS Policy, Planning, and Program Development Director John Hill during the Rate Reform Work Group’s next meeting. B. Innovation & Systems Change Committee Steve Cook reported that the Innovation & Systems Change Committee met on June 20 and hosted FSSA representatives John Hill and Satrina McDonald, who spoke to the group about the Balanced Incentives Program (BIP) and single point of entry developments. In addition, the Technology Task Force is reviewing electronic health record requirements and the Advocare information technology system. Bill Keown of KWK Management Group will attend the next Committee meeting to discuss pharmacy matters relating to managed care. C. Membership Support Committee Susan Rinne reported that the Membership Support Committee is currently working on tools to help INARF measure member engagement and define success in Association endeavors. INARF recently launched a membership survey which will be used in conjunction with the strategic planning session to chart new directions forward. Ms. Rinne announced that INARF continues to aggressively pursue new members, with case management organization The Columbus Organization recently joining INARF as the most recent institutional member. Nanette Hagedorn reviewed the member engagement tracking tool, noting that the tool’s intended purpose is to provide a snapshot of membership engagement to gauge INARF’s efficacy as a professional development or informational resource. In evaluating the data, the Committee will pay special attention to members who have participated in fewer than 20% of INARF events and agencies whose activities have decreased more than 20% over the past year. Current member data reflects that 16 member agencies have participated in 20% or fewer of INARF events; current membership participation data will allow INARF to better target messages and marketing materials. In addition, membership data will provide INARF staff with information about highly engaged agencies, creating a pool of potential participants in Association volunteer opportunities. To complement efforts to gauge membership activity, INARF staff will proactively visit members around the state to gain a better understanding of member issues and position INARF as the prime resource for the provider community. Mr. Digman and Ms. Hagedorn anticipate staff visiting 40 member agencies in 2013. Staff will initially reach out to agencies undergoing leadership transitions, in crisis, or requesting visits. The second tier of member visits will include members who are less engaged in INARF activities, targeting those who have engaged in 20% or fewer events. By visiting members at their place of business, INARF’s goals are to increase visibility for the Association, develop stronger connections with agency staff, and gather data which will allow INARF to better serve the needs of members. D. Training & Professional Development Committee Nanette Hagedorn reported that the 2014 Annual Conference will be held on March 13 and 14. The Marketing Subcommittee will collaborate with the Training & Professional Development Committee regarding themes around INARF’s 40th anniversary. Members who wish to join the Marketing Subcommittee are encouraged to contact Ms. Hagedorn. E. Industry Infrastructure Committee Christiaan Campbell reported that the Committee remained focused on the Marketing Consortium, with the Phase 1 Feasibility Study expected to conclude at the end of July. Recent activities included a Collaboration Capacity Workshop held in May to review the results of the SDI and Netform surveys completed by key participants. This meeting included a review of network strengths and opportunities, with recommendations for improving communications. During the first week of June, INARF conducted a survey of Consortium participants to identify remaining questions to be covered in the final report. Results indicated that clarification of next steps was necessary to complete the Phase I project. On June 17, the monthly Committee meeting included a discussion and review of the Phase I Feasibilty Study deliverables and feedback from survey participants. Other topics discussed included development of a member to member purchasing program, preparation for HB 1619 elimination of the sub-minimum wage, and affordable front-line supervisor training. Over the next month, CEOs will discuss the Marketing Consortium with key staff and determine next steps for their agencies. The Committee will host cluster meetings for CEOs to determine whether their agencies may continue participating in the Consortium. Lastly, participating CEOs will outline next steps toward Phase II. VII. Strategic Discussions and Feedback A. Strategic Planning Update Steve Sacksteder reported that INARF engaged Mike Stone of Impact Strategies to conduct the Association’s strategic planning retreat. Mr. Stone offered comments to staff regarding the INARF membership survey, which will play an important role in strategic planning as the Board moves forward. All members were encouraged to complete the survey. Ms. Opsahl closed by confirming that the July Board meeting would be incorporated into the retreat with no Member Forum to be offered in July. B. Managed Care Ms. Opsahl reviewed managed care issues, directing the Board to the managed care issue brief included in their packets. The first section of the brief noted that managed care has been effectively implemented for acute services, but illustrated the diversity of the developmental disability population and questioned whether managed care would meet their needs. The second section included details to aid policymakers as they determine who would be impacted if managed care was implemented. The third section concludes that Indiana may not need to implement managed care for long-term services and supports, as it has already achieved many goals which managed care purports to remedy. Ms. Opsahl remarked that issue brief is oriented toward advocating that the developmental disabilities population be carved out of managed long term services and supports. However, the brief will include recommendations and solutions for sustainable system design if a carve-out was not feasible. Specifically, it appears that the preference would be to consider having the state agency serves as the managed care organization; having the provider serve as both managed care entity and direct service provider; or developing locally operated non-profit organization to serve as the managed care organization. All three of these models have been used to varying degrees of success in other states. C. Balancing Incentives Program/Group Home Conversion Ms. Opsahl reported that Satrina McDonald and John Hill of DDRS participated in the last Innovation & Systems Change Committee meeting, during which they discussed a variety of issues including the Balancing Incentives Program (BIP). Ms. McDonald and Mr. Hill requested that INARF assist in disseminating information regarding the BIP, and Ms. Opsahl offered to work with them to accomplish this task, which may be done in conjunction with the Professional Interest Section meetings on August 15. In addition, they discussed challenges related to coordination between the Division of Aging, Division of Mental Health and Addiction and DDRS and technology. Ms. Opsahl briefed the Board on children’s group homes, noting that Ms. Norvell has expressed concerns regarding children’s group homes and the age ranges of the children residing in these homes. In response, INARF and the Arc of Indiana will partner with DDRS to issue joint communication regarding FSSA’s change in approach to children’s homes. To complement this message, FSSA will host an informational meeting for children’s group home providers in the near future. VIII. Adjournment The next Board of Directors Meeting will be held in July in conjunction with the Strategic Planning Retreat. Respectfully submitted, ___________________________________________ Jonathan Burlison, Secretary JB/ecp