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April 26, 2013

Open Line

This edition of Open Line includes important information I want to share with you:

Director of ICF/IID Survey Operations: The Office of Quality Management would like to welcome Bobbi Halgrim to Central Office as the Director of ICF/IID Survey Operations. Bobbi has 30 years of experience in program administration and quality assurance in Intellectual and Developmental Disability services, most of which has been in ICF/IID programs. She was the Director of Quality Assurance at the Open Arms Care Corporation for many years where her primary responsibilities included ensuring compliance with ICF/IID federal regulations. Moreover, she also has prior experience in managing a large CQL accredited agency. Most recently, Bobbi has worked in the Middle Regional Office as a Plans Reviewer. In her new role, Bobbi will be responsible for overseeing the surveys of private ICF/IID facilities across the state. Please welcome Bobbi when she arrives on April 29th!
clipCommunity Visit: This week, my wife Pat Henry accompanied by Susan Moss visited Pacesetters in Cookeville. Pacesetters Inc. is an organization serving adults with disabilities in Overton, Putnam, Macon, Warren and White Counties. The agency’s mission is to “Empower and support individuals with disabilities and their families in order that they lead enriched and fulfilled lives.” Part of the day program at Pacesetters includes an art program. For the last 11 years individuals served have performed a story; narrated and complemented with art they created while at the day program. This year’s installment was a story adapted from a West Africa tale entitled “Why Do Mosquitos Buzz in People’s Ears?” In the photo are the Pacesetters Players of Putnam and White Counties along with storyteller Marcia Donovan, as well as visual artists Merritt Ireland and Ramie Nunally who created props and costumes. This year’s play was performed at area schools, nursing homes, and libraries April 8th thru April 18th.
Pat and Susan also visited Hilltoppers in Crossville and met with staff and persons supported. They had a wonderful tour of the facility and enjoyed time in the Sensory Room. Thank you to Jeanene Houston Executive Director and her staff for welcoming them and taking time out of their busy schedules.

Legislative Wrap Up: The General Assembly adjourned last Friday, April 19th.  The fast-paced legislative session ended in April for the first time since 1999.  Congratulations to Lt. Governor Ron Ramsey, Speaker Beth Harwell and the entire General Assembly for an efficient and successful session.  I would like to extend my personal thanks to those legislators who sponsored, co-sponsored or worked with sponsors on legislation to advance DIDD’s mission.  My sincere appreciation goes to: Senator Becky Massey, Senator Randy McNally, Senator Doug Overbey, Speaker Pro Tempore Bo Watson, Senator Ken Yager and Representative Mike Carter, Representative Andrew Farmer, Representative Richard Floyd, and Representative Dennis Powers.

The following is a list bills they sponsored or played a role in passing during this past legislative session:
HB 0531 by *Powers ( SB 0675 by *Yager)
Disabled Persons - As introduced, enacts "Lynn's Law" and defines abuse or neglect of an adult to include a caretaker who knowingly abandons an adult if the caretaker knows the adult is unable to care for himself without assistance.  The bill passed the House as Amended 92-0; Amended Bill passed the Senate 32-0 and is enrolled and ready for signatures.  The
HB 1097 by *Floyd ( SB 1223 by *Watson)
Hospitals and Health Care Facilities - As introduced, authorizes certain ICF/MR beds to be filled with persons from department of intellectual and developmental disabilities' waiting list after the death of persons occupying the bed who came from a developmental center. An amendment was placed on the bill that requires DIDD to establish a process to determine who from the waiting list will go into the private ICF beds once they become available.  The bill passed the House as Amended 94-0; Amended Bill passed the Senate 29-0 and has been signed by the Governor.  The bill shall take effect July 1, 2013.
HB 0692 by *Farmer ( SB 0555 by *Overbey)
Guardians and Conservators - As introduced, revises various provisions relative to court appointed guardians and conservators. 
Under the bill uniform procedures would be established for placing someone in a conservatorship on an emergency basis. A person being placed under the emergency rules would have to be notified within 48 hours of the action and a hearing would have to take place within five days. The Tennessee Bar Association recommended the changes after a series of statewide hearings.  The bill passed the House as Amended 93-0; Amended Bill passed the Senate 32-0.  Once signed by the Governor, the bill shall take effect July 1, 2013.

DIDD Staff Development Update on Relias Learning: Last week DIDD and Relias Learning staff facilitated forums in Memphis, Oak Ridge, and Nashville. The forums were well attended by agency trainers/web based training administrators, agency executive directors, DIDD Central Office and Regional Office Global Administrators and other staff development personnel, DIDD Central Office and Regional Office Quality Assurance Staff, Independent Support Coordination agency representatives, Independent and Agency Clinical Staff and other interested stakeholders. Thanks you all for your participation. The bulk load spreadsheets are being sent to agencies for review. Please follow the directions sent with the spreadsheets and return them timely.
All agencies should receive their bulk load spreadsheet by COB on Friday, April 26th. If you have not, please reach out to Relias Learning at jdumax-baudron@reliaslearning.com." There will be a training webinar on the bulk download. Please watch for an email from your global administer in the next few days for days and times of trainings. If you do not receive information on the “bulk download training” please contact your global administrator.
A power point presentation was utilized to engage the participants in the learning process and fostered conversations, questions and answers. A copy of the power point is available here.

DIDD Training Survey: We have received over 100 training surveys by email or from participants at the forums. The due date for the surveys is Monday, April 29, 2013. If your agency has not yet turned in a training survey it is still available here.
Final Date for Learners Completing Training in College of Direct Support (CDS): Friday, June 21, 2013.

Aligning the Sweep with the Period in PCP: As mentioned in last week’s Open Line, the Offices of Business Services and Information Systems are working together to get the two-week billing period in line with the sweep dates. We expect to have this completed by the end of May 2013.  We do not anticipate any changes in the sweep schedule or the payment process. All changes will happen in the background and will result in a single, one-time “one-week” report period on the Report Pull-down menu. Then we will return to our regular two-week period reporting format. More details and dates will be given in the Open Line over the next couple of weeks.

DIDD Four and Three Star Awards Recognition: As a follow-up to last week’s item about criteria for star status, we wanted to provide some information about provider performance levels over the past three years. Our focus today is on Day-Residential providers.
Implementation of the star awards recognition program seems to have served as an incentive for providers to improve and maintain quality of services as shown in the data below compiled for Day-Residential providers receiving either first-time awards or renewal of star status.

  • Across three years, we have noted a definitive upward trend overall for Day-Residential providers, as star awards have increased from 24 star providers for the 2011 survey year to 44 star providers for the 2013 survey year.
  • This includes an increase among 3-star award recipients, from 11 providers for the 2011 survey year to 25 recipients for the 2013 survey year.
  • Day-Residential providers receiving 4-star awards have also increased steadily from 13 recipients for the 2011 survey year to 19 recipients for the 2013 survey year.

DIDD will continue to review trends among high-performing providers as we consider possible enhancements to the star recognition program.

Division of Safety Systems: Over the last year, the Department’s Division of Safety Systems has been collaborating with the University of Tennessee, Knoxville to develop a safety culture assessment survey called the Cultural Assessment and Reporting Experience (CARE) survey. The goal of this tool is to receive an assessment of safety from those that are working on the front lines each and every day. Specifically, the survey will gather information regarding communications concerning safety, comfort levels when reporting safety related information, and how safety issues are addressed. The CARE survey is being designed specifically for service delivery systems which serve persons with intellectual and developmental disabilities. It is the first of its kind and is an important step towards becoming the safest state in the nation for individuals with intellectual and developmental disabilities.
An initial survey tool has been developed and is in the process of being piloted at the Orange Grove Center. Additional surveys to test the validity and reliability of the tool will also be completed prior to statewide data collection. The survey is set to be standardized and ready for statewide data collection by the end of the year.
It is important to note that this tool is for informational purposes only and will be used to inform future practice. All data collected will be anonymous and handled only by the UT research team. Collective data will be shared with the department; however no identifying data will be included.

Tennessee Government Leadership Council: The 2nd Tennessee Government Leadership Council meeting was held with DOHR Commissioner Rebecca Hunter on April 15, 2013. The Council formed 5 committees designed to transform state government: Communication, Engagement, Forward Focus, Systems Thinking and Vision. Tom O’Brien was assigned to the Systems Thinking Committee and encourages all graduates of TEI, TMI and Lead Tennessee to contact him to volunteer for one of these committees. Seven people have already volunteered to assist with our mission. This Council is directly aligned with the Governor’s mission to radically change the image of state government. Please check this link and learn how you can attain a BLACK BELT IN LEADERSHIP. For more information contact Tom O’Brien at 615-517-6088 or via e-mail at Thomas.O’Brien@tn.gov.

DDPPC Appointment: I am pleased to appoint Mrs. Teresa Cooper of Support Services of the Mid-South to serve on the Developmental Disabilities Planning and Policy Council (DDPPC) as a service provider representative. Mrs. Cooper has a significant amount of experience in quality management, monitoring and compliance. In her current role of Quality Management Specialist; she is responsible for developing monitoring tools, ensuring compliance with governmental regulations and policy development. I appreciate Mrs. Cooper volunteering to serve and providing insight from both her professional and personal experiences.

Employment First (EFLSMP) Grant Consultation Begins in Tennessee: I’m happy to report that the Department’s Director of Provider Services, Jordan Allen and newly hired Director of Employment and Day Services, Amy Gonzalez, spent the majority of last week touring the State in support of our Employment First initiative.
Nancy Gurney, the first of three nationally recognized consultants commissioned by DIDD and supported by the Office of Disability Employment Policy (ODEP), arrived last week and visited with the three Provider agencies selected to lead our change efforts across the state. As I’ve mentioned, DIDD seeks to increase competitive and integrated employment opportunities for all persons living with a disability. This effort will encompass the introduction of several simultaneous strategies involving policy reform, provider training in skills like Customized Employment, departmental collaboration with Vocational Rehabilitation and coordinated efforts with academic leaders in our State.
Additionally, as facilitated by Ms. Gurney, financial conversion strategies for agencies still supporting segregated Day Service environments in facility and workshop based settings are addressed in a systematic and fiscally attainable strategy. Over the course of the last year this Department has pledged a renewed and revitalized intensity to ensure that the State of Tennessee is not only doing our part, but is recognized as a national leader in the area of employment services for our stakeholders. Our commitment is reaffirmed in the work being done by Ms. Gurney and the dedication of the entire staff bodies at SRVS, Rochelle Center and the Orange Grove Center.
My staff reports that these initial consultation sessions were intense but productive. Ms. Gurney found the executive staff at each agency to be skilled and energized by the opportunity to lead our State in employment outcomes. Overall, the week materialized into a great beginning and will serve as the first new bricks in a foundation of strength and success for our community.
Next steps will include the introduction of Michael Callahan, expert in Customized Employment, and Lisa Mills, Medicaid Waiver consultant and renowned employment services guru. Michael will hold his initial sessions with each of our Provider partners in mid-May while Lisa arrives to work directly with this Department in late-May. We look forward to Michael’s arrival, Nancy’s continued analysis and assistance, Lisa’s policy expertise and this Departments continued commitment to ensure that we provide the very best to our valued customers and continue to push tirelessly forward in the direction of their advancement and success.

Arlington Exit Plan Update: As many of you are aware Dr. Nancy K. Ray resigned her role as Court Monitor in the Arlington lawsuit effective January 15, 2013. On April 15, 2013, the Court issued an order appointing Gaye Hansen as the new Court Monitor and Nicole Arsenault as the Assistant Court Monitor. Many of you know Gaye as the former Executive Director of CSN and Nicole as a former monitor working under Dr. Ray. Both Gaye and Nicole have assumed their duties as the new Court Monitor and Assistant Court Monitor.
Following mediation, the State entered into an Exit Plan which, upon its successful completion, will bring this long running lawsuit to an end. The Court approved the Exit Plan and entered an Agreed Order on January 17, 2013, that includes a new limited court monitor role.     
In light of the new limited role of the Court Monitor, DIDD wanted to provide the following guidance to providers. First, if any provider has any question, concerns or issues involving the provision of services to any class member please contact Debbie Payne at 615-253-6885 or Debbie.Payne@tn.gov. Second, only three agencies will now undergo community status reviews by the Court Monitor. Community status reviews for all other agencies ceased at the time the Agreed Order was entered. Third, if the Court Monitor is directed by a specific order of the Court to undertake any other reviews, DIDD will notify providers of the court order and the specific details of the review.  Please expect a memorandum to be issued from my office next on this topic.

An Ounce of Prevention: This week’s topic covers the Housing Cost Subsidy, which is state funding available to eligible class members receiving Supported Living services. How this subsidy is approved is described in Policy 80.5.2. We would like to remind providers who serve as the Representative Payee of participating individuals that the subsidy request on file needs to be updated when a person’s circumstances change. Examples include when there is a change in the number of persons living in the home and when there is a significant increase or decrease in the individual’s income. Please see Section VI.C and VI.E of policy 80.5.2 for more details.

DOJ and Disability Employment: The Department of Justice has recently announced that they have joined the lawsuit against John Kitzhaber. The lawsuit states that Oregon is allegedly violating the Americans with Disabilities Act by failing to support individuals with intellectual and developmental disabilities who have expressed a desire to work in the community. Those individuals have been placed to work in sheltered workshops with intolerable working conditions and wages that are below the minimum wage. In addition to these factors, the lawsuit maintains that this environment provides little or no contact with persons that are not disabled and thus fails to provide to opportunity for integration into a community.
DIDD, along with our partners, are working diligently to ensure that people with disabilities who are currently working in sheltered workshops are provided the education, experience and exposure to make an informed choice about their daytime activities. The goal is to support individuals who have expressed a desire to work in the community by providing opportunities to realize that goal. Each person will receive an opportunity to work in the community and become a truly active and valued member of their community. People with disabilities deserve to have a voice and choice in deciding where they would like to work and the ability to receive a sustainable and adequate rate of pay.

LPN and RN Training in East Tennessee: Following DIDD goals related to the Governor’s Top to Bottom Review, East Tennessee Community Homes partnered with Tennessee Technology Center’s Practical Nursing Program and Milligan College School of Nursing to host rotation of LPN and RN students.
To date, 10 LPN and 15 RN students have paired with ETCH Nursing staff to expand their clinical experience within the scope of nursing. It continues to be a very positive learning opportunity with great potential for growth. Full of excitement, one RN student met with her supervisor following a rotation stating, “I honestly enjoyed my clinical experience at ETCH more than any other community clinical I have done so far. I have never had the opportunity to visit a group home and it was an amazing experience.”

From Ascend management Innovations: In the April 19 issue of Open Line I included an item concerning Ascend Management Innovations and their arrangement to send Supports Intensity Scale (SIS) reports to agencies by way of secure email. Following is a statement from Ascend concerning this:
At the time we made the offer to send SIS reports electronically we did not anticipate the large number of providers who would prefer this transmission method nor how labor intensive this process would be for our staff. Sending a fax is a simple push of a button, but to send via email requires that the report is opened, saved to PDF, a “secure” email is composed and, finally, sent. While it might not seem like a lot, it is much more time consuming. In order to allow all agencies to have SIS assessments sent electronically, we are in the process of changing our systems to an automated email delivery system. This will, however, take a few months to accomplish. We apologize for the delay this will cause in our ability to send electronic reports. Please be assured that providing this option to you will be our priority and we will let you know as soon as this becomes available.

Community Based Day Clarification: If an agency closes for whatever reason (weather, illness, holidays, etc.), but Community Based Day is provided, then CB Day can be billed as long as it is an approved service on the cost plan and it is within the allotted 243 days. When the facility is closed, Facility Based Day cannot be billed. If you have questions regarding this, please contact your Regional Employment and Day Services Coordinator.

Provider Rate Increase – Views Requested: On April 18th, the Legislature passed the Appropriations Bill setting the budget for fiscal year 2013-2014. In this process, providers were successful in convincing the General Assembly to commit $2,000,000 in state funding, to be matched by $3,694,500 in federal funds for a total increase to the systems of services of supports for people with an intellectual disability of $5,694,500 through a rate increase. Because I am responsible for executing the distribution of this funding, I want to engage interested parties as to how that rate increase should be allocated by service category. Should this funding be split across-the-board or do certain services require a larger percentage share of the increase through distortions that have emerged in the rate schedule over the last few years? If you have views as to how this funding should be allocated, please let me know.

Federal Department of Health and Human Services Audit: Also on April 18th, Tennessee received the final report from the Department of Health and Human Services, Office of the Inspector General (HHS/OIG) concerning costs in the Tennessee system of supports for people we serve, specifically at state operated Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). The time period for this audit was state fiscal years 2009-10 and 2010-11 (July 1, 2009 through June 30, 2011). Tennessee was the fourth system reviewed by HHS/OIG auditors in a series of audits of systems of services for people with intellectual disabilities and previous reports included findings that included recommendations to refund a substantial amount of federal funds. Below, are links to the three prior audits reviewing systems in New York and New Jersey. From these, you should have an idea what bad audits are like.
https://oig.hhs.gov/oas/reports/region2/21001027.pdf - New York (August 2012)
https://oig.hhs.gov/oas/reports/region2/21101029.pdf - New York (May 2012)
https://oig.hhs.gov/oas/reports/region2/21001029.pdf- New Jersey (April 2012)
Federal auditors began their field work in Tennessee last June and have had significant communication with staff at DIDD, the Bureau of TennCare, and the Comptroller of the Treasury throughout the last half of 2012 and into early spring of 2013. Unlike the previous reports on other states, this report did not include any recommendations requiring state reimbursement of funds owed the federal government. I am very pleased that this in-depth assessment of costs in our system by an expert team of federal evaluators validated that these costs are calculated in accordance with federal requirements and that Tennessee has made substantial efforts to reduce costs in the system. The official report is here.

Good Luck! As the State of Tennessee and DIDD undergo new initiatives to encourage the health and wellness of our employees, I want to take this opportunity to show my encouragement and support to all the DIDD staff that are participating in this weekend's Country Music Marathon and Half Marathon. Participation in such an event shows the same dedication and hard work that you all demonstrate each and every day in your performance of your job at DIDD. I wish you all a safe and enjoyable run.

Administrative Professionals Week: As Administrative Professionals Week comes to an end, I would like to thank all of the administrative staff within DIDD who work diligently day after day to ensure seamless operations throughout our department. A business or department in this case, succeeds when we all come together for the greater good - to make life better for those we support.  I am mindful and very appreciative of all you do!