Waiver Reimagine Advisory Committee April 27 meeting summary

Committee members present: Sherri Pickthorn, Elizabeth Scheel-Keita, Tricia Brisbine, Myrna Peterson, Saudade SammuelSon, Phyllis Reller, Lauren Thompson, Susan Mackert, Kathy Rogers, Kayte Barton, Pat Wright, Wa Xiong, Mary Fenske, Rijuta Pathre, Abby Gertken, Meredith McKinnon, Rosalie Eisenrich, Polly Owens, Gina Winter. Bud Rosenfield, Jeanne McGuire, Julie Morrison, Kelly Friesen, Jennifer Draganc, Fartun Weli, Dr. Katrina Jirik, Chad Wilson, Annie Braun, Zahnia Harut

Committee members not present: Arbdella Hudson, Lisa Evert, Lisa Harvey

DHS staff present: Leah Zoladkiewicz, Maria Trueblood, Elliott Rankin, Sandy Zuhlsdorf, Curtis Buhman 

Meeting notes

Agenda

1. Welcome/agenda/DHS updates 

2. Policy development: services by waiver 

3. Break 

4. Policy development: services by waiver 

5. Break 

6. Policy development: services by waiver 

7. Confirm meeting schedule, next steps review, adjourn 

WRAC member and DHS meeting objectives

For WRAC members: 

· Review waiver service definitions 

· Provide feedback on which services should belong under which waiver 

For DHS staff: 

· Provide context on topics for discussion 

· Listen to responses 

· Answer questions and note follow up needed  

Previous meeting recap

The February WRAC meeting was a learning session for members about the support planning process, service rates and service mixes. 

The after-meeting evaluation was sent out and DHS received only 5 responses for the 29 members were in attendance at the meeting. Survey results were as follows:

· Support planning: 60% better understanding, 40% same understanding

· Service rates: 80% better understanding, 20% same understanding

· Service mixes: 40% better understanding, 40% same understanding and 20% more confused 

With service mixes resulting in the most questions, a review of that information will be planned for the June WRAC meeting in addition to the planned exceptions discussion.

DHS updates

· Member accommodations: DHS will continue to meet accommodations on a case by case basis. DHS will ensure all members have final materials (via email/U.S. Postal Service, if requested) two weeks in advance of the meetings. After the meeting, DHS will send the full meeting notes, chat log and meeting evaluation two weeks after the meeting. For those that request a printed evaluation to send back to DHS via USPS, a return envelope will also be included in the mailing.

· Community partner engagement: DHS is partnering with DeYoung and Associates and several WRAC members to design communication and engagement for Waiver Reimagine to take place over the next year. 

Comments from members

· Self-direction conference in October. Might be a good opportunity to share information about Waiver Reimagine and the WRAC.

· There have been a couple of things that have risen to the forefront during the meetings with DeYoung, including information/communication to culturally specific groups. Also, people who currently receive a waiver don't really know what they have, so information that is understandable about waivers and services should be made available and shared in an accessible way.

Policy development  

Round 1 WRAC recommendations: Services by waiver

28 members shared their recommendations on which waiver the following services should be available under:

· Extended PCA: One recommendation for Waiver 1 and 27 recommendations for both waivers

· Extended HHA: One recommendation for Waiver 1 and 27 recommendations for both waivers

· Extended Nursing: One recommendation for Waiver 1 and 27 recommendations for both waivers

· Extended Home Health therapies: 28 recommendations for both waivers

· Positive Support: 28 recommendations for both waivers

· Prevocational Services: 28 recommendations for both waivers.

Comments/considerations from members:

· There are some services like customized living that could really benefit from a service like the extended PCA.

· Maybe the WRAC can break into small groups by waiver, job description, interest to learn how services play out in the real world

· Policies don't matter if there is no backing, especially because of the shortage of people

· Caveat that when choosing "both" there may be some settings it may not be allowed due to duplication of services

· Consider concern of duplication

· Case managers are supposed to be reviewing services so if there's a duplication there should be a training and guidance and a process in which case managers should be protecting the flexibilities of people to have whatever therapies they need even if their place of residence cannot necessarily provide it but there's concern of duplication.

· One waiver: one set of services, one budget

· If a provider can't meet the need, able to bring service in (safety net)

· In a perfect world both, but need to consider duplication of services (PCA, HHA and Nursing as part of residential service package)

· Focus on what and why services are needed instead of where these services are being provided.If we're going to be serious about providing flexibility and informed choice to people regardless of which waiver we're in and recognizing the reality that some providers are getting paid to provide services that they're not providing

· All services for both, if we can develop a way for providers to identify when they're not able to meet needs and then the payment structure for them reflects that and someone else can be brought in. It would be helpful for case managers to have a definition of what those provider-controlled settings are responsible for and determine what is/is not being provided, what would/would not be duplicative.

Round 2 WRAC recommendations: Services by waiver

28 members shared their recommendations on which waiver the following services should be available under:

· Specialist Services: 28 recommendations for both waivers

· Specialized Equipment and Supplies: 28 recommendations for both waivers

· Transitional Services: 28 recommendations for both waivers

· Transportation: 28 recommendations for both waivers

· Individualized Home Support without Training: Two recommendations for Waiver 1, 27 recommendations for both waivers

· Individualized Home Support with Training: Two recommendations for Waiver 1, 27 recommendations for both waivers

Comments/considerations from members:

· Be mindful of duplication of services. Different providers should be considered for more than just individualized home support if allowable in provider-managed settings.

· Both for all to provide for flexibility.

· Both for all with caveats if residential should be providing service.

· IHS with training should also be allowed in a CRS setting just as IHS without training. Skill building in the area of community participation at an individual level is just as needed and there may not be CRS staff capacity to meet individual needs.

· Both, with separate providers in residential settings.

· IHS with training should also be available to people in both, as a person could use 1:1 assistance with skill building in the community.

· Assure carve outs necessary to not duplicate services.

Services out of scope

· A person on Waiver 1 is not eligible to receive provider-managed residential services, community residential services, customized living, family residential services and integrated community support services as they are bundled and can only be provided to people living in provider-managed residential settings (people on Waiver 2)​.

· The WRAC will not be recommending services by waiver for CRS, CL, FRS and ICS, as this has already been determined within the scope of waiver limitations​.

Additional notes

· Bundling means the combining of two or more discrete services with distinct purposes under a single waiver service definition. A single provider is paid one rate for the provision of the combined services.​

· “Carve outs,” how DHS talks about allowance of other services typically only available to people who live in their own homes, when a person is living in a provider managed setting​

· Since CRS, FRS, ICS and CL are distinct services, they are each bundled differently and have carve outs unique to those services​.

· If we allowed the following services to be provided to people on Waiver 2, a person would either be ineligible to receive the service or it would be a duplication of services: ​

o Caregiver living expenses

o Individualized home support (IHS) with family training

o Night supervision.

WRAC comments/additional considerations: Exceptions to duplication of services should be considered based on cultural or language-specific needs.

Adjourn

The meeting was adjourned. The next meeting of the WRAC will be on June 29, 2023. Meeting details can be found on the Waiver Reimagine Advisory Committee website under the Meetings tab.