Community Living Committee
DRAFT MINUTES
Thursday, February 8, 2018
3:00 p.m. to 5:00 p.m.
Hilton Garden Inn, Cary, NC

Members Present: Kerri Eaker, Aldea LaParr, Michael Groves, Mya Lewis, Vicki Smith, Joshua Gettinger, Peggy Terhune, Katherine Boeck

Members Absent: Christina Dupuch, Brendon Hildreth, James Stephenson, Sandra Terrell, Jason Vogler, Andrea Misenheimer

Staff in Attendance: Philip Woodward, Yadira Vasquez, JoAnn Toomey, Chris Egan, David Ingram

Guests: Kenneth Bausell (here for Sandra Terrell and Deb Goda), LaToya Chancey, Linda Kendall Fields, Kate Walton, Karen Luken, Steve Strom

Introduction:

Kerri Eaker opened the meeting welcoming the members and doing an icebreaker activity focused on a string connection and what members have done for the past six months for NCCDD. 

The minutes from the November 2017 Community Living Committee meeting were reviewed. 

MOTION: Aldea LaParr made the motion to approve the minutes as read, and Kerri Eaker seconded the motion.  The motion was approved.

Initiative Updates:

Supported Living: Making the Difference

Jesse Smathers from Vaya Health provided a Supported Living: Making the Difference update by phone.  As of December 31^st, 2017, 21 people with I/DD had moved into their own homes with Supported Living.  The initiative is working with 13 others.  There are six webinars scheduled for 2018, and each provider webinar will show an individual who transitioned and how that individual made the transition.  The initiative will develop a user manual or a handbook to share with all seven Local Management Entities/Managed Care Organizations (LMEs/MCOs) in North Carolina.  This will be a statewide document that will help reduce barriers.  Each LME/MCO has a different interpretation about Supported Living, and there have been some barriers with Supported Living Level 3.  There are three group homes in the discussion of transitioning to Supported Living.  He also mentioned the stakeholder advisory group meeting on November 30^th.  The group had no questions.  Philip Woodward said the webinar links will be posted on NCCDD’s website and shared as they become available.  He also said they are e-mailed to the Learning Community listserv; he asked members to let him know if they want to be added to this list.

Kerri Eaker shared a comment card from member Paula Woodhouse: “If Vaya was granted the contract and they had an individual outside their catchment area, and this created issues, perhaps we should have addressed that in the RFA. And should address this going forward with RFAs.  We should have anticipated this if indeed we allowed LME/MCOs to bid on the RFA.  A lesson learned.”  Mya Lewis mentioned that the issue is that the providers involved brought in individuals from their area. Linda Kendall Fields noted that she was involved from the beginning and noticed the issue with how Vaya Health shared information with other LMEs/MCOs and providers.

Kerri Eaker expressed concern about an individual from another state accessing an Innovations Waiver slot trying to access Supported Living services. 

Joshua Gettinger said this initiative is supposed to be statewide but was given to one grantee.  He said what we learn in one area can be applied to another area – how do we do this well?  Vicki Smith said identifying a model program does not need to be statewide, and Kerri Eaker said this shows the need for some kind of centralization of services so that it can be done statewide.  Mya Lewis said the issue is not unique.  Vicki Smith said how you provide Supported Living Services in Asheville is not the same as how you provide it in Charlotte.  Kenneth Bausell said Vaya Health is more strongly connected to those individuals getting Supported Living services in Vaya’s catchment area.  He added that there has been a lot of tension with those agencies doing it statewide, and he said the Learning Community is intended to be statewide.  Kerri Eaker asked, why is Vaya Health trying to serve individuals in another area because the entity is not responsible for getting paid to coordinate care in that area?  Kenneth Bausell said someone will just move somewhere else to access services because one agency might provide care differently than another agency.  Mya Lewis said it sounds as if Vaya Health is doing what it needs to do.

The Committee received another comment card related to the above discussion: “LME/MCOs appear to be inconsistent in how they administer services.  Why is this allowed?  Shouldn’t these be standardized?  Should we be more engaged in this?  It could have avoided the Cardinal fiasco.”  No discussion followed.

Rethinking Guardianship: Building a Case for Less Restrictive Alternatives

Linda Kendall Fields provided an update and distributed the two-page Executive Summary.  She showed the committee the North Carolina Court System website and the first five minutes of the captioned Understanding Guardianship video at: http://www.nccourts.org/Training/Guardianship.asp.  She mentioned the current statutory language used such as calling individuals under a guardianship “wards” and the push for legislative reform to update the language.

Joshua Gettinger asked about specific training for the Administrative Office of the Courts.  Linda Kendall Fields said the UNC School of Government provides training.  Peggy Terhune asked if the work is done, and Linda  Kendall Fields said no.  Peggy Terhune shared a personal story about one of her children aging out of foster care, and she was asked to become her guardian, but she refused.  Linda Kendall Fields said the initiative has a connection to the Department of Social Services (DSS) and its welfare system.  She also mentioned efforts to protect against exploitation of elders within the guardianship system.  The first meeting post-NCCDD funding will be February 20^th.  She said guardianship is one of the Division of Aging and Adults Services’ (DAAS) priorities, said there’s momentum and interest, and mentioned the recommendations the workgroup made.  Vicki Smith said this was an amazing project; she was concerned at the beginning, but this project changed minds.  Joshua Gettinger is interested in hearing where this goes – the stories that will come up in three years since this initiative can take seven to ten years to make its full impact.

From Planning to Action: Integrated Collaborative Care for People with Intellectual and Developmental Disabilities (I/DD)

Karen Luken provided an update.  She mentioned a UNC TEACCH hub in Halifax that started in January with cohorts that will generate real cases.  TEACCH joined a national ECHO and autism collaborative.  She mentioned MOC – Maintenance of Certification and Federally Qualified Health Centers (FQAC).   She said the Duke project is providing psychiatric access by phone.  She highlighted the collaboration between UNC and Duke.  She said there is a Massachusetts Child Psychiatry Access Project (MCPAP) funded by Cardinal Innovations.  She said there will be a glossary of terms, and there is a focus not just on healthcare but health in general.  She recently met with Disability Rights North Carolina to discuss children with complex needs.    She mentioned a federal workforce development grant.  She also went to the Campbell University Rural Health Summit that focused on dental needs.  Vicki Smith asked her why there are so many single dental offices; can integrating them together help physical health needs?  Karen Luken said they are small businesses, but some dentists accept Medicaid.  The group discussed dental insurance not providing enough coverage. 

Kerri Eaker said it’s amazing to see the systems change that will happen.  Karen Luken said almost everyone in the committee meeting is connected to this initiative.

Fiscal Update:

Yadira Vasquez provided the fiscal report.  The committee likes the colorful graph – good for visual learners.

Motion Items:

RFA Discussion:

Cross-System Navigation in a Managed Care Environment (Case/Care Management)

Prior to the meeting, Kerri Eaker informed all of the Council members that NCCDD received an additional background comment from a member that will be incorporated into the background section of the RFA.  Joshua Gettinger asked who the recommendations are intended for.  Chris Egan said we will have forums to collect what we know to provide information to the North Carolina Department of Health and Human Services (DHHS).  Chris Egan mentioned a legislative commission named the Legislative Research Commission (LRC) and DHHS documents becoming public documents available to the General Assembly.  Joshua Gettinger said the idea is the grantee will give us some recommendations that we will share with DHHS.  Vicki Smith talked about sharing reports and how this process becomes the remedy later.

MOTION: PeggyTerhune made a motion for staff of the Council to have authority to release the RFA regarding the Cross-System Navigation in a Managed Care Environment initiative in an amount up to $125,000 per year with a required minimum of 25% non-federal matching funds for a period of up to two years.  Council staff have approval to extend the due date for applications, if necessary.  Katherine Boeck seconded the motion.  The motion was approved by unanimous/majority vote.

New Initiatives:

Transportation (Application Update)

Philip Woodward told the committee six individuals representing four different entities participated in the Bidders’ Workshop, but we received one application.  Kerri Eaker asked if we will follow up with those entities who attended the Bidders’ Workshop but did not submit an application to find out why.  Philip Woodward will follow up.

Philip Woodward mentioned the RFA Application Review Committee lists in the packet folder and invited the members to participate if interested.  Katherine Boeck expressed an interest in joining the Transportation RFA Application Review Committee.  Vicki Smith asked if we need to give the RFA Application Review Committee list back?  Philip Woodward said no, keep it safe and confidential.  Chris Egan followed up talking about fairness in the process, and after it ends, the materials will become part of the record.  Philip Woodward said to shred it instead of recycling it.

Natural Supports

Philip Woodward provided an update on the contract with FIRST.  He has drafted the scope of work and is waiting for the final budget.  FIRST will hold several events to find individuals with I/DD, family members, and professionals such as Community Navigators and Care Coordinators who are interested in the development of natural supports.  Twenty-five professionals will take the training, and each will select an individual with I/DD to participate.  FIRST will subcontract with the Asset Based Community Development (ABCD) Institute to adapt the PLAN Curriculum for North Carolina.  Joshua Gettinger said this initiative will produce both data and stories.

Mya Lewis requested a copy of the Natural Supports RFA, and Philip Woodward will send it to her.

Wrap Up and Reminders

Kerri Eaker went over the conference list of relevant conferences and the travel forms and motioned to adjourn.  The meeting was adjourned at 4:55.