Community Living Committee
Thursday, November 2, 2017
3:00 p.m. to 5:00 p.m.
Hilton Garden Inn, Cary, NC
Members Present: Kerri Eaker, Brendon Hildreth, Katherine Boeck, Aldea LaParr, Peggy Terhune, James Stephenson, Andrea Misenheimer, Jason Vogler, Michael Groves, Dreama McCoy
Members Absent: Christina Dupuch, Mya Lewis, Vicki Smith, Joshua Gettinger, Sandra Terrell
Staff in Attendance: Philip Woodward, Yadira Vasquez, Chris Egan
Guests: Karen Luken, Darcy Hildreth (with Brendon Hildreth), Erika Hagensen, Corye Dunn, Caryn Cook (ASL interpreter), Natalie Davis (ASL interpreter), Paula Coppolla
Ms. Eaker opened the meeting welcoming the members and doing an icebreaker activity focused on strengths and goals.
The minutes from the August 2017 Community Living Committee meeting were reviewed.
MOTION: Ms. LaParr made the motion to approve the minutes as read, and Mr. Stephenson seconded the motion. The motion was approved.
Ms. Vasquez provided the fiscal report. NC Emergency Management (NCEM) spent of all the funds for the Emergency Preparedness initiative. The Arc of North Carolina is doing a realignment for the From Planning to Action: Integrated, Collaborative Care for People with I/DD initiative.
The committee received one question from the presentation to the full Council earlier in the day: “What happens when existing natural supports die or are lost?” However, the notecard said Case/Care Management RFA Draft at the top, so the committee did not discuss the question.
Ms. Eaker asked for other feedback on the recommendation of the selection committee for the Natural Supports RFA, including any additions or outcomes, but the committee provided none. Ms. LaParr likes the attention on the individuals, and Ms. Terhune said people with I/DD will become confident and be trained naturally.
MOTION: Ms. Terhune made a motion that FIRST be approved as the applicant selected for the NCCDD initiative entitled Using Natural Supports to Build Greater Community Engagement initiative, in an amount up to $75,000 per year with required minimum of 25% non-federal matching funds for Year 1 (of up to 3), beginning March 1, 2018 to February 28, 2019. Dr. Vogler seconded the motion. The motion was approved by unanimous vote.
The committee received one question from the presentation to the full Council earlier in the day: “What are the opportunities to dually fund a grant with another agency – e.g. NCDOT? Seems like a good way to increase funding and thus interest is feasible.” Mr. Woodward said he has developed a relationship with Debbie Collins, Director of the Public Transportation Division at the North Carolina. Department of Transportation (NCDOT) and can discuss the idea with Mr. Egan and Ms. Toomey. If they agree, they will initiate a discussion with NCDOT. Ms. Eaker attended a Public Transportation hearing where they discussed their five-year plan and said it is focused on rural and urban areas. Ms. Terhune advised against having a contract with NCODT and suggested that public transportation needs to work with people with disabilities. Ms. Eaker said people with disabilities cannot easily travel from one county to another, and there is a need to develop something more statewide. Ms. Terhune said Uber already has an infrastructure. Ms. Misenheimer said Cardinal Innovations did some investigating, but Uber could not guarantee that people with disabilities would not be discriminated against.
Mr. Stephenson said he used Uber in San Antonio, and it was great, but the service is very loosely regulated. He also pointed that NCDOT’s budget is controlled by the General Assembly. He said maybe we want to figure out what we want because the goals of this RFA are broad. For example, he offered that perhaps the initiative can develop a special app for people with transportation needs. He asked, “What are we looking for?” He said the committee would be disappointed if we put it out without knowing what we want. Ms. Eaker commented that the Council did not want to specify exactly what we want but to see the applicants’ ideas for improving transportation options.
Mr. Hildreth said if the government is involved, the cost will go up and he asked, “Why should I pay more when I’m in a wheelchair?” He also mentioned the limited hours that transportation is available to people with disabilities.
Dr. Vogler made three points:
1. We thought we could give the RFA to Debbie Collins at the NCDOT.
2. Meet with faith-based groups. There are liability issues associated with transporting individuals.
3. He suggested information, such as social determinants of health, to see the real cost.
Ms. Boeck suggested releasing the RFA again. Mr. Stephenson asked about the feedback we received after the first RFA release. Mr. Woodward said that if NCCDD does not approve to re-release the RFA now, we will need to wait until the February meeting to consider a re-release.
MOTION: Ms. Boeck made a motion to grant NCCDD staff authority to re-release the Request for Applications (RFA) regarding the I Get Around – Improving Transportation Options initiative, in an amount up to $150,000 per year with required minimum of 25% non-federal matching funds for Year 1 (of up to 3), beginning July 1, 2018 to June 30, 2019. Approval to fund will occur at the May 11, 2017 Council meeting. Mr. Stephenson seconded the motion. The motion was approved. The length of the RFA posting will be determined by staff.
Future Investment Priority Discussion:
Case/Care Management in a Managed Care Environment
Ms. Eaker said we need to do more research to see what we are missing, and Ms. Misenheimer said we currently have 12,000 people on the Registry of Unmet Needs.
Corye Dunn from Disability Rights North Carolina came per Chris Egan’s request to talk about the way this group sees case management. She said the Adult Care Homes report made recommendations to transition people from institutions to community living. She explained how there are different terms such as the difference between case management and care management; meanwhile, insurance companies assign people to a care manager. However, she pointed out that case management as we understand in the I/DD world is different. Ms. Dunn said to not expect the new system to provide an individual with I/DD someone to hold their hand all the way through.
Ms. Terhune asked if the I/DD definition of targeted case management is different than the federal definition of case management. Ms. Boeck mentioned not socializing on her days off of work and said people who work at DSS don’t know more about the Medicaid Buy-In. Ms. Dunn said that could be a community navigator’s function. Ms. Boeck thought the community navigator definition included advocacy, but that is not in the federal definition. Ms. Dunn said case managers connect people to services and can advocate in ways such as making third and fourth calls for people.
Ms. Eaker said our goal is to move to Medicaid transformation and asked Ms. Dunn what she envisions. Ms. Dunn asked, “How can you help people access services they need, and can they do both in behavioral health services?” She pointed out how individuals in the medical health homes need help navigating the healthcare system. Ms. Dunn also asked, “Do we want to focus on people with I/DD accessing healthcare, or do we want to limit whatever we want to do related to targeted case management?” She mentioned that an individual with I/DD leaving a facility is a transition that needs case management and advised the committee, “You are in a unique position to make it happen.”
Dr. Vogler said the words and the language in the definition are important, and they can have different meanings depending on whom you are talking with. He said this type of work is needed versus a pilot, and there is a difference between accessing the service and engagement with the service. He hears that the Council wants engagement and remarked that people will look to see what works, what’s technical, and what doesn’t work. He said the Council does not want to lose the people who don’t have Medicaid benefits – they still need case management.
MOTION: Ms. Boeck made a motion for staff of the Council to have authority to draft the RFA regarding the Case/Care Management in a Managed Care Environment initiative, in an amount up to $125,000 per year with required minimum of 25% non-federal matching funds for a period of up to three years. Request for permission to release the RFA will occur at the February 9, 2018 Council meeting. Dr. Vogler seconded the motion. The motion was approved with an amendment:
The committee motioned to amend the RFA to expand the scope of the review to be inclusive of all groups beyond those participating in Medicaid or who are Medicaid-eligible.
Mr. Hildreth had two questions:
1. What would happen if this initiative helps him improve his independent living outcomes? He recused himself from voting.
2. What happens beyond Medicaid and private insurance?
Ms. Eaker said NCCDD will plan to build it into the current Supported Living: Making the Difference initiative.
Emergency Preparedness for People with I/DD
Ms. Eaker asked Dr. Vogler if we can include emergency preparedness information and kits in their Individual Support Plan (ISP)? There is a difference between emergency preparedness and a crisis plan. Dr. Vogler said there is not a formal answer. Whatever is happening is happening.
From Planning to Action: Integrated Collaborative Care for People with Intellectual and Developmental Disabilities (I/DD)
Ms. Luken provided an update. She said for the Medical and Health Homes initiative, the focus was to get information on what models of care would work. In the current initiative, doctors get access to consultation services. One recommendation is that the state needs a system of best practices and evidence-based practices. She added that Medicaid reform is one area of focus, and the Council is in a position to recommend to the state system what needs there are. She said it is important to understand what the data tells us, as children with I/DD often grow up undiagnosed.
Ms. Luken met with the DHHS Deputy Secretaries and then Secretary Cohen two weeks prior to the November Council meeting. The initiative has collected national information about integrated care.
Wrap Up and Reminders
Ms. Eaker went over the travel forms and motioned to adjourn. The meeting was adjourned around 5:10.