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Personal Independence Commission

July 14, 2003

Hearing Room 3, State Capitol Building
MINUTES

Lt. Governor Joe Maxwell called the meeting to order. A quorum was not established so the Commission convened as a sub-committee. PIC members in attendance were: Lt. Governor Joe Maxwell, Kirsten Dunham, Ron Vessell, Sandi Levels (for Greg Vadner), Kay Green (for Anne Deaton), Rick Horrell, John Solomon, Senator Bill Foster, Mary O'Brien, Brenda Campbell (for Nancie McAnaugh), arrived and a quorum was established.

Co-Chair Reports:

The Lt. Governor thanked the department heads and Lois Heldenbrand for their commitment and the work they have done. The work that they are doing is one of the key steps in achieving the broad goals and outcomes of the PIC. This work is linked to the work groups and the eleven objectives that were targeted.  He also reminded everyone about the speaker's bureau training following the PIC meeting and urged everyone who was interested to attend the training.

Kirsten Dunham gave an update on CMS grant opportunities. These are:

  • The Quality Assurance and Quality Improvement Grant will look at insuring quality assurance in Home and Community Based Services that is consumer driven but does not invade privacy or self direction.
  • The Independence Plus Grant, which the Division of MR/DD and the MO Planning Council are applying for. This grant is aimed at implementing and testing a self-determination demonstration project and individualized budgeting to give people more flexibility and control over their dollars and services. The grant will also look at existing waivers in Missouri, what types of changes may be needed and if new waivers are needed.
  • The Aging and Disability Resource Center Grant looks at testing single points of entry and one-stop shopping idea, and making it really easy for people with disabilities and seniors to access information, resources and referrals to get the Home and Community Based Services.

Ms. Dunham asked is there were any other grants she was not aware of. Kay Green, DMH, said Division of MR/DD is working with University Affiliated Programs on the Direct Care Staff Recruitment-Retention Grant. Ms. Dunham said she would be interested in the PIC doing a letter of support for the Quality Assurance and Independence Plus Grants. She asked if the PIC would be interested in writing a letter of support saying the grants will complement the work of the PIC and build on their Olmstead goals.

Lt. Governor Maxwell said the co-chairs would like to draft a letter of support from the PIC to send to the agencies that are applying for the Quality Assurance Grant, the Independence Plus Grant and the Aging and Disability Resource Center Grant. Ron Vessell made a motion for a letter of support.  Mary O'Brien seconded the motion.  Motion passed.

Report from the Governor's Office:

Lt. Governor Maxwell read a letter from the Governor praising the PIC and the department heads for the work they have done and the progress that has been made.

Status Report Discussion of PIC Accomplishments:

Rob Honan - Governor's Council on Disability - The major priorities that need work are establishment of a lead agency and the universal application form. Also, the state agencies need to work together and Lois Heldenbrand has started this process.

Real Choice Systems Change Grant Update:

Sandra Levels, Department of Social Services - Ms. Levels handed out a report outlining the seven objectives of the grant and explaining how they relate to the eleven PIC objectives.  As far as selection of a lead agency and a universal application form, these activities are being addressed in the meetings with Ms. Heldenbrand and a final report is to be presented to the PIC at the September 8th meeting. She told the PIC that 9,000 of the 10,000 copies of the Missouri Guide to Home and Community Based Services have been distributed and there is a request for 600 copies, which will leave 400 copies. She asked the PIC for permission to re-print the guide. The funding to do this would come out of the grant. There is $134,000 left in the grant for this purpose.

Lt. Governor Maxwell had concerns about the amount of money left in the grant. He wanted to be sure there would be enough money for the PIC to accomplish their objectives. And meet other expenses. He proposed that John Solomon, Robin Reed, Chris Rinck, Kirsten Dunham and himself, as a sub-committee, go through the actual grant document to be sure that the grant and the objectives of the PIC are in agreement, and put together a budget to accomplish each of the objectives.  Sherl Taylor and Rob Honan will also work with this sub-committee. They will then bring the budget back to the PIC at the September 8th meeting for a vote. There was discussion about the re-printing of the booklet and that some revisions are needed. Mr. Solomon made a motion to print 2,500 copies of the current booklet. Ms. O'Brien seconded the motion. Motion passed. A sub-committee was appointed to make the necessary changes in the booklet and check for the most economical source for the reprinting of the booklet. This sub-committee will then report to the PIC at the September meeting for a vote.

Update on Demonstration Projects:

The six pilots received grant funds to create a curriculum that will train individuals with disabilities and their -planning partners to overcome the impact of compliance bias on the part of the consumer in the person centered planning process. Most of the pilots are on schedule with their projects. The only pilot that is not on schedule is Comtrea. They are having a difficult time finding people who can pay for the in-home type services of their program. Discussion followed as to what to do if they cannot meet the requirements of the grant.  Lt. Governor Maxwell requested Mr. Honan and others to review the grant and report back as to what the PIC can do if Comtrea cannot meet the grant requirements.

Ms. Levels also gave a budget report on the grant. With the expenditures of the first year of the grant and the anticipated expenditures from the second year of the grant, there is an estimated balance of $429,000. This is on top of what they will receive next year. A discussion of the grant and the responsibilities related to the grant followed.

There was some discussion about quality assurance. CMS will not allow states to use grant money to do quality assurance. Lt. Governor requested Ms. Hendenbrand to ask the department directors how they anticipate doing quality assurance.

Update on Informed Choice Provider Training:

Duane Gruis, Paraquad - Five informed choice providers were trained in February, four to go into nursing homes and one to go into habilitation centers. Progress has been slow, partly due to illness of several of the informed choice providers and partly due to establishing protocol through Division of Senior Services. He has also met with some resistance from the nursing homes. Paraquad has a small grant through St. Louis City to work with getting people out of nursing homes. Under this grant they have moved ten people out of nursing homes since the first of the year. On the other hand working through an informed choice provider he has only been able to move one person out.

Karen Moss, Marshall Habilitation Center - They are very pleased with the pilot project at Marshall. Sue Gibson, the volunteer assigned to Marshall, met with guardians and consumers and toured the facility to better understand facility and the services provided. Letters to obtain permission to meet with residents were sent to guardians of residents at Marshall.  As of July 10th 85% of the letter responses had been returned.  Of these 12% of the guardians wished to meet with the volunteers first so they could completely understand the focus of the project and 43% authorized for the volunteer to meet directly with the consumer. The volunteer has met with about 75 consumers and it has been very successful.

The Lt. Governor requested Nancy McAnaugh meet with Linda Allen to get an update on where Ms. Allen was on the project and then report the next phase to the PIC co-chairs.

Presentation on the Progress of the Special Project:

Ron Vessell, Vocational Rehabilitation - The Special Project Group met on July 2nd and are scheduled to meet again on July 21st. There are four focus areas they will organize their efforts in. Each of these areas will have a lead agency and staff from the lead agencies will be assigned and will work with the other agencies to identify result areas, actions and timelines for those actions.  The areas and lead agencies are:

  1. Community Based Personal Care - Department of Elementary and Secondary Education, Division of Vocational Rehabilitation
  2. Transition from Institutions to the Community - Department of Mental Health
  3. Diversion or Prevention from Institutions - Department of Health and Senior Services
  4. Real Choice - Department of Social Services

Discussion Regarding the Organization and Current Tasks Given to the Work Groups:

Kirsten Dunham - As the PIC moves forward with the new Special Project the work groups will probably change. The work groups could be tied in with each of the specific areas, and thus would have agency help and guidance from the lead agencies when needed. The work groups would meet in August and provide a final report to the PIC co-chairs by August 29th.

Lt. Governor Maxwell felt this is a good transition period. The state is entering the last twelve months of the grant and need to focus on the outcomes. The PIC also needs to work on accomplishing the eleven PIC objectives. The co-chairs can use the information from the final reports of the work groups in the report of the Commission due October 31st and make recommendations for the next phase.

Public Comment:

Wayne Lee - He was on the Legislative Work Group which only met one time. He would like to be on a work group when they begin meeting again. He also commended the PIC for their dedication and participation.

The next meeting of the PIC will be September 8th. All reports and other written information to be shared with the group must be to Rob Honan at the Governor's Council by September 3rd. If the information is not received by September 3rd the person will be required to make an oral presentation to the PIC followed by a written summary.

Mr. Vessell made a motion to adjourn the meeting. Mr. Solomon seconded the motion. Motion passed. Meeting adjourned.