Last year, nearly one thousand cases of abuse against at-risk adults were reported in Colorado. In Denver, police report over a 200% increase in these types of crimes.  Adult Protective Services estimate for every report of abuse against an at-risk adult, many more cases go unreported.

A Colorado legislator has introduced a bill to strengthen efforts to decrease crimes against at-risk adults. Senator Jessie Danielson is sponsoring Senate Bill 19-172 which makes it a Class 6 Felony to unlawfully confine an at-risk adult and a Class 1 Misdemeanor to unlawfully abandon an at-risk adult.  Senator Danielson says this bill will cut down on this type of abuse of the most vulnerable Coloradans.

How did you come to be the sponsor on this bill?

I have worked on issues of elder abuse and at-risk adults since I was elected.  Having worked on elder abuse issues and having promoted the rights of Coloradans with disabilities, it was a good fit.  The issue of abandonment and confinement was brought to me by the District Attorneys (“DA’s”), area agencies on aging, and the senior lobby.  This is something that is happening in our community.    There are elder abuse statutes and statutes against at-risk adults. However, we are finding that these two particular types of abuse are not defined in statute as a crime.  We need to define them as crimes so that the DA’s can go after the people who are responsible for this type of abuse and prosecute them.  It attaches penalties to the crimes.

What kind of abuse does the bill specifically address?

 There are two types of abuse we are defining in the bill.  One is unlawful confinement; one is abandonment.  Denver District Attorneys showed me a photograph of a room where a grandmother was being kept every day. They left this individual in a little room under the stairs in the basement.  She was left with no food and no water, just a bucket.  That is an example of unlawful confinement.  When an at-risk adult is in the care of someone in this manner, we define it in the bill and attach a punishment to it. The purpose of this is to give law enforcement the tools to prosecute.  It is also an attempt to deter people from committing the crime in the first place.  The second thing in the bill is similar.  People are leaving, abandoning, dumping people they no longer wish to care for.  There was a high profile case picked up on the local news.  This man was put on a plane and sent to Denver.  When he got to DIA, there was no one to take care of him. He didn’t know who he was.  Ultimately, he got picked up and ended up at a hospital.  That is the type of abandonment happening that cannot be prosecuted under the current statute.

How do the bill’s amendments clarify the kind of caregivers it is targeting?

We don’t want to have any unintended consequences where good caregivers are somehow implicated in these crimes because that is not the intent.  The intent is to find the people who are doing the most serious kind of abuse and prosecute them.   Some of the language concerned the disability rights advocates and we have addressed their concerns.  The concept of the amendments is clarifying anything they see as problematic, where someone could be accused of this crime when they are not committing it.  We in no way want to implicate someone who has taken on the work of providing care in an ethical and caring way. When someone is a good quality caregiver, be they family or not, we want that care to continue.  We don’t want to intimidate caregivers.  We are not talking about safety measures in the home that are reasonable.  We are talking about people who abandon their loved ones.

How does this impact the community of individuals with intellectual or developmental disabilities?

It impacts individuals with these types of disabilities because we say the crimes are against an at-risk person.  What I have seen is heartbreaking because these are vulnerable people.  For example, the case I described where the woman was kept under the stairs was one of the cases I reviewed to help with this bill.  She was a nonverbal adult.  When someone has an intellectual or developmental disability, they are disproportionately targeted for this type of abuse because they can’t stand up for themselves.  They cannot tell someone what happened.  It will have a positive impact in the sense that if this is happening to members of our community who have intellectual or developmental disabilities, we can stop it from happening because we can finally prosecute it.  We can deter it from happening in the future because of the penalties we put in place.   We do not currently give law enforcement the tools to stop it.  That’s what we are doing.  I think that is a crisis that needs to be solved.  It’s less common than other forms of abuse. However, it is still happening.  They need the legislature to do something about it.  

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

The post Bill Enacts Penalties Against At-Risk Adult Abuse Crimes appeared first on AdvocacyDenver.

An Interview with Catherine Strode

When Denver Human Services (DHS) released the findings of a needs assessment for individuals with developmental or intellectual disabilities, one Denver nonprofit organization took it as validation of its work. As part of the needs assessment, Denver Human Services surveyed recipients, providers and others and asked how supportive people are of the current mill levy services being provided by Rocky Mountain Human Services. On a scale of one to ten, where 1 is the lowest level of support and 10 is the highest level of support, across the different types of respondents to the survey, the scores were just over seven and just under nine in terms of how satisfied people were with those current services. Executive Director Sheri Repinski says the results of the needs assessment reflect that RMHS is on the right track and doing work that people value with Denver property tax mill levy dollars.

The report also highlighted key gaps in services and supports. Sheri Repinski addresses how RMHS is responding to the results of the needs assessment moving into the next year.

How will client assistance paid for by mill levy funds look different moving forward?
Mill Levy client assistance allows individuals to request services that are unique and individualized at any time these services are needed. It also includes family support and services that are in a person’s service plan. There’s concern we have shut the door on individual requests through client assistance or substantially limited what people can access. That is just not the case. We realized an increase in number of requests we received each month. These increased about 112 percent from January to June of 2018. Our trends in delivering services exceeded what we had in the budget. We developed a framework around it so it was more predictable and we could ensure funds would be available equitably across all individuals. The new framework we have developed will be helpful for individuals and families to understand what’s available to them. It will also give them an avenue to express concerns if they believe they have a need that is not being met. This framework will help offer clarity. It will help ensure we are being fair and equitable because we will be able to establish limits. We’ll be able to ensure that the services are sustainable.

What change in services come with the new framework?
Most of the services that were requested before will continue to be funded and it’s important that individuals continue to contact us so we can explore services to help them. There are a couple of places where the expenditures were higher than we expected so we’re making some changes. There are changes in rental assistance, moving expenses, and home repairs. Temporarily, if somebody requests rental assistance, we have not always been able to fund those requests. We are looking at a way to be able to do this moving forward. We’re aggressively pursuing additional options for families needing rent assistance. There’s a variety of options we’re looking at and believe we can go back and build a system that allows limited rental, deposit/moving assistance to be provided. We just need a little bit of time. There are limits to cultural passes (e.g. Museum of Nature and Science) and long term services. As for individuals who need behavioral therapy on a long term basis, we have not been able to approve them beyond the limit that we have set. We are exploring other avenues for them to receive this service. We will no longer be able to cover temporary shelter, travel expenses, purchasing a vehicle, vehicle repairs and furniture.

How will agency initiatives look different moving forward? ( For example, classes such as financial planning, yoga, etc.)
There are no changes to external initiatives at this time. We are in the process of documenting how agencies will be selected in the future. The process of selection for external initiatives has changed primarily to organize it within specific timelines. We’ll release announcements to the community outlining the procedures and timeline for submitting a proposal. Agencies will submit proposals like they did before but the due date will be the same for all applicants. The review process will include using a rubric where the proposals are all scored against the same criteria. The Community Advisory Council will review summaries of those proposals and provide a collective score that will be averaged into the total score. Establishing a regular process and schedule makes it predictable for us, the agencies, the public, and for the budget. We are hoping to release the proposal outline and timeline by late October. The contracts for proposals that are approved will be in place by January 1, 2019.

What is the allotted budget for each area?
External initiatives (for the period of July 1 to December 31 2018) is at about 1.8 million. Client assistance, that includes individual requests, family supports, and services developed in the service plan are at two million for the six months. After December 31, we will have a different budget that is yet to be set. Denver Human Services (DHS) has implemented a contract that reduces our contract amount by two million next year. We don’t know exactly how that will play out. That is yet to be determined.

Which programs will be given priority by RMHS?
We work closely with the Community Advisory Council so they can give us recommendations on how to set those priorities. We have received overwhelming support for the Client Assistance program. For External Initiatives, the Community Advisory Council met recently and identified housing, behavioral health, parent education and competitive employment are priorities.

What measures are in place to ensure all communities know about this available funding?
We focused a lot on communication and outreach so that all Denver residents who have intellectual or developmental disabilities are aware these services are available. This happens through a variety of ways. The most important way is directly through the Service Coordinator. The Service Coordinator has the responsibility to know about these services and how we can help with these funds. We’ve increased our communication through our social media and through our newsletters. All Board and Community Advisory Council meetings are open to the public. We are also scheduling community forums every quarter. What is new with our community forums is a focus of going out into the community, in places throughout the city as opposed to holding them at Rocky Mountain Human Services. Community forums will be focused on having the providers, those agencies delivering the services, available to provide an overview on what we can help with and answer questions. We are visiting with registered neighborhood organizations to make sure they know how to contact us and what services are available. We’re trying to get the word out as much as we can. We wanted to be sure we were connecting not only with those who were already receiving services, but with those who may not yet be receiving services, or know someone in need of services.

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

The post Needs Assessment Validates Services Offered By RMHS appeared first on AdvocacyDenver.

The results of a needs assessment on services available to Denver residents with intellectual or developmental disabilities have been completed. Denver Human Services (DHS) has released the findings and is now in the process of seating an Advisory Council to recommend solutions. The assessment rated support for the use of Mill Levy funds for enhanced services was high, but cited key gaps in unmet needs. Denver Human Services Mill Levy Program Manager, Justin Sykes, explains the systemic challenges revealed in the needs assessment and discusses the next steps.

In the past, all Mill Levy monies were managed and distributed by Rocky Mountain Human Services. Going forward, Rocky Mountain Human Services will continue to manage and distribute the majority of the funding. Denver Human Services will manage a slice of the funds as well as approximately nine million unspent funds from prior years.

What was the reason for conducting a needs assessment?
The reason we conducted a needs assessment was because there is unspent Mill Levy money from prior years that is dedicated to providing services for people with intellectual and developmental disabilities who live in Denver. Going forward, there will be funding every year that is not committed to the Denver Community Centered Board, Rocky Mountain Human Services. We wanted to do the needs assessment to identify what are the greatest issues for Denver residents with intellectual or developmental disabilities. When we program these dollars from prior years as well as the new revenues in subsequent years, this will help us to orchestrate it in a way that is responsive to the needs of the community.

What did you learn from the needs assessment?
The top problems that were identified through the needs assessment were number one, affordable housing and number two, waiting list for services. Other top issues included: mental or behavioral health services, obtaining employment and transition from school to community/adult services. It is very likely that some, or all of these issues, will be addressed by the funding that is available. I cannot tell you how each will be addressed, or what the programs addressing each of these needs will look like. Denver Human Services (DHS) will establish an Advisory Council and the Advisory Council will make recommendations to us. DHS will evaluate and implement those recommendations.

As part of the needs assessment, we surveyed recipients, providers and others (e.g. self advocates) and asked how supportive people are of the current services being provided by the mill levy. Service areas included enhanced services from RMHS, community agency programs, individual annual plans and client assistance/individual requests. We found overall that people are quite satisfied. Across all providers of services with regard to the enhanced services Rocky Mountain Human Services (RMHS) is providing, on a scale of one to ten, where 1 is the lowest level of support and 10 is the highest level of support, the average score for providers was a 7.7. When you look at the four different services across the different types of respondents to the survey, the scores were just over seven and just under nine in terms of how satisfied people were with those current services. That was very encouraging to us to see the way we are spending these dollars, for the most part, is supported by the community.

What are the next steps?
The next steps are two-fold. First, there will be an application on the DHS website to serve on the Advisory Council. That will be our first step towards appointing an Advisory Council. We do not have an end date on when we will stop accepting applications. Initially, we will accept applications through early November. DHS Executive Director Don Mares will review the applications and appoint persons to serve on the Advisory Council. Simultaneously with that effort, DHS will issue a Request for Information. Request for Information (“RFI”) will allow anyone in Denver with a good idea for how to better provide services to get that idea on the table. As soon as the Advisory Council is seated, we will hand over the RFIs for the Council to review. They will have the needs assessment. They will have the responses to the RFI. With that information, they will issue a Request for Proposal (“RFP”) for a particular or multiple services. This process is open-ended at this point and will hinge upon what the Advisory Council recommends.

The Council is going to be the one who represents the community, the stakeholders. We anticipate that the Advisory Council will recommend DHS issue an RFP for services related to affordable housing, obtaining employment, providing services to people on the wait list and mental/behavioral health services. In that case, DHS would be the entity issuing the RFP. We would rely on the Advisory Council to help us pick a vendor, and to vet the responses to the RFP. DHS would be doing the legwork of that process.

What measures will be in place for accountability and transparency in distributing the funds?
That is so important given the history with these dollars. Right now in the contract that DHS has with RMHS, they are required to report to us every month on over 30 performance metrics. What that allows us to do is track the number of intakes, the number of people receiving service coordination, the number of community engagement events they have hosted. In any given month it doesn’t tell you too much. However, if you look at those trends overtime you get a better understanding of whether the demand for a service is going up or down. RMHS is also required to provide a yearly report on services, how many people are being served, and outcomes. I am very confident that with the contracts we execute with providers, there will be strong reporting and accountability measures because that is so important with these dollars. If the dollars are not going to something that fulfills the need, our obligation is to put those dollars towards something else does meet that need.

Read the full Needs Assessment here.

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

The post Affordable Housing Tops List In Needs Assessment for Individuals with Intellectual or Developmental Disabilities appeared first on AdvocacyDenver.

The Washington DC House of Representatives successfully passed H.R. 6042 that would delay by one year the implementation of Electronic Visit Verification. Electronic Visit Verification (EVV) is a tracking system that requires electronic verification of when a person receives Medicaid funded personal care or home health services. The bill that has passed the House extends the deadline to January 1, 2020 for implementing EVV for personal care services. A Senate vote on the bill is expected in July

Nicole Jorwic, Director of Rights Policy at The Arc of the United States, calls the delay of EVV a ‘civil rights issue.’ She says the delay is important because it will give stakeholders the opportunity to work out the challenges of privacy protection.

Why is The Arc of the United States in favor of delaying the EVV implementation?

“The Arc’s perspective on the EVV issue from the very beginning has always been a civil rights issue. That has been the focus of all of our advocacy and our outreach. It’s a civil rights issue because of the concern around unintended consequences of impeding upon an individual’s privacy rights.

“Our position is strongly in favor of legislation that would require a delay because of the troubling things that we have seen with implementation of EVV systems in many states.

“In Ohio there have been several instances where the systems being used for EVV also have audio and video recording functionality. That’s a concern because we are obviously talking about very private services that are going on, personal hygiene or toileting. We’re concerned about privacy andwhat happens with that information. Who has access to it? Does the state have access to it?”

What is the timeline with the bill’s passage?

“We have had bipartisan support in both the House And the Senate on the delay. I think because of the realization there were some real unintended consequences through implementation, nothing was said on the Floor in opposition of the delay. There continues to be concerns by some of the members who recommended EVV in the first place, that it can be a tool for taking a look at some rare and occasional instances of fraud. What we anticipate now that the bill has passed the House, is that a similar bill will be voted on in the Senate sometime after the 4th of July recess. We are hopeful from the meetings that we have had, that the bill will pass the Senate. I am relatively hopeful that we will see this bill become law.”

Why are these bills significant?

“The passage of the bills that will ultimately delay implementation of EVV is step one of a two-part fix. But it is an important first step. The delay of implementation will allow for stakeholder input. It is important that individuals who are receiving services and family members have the opportunity to have their voices be heard. It is also important to have the industry hear from families so they can create products that don’t violate privacy in the way that some of the tools that have been used; some states are experiencing that consequence.”

What is the second step?

“The second thing is we will be working with the legislators on is to go back in and make a legislative fix. It’s not a huge change to the underlying legislation. All we would need to do is remove the language requiring EVV systems to have geotracking. While CMS (Centers for Medicare and Medicaid Services) guidance clarified that states do not have to have a geotracking component in the implementation of EVV, it did not say that they cannot. We know that we need to go in and make that legislative fix to remove any misconceptions that EVV has to require a tracking component.”

Why is eliminating geotracking important?*

“Eliminating language in relation to geotracking is very important because it eliminates the ambiguity for states. Eliminating that ambiguity will help states move forward in a more streamlined process. From a rights perspective, removing the geotracking component of EVV is extremely important. There are a lot of unintended consequences that come along with the use of geotracking, including the fact that the phone system requires the use of a landline. That can have unintended consequences of isolating an individual, requiring them to stay home to receive services when we want to continue to provide support services out in the community. There are other ways of doing electronic timesheets that don’t have geotracking. The underlying root of why a lot of folks were proposing EVV was making sure services that are bring reported are actually provided. We support that assertion. But in order to make sure services were rendered, we don’t need to know where they were rendered.”
*Please note the Colorado plan does not require or mention geotracking or any other tracking component.

What is your opinion of state’s still implementing EVV in January of 2019?

“What I am hearing is states being gratified for this delay. If they were pushing forward, this is a pivot point. I would hope Colorado looks to its fellow states and follows a similar path. There’s no reason to rush into something when we know the industry and stakeholders are going to be making a lot of improvements over the next couple of years. There could be some unintended consequences if they push through with implementation whether it’s a soft rollout or hard rollout.”

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

The post Call For Electronic Visit Verification Delay Grows Strong Nationwide appeared first on AdvocacyDenver.

Over 30,000 Coloradans receiving Home and Community Based Services through the state will be impacted by the federal mandate of electronic visit verification (EVV.) The federal mandate goes into effect on the first day of January 2019. The verification system must be in place in order to continue to receive a 50 percent match from the Centers for Medicare and Medicaid Services (CMS). Stakeholder groups are meeting with representatives from the Department of Health Care Policy & Financing throughout the state to become educated about the verification system requirements.

In an interview with Catherine Strode, the state’s Director of Benefits and Services explains Electronic Visit Verification (EVV), how the state will implement it and what concerns are being expressed by clients and providers. In Part One of this interview, Colin Laughlin explains how Colorado will do a “soft rollout” of the Electronic Visit Verification with the formost concern being protection of privacy.

Some of the states that have moved really quickly are running into some unforeseen issues. We want to make sure that with a thoughtful approach, we are able to consider all the angles before we flip on a switch and upset a system that we believe works well.” — Colin Laughlin

What is Electronic Visit Verification?
“EVV (electronic visit verification) is a federal mandate. It is part of the 21st Century Cures Act, a piece of legislation that was passed in 2016. The Act is 312 pages long. The specific part that talks about EVV is about two and a half pages. Initially, there was not a whole lot of federal detail that was given. Essentially what it does is require electronic verification of services that are either home health or personal care services in nature. The intent is to ensure there are not inappropriate billing practices or misaligned billing practices. The intent is also to ensure that people are not submitting something that is incorrect and billing the state when the services in that method may be not fully rendered. It requires six points of data. It’s the ‘who’: who is receiving the service, who is rendering the service. It’s the ‘when’: time and date are required. It’s the ‘where’: where are they doing the service. It’s the ‘what’: what type of service are they providing.”

How is EVV implemented?
“The approach varies state by state. There are different ways to do it. Colorado is approaching it from a hybrid model which allows for the greatest flexibility in meeting this mandate. That allows for provider agencies who are delivering some of these services to use their own electronic verification technology. A lot of providers in this state have already been using EVV in some way, shape, or form. It also allows them, if they don’t already have it, to connect directly to the state system with whatever vendor we’re using. With the flexibility we are requiring, you can verify different ways. You can verify through a telephone. You can verify through geographical positioning. If someone is uncomfortable with being ‘GPS’ed’, they don’t have to use GPS. We are going to (within the space that we can) allow for the most flexibility within those services.”

How will Electronic Visit Verification impact clients?
“In Colorado, we are trying to roll this out with the most flexibility as possible. We want to make sure we are not materially changing how people receive services. Colorado has historically been one of the leaders in Community Based Services. In fact, we are typically one of the top three, top five, in the country in those types of delivery of services. We also have a very large percentage of people who receive services in the community as opposed to a nursing facility placement. We don’t want to impact those numbers. We believe people are better served in the community. We believe that the choices people are able to make about their services is critical and a philosophical cornerstone in what we do. We don’t want to impact that. Our goal is to not impact the client as best as we can. It is going to be a shift for service providers. They are going to have to learn how to use this technology. We expect there to be some growing pains and so what Colorado is doing is what we are calling a soft roll out.”

What is a soft roll out?
“A soft roll out means we are not going to tie it to claims at least for the first six months. We are going to require the verification components but we are not going to say it’s directly tied to payment. We want to make sure those records exist. We are mandated to do this by the Centers for Medicare and Medicaid Services (CMS) in order to receive our 50 per cent match for services. We know there are going to be some bumps here and there and so we’re not going to do anything right away. We’re not going to flip a switch that could potentially create situations where people aren’t receiving payment. We are going to do all that we can to allow for some flexibility and some growth to make sure we can work out all the kinks before we move forward.”

We’re going to be doing some myth busting. We want to keep this as minimally as invasive as possible.” — Colin Laughlin

How are you addressing the privacy concern?
“We have a subcommittee dedicated to this topic. We’re going to be doing some myth busting. There are some people who have heard they are requiring us to take a picture when they first get there. Also, that they are requiring us to verify a location by going outside of their house and taking a picture. Those are not things we are going to require. We want to keep this as minimally as invasive as possible. We are not going to require pictures. We are not going to require voice recordings. We are not going to require someone to carry a monitor device. We’re not going to require someone to turn on geographical positioning (GPS) unless they are okay with that. There are a lot of different ways you can go about verification. You can call. You can have a locator in your phone where it doesn’t track anything. It just is a button that says, ‘Yes, I’m here.’ It does not require us to go to some of the extents that I think people are concerned about. This does require verification of the component of knowing where people are. We are trying to be as considerate and thoughtful as possible about this process. That is why we have dedicated an entire subcommittee to this conversation. We have an open dialogue with our federal partners. We are continuing to say, ‘There is a concern about this approach. Is there another way we can do this verification?’ Here in Colorado, we are trying to emphasize flexibility in these options.”

What concerns of providers do the meetings address?
“The providers are concerned how we get this data to ensure we are compliant. There are a lot of moving parts. The training talks specifically about how to utilize the system and what pieces of information must be verified. The system design talks about the actual design, what it looks like and how it interacts. We talk about: on my cell phone how does this application work? How do I go about making sure this data goes back to the aggregator? How do I make sure I can check in if I am in a place with spotty cell service? Those types of things. We are going to be working with our vendor to make sure there is robust training. The training component is to ensure people can use our system correctly and are able to verify the six points of data. We have 12 training visits scheduled throughout the state. We’ll be going to regional locations: Grand Junction, Durango, and Pueblo to talk about what this is, what this looks like for providers. We anticipate that a lot of people who are receiving services want to know what this is too.”

What do the meetings with clients receiving services address?
“We have stakeholder groups on participant direction. We have two service delivery methods in Colorado: In Home Support Services and Consumer Directed Support Services. Participant direction is speaking directly to services offered under those models. When they have the ability to hire, fire and pay their own attendants, they have different concerns than a home health agency. That allows for an uninterrupted service modality. Someone can receive personal care which is a more skilled type of service as well as support from a homemaker who can help them with their dishes or help them prepare lunch. It is a service option that allows people to receive services across three different services uninterrupted. It is different than a provider who would go in and provide 15 minutes of personal care and then 15 minutes of homemaker services. There are concerns because there is some fluidity on how those services are provided. It is a bit of a different approach. We are trying to address those specific concerns that community has.”

Why are you holding the stakeholder meetings?
“We are very aware this is a big change and a big system rollout. Some people, I think, are still unsure of what this overall means. When you have 60 plus people in a room and you are talking about this very large thing, not everyone’s questions are going to be answered. We want to give people the venue to have those conversations. We want to have those meetings where people can talk about the things that are concerning to them.”

Click here for more information about stakeholder meetings.

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

The post State Prepares for Electronic Visit Verification Rollout appeared first on AdvocacyDenver.

Seven months ago, Christiano Sosa took over the helm of the Arc of Colorado. During that time, he united the state’s 14 Chapters around the 2018 legislative agenda. That agenda produced five prioritized bills that all successfully passed.

In an interview with Catherine Strode, Christiano reflects on this legislative progress and offers his vision moving forward. Part of that vision includes a statewide listening tour he will kick off this June.

What are your reflections on the past seven months?
“A tremendous foundation has been built over the last 10 years. I am fortunate to come into an organization that is widely known and respected at the Capitol for our bipartisan work on behalf of those with developmental or intellectual disabilities (IDD). This is difficult, complex work. It takes whole communities to rally together. I saw that in this Session. We have tremendous Chapters throughout the state. These Chapters are comprised of parents, of siblings, and of people with IDD. Their voice is amazing. The job of the Arc of Colorado is to help folks find voice in legislation. It is a privilege and an honor to be able to do that.”

What are your reflections on the Session?
“We had tremendous wins in this Session. All five of our prioritized bills went on to the Governor. That is an amazing accomplishment. We had a priority in ensuring that people with intellectual or developmental disabilities (IDD) have clear paths to employment. We worked with our partners at the Department of Health Care Policy and Financing (HCPF), the Disabilities Council, the Arc of Larimer County and countless others to ensure that people understand best practices under discovery and intake. Employment is talked about first as an option. Meanwhile, employment is talked about first as an option. People with IDD in the state now have landlord tenant rights. Previously, they were excluded from statute. We were able to increase Direct Service Providers’ wages 6.5 per cent. We whittled down the waiting list for the Comprehensive Waiver. That waiting list is close to three thousand. We were able to get three hundred new slots, or about 10 per cent. We were able to reauthorize the Child Mental Health Treatment Act and make that permanent.  Finally, we were able to move the Children’s Habilitation Residential Program Waiver (CHIRP) over to HCPF from the Department of Human Services. In the process, we got rid of the requirement that parents give up their custodial rights if their child has mental health needs and requires residential treatment.

With some of those bill sponsors leaving the legislature, are you concerned about how those voids will be filled?
“Fundamentally I believe policy issues around individuals with intellectual or developmental disabilities are bipartisan. I believe our legislators are looking out for those in the community that have the most need. The Arc of Colorado and our 14 Chapters have a lot of practice in terms of grooming legislators to understand the complex issues that make up of the world of IDD. Our job is two-fold, one is about education and the other is to work with our elected officials so the voices of people with IDD and their parents and siblings are heard.”

What issues will continue to be important in the 2019 Session?
“We will always have our eye on reducing the waitlist so people get the right services at the right time. We will be looking at the settings rule and how that is implemented in Colorado. The Arc of Colorado’s work is not done. We will be working with our partners to ensure all of the rules and the promulgation of those rules are informed by the collective experience of the 14 Chapters across the state.

What is your vision for policy issues in the coming year?
“I am looking forward to a statewide listening tour this summer to identify the issues that are at the top of mind for local Chapters. The listening tour will begin in June and go through August. It is a road show to: the Arc Chapters, legislators’ offices in their home turf, partners such as HCPF and the Department of Human Services. We want to understand what their priorities are and how we can all work together in identifying the issues that will have most promise in the 2019 session.”

What is your vision for the future of the Arc of Colorado?
“I think we are unique in lots of different ways. We are part of a national movement, a movement that mirrors what we have organically created in Colorado. Parents, families, people with intellectual or developmental disabilities, and siblings have a strong voice. That voice is echoed throughout every state.  We are part of a chorus. What happens at the federal level has implications at the state level. The Arc of Colorado will always have one leg in the federal world and one in the local sphere statewide. We have Chapters working at the municipal and county levels and the way all of those things roll up together is powerful in social justice movements. It is a tremendous asset. I hope the Arc of Colorado can be a depository for social justice and the stories that come from that.”

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

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An Interview with Catherine Strode

It’s estimated that 85 percent of people with intellectual or developmental disabilities are unemployed or underemployed. The state legislature is in the process of passing a bill (Senate Bill 18-145) to address that problem and lower that rate in Colorado. The bill implements three main recommendations of a five-year strategic plan created by a State Advisory Partnership. The bill’s sponsor, State Senator John Kefalas (Senate District 14) says the bill also supports a culture shift.

In an interview with Catherine Strode, Senator Kefalas says the bill supports the concept of ‘Employment First’. The concept is based on developing a culture of meaningful employment for people with intellectual or developmental disabilities which moves them out of sheltered workshops and into community-based jobs.

What problem does this bill address?
“We are pushing the idea of ‘Employment First,’ or competitive integrated employment. We want to make sure we do a culture change so that people understand that everyone wants to work. Most people want to work within their capabilities. We need to support them in making good decisions with supportive employment services. They can work in what’s called a competitive integrated employment setting. We are trying to move away from segregated work settings. Those are the two issues we are trying to address: help more folks get jobs; and help to get them into jobs in the community, not in a sheltered workshop. That is defined in statute as competitive integrated employment.”

What is the central importance of this issue to the state of Colorado?
“It’s a work force development issue. We have a low unemployment rate (with exception) and small businesses and other types of businesses indicate they have a hard time finding people to do the work that needs to be done. Some of that gap can be filled by people with intellectual or developmental disabilities. It’s about addressing work force issues and it’s about supporting people with disabilities to fill some of those jobs. It’s making sure that we, as a society, recognize and embrace the fact that most folks want to work. These are people that are on Medicaid, through Home and Community Based Services (HCBS) waivers. These are people who are eligible for supported employment services. We have some good systems in place. We have some good best practices and examples of success. We want to build on that. In this bill there are key provisions to move the dial in a good direction.”

What recommendation on training does the bill implement?
“It was identified that the job people with intellectual or developmental disabilities are looking at is often what is referred to as a ‘customized job.’ It requires a supportive employment specialist, or a job coach, to help with that transition. Ultimately, the goal is to be able to pull back from the job coach. One of the gaps that was identified is that we can have better outcomes if these supportive employment specialists had better training and certification. That is one piece of this bill. There are over 500 people this would impact. Over a five year period we want those people to get nationally certified training. By improving their skill set, there will be greater success in helping people find a good match, a good job, and providing the supports for that person to be successful as they transition. Some people might need that support for a long time but the goal is to pull back some of these supports so that people can be on their own.”

What is the employment ‘discovery process’ recommendation?
“If somebody is receiving supportive employment services, you need folks who know how to get into the community and work with businesses to help find a good match. It is called a ‘discovery process.” This would apply to the Department of Labor and Employment, the Division of Vocational Rehabilitation. This would require that we would use the ‘discovery process.’ The discovery process is basically a job career process where we look at the individual holistically: what their preferences are in the work setting, their job history, and their experience in school. That is another provision that I think is really critical. Right now, it doesn’t happen the way it should be happening. This is basically putting in statute that the Division of Vocational Rehabilitation needs to do that. It’s an example of a best practice that should help.”

What is the data gathering recommendation?
“Years ago, they were doing data gathering and to some extent they still do it. The bill adds some other factors, other data sets we want to collect. One of them is the employment sector. What employment sector is the individual working in? Also, we want to collect the number of people who are eligible for supportive employment services who may not be getting services. The idea is that if we have better data collection, we will be able to evaluate whether these other interventions are making a difference. The goal is to see how many people are working at minimum wage or above in different job settings and to tract other aspects that would help inform us going down the road. That is critical.”

What will the state gain from this bill’s passage?
“If we have more people engaged in the work force meaningfully, they are earning an income and paying taxes. That helps in terms of revenue to the state. The state benefits because we are supporting people who can have greater dignity and self-worth by finding employment, and being supported in that employment so they can be successful, by bringing home a pay check. It also encourages the concept of self-determination. Ultimately, it’s part of a culture shift.”

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

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An Interview with Catherine Strode

State Senator Bob Gardner (Senate District 12) has a long legislative history of sponsoring bills that support the rights and interests of individuals with developmental and intellectual disabilities. He is currently the sponsor of Senate Bill 174, a bill that brings Colorado law into alignment with federal law protecting the rights of individuals living in group homes and other residential settings.

In an interview with Catherine Strode, Senator Gardner says Senate Bill 174 is part of an ongoing bipartisan effort in Colorado to maintain equal rights for all state citizens.

Do you consider this bill a human rights issue for people with developmental disabilities?
“Yes. You can look at it that way, as a human rights issue. I thought of it as an issue of rights for people with intellectual and developmental disabilities. Our Colorado statute originally read that they would not be extended the rights of a tenant. The statute reads, ‘No real property rights shall accrue to a person with a developmental disability by virtue of placement in a residential setting.’ The practical effect of that is that they don’t have rights against eviction, in the same way that any other tenant would be. That is what the statute said. This bill, in those two lines, strikes that language. Now, people with IDD have the same tenant rights even in a group home setting, as any other residential tenant would.”

Why did the law originally not provide them with property rights in residential settings?
“Many years ago there was a lot of debate around whether those in residential settings and group homes would be treated as tenants or have some other status. Right now, the Colorado statute says that they don’t have that kind of right. Federal law has changed over the years. What has happened is federal law and regulations have made it very clear that people with intellectual and developmental disabilities in group home settings have to have, and should have, the rights of a tenant in terms of evictions. In order to comply with federal law, and Medicaid, and other grants, Colorado was required to ensure that people with IDD had the same rights as other tenants did. There has been a lot of development in the rights of those who are in group home settings and in residential settings to ensure they have the same rights that others do in our society. We were out of step with development of the federal law which has evolved over time. The bill was to bring Colorado statute into line with current federal law. This is kind of a catch up provision.”

Does the bill also add service providers to Colorado law?
“There are two things going on in this bill. The second part of this bill is a matter of bringing our statute in line with the rest of our statutes. While we were doing the bill, the community realized we had not made some changes in terms of who was providing services, case management agencies versus community center boards, and all of that definition is in the change. It adds case management agencies, case managers, as one of the other entities that might be a manager of services for people in a group home. Part of the bill conforms our changes in the law with the residential settings legislation.”

Why did the bill expand to include case management agencies as service providers?
“This was a section of the law that had not picked up the change from conflict free case management. That had happened in other parts of the statute. That piece is a cleanup of the references because those changes have already taken place. The statute itself was out of step with the rest of Colorado law. As we tried to bring the law into line with current federal law, the bill pointed up other things in the statute we hadn’t caught up with, with our own changes. Every year in the state of Colorado we have laws that revise our statutes in non-substantive ways to simply change language and add certain things that have happened in other sections of the law. That’s part of what this bill is about.”

How is this bill more than a technical legislative ‘cleanup’?
“The first part does have more importance: the residential rights for people with intellectual and developmental disabilities. A lot of things have gone into statute 30 and 40 years ago. In this case, they were not afforded the same rights in terms of their group home tenancies that regular tenants would be. This brings us forward. It recognizes what we all believe ought to be the law, brings us in line with federal law. It is part of an ongoing process to ensure people with disabilities have the same rights as other citizens.”

Does this bill still define you as a champion of rights for people with developmental disabilities?
“I like to think so. One of the things about being a champion of those rights is like this bill. There’s something here that’s pretty important; and there’s something that’s just the regular every day work, making sure we are getting it right.”

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

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An Interview with Catherine Strode

State Representative Tony Exum is one of 11 siblings. He speaks of growing up in poverty and how that experience shapes his support of legislation. His sponsorship of House Bill 18-1196, “Applications for Aid to the Needy Disabled Program,” is representative of his commitment to serve individuals enduring chronic homelessness, unemployment, and economic need. The bill is targeted to help individuals be verified as having a disability who are homeless due to behavioral health disorders. The bill has passed with strong bipartisan support.

In an interview with Catherine Strode, Representative Exum and Advocate Jack Regenbogon discuss the bill’s importance and impact on low income Coloradans.

You have previously sponsored bills to support the state’s Aid to the Needy Disabled (AND) Program. Why?

“It impacts a good portion of my district. My district is about 50 per cent low income working families that are struggling. I didn’t know the significance of the impact until after we passed the bill in 2014. I was walking the district for reelection and ran into several families who said thank you for the AND bill because I’m one of the recipients. Once they qualify for AND, then they qualify to put their application in for SSI, which is about a five or six hundred dollar benefit.”

How does this year’s bill differ from the one you sponsored in 2014?

“In 2008 with the recession, the benefit was reduced significantly. The benefit was $216 a month; they reduced it to $175 a month. My (2014) bill created a pilot program to help people with their applications. It also increased the aid from $175 to $189, where it is today.”

Where do you draw your passion from for this issue?

“I listen to what my constituents are saying and I know what the needs are. I’ve lived there a long time. I grew up in poverty. The lesson I learned from that is there are people out there to help. It’s help to give you a hand up and not a hand out. I know people are struggling from time to time but they are hardworking people. They just need a little help to get over the hump. When you’re homeless or when you’re living in poverty, $189 could be a gold nugget for somebody. It’s a temporary benefit. It’s never meant to be permanent.”

What has been your role in getting HB18-1196 passed?

“The Colorado Center on Law and Policy works closely with community partners that work on programs such as Aid to the Needy Disabled (AND). Colorado’s program supports folks with disabilities who are experiencing homelessness. AND is a state program that is meant to provide some support to people while they are in the process of applying for federal disability income such as SSI or SSDI. It currently provides for $189 per month. We grew aware of certain issues that were limiting people’s ability to access the Program. Our role was to work with these community partners on developing legislation that would address some of these issues. Our goal is to expand the types of medical providers who are able to verify someone’s inability to work, which is a key stage in the application process.”

What does HB18-1196 do?

“House Bill 18-1196 does two things. It expands the list of providers who are able to verify someone’s disability. It would immediately add psychologists to the list of medical providers who can verify someone’s inability to work. This is a form called the MED 9 form. Currently, it’s just doctors, nurses, and nurse practitioners who are able to sign off of the form. But in many cases, particularly for people that have mental health related disability, it’s their psychologist that is in the best position to assess their functional abilities to work. It’s the psychologist who they might be seeing on a most regular basis and with whom they have that longstanding relationship. The second thing that HB18-1196 does is give discretion to the Department of Human Services to add other licensed providers in the future. When the list of providers changes federally, we won’t have to rely on legislation in order to make those adjustments. It can be affected through a rule change instead.”

What impact will adding psychologists as providers have?

“I think there will be two impacts. One is we are going to see greater parity for people that have mental health related disabilities. If someone has a mental health disability and their primary health care provider is their psychologist, it might be a real struggle to fill out the necessary forms in order to be approved for AND. They have to set up an appointment with a different doctor and have to see (that doctor) several times in order to develop the relationship that would allow the doctor to feel comfortable signing off on this form. This is going to be a real boost to people that have mental health related disabilities by easing a major barrier to access AND. The other impact is that this is going to improve county processing procedures. Currently, counties are responsible for processing AND applications. County workers also have to follow up with clients that are struggling to get a doctor’s appointment. This results in delayed disability verifications. What we would hope to see with this bill is that county processes for evaluating applications will become more efficient.”

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

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