124 Marriott Drive, Suite 203, Tallahassee, Florida 32301-2981 Phone: (850) 488-4180 | (800) 580-7801 • Fax: (850) 922-6702

TDD: (850) 488-0956 | (888) 488-8633 • www.fddc.org

Health Care and Prevention Task Force Meeting

July 28, 2016

Tampa Airport Marriott

Tampa, Florida

Tab 1

Florida Developmental Disabilities Council, Inc. Health Care and Prevention Task Force

Thursday July 28, 2016 – Tampa Airport Marriott Conference Number – 1-888-670-3525

Conference Code – 1163856891

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Time Action

Item? Subject Section Presenter Notes

9:00 AM No Call to Order and Introductions

Maggie Reilly

Yes Review and Approval of Minutes • April 19, 2016

Maggie Reilly

9:15 AM Yes Legislative Update and Discussion of 2017 Legislative Priorities

Margaret Hooper

10:00 AM Yes Implementing Activities Funding Proposals (IAFPs) for Workforce Goal of 2017-2021 State Plan:

• Waiver Provider Compensation Stakeholders Workgroup

• Advocacy and Communication Efforts

• Workforce Collaborative Training Initiative

Holly Hohmeister

10:30 AM Break

10:45 AM Yes Implementing Activities Funding Proposals (IAFPs) for Workforce Goal of 2017-2021 State Plan – Continued

11:30 AM Current Health Care and Prevention Task Force Project Review and Updates

Holly Hohmeister

Budget Review and Updates

Holly Hohmeister

Florida Developmental Disabilities Council, Inc. Health Care and Prevention Task Force

Thursday July 28, 2016 – Tampa Airport Marriott Conference Number – 1-888-670-3525

Conference Code – 1163856891

2

12:00 PM No Working Lunch • Member announcements and

updates

1:00 PM Project Presentation – Nurse Practitioner Training in Developmental Disabilities Program

Matt Holder, American Academy of Developmental Medicine and Dentistry

2:00 PM Break

2:15 PM Yes Upcoming Calls and Meetings • Council Meeting Dates • Conference Call Dates

Holly Hohmeister

No Old Business or New Business Any Task Force Member

No Public Comment Members of the public who would like to speak to the Task Force

4:00 PM No Adjourn

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Florida Developmental Disabilities Council, Inc. Health Care and Prevention Task Force

Task Force Meeting Minutes

April 19, 2016 Tampa Airport Marriott

Tampa, Florida

Members Present: Members Absent: Maggie Reilly Elizabeth Perkins Laurie Harlow Jeff Brosco Shevaun Harris (via phone) Oscar Padilla Sue Kabot Susan Redmon Kathy Leigh Jean Sherman Staff: Rebecca Crosby Holly Hohmeister Dennis Hart Sheila Gritz-Swift (via phone)

Rick Lockenbach (via phone) Margaret Hooper (via phone)

Guests: Waldo Carbo Roberta Dykes Janet Hess Celeste Putnam Call to Order: The meeting was called to order at 9:11 a.m. by the Chair, Maggie Reilly. The attendees introduced themselves. She welcomed the members and reviewed the agenda for the meeting. Review and Approval of Minutes:

Maggie Reilly directed the members to the meeting minutes dated November 5, 2015 and asked if there were any needed revisions. A minor wording correction needed to be made. Motion: Jean Sherman moved to approve the minutes with the noted correction. Dennis Hart seconded the motion. Motion carried. 2017 – 2021 State Plan Development – Workforce Goal Action Steps and Funding Allocations: Holly Hohmeister and Sheila Gritz-Swift reviewed the draft action steps and funding allocations for each Workforce objective. This included revisions that were made after the March 30th conference call. Holly and Sheila clarified that the proposed funding amounts included the costs for contracting, consulting, and to develop products. The members offered the following comments and suggestions:

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- May want to consider not specifically naming the Arc of Florida and the Florida Association of Rehabilitation Facilities in the wording of Key Activity 1. This revision can be addressed during the public comment process.

- Ensure that developing a way to ensure maintenance of competencies is addressed. - Ensuring that best practices are pursued and to not use other states to develop or

establish these standards. - May want to consider adding to Key Activity 2 a phrase about ensuring person-centered

planning processes are used. This can be addressed during the public comment process.

Holly Hohmeister and Sheila Gritz-Swift will prepare the revisions to the action steps for review at the May Council meeting. The changes to the Key Activities will need to be addressed when the Goals, Objectives, and Key Activities are sent out for public comment. Motion: Dennis Hart made a motion to approve the revised Action Steps and Funding Allocations for the Workforce Goal. Kathy Leigh seconded the motion. The motion carried. Shevuan Harris abstained from voting. There was a break from 10:50 a.m. to 11:05 a.m. Holly Hohmeister briefly discussed the comments about the Workforce Goal, Objectives, and Key Activities that had been submitted during the recent public input survey. 66 out of 68 survey respondents agreed with the proposed goal, objectives and activities. The members noted the comment that emphasized the need to ensure accountability for providers paid to serve people with disabilities. Legislative Update: Margaret Hooper joined the meeting via phone and the members introduced themselves. She provided an update to the members about the activities during the legislative session that ended in March. Help Me Grow received adequate funding to continue activities in the current affiliates. Operational language for Early Steps was approved to expand the eligibility requirements, which will allow more children to be served by the program. Funding to enroll more individuals on the waiver and funding for the Adults with Disabilities educational program was provided by the Legislature. AHCA is hosting public meetings to discuss alternative residential care services for children. Council staff attended a public meeting and provided comments and will continue to monitor these activities. Maggie Reilly thanked Margaret for participating in the meeting and for her efforts. My Health Care Secondary Curriculum Development Project Presentation: Janet Hess joined the meeting to discuss present this initiative to the members. This initiative will modify the My Health Care program as needed to create lesson plans and instructional materials for submission and approval to the Curriculum Planning and Learning Management System (CPALMS). She gave an overview of current activities, including the integration of the program with Florida Standards for special education and transition and the development of an assessment rubric for learners. The program should be available in CPALMS sometime this

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summer. She answered brief questions. The members thanked her for her work on this initiative. Working Lunch and Announcements: A working lunch was held and the members shared brief updates about their recent activities. Jean Sherman and Kathy Leigh discussed their recent visit to the Developmental Disabilities Defendant Program (DDDP) as part of the Council’s Florida Criminal Justice System Workgroup. There was a break from 12:55 p.m. – 1:10 p.m. Improved Coordination of Medicaid State Plan and Community-Based Services Project Presentation: Celeste Putnam joined the meeting via phone to present this project to the members. She discussed that AHCA is going through all current Medicaid Handbooks and converting them to more concise Coverage Policies. Other key findings from her research include:

• The issues pertaining to physical, speech and occupational therapists’ reluctance to provide maintenance services is resolved. All proposed Coverage Policy documents include language covering maintenance services. However, there may be reduced emphasis on these services for adults.

• Problems with dental services are associated with a lack of available Medicaid providers • There is no longer duplication of services with personal care, personal supports and

respite. Difficulties remain in accessing these services due to provider shortages. • It is very difficult to get a new wheelchair. • There is a “drop off” of coverage for Durable Medical Equipment after age 21. • Transportation remains a problem especially for persons attempting to get to and from

work. The project workgroup recommended the following areas for further research in the next phase of this project:

• Determine issues associated with obtaining a new wheelchair and recommend means to streamline the process.

• Encourage a focus on physical health and physical abilities when a child moves into adulthood and as they age.

• Personal care, personal supports and private duty nursing services need to be more available. Are there any policies that can help expand access?

• Determine what consumable and durable medical supplies are available for persons 21 and over on the iBudget Waiver.

• Determine where there is the need for coordination of medical services with waiver services.

• Identify what Transportation is available for persons to help support access to work. There was a discussion about the lack of private insurance coverage for durable medical equipment. Celeste and Holly will keep the task force updated on this project’s activities and how any recommendations for improved coordination can be implemented.

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Current Project Review and Updates:

Holly Hohmeister provided the members with an overview of current task force initiatives. Items of note:

- Help Me Grow Florida received enough funding to continue in nine affiliates for 2016-2017. We are in the process of transitioning operations from FDDC to the Children’s Forum. This will be complete this summer.

- The Nurse Practitioner training program is being implemented in two university settings (Nova and FIU). The provider is conducting site visits at the programs this week. One challenge has been the difficulty of finding nurse practitioners to serve as preceptors for the students.

- Gainesville Health and Fitness is implementing their inclusive health and fitness program and in the process of recruiting participants.

- Holly Hohmeister announced that she is representing FDDC on the Quality Council, which is which is administered by AHCA and the Delmarva Foundation. Quality Council members provide oversight of quality assurance activities conducted by Delmarva for waiver recipients.

Budget Update:

Holly Hohmeister gave the members an update on the task force’s budget and reviewed a schedule of when projects and initiatives are scheduled to be submitted to the Council for approval. The task force is on track to meet its commitment, obligation, and liquidation deadlines. Member Announcements:

Jean Sherman reported on the FCIC Aging Symposium that was held in February 2016. There were about 160 attendees, which shows interest in the needs of aging adults with disabilities and their caregivers. Old Business or New Business:

There was no Old Business or New Business. Public Comment:

Waldo Carbo, PCA to member Rebecca Crosby, mentioned that he is studying Urban Studies and Regional Planning and found the discussions of the Task Force interesting. Adjourn:

Motion: Dennis Hart moved to adjourn the meeting. Kathy Leigh seconded the motion. The meeting adjourned at 2:50 p.m.

Tab 2

June 15, 2016

Respectfully Submitted By

RB OPPENHEIM ASSOCIATES PUBLIC RELATIONS COUNSELING • ADVERTISING • DIGITAL MARKETING

2040 Delta Way • Tallahassee, FL 32303 • (850) 386-9100 • FAX: (850) 386-4396

PROPOSAL FOR

A PUBLIC INFORMATION PROGRAM ON THE

PROVIDER RATE ISSUE FOR THE

FLORIDA DEVELOPMENTAL DISABILITIES COUNCIL PHASE 1

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1 Thank you for this opportunity for RB Oppenheim Associates (RBOA) to provide a proposal for a public information program on the Provider Rate Issue for the Florida Developmental Disabilities Council (FDDC). People with developmental disabilities and their families have had increasing difficulties in recent years securing and maintaining essential services from developmental disability waiver providers. This has been in large part due to providers being grossly underpaid for many years. While this has been a key legislative issue among advocates for people with disabilities, the Florida Legislature has only just started to resolve the issue. Most recently, the 2016 legislative session yielded a 3 percent cost-of-living increase for in-home support, adult day training and residential rehabilitation – but a 14 percent increase was needed just to bring provider rates to 2003 levels. Compounding the problem now are new U.S. Department of Labor rules that require in-home support services to be paid by the hour plus receive overtime (up from a daily rate including sleep time), taking costs for support services up from about $6 per hour plus overtime to $8.05 per hour for ALL time awake plus overtime. In addition, new rules will change the status of many service providers from independent contractors to employees (subject to workers compensation and other employer-related requirements), which will drive costs up even further. These new rules – coupled with continued low wages – will result in two outcomes: dramatic turnover among services providers and the likely inability for families in need to find qualified service providers. Unfortunately, many of the people who will be most severely affected by this issue are unaware of what’s coming. Many may find themselves in dire straits very soon. To address this serious problem, FDDC wishes to launch an initiative to inform individuals with intellectual and developmental disabilities, their families and providers on the new rules and provide them with knowledge about the issue and how to advocate for change to improve this situation. FDDC wants to lay the foundation to build a cadre of informed and vocal advocates that can make their voices and concerns heard by the Florida Legislature so that corrective actions can be taken during the 2017 Legislative Session. To this end, RB Oppenheim Associates respectfully submits the following proposal and recommendations for the first of a two-phase public information program on the Provider Rate Issue. We are grateful for your consideration and look forward to the opportunity to work with you.

PROPOSED SCOPE OF WORK Phase 1 (June – September 30, 2016) Strategy Develop messaging and materials to inform affected individuals on the Provider Rate Issue and to provide them with knowledge about the issue and the information to advocate for corrective changes. Tactics/Activities Message Development.

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2 Messaging. Develop an “elevator speech” (brief summary of the issue) and a series of five-to-eight simple, easily understood statements that summarize the problem and possible solutions. To maintain consistency in all communications, this messaging will be used in all collateral, media relations (anticipated in Phase 2), public relations, digital marketing and other communications. Collateral Production Brochure/flier. Create a visually appealing brochure and/or flier on the issue that could be used to inform affected individuals and families on the situation and provide resources for getting assistance. These materials would be produced and provided digitally so FDDC could provide them electronically to constituents, post on its website or get limited copies printed, if needed. Share these materials with other organizations serving people with disabilities and their families and ask them to make them available to their constituents. Digital Communication Social media engagement. Develop extensive content on the initiative for posting on FDDC’s Facebook page and identify other organizations serving people with disabilities and request that they also share our posts and content with their fans, friends and followers. Digital Advertising Facebook ads. Create highly targeted, organic-appearing Facebook news feed advertisements to build awareness of the issue and drive people to the FDDC website for more information. Especially use this tactic to promote the webinar or any informational events. Ads could be targeted to appear in the newsfeeds of people who live in Florida, who have interests in disabilities issues, who fit certain demographic characteristics (age, gender) and/or who use certain key words in their posts. Marketing/Community Outreach PowerPoint presentation. Develop a compelling and informative PowerPoint that could be used in conjunction with presentations to Family Care Councils and other local community organizations, supports groups and civic groups. Measurement and Evaluation. Reports/analytics. Provide FDDC with reports detailing work performed and progress made. Utilize analytics tools for Twitter, Facebook and other social networks to measure social media activity, engagement and effectiveness and provide social media reports. Also, provide reports on Facebook advertising outcomes.

Summer-Interim Public Policy Plan 2016

June 1, 2016 to November 1, 2016

Workforce Goal: By the end of the five-year state plan, one or more improvements will be made to practices, services and compensation for community-based service providers to ensure that individuals with intellectual and developmental disabilities have access to, and receive services and supports from, a sustainable, qualified provider base.

Public Policy Focus-Provider Rate Workgroup

• Assist with the formation of a workgroup with representation from provider advocacy organizations, waiver providers (including independent providers), labor organizations, and other appropriate stakeholders. This was started last year and work is ongoing with stakeholders

• Assist with recommendations from workgroup, Identify two categories of providers for targeting advocacy efforts.

• Develop and implement advocacy and communication efforts in conjunction with Florida’s self-advocates, family members and other key stakeholders to address needed changes to statutes, rules, policies and/or procedures that improve compensation for community-based service providers.

Summer Action

June 1, 2016 to November 1, 2016

• This group was started last year and work is ongoing with stakeholders • In collaboration with workgroup, develop an Advocacy Plan with strategies, marketing

language, outreach activities, and plans for collaboration with stakeholders. • Use Advocacy Plan and collaborate with stakeholders (including service providers) to

educate legislators, state agencies, and other policymakers for competitive compensation for community-based service providers.

• Advocate with stakeholders to prevent potential reductions in provider rates. • Advocate with stakeholders to prevent reductions in allowable service hours.

The Individual Budgeting/Home and Community Based Services Waiver – a lifeline for

individuals with intellectual and developmental disabilities to ensure choice, independence and access to their communities

• The Council urges the Florida Legislature to ensure that individuals with intellectual and

developmental disabilities and their families who receive the Individual Budgeting/Home and Community Based Services Waiver have stable and qualified service provider staffing for delivering waiver services. Providers need greater compensation. A 3% increase in provider rates for this fiscal year was a good start that must be increased for next year.

• The Council urges the Florida Legislature to continue their support of a meaningful long-term commitment to eliminate the Individual Budgeting/Home and Community Based Services Waiver waitlist and to appropriate enough funding for any new individuals on the Waiver waitlist in categories three, four and five.

The Individual Budgeting Home and Community Based waiver administered by the Agency for Persons with Disabilities offers supports and services to assist almost 30,000 individuals with intellectual and developmental disabilities (I/DD) to live in the community by ensuring that their health and safety needs are met, as well as providing services to improve their access to their community and a meaningful life. The Florida Legislature started to address provider compensation during the 2016 legislative session. Funding was allocated to provide compliance with the Department of Labor Rule of providing minimum wage and overtime for home care services. In addition there was a 3% increase in provider rates for several major services. Unfortunately the cost of complying with the Rule as an employer with a new category of employees was not addressed. Retaining a qualified workforce is reaching crisis proportion with increased turnover rates, little service availability and the closure of group homes and other provider businesses. Florida needs to offer providers a rate that will maintain and improve the availability of a qualified workforce that can adequately address the needs of individuals with intellectual and developmental disabilities. Provider agencies and individual providers are facing increased insurance costs and the state has added multiple unfunded responsibilities in the form of additional billing requirements, background screening costs for staff, licensure standards, staff training and experience requirements. Remaining on the current path will continue the deterioration of a network that exists to provide for Florida’s most vulnerable citizens. Florida has seen a 29.8% drop in the number of providers actually providing services since FY 07-08.

Florida’s expenditures on its most vulnerable individuals are very low compared to other states. According to The State of the States in Intellectual and Developmental Disabilities, (10th Edition, 2015, Braddock), Florida’s fiscal effort in 2013, or spending for intellectual and developmental disability services(I/DD) per $1,000 of aggregate statewide personal income, ranked 50th out of 51 entities (50 states plus the District of Columbia). Florida’s fiscal effort for I/DD services has decreased 13% since 2011!

There are approximately 20,000 individuals on the waitlist for Waiver services. Funding was allocated during the 2016 legislative session to take about 1500 individuals off the waitlist, making this the fourth time in nine years that individuals were taken off the waitlist. The problem of the Waiver waitlist is a longstanding one and reducing the number of people on the waitlist requires continued long-term support. The Council understands the financial commitment needed to compensate providers and still wants to maintain the positive waitlist reduction momentum from the past four years. Therefore, the Council requests funding to remove new individuals on the iBudget Waitlist with the understanding that the provider infrastructure also must continue be addressed.

FLORIDA DEVELOPMENTAL DISABILITIES COUNCIL, INC. 124 Marriott Drive, Suite 203, Tallahassee, Florida 32301-2981

Phone (850) 488-4180 ● Toll-Free (800) 580-7801 Fax (850) 922-6702 ● TDD (850) 488-0956/(888) 488-8633

Tab 3

Health Care and Prevention Task Force Project Status – 07/18/2016

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Project State Plan Goal

and Objective

Services Provided Status Monitor

953HC15E My Health Care Secondary Curriculum Development 10/06/2015 – 08/31/2016

Goal 4 - Objective

4.2

This project will modify the My Health Care program as needed to

create lesson plans and instructional materials for submission and

approval to CPALMS.

My Health Care is now available in CPALMS. Notification has been sent to educators and

other stakeholders.

Sue Kabot

954HC15B Nurse Practitioner

Training Program Year 2 American Academy of

Developmental Medicine and Dentistry

10/19/2015 – 10/15/2016

Goal 5 – Objective

5.3

This project will continue to promote the continuing education program to

practicing nurse practitioners and integrate the curriculum topics into

Florida-based academic programs for nurse practitioners

Nurse Practitioner students at Nova and

FIU are participating in the program. Final

evaluation results will be available in September.

The NPEDD webinar series continues to be

utilized.

Jean Sherman

944HC15 Improved Coordination of Medicaid State Plan and

Community-Based Services

08/17/2015 – 12/15/2016

Goal 5 – Objective

5.2

The goal of this project is to develop a plan with recommendations for

improved coordination of the existing Medicaid State Plan and

Developmental Disabilities Home and Community Based Services (DD HCBS)

Waiver services that benefits individuals with developmental

disabilities in Florida.

As part of the project Implementation Plan,

the provider is developing “Fact

Sheets” for individuals and families on

accessing specific services (Private Duty

Nursing, Transportation to and from work,

acquiring a new wheelchair, and

accessing consumable medical supplies after

turning 21)

Elizabeth Perkins

972HC16 Community Health and

Wellness 02/15/2016 – 03/10/2017

Goal 4 – Objective

4.4

The goal of this project is to improve access to inclusive community health and wellness activities which will lead to the reduction of obesity and other

secondary health conditions for adults with developmental

disabilities. Specifically, the primary target is adults over the age of 22 who are on the DD HCBS Waiver

waitlist for services

Gainesville Health and Fitness is implementing

their “FIT for All” program and recruiting adults on the wait list to participate. A mailer was

sent to individuals on the wait list encouraging

them to participate.

Maggie Reilly

Health Care and Prevention Task Force Project Status – 07/18/2016

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Internal Initiatives and Monitored Projects Initiative State

Plan Goal and

Objective

Services Provided Status

Easing Your Stress – Information for Caregivers

Publication Printing and Dissemination

Goal 4 - Objective

4.1

This project will provide funds to reprint and effectively disseminate

“Easing Your Stress – Information for Caregivers of Individuals with

Developmental Disabilities” via existing caregiver training and

technical assistance activities. We will also evaluate satisfaction with the publication and if stress-relieving

strategies were used.

FDDC is reaching out to other entities to promote and disseminate these publications. Also developing text-only and speech to text versions of

Stress and What You Can Do About It. Stress and What You Can Do About It

is now available in the DBS Talking Library.

Both publications are being re-printed

with available funds. Stress and What You Can

Do About It Publication Printing and

Dissemination

Goal 4 – Objective

4.1

This project will provide funds to reprint and effectively disseminate

Stress and What You Can Do About it through existing self-advocacy and

disability organizations. We will also evaluate satisfaction with the

publication and if stress-relieving strategies were used.

Physician Training Program

Goal 5 - Objective

5.3

This project will continue to promote the continuing education webinar series to practicing physicians and

integrate the curriculum topics into physician residency programs

FIU and UF are continuing to use the curriculum that was developed for their physician residents. Reaching

out to other FL residency programs to share curriculum and webinar series.

PEDD webinar series is also on YouTube.

7/18/2016

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Nurse Practitioner Education in Developmental Disabilities 

(NPEDD)

Matthew Holder, MD, MBA

American Academy of Developmental Medicine and Dentistry

July 28th, 2016

NPEDD Archive View DataAs of May 16, 2016 (new results available in August)

Total Webinar Views: 1714

Total Participants: 295

Total NP Participants: 105

Total Nurse Participants: 92

From the NP Student Program at Nova

62 NP students enrolled in the program

49 completed the training modules

7/18/2016

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NPEDD Student Program Pilot

Purpose: To pilot the implementation of DD‐focused curriculum enhancements in two Nurse Practitioner training programs.

NPEDD Student Program Overview

Two programs selected to participate (Nova and FIU)

Nova began in the Spring semester, FIU in the Summer

Programs were given a “toolbox” of teaching methodologies and content resources and asked to design their own curriculum.

Curricula was approved and initiated.

All students were pretested using questions derived from the NPEDD webinar series.

Students will be post‐tested after completion of curriculum.

7/18/2016

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NPEDD Programs Miami ‐ Florida International University

Family, Psychiatry and Adult primary care tracks included

Total of more than 100 students will participate

Director – Dr. Yhovana Gordon

West Palm Beach – Nova Southeastern University

Primary care track

Total of more than 60 students will participate

Director – Dr. Stefanie Lemanna

Tool Kit Overview NPEDD and PEDD Webinar Series

Patients with Disabilities as Teachers (P‐DAT)

Home Visit Program

DD‐Focused Objective Structured Clinical Examination

Book Learning (textbooks and articles)

In‐person Experience

7/18/2016

4

Curricula Overview FIU 

NPEDD Webinar Series 

Patients with Disabilities as Teachers (P‐DAT)

Looking to add standardized patients with DD in the future

Nova

NPEDD Webinar Series

Book Learning

Looking to add P‐DAT in the future

Testing Overview Common database of 70 questions for pre‐ and post‐

Each test is a random sample of 30/70 questions

All students are given a pretest prior to IDD training

Students take posttest after completion of program

Average raw pretest – 61.5% (does not include summer)

Average raw posttest – (70.5%)

7/18/2016

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Finishing Up Nova desires to make this a permanent part of there curriculum.  They 

have voluntarily added the program to their summer semester. We will track the results.

FIU will complete their summer semester at the end of August, result will be available then.  They are looking to also make this permanent and have developed a relationship with a family and a person with DD who can present to the class.  They will also attempt to create a standardized patient experience with somebody with a DD.

This could impact the training of more than 400 NP students per year.

Thank YouSponsored by the United States Department of Health and Human Services, Administration on Intellectual 

and Developmental Disabilities and the Florida Developmental Disabilities Council Inc. 

Matthew Holder, MD MBA

mattholder@aadmd.org

602‐625‐3805