Meeting Minutes---Wednesday, September 1, 2004 MISCC Committee Meetings


Jump Directly To... Community Services Committee Transportation Committee Data Committee Assessment Committee Quality Assurance/Quality Improvement Committee

Community Services Committee
Present: Tim Williams (OASAS), Kim Hill, Harvey Rosenthal, Constance Laymon, Kathy Kuhmerker - Committee Chairperson (DOH), Susan Peerless(DOH), Lisa Kagan (OMRDD), Bob Bohlert (CQC)

During this meeting, a draft copy of the committee's report to the full MISCC was distributed to committee members and reviewed. ADAPT's Chris Hilderbrant requested a copy, but was denied by Kathy Kuhmerker. Kathy Kuhmerker indicated that she had created this draft based on the charges of the committee as listed in the statute for the MIS law and the work that the committee had done thus far.

The report will include an inventory of the available community services/observations of the information. This information was obtained through the state agencies. Ms. Kuhmerker indicated that there was a lot of information that covered a broad range. She intends to again contact the agencies for more concise information. The second part of the report will include principles and guidelines that the committee recommends the full MISCC use in their final report.

Harvey Rosenthal indicated that the committee is just scratching the surface. He pointed out that it has taken quite a while to get to this point and there should be more information regarding specific gaps in service. He also indicated that there has been no discussion regarding waiting lists and their accuracy. Harvey went on to say that the guidelines/principles Kathy presented were great, but questioned how they would be implemented? He also informed the committee that people in general do not have confidence in the MISCC.

Kathy responded that she agrees with Harvey, but does not believe this committee was to do anything in regards to the waiting list as the data committee has been collecting this information. Kim Hill indicated that the committee needs to include specific suggestions in the report that they submit to the MISCC.

Harvey interjected asking about the inventory (that was on the draft report) - it did not get to adult homes or prisons. Is this an unmet need? Are people being retained in a restricted setting due to a lack of community services? Harvey stated that advocates need to have more of a role in writing this report to the MISCC. Harvey and Kim each indicated that they did not even know that a draft report was going to be issued at this meeting.

Tim Williams from OASAS, after reviewing the report, indicated that there needs to be more detail in how the principles will be implemented.

Bob Bohlert, CQC, indicated that he thought this final report the MISCC is preparing would provide direction, not be the end all be all report where the council would then dissolve. Bob went on to say that the observations of community services should be expanded beyond nursing homes and the point of entry should be an independent system of service delivery to the extent possible. Kathy Kuhmerker interjected that not everyone knows where to go for services, regardless if they are in the community or an institution, thus, how should the point of entry be set-up?

Lisa Kagan suggested that the state agencies look at themselves in accordance with the principles developed - what new services are needed; services need to be changed - unmet need - how are services publicized - how can we do better? How can we improve access?

Constance Laymon stated that there are gaps in service. With a crisis, providers often find services needed do not exist; people in the trenches know best.

Lisa and Bob suggested the committee take the principles and make questions for the agencies to examine their programs (all programs-old or new).

Kathy reminded the committee that Lisa previously suggested there is constant change and improvement in the system - what is great now, may not be so great in 5-10 years.

Harvey indicated that agencies need to examine how the principles are working and Lisa replied that this report and the observations within it should be turned into a yardstick for the agencies to use.

Constance indicated concern with some aspects of the language of the report. Specifically, Constance was concerned that the statement "New York may need better or different services, not necessarily more services" might be later used to prevent the development of new services. Constance was also concerned by the language regarding "budget realities". She suggested some changes to the wording within the report to provide more context/elaborate and Bob added that we need to push agencies to obtain public feedback to the direction this committee should take.

Constance indicated that the need for housing all across the state is huge. Ms. Kuhmerker suggested that housing was only a critical issue in New York City, but several other committee members disagreed and indicated that the housing crisis was universal. Tim added that housing, access, and transportation will need to be worked into the principles with detail. Bob suggested in this regard that there is a need for professionalized service coordination, as negotiating the system is difficult. Kim reiterated that housing should be priority as there is no place for people to go.

Audience Input:
Bob Gumson from VESID indicated that a change is needed, as home support services are inconsistent county to county.

Chris Hilderbrant stated that Commissioner Maul should be directly informed of the conversation the committee had regarding housing as a priority. Chris agreed that the committee should ask for agencies to provide feedback on how they will implement Olmstead, but Chris added that the MISCC should add details and specific actions to whatever the agencies may self-report. Chris emphasized that the MISCC and its committees needed to make concrete plans to reform the bias of the long-term care system and get people out of institutions.

Chris suggested that the committee look at the language of the Olmstead decision as a guide to how "budget realities" should be addressed.

Kathy Kuhmerker indicated that she will be gone for several weeks, but the committee should schedule another meeting prior to the full council meeting on 9/20/04 - Susan Peerless will have the date.

ADAPT Commentary:
The Community Services Committee has been the least effective committee thus far. Despite having the most potential to improve the integration of our people, the CS Committee has limited its own power to only suggesting guidelines and principles. The fact that DOH developed a report from the committee without soliciting any input from other committee members only reinforces that the state agencies have hijacked the committee and are refusing to allow the committee to make any recommendations that would affect the institutional bias of New York's long-term care system.

ADAPT will be pushing the committee to include concrete recommendations and specific actions that the MISCC could include in order to end the institutional bias and ensure that our people are able to live in the most integrated setting!


Transportation Committee
Present: Greg Montegue, Susan Peerless, Mike Paris, Henry Sloma (via telephone), Lisa Kagan, Bob Bohlert, Harvey Rosenthal

Greg Montague, DOT, began the meeting with a review of the mission statement of this committee. He then went on to suggest that a sampling of agencies providing paratransit services should be taken. Greg gave figures representing paratransit as opposed to fixed route service: 9.3% of the entire cost of transit system in NY (not including MTA) goes to paratransit services; the ridership is 2% of the entire system; the average cost of one trip is $26.22; the average mileage is .21 miles per trip; there are about 1280 paratransit vehicles in service (not MTA).

Greg then introduced two speakers; one from the Capital District Transit Authority (Marcia Chase) and one from the Syracuse paratransit (CRTA). Both women spent time reviewing their services: eligibility process, the concept that paratransit can go ¾ mile outside of fixed route, rate of service, door-to-door service, the reservation system (can take reservations up to 2 weeks in advance and can provide next-day service), Medicaid appointments (neither agency had luck with billing Medicaid for doctor appointments). Both agencies suggested that new housing developments or people moving should consider being close to public transportation to prevent a lack of service.

Bob Bohlert, CQC, interjected a question in regards to travel training, and CDTA indicated that they had a program to teach people how to use the fixed route system.

Henry Sloma indicated that ADA allows the service to charge up to 2x the fixed route fare amount and both agencies indicated they were aware of this.

Greg went on to outline the suggested format for the written report. The report will contain: a mission for the committee, a description of services from a survey of paratransit agencies, include information from United We Ride (from the Federal government), best practices, include paratransit info and public hearing info (summarize for report), and recommendations (survey paratransit criteria and obtain criteria for 5310 program applications). Greg also noted that we would need to ensure that facilities, new housing developments, etc. are built accessible to paratransit services.

Audience Input:
Chris Hilderbrant indicated that the paratransit service in Rochester was sued due to non-compliance and as a result a federal audit confirming this was completed (Chris will forward to Susan Peerless for distribution to the committee). Chris indicated that what he has heard from other advocates across the state is that many paratransit providers are not in compliance with the ADA. Chris suggested that the MISCC report include a directive for NYS to enforce laws pertaining to paratransit as a means of better integrating people with disabilities. The DOT or Attorney General should be enforcing this. Chris agreed that travel training was great, but there are some people who will not benefit from this training and will always need paratransit services.

Chris also brought to the committee's attention that there are no accessible cabs in many areas of the state and only a few accessible cabs in NYC. Chris recommended that enforcement of laws pertaining to accessible cabs would be another possible element of the transportation committee's report.

Bob Gumson from VESID asked how paratransit dealt with seasonal users and both indicated that they have conditional certifications (bad weather, extreme heat, etc.).

ADAPT Commentary:
The Transportation Committee has received very little information from the user end of transportation. The presentation by two paratransit providers about how wonderful their services are demonstrated the need for more input from people with disabilities about the realities of transportation. Our knowledge of the realities of paratransit was critical in restructuring the committee's thinking about their report to the full MISCC. Advocates should send more input about transportation to Susan Peerless to be shared with the transportation committee.


Data Committee
Present: John Allen - Committee Chairperson, Lisa Kagan (OMRDD), Susan Peerless (DOH staff), Harvey Rosenthal (NYAPRS), Bob Bohlert (CQC)

John reported that the committee will review the report created for the MISCC. He also indicated that the data requests have been sent to the agencies. The report will include data collection activities, what needs to be collected, and trends in institutional and community-based services (where have we been, where are we today, and where are we going). The committee should analyze the data to look at the dependence on community supports to prevent institutionalization, how do the waiting lists look - how does funding affect them, what does the public want, are waiting lists appropriate? What are the alternatives and how will access to services be monitored? John indicated a concern that some federal funding was dependent upon every qualified person being served. If a waiting list for those services was developed, NYS would jeopardize the Federal funding. The final report will also include best practices and a discussion of public comments from the forums.

John distributed the list of questions that the committee will be asking each agency to answer. The list was very detailed regarding the number of people in institutions and the number who were appropriate for community living. Harvey was impressed that these questions were going to be asked and stated that this was the best news from the MISCC of late. The report should also include the number of people institutionalized who qualify for community placement.

Lisa Kagan added that what Karen Oates stated prior should be included - looking at the local levels and not just statewide trends. Bob added that the committee should highlight the factors that will undermine the numbers collected such as inconsistent definitions. John went further to remind the committee that Olmstead indicates the most integrated setting, not the least restrictive. Maybe MISCC should look at deinstitutionalizing adult homes as truly integrated housing is not sponsored by any state agencies at this time. In gathering further information, Harvey asked about the source of the information, should it be gathered from the provider level or the consumer level? John responded that the committee will not assess how to gather the information and instead should leave it to MISCC to decide.

Harvey added that the Department of Labor is not included in MIS law. John responded that work is not a part of Olmstead per se, but the MISCC should include what people will need during the day. Harvey indicated that it is important to identify unmet needs as a result of the data collection.

Audience Input:
Chris Hilderbrant noted the need for waiting lists to be created based on unmet needs regardless of the federal funding stream. John clarified that he was suggesting to not have waiting lists based on a certain provider of choice, but that waiting lists for an overall service were appropriate. Chris also noted that it was well within the MISCC's authority to address labor issues as it pertains to services being provided in the most integrated setting.

ADAPT Commentary:
The information which the data committee plans to collect with their survey will be vital to the ongoing planning process. This information will need to be shared with other committees and advocates will need to be active in ensuring that state agencies respond to the surveys and that the state agencies act on the information gathered.


Assessment Committee
Present: Lisa Kagan (OMRDD), Susan Peerless (DOH Staff), Constance Laymon, Bob Bohlert (CQC), Harvey Rosenthal (NYAPRS), Nancy Martinez (OCFS)

Lisa began the meeting by reading the statute, which essentially states that the committee should work to determine an assessment procedure for those who could benefit from living in a more integrated setting (a specific method/tool to be used). Lisa provided the committee with the outline for their report, which would include an outline of statues, current assessments, principles of assessments (and include later how the agencies are doing them and how can it be improved), and input from the public forums.

It was then discussed the possibility of using MDS (minimum data set) data from CMS as a referral source. The committee was unsure exactly what the CMS has collected or if they would release the info. The committee will look into how and if Maryland was able to use this data for their referrals.

Harvey brought up that the current tools are biased to the services that are currently offered to essentially move people into existing slots, which is not the purpose of the MIS Law. Lisa responded that the principles of the assessments would need to be person-centered, and as Karen Oates previously added from another meeting, include multiple areas outside of the agency (OMH services, transportation, housing, etc.). The assessments should check for individual strengths and existing natural supports. It should make the consumer aware of community options and should be broad enough to find underlying needs (not only focus on the medical). Bob brought up that the assessment should not necessarily be a tool, but a process or procedure to discover the individual's needs (Harvey added that there should be a "really listening" focus to the assessment). Bob added that the assessment should be independent of the service delivery network.

The MIS Law calls for a single portal in each county for individuals to access the services (similar to the OMH version of a single point of access or SPOA) and Bob called attention that the assessment needs to be separate from eligibility determinations. Lisa added that it might not be necessary to use the single point of entry as an individual could go through the back door directly to an agency.

Bob indicated that if using the single portal method, the agency/individual would need to collect information, assess and refer. It will need to be active and have established links and contacts and possibly advocate for the individual, but not necessarily coordinate services. Lisa added that we need to remember discharge planners and be sure they are aware of the portal.

Audience Input:
Anna, from DDPC, added that the portal should be portable. It should be able to be at the nursing homes, homeless shelters, prisons, etc. Maybe the Office for the Advocate's referral line (SATIRN - catalog in a database with disability services) could be utilized for information.

Chris Hilderbrant cautioned that while an assessment process was a good idea, it was difficult to make concrete. An assessment process may be implemented in wildly different manners from county-to-county, only further complicating the disparity that is already found in New York.

The final statement of the committee was that Lisa would look into what the MIS Law means by "one community-based organization in each county".


Quality Assurance/Quality Improvement Committee
Present: Neal Lane - Committee Chairperson (NYSOFA), Kim Hill (NYS Assembly), Susan Peerless (DOH staff), Harvey Rosenthal (NYAPRS), Bob Bohlert (CQC)

Neal opened the meeting with a discussion of the consumer satisfaction tools that have been collected and that they have now been narrowed down to 19. Neal proposes that the MISCC look at the 19 tools and see what the gaps/weaknesses are, the positives/strengths, unique data elements, and the process of evaluation for each tool. Neal indicated that Karen Myers had already done a comparable analysis of tools under OMH.

Neal explained that the report would include the future of the committee, beginning with a presentation of the background followed by recommendations, guidelines and principles, and next steps.

Kim interjected that the people who are administering the QA tools should not be intimidating to the "receiver". Chris Hilderbrant added that there needed to be some guarantee of corrective action when an assessment is completed or a complaint is made.

Neal then asked all in attendance if anyone remembers any info from the forum that influence/effect QA/QI. Bob added that accountability for relaying the services would also need to be added to the report.

Neal added that if any individual or agency has any suggestions, that they should be sent to the committee in writing by 9/12/04.


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