Minutes First Steps South East LPCC February 18, 2012 9:30 a.m. to 11:30 a.m. Aging and Community Services 1531 13th Street Columbus, IN 47201 Attendance: Present Affiliation Present Affiliation Kim Amberger-Fledderman EI Provider Cyndi Johnson Parent Barbara Andrews Head Start Stacy Likens* ACS Staff Denise Arland* LPCC Staff Kari McCarty* LPCC Staff Jeanne Baldwin* SPOE Staff Debbie Miller EI Provider Barb Blain EI Provider Nancy Moore EI Provider Kim Gaffney* LPCC Staff: Jackson County Whitney Piercefield* LPCC Staff Lori Hart Community Angela Miller Quality Review: State Becky Haymond* Staff: Administrative/Supervision Megan Robbins EI Provider Connie Hempstead Education Stacy Stillinger Parent Katie Herron* LPCC Staff Debbie Toth EI Provider Shirley Huntsman* LPCC Staff Lisa Wagers EI Provider F.I-W Parent Michele Weidenhammer EI Provider The chairperson was called out of the meeting just before 9:30, so Jeanne Baldwin shared her inspirational story prior to the meeting start. Cyndi Johnson called the meeting to order at 9:43. Cyndi called for a motion for the consent agenda. Denise offered one correction to the LPCC report, adding a child find activity in Brown County. Kim made a motion to accept the consent agenda with the noted edits. Connie Hempstead seconded, and the motion carried. Stacey Likens presented the financial report through the second quarter of the grant. (attached) Only 40% of the grant has been expended because the agency has been conservative awaiting word on the holdbacks. 100% of the hold back funds have now been released, so more of the grant will be spent down in the areas where funds are allocated. Stacy also covered a financial report on the ED teams. To date the ED team budget is running at a $7800 loss. Staffing changes were made in an effort to reduce the loss to $2000 by the end of the grant. There will be no reimbursement from the state for the loss. Staff Updates: Becky gave an update on staffing. She announced that Whitney Piercefield has been hired to cover Brown County and to do other coverage as needed for vacations, maternity leaves, etc. Shirley Huntsman has taken on responsibility for training service coordinators, so she will be in the office two days a week for training and available to answer service coordinator questions and concerns. ED Team Updates: Jeanne Baldwin said that ED teams now have full coverage. They are busy in most areas and systems are in place and working well. Staff has been added to handle add on evaluations.
Provider Networks: Becky reported there are concerns in Jefferson, Jennings and Ohio counties about keeping the minimum number of providers needed. They have approached other networks, and DSI is considering adding that service area. They are awaiting approval from the state to determine if they can proceed. In this area of the state, providers still struggle to get adequate coverage in place when someone leaves. This has been a historical problem in this area. Service coordinators, agencies, and the SPOE are continuing to work together to meet needs. The state is aware of this concern. F. Wright questioned the state s response on this issue. There was discussion on how to get more providers. Nancy suggested that the state thought provider networks would help, but it s still a problem. People are starting to hear negative comments around the community about First Steps and this issue. One idea to generate providers is to have students shadow, with the hope of generating interest in open positions. Most providers noted that pay is an issue because they cannot pay what hospitals, nursing homes or schools pay. The council would like to find a way to pass feedback from local communities along to the state. LPCC Goals Data Review: Becky went over data provided by Michael Conn Powers about children exiting First Steps from July 1, 2011 to September 30, 2011. The demographics for our cluster seem to accurately reflect our population. The data also shows that the majority of our families are not subject to cost participation (77% under 250% of poverty). There was some discussion about children going to hospitals instead of First Steps now because co-pays are often less with their private insurance. Providers feel that hospitals are steering parents to this option more than to First Steps. Some parents have also talked about doing this due to the monthly parent participation requirement that can create a hardship for working families. Becky also covered the profile reports for calendar year 2010 compared to contract year 10/1/10 thru 9/30/11, looking at services delivered by service type. The data shows not much change between the two time periods in percent of children receiving services. The only big change appears in technology, which is likely a reflection of the state no longer covering orthotics. There was discussion about developmental therapy being used when OT and PT providers are not available. Services now are authorized every 3 months, so if changes need to be made, such as switching to PT or OT, those changes can be made. Sometimes providers have to decline a referral because they don t have someone available at the time of request. The state questions whether or not anticipated openings are being considered. Providers all stated they do consider potential openings coming up within 30 days before declining those referrals. Becky recommends that all sides document those conversations so we can go back and talk case by case about how decisions are being made and what availability issues really exist.
F. Wright asked if anyone is tracking the impact on outcomes of therapy if parents do not have access to orthotics. Several ideas were discussed about how that could be tracked, but most parents end up getting orthotics from another source like insurance or Medicaid. Since orthotics will not be paid for by First Steps, there will be not future data available in the system. Parent Survey: Denise presented initial results from the quality survey. Lessons were learned from this first pilot month. Only 12 IFSPs were scheduled in January in Bartholomew County where the survey was piloted. Six surveys were returned, one annual and five initial IFSPs. Most of the questions showed agree or strongly agree responses. There was discussion about revising one of the questions and the response format. There will be an additional month of pilot, adding two counties, to see what kind of results come in with more activity. The survey was done in the free version of Survey Monkey, which does not allow for any exporting of the data, so results can only be viewed online. If the online survey turns out to be a good tool, we will have to spend money for the paid version. If it does not, we will move back to a paper survey done on a regular basis instead of doing that once a year as was done in the past. Parent Participation Denise presented the LPCC parent participation survey for feedback. Formatting changes were recommended to make it easier to read. Distribution was discussed. The LPCC will mail this survey to all enrolled families. Cyndi suggested the survey be made available to other groups to capture feedback from parents who have already exited the system. Provider Retention Denise shared the provider retention survey that was developed with the provider network representatives and asked for feedback on how the survey should be distributed. After discussion about the pros and cons of networks distributing versus the LPCC distributing, it was decided that network representatives will hand it out and provide envelopes from the LPCC so it can be more anonymous for providers. Providers also suggested a scale be added so providers can indicate to what degree each of the items contributed to their decision to leave the system or reduce availability. Results of these surveys will be reported at the quarterly meetings. New Business Becky reviewed information about cost participation and insurance concerns. The state has resumed billing private insurance. They recently implemented a new log for SPOES to report cost participation or insurance billing concerns. The state has been very responsive to issues reported on the log, and those are being resolved. We have 13 families on the suspension list. Agencies are notified as soon as the service coordinator makes their final contact with the family right before services are suspended. Families are given multiple contacts and opportunities to pay before SPOE will contact the provider, to make sure services are not cut off for families who end up paying at the last minute. Services are resumed when the state verifies payment is received. LPCC members would like to know how many families are dropped from services for nonpayment at the end of the year.
Becky also responded to questions about billing. One of the challenges is to educate families about their private insurance and whether it is self insured or fully insured. For fully insured plans, state is billing the capitated rate of $400 a month. For self insured plans, it is fee for service. Families can call the SPOE with any billing concerns so they can be documented on the log. Networks have some problems with no shows because they cannot bill the state to recover any of the time. Providers suggested explaining on the first visit the importance of families keeping appointments, emphasizing that providers and families must work together for the system to help their child. Announcements and Updates Cyndi announced that her support group is honoring early interventionists during disability awareness month, and she passed out small gifts of coffee mugs and other items to LPCC members. The next meeting is May 18, 2012. Having no further business, Cyndi made a motion to adjourn, Lori seconded, and the motion carried.