Board of Social Services Minutes
August 24th, 2015
Second Floor – County Administration Building
10:00 am – 12:00 am
In Attendance: Commissioner Lew Gaiter, Commissioner Steve Johnson, Commissioner Tom Donnelly, Linda Hoffmann, Lorenda Volker, Neil Gluckman, Laura Walker, Heather O'Hayre, Marsha Ellis, Jim Drendel, Ed Rutherford, Beverly Dahan, Vice President of Government & Legislative Affairs for InnoVage, Emily Dawson Peterson, Loveland PACE Center Director, Laura Sartor, and Ann Marie Grobarek
A recording of this worksession is available at: http://larimer.org/bcc/list_worksessions.cfm.
Introductions & Announcements
Commissioner Gaiter welcomed everyone and called the meeting to order. Director Laura Walker asked if there were any additions to the agenda.
Overview of the Program of All-Inclusive Care for the Elderly (PACE)
Beverly Dahan, Vice President of Government & Legislative Affairs for InnoVage and Emily Dawson Peterson, Loveland PACE Center Director provided a presentation of InnoVage, an organization focused on keeping the elderly in their homes and communities with dignity. InnoVage was a pilot of the Program of All-Inclusive Care for the Elderly (PACE) and also provides home health agencies, senior housing, coordination of care and an adult day program for people in need of memory care. Highlights of the presentation include:
- InnoVage is the second largest PACE program in the country, serving 2,600 seniors out of 32,000 participants. Many more people are eligible for the program and do not participate.
- PACE provides coordinated comprehensive services through an individualized plan managed by an interdisciplinary team that meets daily.
- To be eligible you must be 55 years old, live in a State-assigned PACE service area, be certified as meeting the State's criteria for nursing-facility level care by the Singe Entry Point, and be able to be served safely in their community. A majority of the participants are low income (Medicare and Medicaid eligible.)
- Provides respite and support for caregivers, transportation to and from the PACE Center and specialist appointments, social activities, meals served, clinical oversight and geriatric specialists, physical and occupational therapists, dental, vision, hearing and podiatry services provided, and drugs, supplies and equipment are included and delivered to the participant.
- Publicly funded from Medicaid (66%) and Medicare (33%), including Part D. They are Ňat-riskÓ and can approve things that Medicaid and Medicare will not.
- PACE programs save Medicare over 26% in the last two years of life and over 65% in the last six months of life compared to a population that pays for services one at a time and does not have communication and coordination between caregivers and care providers. This also is helpful for caregivers.
- There are an estimated 2,000 frail seniors eligible for PACE, but not everyone will want to participate because you have to give up your own doctor and use the PACE doctor.
- The Loveland PACE Center will serve Larimer and Weld Counties. It is located on East 11th Street and will open October 14, 2015 at noon, with Senator Gardner. If he accepts our invitation, the Commissioners will be invited.
Laura Walker mentioned that this would not have a substantial impact on our Options For Long Term Care Single Entry Point (SEP) program (current caseload is approximately 1300 people) because the Options team would still be assessing clients prior to referring them to PACE. We will continue to be responsible for initial and ongoing assessments. Commissioner Donnelly indicated they are fortunate in their Director, Emily Dawson-Peterson.
C-Stat Dashboard Review
Laura Walker discussed the monthly C-Stat Dashboard reports the Commissioners have been getting from the State in order to review their content, purpose and how best to use them going forward. The reports were originally intended to be an internal auditing tool, but messaging from the State makes it sound a bit different. Laura reviewed the most recent Dashboard report:
- Larimer County met 15 out of the 21 goals, and were close to meeting several others.
- In comparison, the Big 10 counties met 8 of the 21 goals, and Boulder County, comparable to Larimer County in size and structure, met 12.
Laura reported that the full report, which sometimes can be about 80 pages long, may provide too much detail for what the Commissioners want or need. She asked if they would like regular updates on this report or how they would like to use the information moving forward.
Commissioner Gaiter responded that there is no need for regular updates, but it would be good to review at our next meeting progress against this month's report and then review whether or not these metrics are best for our needs. Laura responded that there has been some questioning of the data provided in this report. Arapahoe County has questioned the data from this report several times over the past year as it differs from their own numbers. They have sent a letter to the State and the Colorado Human Services Directors' Association is waiting on the response from the State before taking further action. Concerning issues include the State not allowing County Directors access to the raw data from the Adult Protection system because they are not Adult Protection staff and the State not communicating a change in the standards for a Child Support metric. Larimer County priorities are safety for children and outcomes for our other clients.
Commissioner Donnelly asked about the impact on Larimer County if we do not meet the metrics on the C-Stat Dashboard. Laura replied that performing well on these metrics results in an award certificate at the end of the year, but it is not tied to other funding. Jim Drendel added that allocation formulas for his department are tied to metrics that are not those in the C-Stat Dashboard. Commissioner Gaiter requested we be sure that metrics we have are meaningful to our clients, and Laura indicated that Heather and Ed are currently in the process of reviewing them as we build them into the budget for next year.
2015-2016 Allocation Changes
Ed Rutherford reported on allocation notifications from the State, which indicate the following changes for FY 2015-2016:
- The Colorado Works allocation has decreased 5%, which is $343,078.00. Basic Cash Assistance spending has continually increased, and if we go over our allocated amount we will have to take money from the TANF reserve fund, which is dwindling.
- County Administration went down 3.6% ($190,612.00) and we are unsure of the impact for that.
- Adult Protection received 6% ($51,319.00) additional funding.
Laura added that a key piece of information missing from the State was a major factor in the decrease of the Colorado Works allocation. The Workforce Center worked very hard on a proposal for additional funding from 1415 that the JBC had allocated to the WAC ($2 million statewide). Larimer County had $780,000 added to their budget. Our strategy was to spend that money first, but then in May Laura learned from CDHS that this money did not count towards allocation spending. This resulted in the calculation of the allocation formula showing Larimer County was underspent even though we were technically overspent. Laura has concerns about this practice as counties who do not spend all of the funds provided this way are allowed to put that money into their TANF reserves, so the money is treated the same as TANF allocation money. The Workforce Center has put in a new proposal for FY 2015-2016 and if Larimer County receives additional funds this year, Larimer County strategy will be to make sure to closely track other expenditures and adjust spending three to four months into the year as appropriate. It could result in Larimer County using the flexibility of this funding for good use in the community according to the four purposes outlined in federal legislation.
Commissioner Johnson said he understood why the State does not count that money because not every county applied, so it wouldn't be fair to the counties that did not apply.
County Administration Funding Errors – FY 2010 through 2014
Ed Rutherford reported that the State discovered during an audit that they had made an error in calculating County Administration funds at the close-out of each year, going back to FY 2010-2011, resulting in over $7 million dispersed in error to the counties over that time. They have calculated that Larimer County needs to pay back $526,000. The State says they thought they were drawing down more Federal money than they actually were. Ed will be getting a detailed report of the information from the State Controller but has not yet received it.
Laura reported that the State has told counties there will be a menu of options to pay the money back to the State. Larimer County is most interested in an option allowing us to pay the money back over time due to our anticipated decreases in County Administration allocation. This option would allow Larimer County to take any extra revenue left at the close-out of each fiscal year and apply it to the balance. Larimer County can then determine how to pay any remaining after revenues are applied. The State cannot pay the money out of the General Fund as it would be against current legislation. As a result, Weld County has suggested legislation to fully fund County Administration, so Larimer County would like to support this legislation as it would provide a longer term solution to this issue.
Commissioner Johnson suggested that Larimer County's position be that the State should allow five years to do this as that is the number of years the State is going back to calculate the amount owed. Commissioner Donnelly asked how many counties had this issue. Laura indicated that many counties are impacted since the calculations go back over five years, but not all of them. Commissioner Johnson reported that Denver County owes $2.7 million, Weld County owes $622,000, and Boulder County owes about $500,000. Ed replied that about 40 counties were affected.
Commissioner Johnson asked about our progress in hiring the additional Child Welfare staff that will be 90% funded by the State. Laura reported that we were approved to hire five new workers and Jim indicated that all of the positions were filled. Commissioner Johnson asked about our other vacancies in Child Welfare. Jim replied that turnover is down significantly over the last ten months. We have roughly 3-5 vacancies at a time, and they last a few weeks. The State Training Academy takes a significant amount of time, but they have made some changes, including a rolling admission that reduced our waiting time before someone is ready to take cases. They had allowed people to take cases during their time in Academy, but just recently this was changed because of a decision made by the Attorney General. The certification process is unclear due to this new decision, so we are waiting to see what this will mean for how long it takes to prepare new employees to take cases.
Update on CBMS Client Correspondence Issues
Laura reported that the State Office of Information Technology caused errors in the noticing functions in CBMS in July, resulting in a five day period where thenotice function was shut off without consulting or notifying counties. This resulted in many clients being impacted because of late notices being received for notifications of approvals, denials or requests for information.
In addition, there have been errors in the notifications that have resulted in horror stories from other counties. For example, Routt County had a person come forward who was not a client that received 80 pages of notices with other people's information. The State is working hard to provide a remedy for this problem and have created categories of breaches ranging from one that released personally identifiable information, one that released a social security number, and one that released protected health information. On the 15th of August, the State was sending out notices with remedies including credit monitoring for breaches that did have Protected Health Information.
Marsha reported that staff were expecting to process hundreds of redeterminations at the beginning of the month and did not receive very many, so now they are working hard to catch up. Clients have had benefits discontinued and have to wait in long lines to communicate and get the mistakes corrected.
Laura added this will mean that our August C-Stat metrics will be affected by that, and the Dashboard does not allow for a note showing this kind of issue. Commissioner Johnson asked to be informed about issues like this in the future as he believes we should write a letter informing the State of our concerns about this problem.
Client Activity Report
Ann Marie Grobarek, Business Operations Coordinator, presented an overview of the department's client activity. Ann Marie reviewed: monthly average caseloads, program activity, complaint totals, and results from the client follow-up survey regarding complaints from April 1, 2015 through June 30, 2015.
During the 2nd Quarter of 2015:
- The Food, Medical & Financial Assistance Program caseloads continue to increase. We currently have 62,808 cases.
- Child Support collected over $4.9 million.
- Children, Youth and Family received 1,939 referrals, and 97% of children with a case plan to remain home did.
- We received a total of 9 complaints during the 2nd Quarter.
Marsha reported that the increase in the Food, Medical and Financial Assistance increase was due to the caseload coming to the County that had previously been processed by Maximus. Jim reported that the increase in Child, Youth and Family referrals is due to the State Hotline number. Commissioner Gaiter commended the performance of the Department as we only had nine complaints this quarter and reiterated that we cannot do anything for a client who has concerns about customer service unless they register a complaint. And Laura thanked Commissioner Gaiter for his recommendation to show what percentage of our work is free of complaints on this regular report as it reinforces the positives in the work we do.