October 8, 2010
To: Foothills Gateway, Inc. Clients, Parents, Family Members, Staff and
other interested parties
From: Tim O’Neill, Executive Director - Foothills
Gateway, Inc.
Re: The
Statewide Conflict of Interest Task
Force Study and Related Recommendations
Dear Foothills Gateway, Inc.
Clients, Parents, Family Members, Staff and other interested
persons,
As you are probably aware, the past several years
have seen the system of services to people with developmental disabilities going
through major changes. These
changes, which include funding reductions, individual service plan reductions
and increased state requirements are ongoing, and, will likely continue into the
near future. Additional
major system changes, are being
considered by the state of Colorado as well.
This past spring a Statewide Task Force was created to discuss the issue
of “Conflict of Interest”. As
Executive Director of Foothills Gateway, Inc. I was selected as a Task Force
Member. The Task Force met nine
times over a four month period and included a statewide public forum to gather
public input. Task Force
recommendations are included in a final report which can be found on the
Foothills Gateway, Inc. website at
www.foothillsgateway.org.
In the body of this letter, I have attempted to
answer the following questions you may have about conflict of interest and these
possible changes:
·
Why is this important to people with
developmental disabilities and their families?
·
What financial impact, to clients and the system,
would this have?
·
What were Foothills Gateway’s votes on the
recommendations included in the report?
·
Where does the Conflict of Interest Report go
from here?
·
What action can I take to provide my input to
these possible changes?
Why is
this important to people with developmental disabilities and their families?
The recommendations that received a split vote, 9 in favor and 8 opposed, included in the Conflict of Interest
Task Force Report, if approved, would mean that Community Centered Board
organizations, like Foothills Gateway, Inc., could not continue to provide both
Case Management Services and Direct Care Services. Therefore, clients and families
would not have the choice to have
their Case Management and Direct Care Services provided by Foothills Gateway. The direction the State seems
to be taking is to remove the Community Centered Board system altogether in
favor of creating a state operated system of Case Management.
What
financial impact, to clients and the system, would this have?
Nearly all of the majority recommendations coming out of the Task Force Report
move the system toward a state
operated system that may see the State of Colorado contracting with a single
Case Management organization instead of contracting with 20 local Community
Centered Boards. It is my feeling
that the cost of taking apart a functional system in favor of creating an
untested, state operated system will cost the state precious funds at a time
when the current needs of clients are largely underfunded. Additionally, the changes could
negatively impact Foothills Gateway’s ability to continue to receive the Mill
Levy (15% of Foothills Gateway, Inc.’s annual income) funding on behalf of
people with developmental disabilities in Larimer County.
What
were/are Foothills Gateway’s votes on the recommendations included in the
Report?
(For the purposes of this Task Force, the Departments used the following
definition of conflict of interest: “A ‘conflict of interest’ is a ‘real or seeming incompatibility between one’s
private interests and one’s public or fiduciary duties’”).
The seven categories reviewed were:
1.
Information and Referral—CCBs
are the focal point for clients and families to learn of available services and
supports in the community. As a direct provider of care, the CCB has the
potential to limit access to information about other service provider agencies
in favor of its own provider.
·
Task Force
Outcome: (16 members in support
of the recommendation and 1 member against.)
The recommendation going forth would not
have the Community Centered Boards responsible for information and referral
functions, as is currently the case. The function of “information and
referral” is general and specific in nature.
This function could be performed by existing “single access point”
organizations or a similar system of organizations contracting with the State to
provide information and referral. I
voted to support this recommendation.
I did consider that this change would mean that the CCB (Foothills
Gateway) will not be the primary agency to provide information and that could
result in more contacts being made by the client.
This recommendation could create a better outcome for clients to have a
larger referral pool. However, some
confusion may grow if clients or potential clients become overwhelmed by the
number of agencies providing” information and referral services”.
2.
Eligibility Determination—CCBs
conduct level-of-care determinations giving the CCB the potential to limit fair
access to services and providing CCBs an opportunity to screen out
“difficult-to-serve” individuals.
·
Task Force
Outcome: (16 members in support
of the recommendation and 1 member against).
The recommendation going forth would not
have the Community Centered Boards responsible for determining eligibility, as
is currently the case.
The function of “eligibility
determination” requires the organization to confirm that state required
evaluations were used for the purposes of determining whether or not a person is
eligible for these services. I voted to support
the recommendation as it is not crucial to clients which agency determines
whether or not they are eligible.
Caution should be taken not to assign this task to organizations who have little
or no experience or background in evaluating people with developmental
disabilities.
3.
Administration of the Waiting List—CCBs
are responsible for managing waiting lists for services. This gives the CCB the
potential to favor one individual over another or to fill openings in its own
service provider agency prior to filling openings at private service provider
agencies.
·
Task Force
Outcome: (Unanimous decision).
The recommendation includes Wait List
administration, including case management necessary while someone is on the Wait
List and initial notification, up to the point when the consumer is referred for
service planning, be done by an independent third party who is not a service
provider.
Currently, due to the State financial
challenges, the Colorado Department of Human Services-Division for Developmental
Disabilities is managing the waiting list and giving precious few resources to
only emergency situations. My vote
in support of this recommendation acknowledges that the Division for
Developmental Disabilities is managing the wait list now. My vote in support of the
recommendation also indicates that this function, no matter what entity performs
it, could be performed as a state operated function. My concern would be timeliness of
responses to the client, individual attention during the process and follow up
with clients after the process, as is currently the case.
4.
Service Planning (Case Management)—CCBs
create service plans and could potentially identify service needs that benefit
its own service providers or steer consumers to the CCB provider versus private
providers for services.
·
Task Force
Outcome: (9 members supported
the recommendation, 8 members opposed the recommendation).
The
recommendation is for service planning (Case Management) to be done by an
organization (or organizations) that can provide availability of case management
services and is independent, with separate finances and governance, from those
entities responsible for eligibility determination or service provision.
I
did not support this recommendation as I am opposed to a system that does not
provide choice to the client and family.
Essentially, this recommendation, if it goes forward, will mean that
Foothills Gateway, Inc. could not provide program services (including direct
residential and vocational services) while providing Case Management supports. I feel that this takes away a choice
from clients, the choice to stay with current case management personnel and
agency. Furthermore, Foothills
Gateway, Inc. has worked hard over the past ten years to reduced the potential
for conflict of interest. After a
major study by Larimer County Program Approved Service Agencies, Parents,
Advocates and agency staff, Foothills Gateway, Inc. received further
recommendations to continue its work in resolving conflict of interest. Foothills Gateway has demonstrated,
to the satisfaction of local residential and day program providers, parents,
advocates and allied agencies that conflict of interest can be successfully
reduced and that creating more layers of bureaucracy are not necessary or
beneficial to clients. The minority
position that I supported called for CCBs to continue to offer both service
planning and direct services.
Clients/Consumers and families would have a choice between a CCB or another
organization.
5.
Provider Selection—CCBs
are responsible for making sure that clients are informed of all qualified
providers in their area, however, the CCB could potentially steer clients to the
CCB’s provider rather than private service providers.
·
Task Force
Outcome: (9 votes in favor of
the recommendation and 8 votes opposed to the recommendation).
Assistance with provider selection
will be done by the local organizations that are independent, with separate
finances and governance, from those responsible for eligibility determination or
service provision. I did not
support the recommendation as there is no
data showing favoritism.
Also, most CCBs have adopted fair processes leveling the playing field for
Program Approved Service Agencies. A
factual case was not presented showing that CCBs favored one provider over
another and acted upon that favoritism.
Also, based upon the Foothills Gateway, Inc. “Request for Proposal”
documents and related “Provider Selection” data, Larimer County providers
support the current “leveled playing field” we have created. I also believe that creating another
third party entity to perform a duty that is not a problem just increases cost
of providing services and takes dollars away from client services.
6.
Rate Negotiation—CCBs can
set different payment rates for providers that choose to have the CCB process
all Medicaid billings on their behalf. This could allow CCBs to pay its own
provider more for the same service than it would pay other service provider
agencies that choose to bill through the CCB.
·
Task Force
Outcome: (full consensus).
The State will set rates for all services
for people with developmental disabilities.
This decision was made by
the State of Colorado prior to the beginning of the Task Force. Really, there was no decision to be
made.
7.
Monitoring Services—CCBs
are responsible for monitoring the client’s individualized plan, tracking and
responding to client complaints, and reporting incidents. This role could allow
CCBs to enforce a different or lower standard for quality of care for its own
provider versus private providers.
·
Task Force
Outcome: (9 votes to support the
recommendation and 8 votes to oppose the recommendation).
Service monitoring should be an included function in the duties of the
organization that provides service planning (Case Management) separate from
service provision. I did not support this
recommendation as it does not give choices
to clients and families. This recommendation, if approved,
would mean that clients could not receive case management services from their
current Case Manager, if the client were receiving residential or day program
services from Foothills Gateway, Inc., as well.
Or, clients could keep their Foothills Gateway Case Manager, but would be
prohibited from receiving program services (including residential or day program
services) from Foothills Gateway.
The State would have to contract with another third party organization to
provide this monitoring creating confusion and lack of quality in monitoring of
client services. Contracting with
another third party organization will take funds away from services and direct
them to the support of the third party organization.
Minority Votes: Those
members (8) that did not support the majority recommendations in the categories
of Service Planning (Issue #4), Provider Selection (Issue #5) and Monitoring
Services (Issue #7) did present alternative recommendations. Generally, the minority voters
suggested alternatives to the majority recommendations to prohibit CCBs from
providing Case Management Services and Service Provision. I presented results of a year long
study of Foothills Gateway’s status regarding Conflict of Interest in Larimer
County. An independent group of
Larimer County parents, providers and advocates determined that Conflict of
Interest can be significantly reduced while continuing to provide clients,
parents, guardians and other authorized representatives with choice and options.
The Task Force Members who voted in the minority have concern that the majority
recommendations will result in the following:
·
Parents
and Clients will not have a choice to remain with current Case Managers or
Service Providers if they are both provided by the Community Centered Board. Community Centered Boards have a high
satisfaction rating from parents and clients. The majority recommendations would
cater to the small percentage of clients and family members who are dissatisfied
at the expense of the significantly larger percentage of clients and family
members who are satisfied;
·
Throughout
the Conflict of Interest Task Force meetings, no discussions were allowed to
determine the costs associated with eliminating the current Community Centered
Board system in favor of a State operated centralized system. Creating a new system would cost
money at the expense of client care ;
·
The cost
and confusion to clients and families created by the change to a central and/or
state operated system is not in the best interest of people with developmental
disabilities and/or their families.
Where does the Conflict of Interest
Report go from here:
This report will be reviewed by the Colorado Department of Human Services prior
to it being presented to the following bodies:
Human Services Board- October 1, 2010,
Medical Services Board- October 8, 2010,
Legislative Audit Committee- November 8, 2010
These committees will hear the results of the Task Force as presented by the
Colorado Department of Human Services.
What
action can I take to provide my input to these possible changes?
You can submit any input on this matter to Foothills Gateway, Inc. email at:
info@foothillsgateway.org
boardmember@foothillsgateway.org
Comments to State agencies can be sent to:
Sharon.Jacksi@state.co.us
Jenise.May@state.co.us
Letters, email and phone calls can be made to your local and State legislative
representatives at:
State Senator, Dist 15 Kevin Lundberg
(303) 866-4853
kevin@kevinlundberg.com
State Senator, Dist 14 Bob Bacon (303)866-4841
bob.bacon.senate@senate.co.us
House District #49
BJ Nikkel (303) 866-2902
rep.nikkel@gmail.com
House District #51
Brian Delgrosso (303) 866-2947
brian@briandelgrosso.com
House District #52
John Kefalas (303) 866-4569
john.kefalas.house@state.co.us
House District #53
Randy Fischer (303) 866-4569
randyfischer@frii.com
Thank you for taking the time to read about this very important issue. Foothills Gateway, Inc. will continue
to update our constituents on this issue through our website and our Board of
Directors will be working through state and
legislative channels to prevent these recommendations from going forward.
Sincerely,
Tim O’Neill, Executive Director
Linda Drees, President-FGI Board of Directors
To read the Conflict of Interest Task Force full report, click here.