Vermont HCBS-COI Advisory Committee Meeting Recommendations and Feedback

Vermont HCBS-COI* Advisory Committee March 19, 2024 *Home and Community-Based Services - Conflict of Interest

Notice: Meeting Recording Please note that this meeting will be recorded. This recording and all paper and electronic copies of materials presented or shared on the screen will be subject to Vermont s Public Records Act, 1 V.S.A. 315 et seq., and will be made available to the general public upon request. Participants are responsible for ensuring that no confidential or proprietary information is presented or discussed in the meeting and associated materials. This recording may not be deleted or destroyed except as provided under record retention schedule of the Department of Vermont Health Access. Vermont HCBS-COI Advisory Committee March 19, 2024 2

Agenda Recommendations Feedback Summary Solving Individual Problems HCBS-COI Next Steps Public Comment Wrap Up March 19, 2024 Vermont HCBS-COI Advisory Committee 3

Recommendations Developmental Services: Vermont will pursue statewide competitive contract(s) with one or more organizations to deliver case management for the DS system. Brain Injury Program: Vermont will pursue statewide competitive contract(s) to deliver case management for participants in BIP, along with the DS program. Choices for Care: The five current Area Agencies on Aging (AAAs) will provide case management for all CFC participants. March 19, 2024 Vermont HCBS-COI Advisory Committee 4

Public Comments: Recommendations Public Comment was open in December and January Participants in Four Public In-Person Forums: 67 individuals Participants in Two Public Virtual Sessions: 69 individuals Participants in Virtual Self-Advocacy Forums: 21 individuals 674 total survey responses received: 6 Developmental Services: 331 Choices for Care: 330 Brain Injury Program: 15 Survey respondents said they were: individuals with a disability: 61% individuals receiving HCBS: 79% family members of individuals receiving HCBS: 28% providers of HCBS: 12% Vermont HCBS-COI Advisory Committee March 19, 2024 5

Recommendation Feedback Themes What we heard from commenters: Communication about the changes needs to be improved People are worried about losing relationships Staffing and workforce shortages need to be addressed Roles and responsibilities of both case management and service providers must be clear Having choice in case management is important People receiving services may need emotional support through this change Case managers need to be local to the communities they serve The State should provide caseload guidance (how many people each case manager can serve) Case managers need to be knowledgeable Collaboration between case managers and providers must be a focus Compliant and problem-solving processes should be clear There are concerns about funding and resources Vermont HCBS-COI Advisory Committee March 19, 2024 6

Solving Individual Problems (Complaints, Grievances and Appeals) Federal Requirements Findings from the HCBS-COI Assessment Discussion: What is working and not working? What should problem-solving look like in the new structure? March 19, 2024 Vermont HCBS-COI Advisory Committee 7

Federal Requirements Under Medicaid Rules, the State must have a formal grievance and appeals process for resolving service disagreements between participants and the Medicaid program/providers. Grievances may include, but are not limited to: coverage and amount of services quality of care or services failure to respect participant rights other concerns about violations of program rules or requirements States must also have a clear process for participants to notify the state about provider noncompliance with the HCBS Settings Rule, and a way to resolve these concerns States must resolve formal grievances within 90 days of receiving the grievance Medicaid also defines service monitoring and follow up as part of case management to: make sure that services are happening in a way that matches the person-centered plan make sure the services meet the person s needs make any needed changes to the plan or services Vermont HCBS-COI Advisory Committee March 19, 2024 8

HCBS-COI Assessment Findings In Vermont, many complaints are resolved at the local level without state involvement Providers often seek to resolve quickly, without third-party involvement, and without complaints becoming formal grievances Program participants are sometimes reliant upon staff with conflicted roles to assist them in addressing concerns The State has limited data and information about complaints resolved locally Recommendations: Conflict-free case managers could support participants to solve problems or address disagreements: Help mediate differences between participants and providers Facilitate access to third-party entities (such as the long-term care ombudsman or the state protection and advocacy agency) Support participants when needed in State grievance and appeals processes Make the process for complaints to the State easier to understand and access for participants Improve data collection to help with quality improvement Vermont HCBS-COI Advisory Committee March 19, 2024 9

Discussion: Complaints and Solutions What is working and not working now? What should problem-solving look like in the new structure? Vermont HCBS-COI Advisory Committee March 19, 2024 10

HCBS-COI Next Steps Choices for Care: DAIL is currently working with AAAs and HHAs to plan the transition process, and to decide on a final timeline. Each affected CFC participant will receive information about the process individually. Developmental Services and Brain Injury Program: DAIL is reviewing all of the service definitions to help create detailed information about roles and responsibilities for both case management and HCBS providers. This information will be made available for public comment. DAIL is drafting a Request for Information. This will allow the public to comment on the plans for Case Management before the State releases a Request for Proposals later this year. Vermont HCBS-COI Advisory Committee March 19, 2024 11

Public Comment If you would like to speak during the public comment period, please let us know by sending a note in the chat with your name. The HMA team will call on attendees and unmute the audio for one person at a time. Attendees wishing to speak are asked to focus their remarks on the meeting topics. Speakers should make an effort to limit public comments to three (3) minutes. Advisory Committee Members and State staff will not respond to questions posed during the Public Comment session. General feedback or questions about Vermont HCBS Conflict of Interest issues can be provided through vermonthcbs.org at any time. Vermont HCBS-COI Advisory Committee March 19, 2024 12

Next HCBS-COI Advisory Meeting: Tuesday, May 21, 2024, 2-4pm vermonthcbs.org Updates and events: vermonthcbs.org This Photo by Unknown Author is licensed under CC BY-SA-NC Wrap-Up March 19, 2024 Vermont HCBS-COI Advisory Committee 13

2024 Advisory Meeting Schedule Tuesday, May 21, 2024, 2-4pm Tuesday, July 23, 2024, 2-4pm Tuesday, September 17, 2024, 2-4pm Tuesday, November 12, 2024 This Photo by Unknown Author is licensed under CC BY-NC-ND Vermont HCBS-COI Advisory Committee March 19, 2024 14