Appoquinimink State Service Center, Middletown, DE
PRESENT: Ray Brouillette, Easter Seals; Tammy Clifton, DVR; Dr. Jane Crowley, A.I. duPont Hospital; Esther Curtis, Point of Hope; Debbie/Jim Dunlap, Parents; Tony Horstman, SCPD/Parent; Julie Leusner, DSCYF/DPBHS; Kim Marsh, United Health Care; Carolyn Morris, DSAAPD; Al Rose, DDC; Kristin Cosden, GACEC (for Wendy Strauss); Kyle Hodges, Staff and Jo Singles, Support Staff.
ABSENT: Brian Hartman, Vice-Chair; Felicia Connor, Open Door, Inc.; Lisa Furber, BIAD; Jody Hougentogler, Parent; Kevin Massey, DPH; Chris Long, DHSS/DDDS; Dale Matusevich, DOE; Ann Phillips, SCPD/Family Voices; Liz Schantz, Consumer; and Dara Schumaier, DHSS/DSAMH.
Guests: Thaddeus Williams – GACEC
Pattie Wright – Delaware Physicians Care
Kathy Gordon – Delaware Physicians Care
Mary Fox – Delaware Physicians Care
CALL TO ORDER: Kyle called the meeting to order at 2:01 pm. Everyone introduced themselves.
ADDITIONS TO THE AGENDA: There were no additions or deletions to the agenda.
APPROVAL OF MINUTES:
Motion was made, seconded and approved to accept the July 1, 2013 minutes as amended. Debbie asked for several changes on Page 3 (2nd paragraph): move the last sentence up one and change “it” to “there are additional Colorado forms that” for clarification.
BUSINESS BIC Chair Kyle announced that Ann Phillips was elected Chair. Kyle thanked Esther and Debbie for offering to be considered on the ballot.
TBI Trust Fund Kyle provided background information on this. He said that although legislation was not introduced this year, $40,000 ($25,000 from General Funds and $15,000 in Grant in Aid) was given to the SCPD to start a pilot. Kyle stated that we will be working with DHSS to implement the pilot and have recently met with DHSS representatives to discuss, along with Ann, Esther, Brian and Jody. Kyle referred to two handouts: Draft SFY14 Interim TBI Fund Policy and Draft Application for TBI Fund Assistance. Kyle explained that the hope is to get sustained funding through the legislation which has already been drafted. The Draft Policy was reviewed and discussed:
Eligibility – A. Qualifying TBI – There was discussion about including ABI, but the draft legislation states TBI. If the pilot is successful and legislation is introduced, we could revisit this issue and include ABI. In addition, BIC had previously agreed to the TBI definition. There was some discussion about the medical coding for TBI and what category they fall under and the difficulty in pulling the data. DMMA requested that the MCOs provide statistics on TBIs. The MCOs looked at 7 different codes to capture the data we were looking for. Al asked if the 7 codes referenced TBI. Jane asked if this included adults only and the pediatric population needs to be included. Esther spoke about including ABI as a whole and whether to include anoxia and hypoxia brain injury because that is caused by chemical damage or infectious disease damage and is considered physical trauma, not just a blow. Kyle noted that the definition could include “anoxia due to trauma” which is the language in the federal TBI as amended in 2008. The definition in our bill covers injury to the brain due to trauma. Esther commented that it was up to us to be explicit about it. Tony asked about DDDS being included. Kyle explained all DHSS programs are included. Kim explained that they did include the ABI Waiver in the statistics. Tony asked if DDDS’ Family Support Waiver would include services for brain injuries and does not want this lost. Kyle commented that this is a much broader topic than our function, but could be brought up with DDDS. Kyle commented that Tony made a valid point and that DDDS may have people who could benefit from the program eventually. There will be a follow-up meeting on September 26th with the small working group. Kyle will check with DHSS to see if it is beneficial to have the two MCOs included in the discussions. Pattie agreed that it is important that everyone is looking at it the same way so we do not get conflicting data. Kathy explained that hypoxic events leading to brain injury could fall into a different category and be even more difficult to find people. Kyle commented that this will be even more critical when legislation is passed giving sustainable funding.
Jane commented that the pediatric population, which is being left out of the pilot, should be included. Jane added that there is no assistance for children beyond traditional means and adults get services through a waiver. Kyle explained that this population was included in the first draft he did, but then removed due to the limited resources of the pilot. In addition, the grant-in-aid legislation stipulates coordinating with DHSS. Finally, a report is due in January so there are time constraints. Jane stated that she had a strong opinion about children being excluded from the pilot. She added that a lot of long term morbidity can be reduced by effective intervention at a younger age. She stated it was important to include a couple of success stories from children. It was noted that there are some programs in DHSS that provide assistance for children with TBI, for example, the Children’s Community Alternative Disability Program (Medicaid) and Birth to Three (non-Medicaid/Medicaid). Therefore, services for some children are already covered by the draft. Jane offered that A.I. duPont Hospital could quickly contact a few people since they have quicker access to this population. He stated that this could be discussed and followed up on the Sept. 26th meeting if this Committee decides to include children. A motion was made and seconded to include children in the pilot. A vote by show of hands included 5 in favor and 2 opposed. Jim made a suggestion that we state in the plan that we will do research during the year to understand more clearly just what kind of children’s services might be effective or necessary. Julie commented that there is a call for us to look at the children’s piece where they do not fall into existing programs; education has something and hospitals have something, but not a whole lot in between. Kyle will take this feedback to the working group on September 26th and he encouraged others to participate. Jane explained that A.I. could send a letter out to several people asking if they would like to participate in the pilot and follow-up with phone calls.
Eligibility – B. Covered Services – Kyle reviewed the list of covered services. There was some discussion about the costs of different services. Also, Carolyn spoke about families using all other coverage available first before we give assistance (payer of last resort). Kyle commented that this should be more defined at the next meeting.
Page 2 – C. Non-supplantation of DHSS Services. Currently, DSAAPD has 28 people with a TBI and on waiting lists for services.
Kyle commented that once we get through the pilot and if the program is expanded, this would be contracted out. Julie added that it has been successful in the Kids Department to have a monetary cap and set up a definition on what it can be used for. Kim commented that if a service is very costly and a cap is put on it, you might not get what you are looking for—a success story. Since home modifications are very costly, a $500 cap on a $20,000 home modification may not seem very helpful. Kyle commented that only 3-4 people may actually be helped in the pilot. The hope is that they will testify before the Legislature on how this grant has helped them in their lives.
Draft Application (handout) – This was briefly reviewed. Tony asked about the impact of the Affordable Health Care Act on this. Kyle commented that he did not see an impact regarding the services and the intent of what we are trying to do. Suggestion was made to add a question about other avenues checked before applying. Kyle commented that the Availability of Services through DHSS (page 2) could be better defined. Kristin suggested adding a disclaimer where you are granted authority to verify income, etc. Kyle stated that if anyone had other suggestions to contact him after the meeting.
Assessment Update Kyle stated that Debbie has done a lot of research on other states and how they assess cognitive and behavioral deficits. Information on these states was provided to DMMA and DSAAPD. A meeting is scheduled on September 27th with DMMA and DSAAPD representatives. Debbie, Brian, Esther and Kyle will be in attendance. Kim commented that the State has asked the MCOs to compare to what they are currently using. Kathy commented that the Colorado Assessment is very similar to the Pre-Admission Evaluation used in Delaware and had a copy for Debbie. Kathy said that the MI VIA Assessment is very similar to what is required of them. She asked how we identify them so that we make sure we are putting the services in place. Debbie spoke about the Level of Care Determination. The State retains the initial determination of eligibility. Kim clarified that what was shown in a previous meeting from the MCOs was the Assessment for the Plan of Care, but there is overlap. Delaware’s PAE form (LTC Tool) can be found online on the DMMA website. This form determines level of care eligibility. Level of care is not the same as level of hours. The MCOs use their assessment tool to help determine hours. Kyle thanked Debbie for all her work on this.
DMMA/DSAAPD/Point of Hope Pilot Project
Esther spoke about a pilot program being done by Point of Hope. She distributed a flyer on this program. This pilot program is intended to help people with brain injury move out of local institutional setting back to home using Point of Hope’s Acquired Brain Injury Clubhouse Program as a method for the continuum of care. The hope is that once they are in community-based housing, they will continue in the day program. Esther provided an overview of this program. They are working with DSAAPD and DMMA. The hope is that they will eventually transition to MFP and community-based housing, but there is not a time limit for this program. Several people questioned the name of the program and that it could be connected erroneously to another program since this term is frequently used in terms of substance abuse. Esther stated that they hope to have the program up and running in a couple of weeks. Positive comments were given on the concept.
Youth Concussion Summit Follow-Up Kyle gave background information saying the first Youth Concussion Summit was held in May, 2013. The purpose was to look at the diagnosis and management of concussions and how it affects the education, medical and sports communities and state agencies. Three major recommendations came out of this summit:
Establish a more uniform documentation protocol between the medical community and schools for both sports and non-sports related concussions.
Develop a training program for health care providers focused on the diagnosis and management of concussions. Consider statutory change that would require physicians who manage concussions to complete the approved training, diagnosis, and management and return to activity (both school and sports).
Establish a Youth Sports Advisory Council to address education and regulation on community, recreational and travel sports programs. (DIAA only covers middle and high school sports.)
Kyle stated that he and Jane have been working over the summer with the Chairs of the workgroups from the Summit and there will be a press conference on September 25, 2013 at 12 noon at Brandywine High School. A formal invitation will follow and all are invited to attend. Also, Jane will be interviewed this Wednesday by Elana Gordon from WHYY-TV. Jane added that Elana has shown a lot of interest in the Summit, having visited one of the schools and spoken with Kyle and Kevin Charles (DIAA) and others. Information could be given out in several arenas (radio and television). Elana also wants to interview an athlete who has had a concussion and the process they went through. Elana is interested in talking about the Action Summit Plans before the press conference.
Esther spoke about her efforts to increase the number of family advocates. Several names were suggested and Esther will follow-up. Esther also spoke about having someone who has TBI on the Committee. Kyle commented that if anyone knows someone who is interested in participating on this Committee he will reach out to them.
Community of Practice Kyle referred to several emails which give background information. Kyle explained that he was contacted by MarySue Jones (DPH) and Coalition on Injury Prevention to join Children’s Safety Network and TBI Technical Assistance Center’s collaborative Community of Practice (CoP) on the Prevention of Brain Injury, which is a schedule of webinars or conference calls to discuss best practices going on throughout the country. Kyle explained that the Delaware team members include: Peggy Mack, Crystal Sherman, Bhavana Viswanathan, Rose Imhof, Thomas Kaminski, Lisa Furber and himself. Kyle will get clarification on who can participate on the conference calls. The first conference call is September 18th at 2 pm; he will provide additional information. Kyle spoke about the Coalition on Injury Prevention’s Strategic Plan involving TBI and they plan to update it, using what they learn from these CoPs in the context of TBIs. Kyle commented that the Strategic Plan has not been updated for several years. Kyle will forward a copy of the last Strategic Plan by the Coalition on Injury Prevention.
BIAD Report There was no report at this time.
OTHER BUSINESS Esther commented that 377 people participated in the BIAD 5K Run was held at Wild Quail on Labor Day.
There were no announcements.
Adjournment The meeting was adjourned at 3:51 pm. The next Committee meeting is scheduled for Monday, October 7, 2013, Appoquinimink State Service Center, Middletown.