A Place Where Anything Is Possible

Summer 2009

Relationship

sA PlaceWhereAnythingIs Possible

Oklahoma Department of Human Services Developmental Disabilities Services Division

TA B L E O F C O N T E N T S

Summer 2009

Innerthoughts Thinking of Warren

1

Insurance Mandates Autism TreatmentsFail to Pass Oklahoma

Legislature

8

11th Circuit Rules Doctors Donrsquot Trump Stateon Medicaid Care for Children

with Disabilities

9

Compassion Friendship and Longevity

A Good Measure of Success

13

Best of the Best In Direct Support Services Honored

3

Governorrsquos Disability Employment

Awards Showcase Oklahomarsquos Reason to Brag

4

DDSD Employees Win Advocacy Awards

5

Quality Awards Best of the Best

6

DDSD Nicholson Receives Award for Contributions to College

of Allied Health 7

Health and Human Services Rescinds

Medicaid Regulations Affecting Case Management 10

Oklahoma Documentary on Developmental

Disabilities History to Air on OETA

12

State Legislative News 14

A Dream Come True 6

Residents of a Group Home in Vinita Display their CPR Certificates

9

Imagining Everest 10

Waiting and Hoping 11

DDSD Fiscal Year 2010 Budget Outlook

12

Elves Work Year Round to Make Christmas Special for DDSD Clients

16

Our MottoThe name Interface was chosen for this publication

because it reflects our purpose to create a common

boundary where diverse groups interact Interface

represents our effort to bring together different groups

for the benefit of Oklahomans with developmental

disabilities We hope to provide information encourshy

agement and insight

Please send your ideas for news and features to

Sheree PowellWritershyEditor Developmental Disabilities Services Division

Community and Provider Relations

PO Box 25352 Oklahoma City OK 73125

(405) 521shy4972

INTERFACE NEWSLETTER James M Nicholson Division Director of

Developmental Disabilities Services Division

Sheree Powell WritershyEditor

Danny Phillips Graphic Artist

Caroline Miller Sheree Powell Photographer (unless otherwise noted)

S09455 OKDHS Issued 1009 This publication is authorized by the Oklahoma Commission for Human Services in accordance with state and federal regulations and printed by the Oklahoma Department of Human Services at a cost of $557700 for 9295 copies Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries

Oklahoma Department of Human Services Developmental Disabilities Services Division

I N T E R F A C E

INNERTHOUGHTS

James Nicholson

Thinking of Warren

Warren Edds one of the first selfshyadvocates I met after

coming to DDSD in 1988 died on

June 22 at his home in Enid I had

not talked to Warren in a number of years but I used to see him

frequently at Oklahoma People

First meetings rallies and other events He was very active in the

selfshyadvocacy movement and was not bashful about making sure his voice and opinion were heard

The most memorable talk we had

was at a Governorrsquos Conference in

Tulsa many years ago I was scheduled to do a breakshyout session called ldquoA Conversation with Jim

Nicholsonrdquo targeted towards selfshyadvocates As the

start time approached I was surprised at the large

number of people who were in attendance The

topics discussed in these sessions usually centered on

service delivery concernsmdashgood and bad providers or staff not being allowed enough freedom of choice not being listened to etc

During this session Warren stood and began

talking about his life experiences and how they

affected him Everyone who knew Warren knew him

as a very happy guy who always had a smile on his face But this was a different Warren He talked

about his mother leaving him as a small child at Enid

State School and how it pained him to think about being unwanted and abandoned Tears came to his eyes as he struggled to come to grips with memories of many decades past He created one of those

moments for which there is no real response possible

other than a thoughtful respectful silence and a

touch on the shoulder When Warren finished and sat down other selfshy

advocates stood and talked about their life

experiences and the incidents that caused them pain

People you would never expect revealed underlying wounds that they continued to struggle with That afternoon Warren opened the

way for many selfshyadvocates to

honestly share and thus lighten their burdens

After leaving Enid State School as an adult Warren became a wellshyknown figure in that community He established relationships with

everyone he came in contact with

from mayors and city councilmen to

several generations of workers at the

local McDonaldrsquos restaurant When the city dedicated

a new bridge many years ago Warren was invited to be

the first to officially cross it in his famous threeshywheeled cycle

Warren also went on to enjoy a rewarding career volunteering as a camera operator for the Enid public

access television station The Enid News and Eagle

printed a wonderful article marking his passing ldquoDeath of Warren Edds has an impact on communityrdquo As I read it I remembered our session in Tulsa and the

barriers Warren had overcome to become the person

everyone remembered as having a ldquocheery smile and

a kind heartrdquo Great success doesnrsquot come easy and it certainly didnrsquot for Warren

You can see a video clip of Warren that appears in

the documentary ldquoLiving in the Freedom Worldrdquo at httpwwwmnddcorgparallels2onevideovideo76b

shyfreedomworldhtml He was a star on both sides of the camera

James M Nicholson Director Developmental Disabilities Services Division

Oklahoma Department of Human Services 1 Developmental Disabilities Services Division

TA B L E O F C O N T E N T S

Summer 2009

Innerthoughts Thinking of Warren

1

Insurance Mandates Autism TreatmentsFail to Pass Oklahoma

Legislature

8

11th Circuit Rules Doctors Donrsquot Trump Stateon Medicaid Care for Children

with Disabilities

9

Compassion Friendship and Longevity

A Good Measure of Success

13

Best of the Best In Direct Support Services Honored

3

Governorrsquos Disability Employment

Awards Showcase Oklahomarsquos Reason to Brag

4

DDSD Employees Win Advocacy Awards

5

Quality Awards Best of the Best

6

DDSD Nicholson Receives Award for Contributions to College

of Allied Health 7

Health and Human Services Rescinds

Medicaid Regulations Affecting Case Management 10

Oklahoma Documentary on Developmental

Disabilities History to Air on OETA

12

State Legislative News 14

A Dream Come True 6

Residents of a Group Home in Vinita Display their CPR Certificates

9

Imagining Everest 10

Waiting and Hoping 11

DDSD Fiscal Year 2010 Budget Outlook

12

Elves Work Year Round to Make Christmas Special for DDSD Clients

16

Our MottoThe name Interface was chosen for this publication

because it reflects our purpose to create a common

boundary where diverse groups interact Interface

represents our effort to bring together different groups

for the benefit of Oklahomans with developmental

disabilities We hope to provide information encourshy

agement and insight

Please send your ideas for news and features to

Sheree PowellWritershyEditor Developmental Disabilities Services Division

Community and Provider Relations

PO Box 25352 Oklahoma City OK 73125

(405) 521shy4972

INTERFACE NEWSLETTER James M Nicholson Division Director of

Developmental Disabilities Services Division

Sheree Powell WritershyEditor

Danny Phillips Graphic Artist

Caroline Miller Sheree Powell Photographer (unless otherwise noted)

S09455 OKDHS Issued 1009 This publication is authorized by the Oklahoma Commission for Human Services in accordance with state and federal regulations and printed by the Oklahoma Department of Human Services at a cost of $557700 for 9295 copies Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries

Oklahoma Department of Human Services Developmental Disabilities Services Division

I N T E R F A C E

INNERTHOUGHTS

James Nicholson

Thinking of Warren

Warren Edds one of the first selfshyadvocates I met after

coming to DDSD in 1988 died on

June 22 at his home in Enid I had

not talked to Warren in a number of years but I used to see him

frequently at Oklahoma People

First meetings rallies and other events He was very active in the

selfshyadvocacy movement and was not bashful about making sure his voice and opinion were heard

The most memorable talk we had

was at a Governorrsquos Conference in

Tulsa many years ago I was scheduled to do a breakshyout session called ldquoA Conversation with Jim

Nicholsonrdquo targeted towards selfshyadvocates As the

start time approached I was surprised at the large

number of people who were in attendance The

topics discussed in these sessions usually centered on

service delivery concernsmdashgood and bad providers or staff not being allowed enough freedom of choice not being listened to etc

During this session Warren stood and began

talking about his life experiences and how they

affected him Everyone who knew Warren knew him

as a very happy guy who always had a smile on his face But this was a different Warren He talked

about his mother leaving him as a small child at Enid

State School and how it pained him to think about being unwanted and abandoned Tears came to his eyes as he struggled to come to grips with memories of many decades past He created one of those

moments for which there is no real response possible

other than a thoughtful respectful silence and a

touch on the shoulder When Warren finished and sat down other selfshy

advocates stood and talked about their life

experiences and the incidents that caused them pain

People you would never expect revealed underlying wounds that they continued to struggle with That afternoon Warren opened the

way for many selfshyadvocates to

honestly share and thus lighten their burdens

After leaving Enid State School as an adult Warren became a wellshyknown figure in that community He established relationships with

everyone he came in contact with

from mayors and city councilmen to

several generations of workers at the

local McDonaldrsquos restaurant When the city dedicated

a new bridge many years ago Warren was invited to be

the first to officially cross it in his famous threeshywheeled cycle

Warren also went on to enjoy a rewarding career volunteering as a camera operator for the Enid public

access television station The Enid News and Eagle

printed a wonderful article marking his passing ldquoDeath of Warren Edds has an impact on communityrdquo As I read it I remembered our session in Tulsa and the

barriers Warren had overcome to become the person

everyone remembered as having a ldquocheery smile and

a kind heartrdquo Great success doesnrsquot come easy and it certainly didnrsquot for Warren

You can see a video clip of Warren that appears in

the documentary ldquoLiving in the Freedom Worldrdquo at httpwwwmnddcorgparallels2onevideovideo76b

shyfreedomworldhtml He was a star on both sides of the camera

James M Nicholson Director Developmental Disabilities Services Division

Oklahoma Department of Human Services 1 Developmental Disabilities Services Division

I N T E R F A C E

INNERTHOUGHTS

James Nicholson

Thinking of Warren

Warren Edds one of the first selfshyadvocates I met after

coming to DDSD in 1988 died on

June 22 at his home in Enid I had

not talked to Warren in a number of years but I used to see him

frequently at Oklahoma People

First meetings rallies and other events He was very active in the

selfshyadvocacy movement and was not bashful about making sure his voice and opinion were heard

The most memorable talk we had

was at a Governorrsquos Conference in

Tulsa many years ago I was scheduled to do a breakshyout session called ldquoA Conversation with Jim

Nicholsonrdquo targeted towards selfshyadvocates As the

start time approached I was surprised at the large

number of people who were in attendance The

topics discussed in these sessions usually centered on

service delivery concernsmdashgood and bad providers or staff not being allowed enough freedom of choice not being listened to etc

During this session Warren stood and began

talking about his life experiences and how they

affected him Everyone who knew Warren knew him

as a very happy guy who always had a smile on his face But this was a different Warren He talked

about his mother leaving him as a small child at Enid

State School and how it pained him to think about being unwanted and abandoned Tears came to his eyes as he struggled to come to grips with memories of many decades past He created one of those

moments for which there is no real response possible

other than a thoughtful respectful silence and a

touch on the shoulder When Warren finished and sat down other selfshy

advocates stood and talked about their life

experiences and the incidents that caused them pain

People you would never expect revealed underlying wounds that they continued to struggle with That afternoon Warren opened the

way for many selfshyadvocates to

honestly share and thus lighten their burdens

After leaving Enid State School as an adult Warren became a wellshyknown figure in that community He established relationships with

everyone he came in contact with

from mayors and city councilmen to

several generations of workers at the

local McDonaldrsquos restaurant When the city dedicated

a new bridge many years ago Warren was invited to be

the first to officially cross it in his famous threeshywheeled cycle

Warren also went on to enjoy a rewarding career volunteering as a camera operator for the Enid public

access television station The Enid News and Eagle

printed a wonderful article marking his passing ldquoDeath of Warren Edds has an impact on communityrdquo As I read it I remembered our session in Tulsa and the

barriers Warren had overcome to become the person

everyone remembered as having a ldquocheery smile and

a kind heartrdquo Great success doesnrsquot come easy and it certainly didnrsquot for Warren

You can see a video clip of Warren that appears in

the documentary ldquoLiving in the Freedom Worldrdquo at httpwwwmnddcorgparallels2onevideovideo76b

shyfreedomworldhtml He was a star on both sides of the camera

James M Nicholson Director Developmental Disabilities Services Division

Oklahoma Department of Human Services 1 Developmental Disabilities Services Division

I N T E R F A C E

Death of Warren Edds has an impact on communityBy Robert Barron Staff Writer Enid News and Eagle

(reprinted from June 24 2009)

Warren Edds never held a public

office He never was successful in business and there are no statues of him

in townBut everybody knew Edds and everyone

was used to seeing him ride his threeshywheeled cycle around town

His death at age 59 has had an impact in

Enid on people who knew him or even just knew who he was

Edds was supposed to wear oxygen at all times since becoming ill with pneumonia in

May He had not been seen for two or three

days when his body was found by a

neighbor inside his apartment about 8 pm Monday June 22 (Enid Police Department is investigating it as an unattended death

and said there is nothing suspicious) His funeral will be 10 am Thursday at

Davis Park Christian Church with the Rev Alan Seibel officiating Burial will follow at Enid State School under the direction of BrownshyCummings Funeral Home An

account has been set up at Central National Bank for funeral expenses The funeral home has asked friends for anecdotes to use

in his obituary Those stories may be sent to familyfirst

brownshycummingscom Edds was born Aug 19 1949 to Thomas

R and Cheryl Holland Edds He lived at Enid State School until earning his statute

of independent living He was a member of Davis Park Christian Church since 1975

He is survived by his father who lives in

Florida brother Steve Smith of Broken

Arrow sister Sandy Brown of Ohio and

aunt Gina Crotty of Stillwater

Edds volunteered at PEGASYS Enidrsquos publicshyaccess television station for 26

years regularly assisting with camera work He also was known for his support for Oklahoma State University athletics

ldquoHe always had something positive to say

about everyonerdquo said Wendy Quarles PEGASYS executive director and a friend

of Edds Edds could be seen frequently around

town riding an adult tricycle donated to

him by local business and groups or at McDonaldrsquos at Maine and Van Buren

engaging people in a spirited conversation

about OSU athletics Edds was a charter member and first

president of the Yes We Can Civitan

Club which consisted largely of people

with special needs He originated the

name of the club and was nominated as regional director of Civitans for Oklahoma and Arkansas He also was the

clubrsquos highest point producer earning the

name ldquoMr 400rdquo Edds scheduled regular programs on PEGASYS and the club

established the ldquoChiller Challengerdquo competition in which people jump into

freezing water to raise money for the

Special Olympics program Edds was 1981 Special Olympian of the Year

ldquoItrsquos people with special needs saying lsquoWe can do thatrsquordquo said Kathy Eck a

sponsor of the club ldquoHe was an icon in this town Even if

people didnrsquot know his name they knew

him because of him riding all over the

community on his tricycle with the orange

safety flag They knew of him He had an

infectious smile and was always concerned

about people He was just a kind personrdquo Eck said

The Enid News amp Eagle Web site

received a number of postings Tuesday after word of Eddsrsquo death became known

ldquoEnid has lost a great man a faithful friend and a dedicated volunteer Warren

will truly be missedrdquo said Lindy Chambers executive director of Main Street Enid

Another stated ldquoWarren will be missed He always said hello to anyone that would

listen OSU has lost a fanrdquo People who saw him casually said it was a

pleasure to know him that he always put a

smile on their face Mayor John Criner said Edds was a good

resident and encouraged him and the city

commission He went to the Public Library

of Enid and Garfield County daily to

remain informed on city matters When the

city dedicated a new bridge on West Randolph in 2007 Edds was the first to

ride across on his bicycle Molly Helm director of communications

and marketing for Autry Technology

Center recalled being a camp counselor at Campfire Camp in high school when some

of the clients at Sunnyside Nursing Home

came for the day Warrenrsquos nickname was Jabber as was Helmrsquos and she said they

immediately struck up a friendship ldquoYears later it has been especially heartshy

warming to see him working the cameras for PEGASYS doing something he

lovedrdquo Helm said ldquoHis cheery smile and

his kind heart will be missedrdquo mdash This article has been reprinted

with permission from the

Enid News and Eagle

Oklahoma Department of Human Services 2 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

Best of the Best in Direct Support Services honored

The statersquos most outstanding direct support professionals were recognized for their work

during the Governorrsquos Conference on Developmental Disabilities March 2 2009 at the Tulsa Renaissance

Hotel and Convention CenterThe annual Awards of Excellence in Direct Support

Services sponsored by the Developmental Disabilities Services Division honors individuals working in direct care in a variety of settings Nominations are sent to DDSD

from all over the state from provider agencies family

members and individuals with disabilities All of the direct support professionals recognized were presented with Awards of Excellence Out of the award winners the Best of the Best were chosen and featured in video presentations at the ceremony Awards of Excellence in Direct Support Services were presented to Will Watkins Rescare OklahomaLarry Lamm Supported Community LifestylesLora Catlett Gatesway FoundationAngel Balenti Phoenix Residential ServicesCharity Mormon Magna Community Living ServicesStephanie Lackas Reach Out IncRandy Brewer Gatesway FoundationKrystal Lewis Goodwill Industries of Southwest OklahomaSteve Poland Oklahoma Life Skills AssociationMattWeintz Volunteers of AmericaNancy Newson Kibois Community Action FoundationPatricia Harper Garvin County Community Living CenterMary Williams Rescare OklahomaLucinda Flynn People IncApril Thompson Independent Opportunities IncLaDonna Lang Central State Community ServicesDneta Carr Central State Community ServicesDaniel Escojido Supported Community LifestylesCindy Simmons Kibois Community Action FoundationDavid Pitts Homelife AssociationBeverly Kichler Volunteers of AmericaFreda Kretchmar BIOSAnnette Bounds Big Five Community ServicesGenea Shatto INCA Career Opportunities

Awards of Excellence in Direct Support Services winners (Back Row from left) Daniel Escojido Larry Lamm Will Watkins David Pitts Stephanie Lackas Patricia Harper Randy Brewer Matt Weintz and Krystal Lewis (Front Row from left) Genea Shatto April Thompson Lucinda Flynn Mary Williams Angel Balenti Charity Mormon Lora Catlett and Steve Poland

The Best of the Best in Direct Support Services Awards were presented to (From Left) Larry Lamm Will Watkins Stephanie Lackas Mikayla Angel Balenti Charity Mormon and Lora Catlett

Mark your calendars The 2010 Governorrsquos Conference on Developmental Disabilities will be held March 8shy9 To nominate someone for the Direct Support Services Awards contact the Developmental Disabilities Services Division at (405) 521shy6254

Oklahoma Department of Human Services 3 Developmental Disabilities Services Division

I N T E R FA C E

Governorrsquos Disability Employment Awards

Showcase

Steve Scott (Right) receives a 2008 Governorrsquos Disability Employment Award for his outstanding work from Howard Hendrick Cabinet Secretary of Human Services and Director of the Oklahoma Department of Human Services Scott was recognized for working 19 years with the same WalshyMart store in Sand Springs During that time Scott has received several promotions and pay raises

Oklahom

arsquos

reason to

brag

Oklahoma may be best known around the country for excellence in many

things from college football to producing awardshywinning countryshywesternmusic stars Probably not as well known is the fact that Oklahoma is the best state

in the nation at supporting people with developmental disabilities to work

in competitive jobs according to an independent ranking by the Institute

for Community Inclusion at the University of Massachusetts BostonldquoFor the past three years Oklahoma has led the nation in assisting people with

developmental disabilities to find competitive jobs and become working taxpayersrdquo said James Nicholson Director of the OKDHS Developmental Disabilities Services Division ldquoToday more than 60 percent of individuals with developmental disabilities served by our division participate in supported employment servicesrdquo

The Governorrsquos Disability Employment Awards are held each October to

recognize individuals with disabilities for their outstanding achievements at work

through the supported employment program Also recognized are businesses that hire people with disabilities and members of the media who promote supported

employment programs The Governorrsquos Disability Employment Awards are coshysponsored by Governor

Brad Henry and Lt Governor Jari Askins along with OKDHSshyDDSD the Department of Rehabilitation Services and the Oklahoma Association

of Persons in Supported Employment

The 2009 Governorrsquos Disability Employment awards will be held on

Oct 22 130 pm at the Governorrsquos Mansion Pavilion in Oklahoma City

InterFace NEWSLETTER

The 2008 award Receipeints wereBUS INESS WINNERS

Gene LukerAramark Glass Plant Tulsa

Gary CookMcDonaldrsquos Ardmore

WalshyMartCushing

Mike amp Terry GentryMcDonaldrsquos Lawton

Joyce and Fred HannahLektron LED Lighting Tulsa

Pizza HutCushing

Guest InnArdmore

JonMilneSODEXO Langston

WalshyMartMoore

City of Muskogee

Angela OwensSonic DriveshyIn Ardmore

WalshyMart Super CenterSand Springs

WalshyMart Super CenterVinita

MED IA WINNER

Dawndee Bostwichreporter Duncan Banner

EMPLOYEE WINNERS

Bobby Bailey

Bob Bennett

Tammie Burrall

Andy Cheater

Tommy Coleman

Jeff Dickson

Chad Joyce

Allen Kouba

Linda Prowell

Phillip Reed

Peter Rowland

Steve Scott

Kenneth Smith

Judy Wolfe

James Young

Oklahoma Department of Human Services 4 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

DDSD employees win advocacy awards

Angela King DDSD Area II case manager and Cindy

Jennings DDSD Area III nurse received awards from TARC in December 2008 King received the

AdvocateshyCase Manager of the Year award while

Jennings was recognized with a Special Achievement in

Advocacy AwardKing has nearly 20 years of experience in DDSD

case management working with individuals on every

type of waiver including the pilot project for the InshyHome Support waiver King began her career in the

field as a direct support professional before

becoming a recreational therapist and case

manager transitioning individuals from The

Hissom Memorial Center King gives each

person on her caseload the individual attention

they need regardless of the time it takes As a

recent example of her advocacy and

dedication she assisted a woman on her caseload in the process of obtaining

a divorce from her husband of many

years King referred the woman to a

community resource for legal advice

assisted her in completing all of the legal paperwork attended

court hearings with her and then took the woman apartment hunting

King even helped her move into the new apartment unpack and

decorate King has been known for her attention to detail and is extremely conscientious exemplifying her commitment to those

she servesJennings has volunteered for Oklahoma People First for the last

11 years assisting in the establishment of new chapters planning

state conferences writing grants to secure funding and soliciting

donations for conferences As an OPF volunteer Jennings is passionate about teaching individuals to advocate for themselves Her belief in their abilities empowers them to have faith in

themselves and in their abilities to make choices She educates OPF members on increasing their independence vocational opportunities voting relationships and community involvement Jennings empowers OPF members by offering them a support network to turn to when in need of assistance By doing so she

teaches others to recognize how much persons with developmental disabilities can do for themselves if given the right supports

InterFace NEWSLETTER

To see Oklahomarsquos ranking as compared to other states in regard to the numbers of persons with developmental disabilities in competitive jobs (supported employment)go to

wwwstatedatainfo

This website is a project of the Institute for Community Inclusion at UMass Boston supported in part by the Administration on Developmental Disabilities US Department of Health and Human Services under cooperative agreement with additional support from the National Institute on Disability and Rehabilitation Research of the US Department of Education

Angela King DDSD Area II case manager is presented with the AdvocateshyCase Manager of the Year award by John Gajda executive director TARC

Cindy Jennings DDSD Area III nurse is presented with a Special Achievement in Advocacy Award by John Gajda executive director TARC

Oklahoma Department of Human Services 5 Developmental Disabilities Services Division

I N T E R FA C E

Governorrsquos Disability Employment Awards

Showcase

Steve Scott (Right) receives a 2008 Governorrsquos Disability Employment Award for his outstanding work from Howard Hendrick Cabinet Secretary of Human Services and Director of the Oklahoma Department of Human Services Scott was recognized for working 19 years with the same WalshyMart store in Sand Springs During that time Scott has received several promotions and pay raises

Oklahom

arsquos

reason to

brag

Oklahoma may be best known around the country for excellence in many

things from college football to producing awardshywinning countryshywesternmusic stars Probably not as well known is the fact that Oklahoma is the best state

in the nation at supporting people with developmental disabilities to work

in competitive jobs according to an independent ranking by the Institute

for Community Inclusion at the University of Massachusetts BostonldquoFor the past three years Oklahoma has led the nation in assisting people with

developmental disabilities to find competitive jobs and become working taxpayersrdquo said James Nicholson Director of the OKDHS Developmental Disabilities Services Division ldquoToday more than 60 percent of individuals with developmental disabilities served by our division participate in supported employment servicesrdquo

The Governorrsquos Disability Employment Awards are held each October to

recognize individuals with disabilities for their outstanding achievements at work

through the supported employment program Also recognized are businesses that hire people with disabilities and members of the media who promote supported

employment programs The Governorrsquos Disability Employment Awards are coshysponsored by Governor

Brad Henry and Lt Governor Jari Askins along with OKDHSshyDDSD the Department of Rehabilitation Services and the Oklahoma Association

of Persons in Supported Employment

The 2009 Governorrsquos Disability Employment awards will be held on

Oct 22 130 pm at the Governorrsquos Mansion Pavilion in Oklahoma City

InterFace NEWSLETTER

The 2008 award Receipeints wereBUS INESS WINNERS

Gene LukerAramark Glass Plant Tulsa

Gary CookMcDonaldrsquos Ardmore

WalshyMartCushing

Mike amp Terry GentryMcDonaldrsquos Lawton

Joyce and Fred HannahLektron LED Lighting Tulsa

Pizza HutCushing

Guest InnArdmore

JonMilneSODEXO Langston

WalshyMartMoore

City of Muskogee

Angela OwensSonic DriveshyIn Ardmore

WalshyMart Super CenterSand Springs

WalshyMart Super CenterVinita

MED IA WINNER

Dawndee Bostwichreporter Duncan Banner

EMPLOYEE WINNERS

Bobby Bailey

Bob Bennett

Tammie Burrall

Andy Cheater

Tommy Coleman

Jeff Dickson

Chad Joyce

Allen Kouba

Linda Prowell

Phillip Reed

Peter Rowland

Steve Scott

Kenneth Smith

Judy Wolfe

James Young

Oklahoma Department of Human Services 4 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

DDSD employees win advocacy awards

Angela King DDSD Area II case manager and Cindy

Jennings DDSD Area III nurse received awards from TARC in December 2008 King received the

AdvocateshyCase Manager of the Year award while

Jennings was recognized with a Special Achievement in

Advocacy AwardKing has nearly 20 years of experience in DDSD

case management working with individuals on every

type of waiver including the pilot project for the InshyHome Support waiver King began her career in the

field as a direct support professional before

becoming a recreational therapist and case

manager transitioning individuals from The

Hissom Memorial Center King gives each

person on her caseload the individual attention

they need regardless of the time it takes As a

recent example of her advocacy and

dedication she assisted a woman on her caseload in the process of obtaining

a divorce from her husband of many

years King referred the woman to a

community resource for legal advice

assisted her in completing all of the legal paperwork attended

court hearings with her and then took the woman apartment hunting

King even helped her move into the new apartment unpack and

decorate King has been known for her attention to detail and is extremely conscientious exemplifying her commitment to those

she servesJennings has volunteered for Oklahoma People First for the last

11 years assisting in the establishment of new chapters planning

state conferences writing grants to secure funding and soliciting

donations for conferences As an OPF volunteer Jennings is passionate about teaching individuals to advocate for themselves Her belief in their abilities empowers them to have faith in

themselves and in their abilities to make choices She educates OPF members on increasing their independence vocational opportunities voting relationships and community involvement Jennings empowers OPF members by offering them a support network to turn to when in need of assistance By doing so she

teaches others to recognize how much persons with developmental disabilities can do for themselves if given the right supports

InterFace NEWSLETTER

To see Oklahomarsquos ranking as compared to other states in regard to the numbers of persons with developmental disabilities in competitive jobs (supported employment)go to

wwwstatedatainfo

This website is a project of the Institute for Community Inclusion at UMass Boston supported in part by the Administration on Developmental Disabilities US Department of Health and Human Services under cooperative agreement with additional support from the National Institute on Disability and Rehabilitation Research of the US Department of Education

Angela King DDSD Area II case manager is presented with the AdvocateshyCase Manager of the Year award by John Gajda executive director TARC

Cindy Jennings DDSD Area III nurse is presented with a Special Achievement in Advocacy Award by John Gajda executive director TARC

Oklahoma Department of Human Services 5 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

DDSD employees win advocacy awards

Angela King DDSD Area II case manager and Cindy

Jennings DDSD Area III nurse received awards from TARC in December 2008 King received the

AdvocateshyCase Manager of the Year award while

Jennings was recognized with a Special Achievement in

Advocacy AwardKing has nearly 20 years of experience in DDSD

case management working with individuals on every

type of waiver including the pilot project for the InshyHome Support waiver King began her career in the

field as a direct support professional before

becoming a recreational therapist and case

manager transitioning individuals from The

Hissom Memorial Center King gives each

person on her caseload the individual attention

they need regardless of the time it takes As a

recent example of her advocacy and

dedication she assisted a woman on her caseload in the process of obtaining

a divorce from her husband of many

years King referred the woman to a

community resource for legal advice

assisted her in completing all of the legal paperwork attended

court hearings with her and then took the woman apartment hunting

King even helped her move into the new apartment unpack and

decorate King has been known for her attention to detail and is extremely conscientious exemplifying her commitment to those

she servesJennings has volunteered for Oklahoma People First for the last

11 years assisting in the establishment of new chapters planning

state conferences writing grants to secure funding and soliciting

donations for conferences As an OPF volunteer Jennings is passionate about teaching individuals to advocate for themselves Her belief in their abilities empowers them to have faith in

themselves and in their abilities to make choices She educates OPF members on increasing their independence vocational opportunities voting relationships and community involvement Jennings empowers OPF members by offering them a support network to turn to when in need of assistance By doing so she

teaches others to recognize how much persons with developmental disabilities can do for themselves if given the right supports

InterFace NEWSLETTER

To see Oklahomarsquos ranking as compared to other states in regard to the numbers of persons with developmental disabilities in competitive jobs (supported employment)go to

wwwstatedatainfo

This website is a project of the Institute for Community Inclusion at UMass Boston supported in part by the Administration on Developmental Disabilities US Department of Health and Human Services under cooperative agreement with additional support from the National Institute on Disability and Rehabilitation Research of the US Department of Education

Angela King DDSD Area II case manager is presented with the AdvocateshyCase Manager of the Year award by John Gajda executive director TARC

Cindy Jennings DDSD Area III nurse is presented with a Special Achievement in Advocacy Award by John Gajda executive director TARC

Oklahoma Department of Human Services 5 Developmental Disabilities Services Division

I N T E R F A C E

Quality

AwardsBest of the Best

Regina ChacePrograms Manager for DDSD Employment Services

Regina Chace Program Manager for DDSD Employment Services receives an OKDHS Quality Award Best of the Best for her leadership in this program Chace ensures there are policies and processes which support participants to have a full range of opportunities for employment As a result Oklahoma has been recognized as the nationrsquos leader in achieving impressive outcomes in integrated employment for people with

disabilities InterFace NEWSLETTER

A Dream Come True Bobby Cooper and his parents were invited by Governor Brad Henry to meet with him and visit the capitol Tom Cooper Bobbyrsquos father is a member of the Governorrsquos Council for United We Ride representing people with disabilities Tom mentioned to Governor Henry in a letter that it had been Bobbyrsquos dream to meet him after seeing him speak on television during his reshyelection Governor Henry was so flattered by Bobbyrsquos request that he invited the whole family for a visit to the capitol in November 2008 They took a few moments to pose for this photograph in the Governorrsquos Blue Room From left Tom Cooper BobbyGovernor Henry and Ruth Cooper

Oklahoma Department of Human Services 6 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

James Nicholson Director of the OKDHS Developmental Disabilities Services Division is presented with a 2009 College of Allied Health Citation for Special Contributions (Left to Right) Jeff Berry Chair College of Allied Health Awards and Honors Committee College Dean Kevin Rudeen Nicholson and Martha Ferretti Professor and Chair Physical Therapy Department of Rehabilitation Sciences College of Allied Health

DDSD Nicholson receives award for contributions to College of Allied Health

On April 2 2009 James Nicholson Director of the OKDHS Developmental Disabilities Services

Division was presented with the 2009 College of AlliedHealth Citation for Special Contributions Nicholson was nominated for this award by Martha

Ferretti Professor and Chair Physical Therapy Department of Rehabilitation Sciences College of Allied Health University of Oklahoma Health Sciences Center In the nomination for this award Ferretti wrote ldquoMr Nicholsonrsquos background is one of diversity and richness

His work ethic sets a standard for us all to follow His calmness humor and general goodwill in the midst of controversy is obvious and remarkable And first and foremost his dedication to improving the lives of children and adults with developmental disabilities has set a standard for us all to emulate Mr Nicholsonrsquos creativity thoughtfulness and ability to target a goal and accomplish it regularly in collaboration with a number of formal and informal partners prove the importance of reaching beyond onersquos own resourcesldquoAs a visionary in the field of developmental disabilities early in his

role as director Mr Nicholson caught the attention of both supporters and detractors His vision was a perfect match for what our faculty were striving to accomplish in preparing our students and in providing servicesin the field of developmental disabilities ldquoWe approached Mr Nicholson shortly after he became the director with

a proposal for introducing assistive technology into the DDSD system differently than had been accomplished at that point Over the past 18 years

he and members of his staff have continued that collaboration on projects that addressed both major and minor challenges

about policy and services for Oklahomans with developmental disabilities

ldquoOur faculty has learned so much from this very politically astute and professional state leader Before the state was aware of its challenges emerging from children with autism and their families Mr Nicholson quietly accepted the mantle of addressing what we have come to know are unbelievable challenges presented by the impact of autism Seven years ago he convened a multishyagency multishydisciplinary task force that included parents of individuals with autism to develop the Oklahoma State Plan for Autism and the Oklahoma Autism Network We are honored by him placing the OAN within the structure of the College

ldquoMr Nicholson has stimulated us to mature as educators researchers and service providers to more effectively address many of Oklahomarsquos needs in the field of

developmental disabilitiesrdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 7 Developmental Disabilities Services Division

Nickrsquos Law

I N T E R F A C E

Insurance Mandates for autism treatments fail once again to pass Oklahoma legislature

For the second consecutive year bills that would have mandated insurance companies to cover

treatments for autism failed to pass through the Republicanshycontrolled legislatureIn February the House Economic Development and

Financial Services Committee voted down House Bill 1312 also known as ldquoNickrsquos Lawrdquo which would have required insurance providers to cover autism treatment The only autismshyrelated bills that did receive enough

support to pass were House Bill 2027 and its companion Senate Bill 135 The Senate version made it through the legislative process and will enact a licensing process for national board certified behavior analysts and enhance existing state programs that would train doctors to diagnose and treat autism Critics of this bill question whether it will actually produce

significant new services if insurance doesnrsquot cover the cost of treatment and parents canrsquot afford to pay the bill

ldquoSadly this bill will do nothing to relieve the pressure on families struggling to care for children with autismrdquo said Sen Jay Paul Gumm author of lsquoNickrsquos Lawrsquo legislation ldquoThis measure was designed to relieve political pressure on legislators who refuse to even consider Nickrsquos Lawrdquo

When Governor Henry signed Senate Bill 135 he said the measure was just a small step in the effort to help affected Oklahoma families He urged lawmakers to pass legislation to mandate insurance coverage for the treatment of autism

ldquoThere is nothing wrong with this bill just like there is nothing wrong with a pack of shingles at a construction siterdquo said Sen Gumm ldquoIf you try to put the shingles on before you pour the foundation you are doomed to failure As Governor Henry wisely noted when he signed the bill the foundation is insurance coverage of autism Absent that Senate Bill 135 is doomed to failurerdquo

Republican legislative leaders oppose insurance mandates saying they drive up the cost of health insurance despite reports from states with similar insurance mandates that show no significant increase in the cost of premiums

Republicans attempted to pass House Bill 1975 which would only allow insurance legislation to be introduced in oddshynumbered years and approved in evenshynumbered years The bill would have also required a 75 percent supershymajority vote to do away with the mandate in the case of an emergency

Henry vetoed that bill and said it would have unreasonably ldquotied the hands of state policy makers on a very important issuerdquo

ldquoThis would empower a small minority of legislators to thwart legitimate state efforts to address a pressing public policy issue and ensure that the restriction would rarely if ever be liftedrdquo Henry said

Henry also questioned why HB 1975 restrictions were only applied to a single issue area saying it raised legitimate concerns regarding why only one subject would be singled out for special treatment

Autism cont on page 9

Oklahoma Department of Human Services 8 Developmental Disabilities Services Division

SUMMER 2009

Autism cont from page 8

ldquoOklahoma and its citizens are better served when policy makers are allowed the freedom to address any pressing issue in the Legislature without the hindrance of arbitrary restrictionsrdquo Henry said Democrats offered a compromise mdash to put autism coverage in highshy

risk insurance pools as a last resort for families who canrsquot afford the coverage elsewhere Republicans again declined and instead went forward with SB 135 This year three more states enacted Autism Mandate legislation bringing

the total to 11 states that now require insurance companies to cover treatment for autism InterFace NEWSLETTER

Proudly displaying their CPR (Cardio Pulmonary Resuscitation) certificates are (From Left) Guy Bivens Allen Larimore Steve Sposato Andy Edwards Joshua Johnson and Tino Hensley residents of the Independence House

Residents of the Independence House at the Home of Hope in Vinita recently became CPR certified after a fellow resident had a heart attack A staff member used CPR to save Allen Larimorersquos life and he has since received a pacemaker Although staff members must be CPR certified this event inspired Larimorersquos housemates to take the class so they could also be prepared ndash just in case Donna Marlow a CPR trainer from the OKDHS Developmental Disabilities Services Division held the class free of charge at the agency and was proud that all the men passed their tests with flying colors

11th Circuit Rules Doctors donrsquot trump state on Medicaid care for children with disabilities by Alyson M Palmer

A federal appeals panel has declared that treating doctors donrsquot have the final say in how much nursing care the state must provide

children with disabilities under MedicaidOn April 24 the 11th US Circuit Court of Appeals reversed a district

judgersquos decision that had said the state must provide the amount of nursing care that a North Georgia girlrsquos doctor said she needs

Despite a slew of amicus briefs by state governments and Medicaid plan administrators the panel dispatched the case in a twoshypage unpublished unsigned opinion that came out a month after oral argument

Holland amp Knight partner Robert S Highsmith Jr who represented a proshystate friend of the court that provides managed care services for Medicaid programs said his client WellCare of Georgia had been concerned about language in US District Judge Thomas W Thrash Jrrsquos ruling that suggested anything ordered by a treating physician is medically necessary under the law ldquoThat one sentence just had to get reversedrdquo said Highsmith ldquoWe are very excited that they saw and reversed that clear errorrdquo

But an advocate for the teenage girl at the center of the case Atlanta Legal Aid Society General Counsel David A Webster said Monday that the decision ldquodoesnrsquot mean muchrdquo and says little about the relationship between the state and the treating physician ldquoThatrsquos going to be open for future litigationrdquo said Webster Webster said the case of his client Anna C Moore will go back to Thrash for the judge to consider the

11th Circuit Rules cont on page 15

Oklahoma Department of Human Services 9 Developmental Disabilities Services Division

I N TERFACE

ImaginingEverest The Story of LaelBy Adrienne Benz

ldquoI prayed for God to open the eyes of my understanding and the pieces began to fall into place Mollyrsquos future had been planned since she was a young girl she would marry andhave a bright healthy family known for their intelligence andkindness However the birth of her first born quickly dispelled the myth of the stereotypically perfect family as Molly learns her son Lael has Down syndrome Struggling to accept the disconcerting news and understand Godrsquos perfect plan Molly faces a challenge no more daunting than the climbing of the greatMt Everest she often dreamed of as a child Guilt hope grief and happiness take Molly and Lael across rocky terrain and risky edges but faith and the resonant voice of God bring mother and son up the emotional mountain 30 years in the making ndash a mountain that revealed the aptitude of Mollyrsquos beloved son and the kindness of others By Imagining Everest Molly and Lael forge a unique and amazing relationship which allows them to overcome even the most intimidating ascension into the unknownrdquo

Molly Mathewrsquos son Lael currently receives services through the OKDHSDDSD community waiver program

264 pages shy $1499 (paperback) This book is available online through Tate Publishing wwwtatepublishingcombookstore

Health and Human Services rescinds Medicaid regulations affecting case management

Department of Health and Human Services (HHS) Secretary

Kathleen Sebelius announed June 29 that the administration will rescind all or part of three Medicaid regulations that were previously

issued and delay the enforcement of a fourth regulation Each of these

rules in whole or in part had been subject to Congressional moratoria

set to expire on July 1 2009ldquoThese regulations if left in place would have potentially adverse

consequences for Medicaid beneficiaries some of our nationrsquos most vulnerable peoplerdquo said Secretary Sebelius ldquoBy rescinding

these rules we can expect that children will continue receiving

services through their schools beneficiaries will be able to

access all available case management resources to help them

better manage their health care and outpatient hospital and

clinic services can continue to be covered in the most efficient mannerrdquo

This ruling was crucial to Oklahomarsquos Developmental Disabilities Services as the state could have lost the ability

to bill Medicaid for 100 percent of the cost of providing

case management services to waiver service recipients which totals approximately $22 million per year

ldquoThe actions we are taking today are necessary to

ensure that the states have the flexibility they need to

fully serve Medicaidshyeligible individualsrdquo said

Secretary Sebelius

The Centers for Medicare amp Medicaid

Services (CMS) and HHS arebull Rescinding provisions of an interim final rule

published Dec 4 2007 which would have restricted beneficiary access to case management services These provisions appeared to in practice restrict beneficiary access to needed covered case management services and limit state flexibility in determining efficient and effective delivery systems for case management services

Regulations Expiring cont on page 11

Oklahoma Department of Human Services 10 Developmental Disabilities Services Division

SUMMER 2 0 0 9

Regulations Expiring cont from page 10

bull Rescinding a final rule published Dec 28 2007 that would have eliminated reimbursement for schoolshybased administrative costs and costs of transportation to and from schools The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students

bull Rescinding a rule published Nov 7 2008 that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories resulting in great impact than previously anticipated

bull Delaying until June 30 2010 the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance CMS may also further review the potential impact of the regulation and give additional consideration to alternative approaches InterFace NEWSLETTER

Waiting and HopingBy Adrienne Benz

Sad is like sitting here when I donrsquot have a home to run away to

So there on the street just waiting for something to eat somewhere to stay and a bed to sleep on and someone to hold

And hoping Irsquom still there the next day

They have to get up from the street in the park sitting on a cold chair in the dark

Just waiting for someone to take them in their home Waiting to open up and talk about their hidden feelings

like they canrsquot wait any longer

Adrienne Benz was a child in state custody when she wrote this poem She is now an adult reunited with her family

Oklahoma Department of Human Services 11 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

James Nicholson Director of the OKDHS Developmental Disabilities Services Division is presented with a 2009 College of Allied Health Citation for Special Contributions (Left to Right) Jeff Berry Chair College of Allied Health Awards and Honors Committee College Dean Kevin Rudeen Nicholson and Martha Ferretti Professor and Chair Physical Therapy Department of Rehabilitation Sciences College of Allied Health

DDSD Nicholson receives award for contributions to College of Allied Health

On April 2 2009 James Nicholson Director of the OKDHS Developmental Disabilities Services

Division was presented with the 2009 College of AlliedHealth Citation for Special Contributions Nicholson was nominated for this award by Martha

Ferretti Professor and Chair Physical Therapy Department of Rehabilitation Sciences College of Allied Health University of Oklahoma Health Sciences Center In the nomination for this award Ferretti wrote ldquoMr Nicholsonrsquos background is one of diversity and richness

His work ethic sets a standard for us all to follow His calmness humor and general goodwill in the midst of controversy is obvious and remarkable And first and foremost his dedication to improving the lives of children and adults with developmental disabilities has set a standard for us all to emulate Mr Nicholsonrsquos creativity thoughtfulness and ability to target a goal and accomplish it regularly in collaboration with a number of formal and informal partners prove the importance of reaching beyond onersquos own resourcesldquoAs a visionary in the field of developmental disabilities early in his

role as director Mr Nicholson caught the attention of both supporters and detractors His vision was a perfect match for what our faculty were striving to accomplish in preparing our students and in providing servicesin the field of developmental disabilities ldquoWe approached Mr Nicholson shortly after he became the director with

a proposal for introducing assistive technology into the DDSD system differently than had been accomplished at that point Over the past 18 years

he and members of his staff have continued that collaboration on projects that addressed both major and minor challenges

about policy and services for Oklahomans with developmental disabilities

ldquoOur faculty has learned so much from this very politically astute and professional state leader Before the state was aware of its challenges emerging from children with autism and their families Mr Nicholson quietly accepted the mantle of addressing what we have come to know are unbelievable challenges presented by the impact of autism Seven years ago he convened a multishyagency multishydisciplinary task force that included parents of individuals with autism to develop the Oklahoma State Plan for Autism and the Oklahoma Autism Network We are honored by him placing the OAN within the structure of the College

ldquoMr Nicholson has stimulated us to mature as educators researchers and service providers to more effectively address many of Oklahomarsquos needs in the field of

developmental disabilitiesrdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 7 Developmental Disabilities Services Division

Nickrsquos Law

I N T E R F A C E

Insurance Mandates for autism treatments fail once again to pass Oklahoma legislature

For the second consecutive year bills that would have mandated insurance companies to cover

treatments for autism failed to pass through the Republicanshycontrolled legislatureIn February the House Economic Development and

Financial Services Committee voted down House Bill 1312 also known as ldquoNickrsquos Lawrdquo which would have required insurance providers to cover autism treatment The only autismshyrelated bills that did receive enough

support to pass were House Bill 2027 and its companion Senate Bill 135 The Senate version made it through the legislative process and will enact a licensing process for national board certified behavior analysts and enhance existing state programs that would train doctors to diagnose and treat autism Critics of this bill question whether it will actually produce

significant new services if insurance doesnrsquot cover the cost of treatment and parents canrsquot afford to pay the bill

ldquoSadly this bill will do nothing to relieve the pressure on families struggling to care for children with autismrdquo said Sen Jay Paul Gumm author of lsquoNickrsquos Lawrsquo legislation ldquoThis measure was designed to relieve political pressure on legislators who refuse to even consider Nickrsquos Lawrdquo

When Governor Henry signed Senate Bill 135 he said the measure was just a small step in the effort to help affected Oklahoma families He urged lawmakers to pass legislation to mandate insurance coverage for the treatment of autism

ldquoThere is nothing wrong with this bill just like there is nothing wrong with a pack of shingles at a construction siterdquo said Sen Gumm ldquoIf you try to put the shingles on before you pour the foundation you are doomed to failure As Governor Henry wisely noted when he signed the bill the foundation is insurance coverage of autism Absent that Senate Bill 135 is doomed to failurerdquo

Republican legislative leaders oppose insurance mandates saying they drive up the cost of health insurance despite reports from states with similar insurance mandates that show no significant increase in the cost of premiums

Republicans attempted to pass House Bill 1975 which would only allow insurance legislation to be introduced in oddshynumbered years and approved in evenshynumbered years The bill would have also required a 75 percent supershymajority vote to do away with the mandate in the case of an emergency

Henry vetoed that bill and said it would have unreasonably ldquotied the hands of state policy makers on a very important issuerdquo

ldquoThis would empower a small minority of legislators to thwart legitimate state efforts to address a pressing public policy issue and ensure that the restriction would rarely if ever be liftedrdquo Henry said

Henry also questioned why HB 1975 restrictions were only applied to a single issue area saying it raised legitimate concerns regarding why only one subject would be singled out for special treatment

Autism cont on page 9

Oklahoma Department of Human Services 8 Developmental Disabilities Services Division

SUMMER 2009

Autism cont from page 8

ldquoOklahoma and its citizens are better served when policy makers are allowed the freedom to address any pressing issue in the Legislature without the hindrance of arbitrary restrictionsrdquo Henry said Democrats offered a compromise mdash to put autism coverage in highshy

risk insurance pools as a last resort for families who canrsquot afford the coverage elsewhere Republicans again declined and instead went forward with SB 135 This year three more states enacted Autism Mandate legislation bringing

the total to 11 states that now require insurance companies to cover treatment for autism InterFace NEWSLETTER

Proudly displaying their CPR (Cardio Pulmonary Resuscitation) certificates are (From Left) Guy Bivens Allen Larimore Steve Sposato Andy Edwards Joshua Johnson and Tino Hensley residents of the Independence House

Residents of the Independence House at the Home of Hope in Vinita recently became CPR certified after a fellow resident had a heart attack A staff member used CPR to save Allen Larimorersquos life and he has since received a pacemaker Although staff members must be CPR certified this event inspired Larimorersquos housemates to take the class so they could also be prepared ndash just in case Donna Marlow a CPR trainer from the OKDHS Developmental Disabilities Services Division held the class free of charge at the agency and was proud that all the men passed their tests with flying colors

11th Circuit Rules Doctors donrsquot trump state on Medicaid care for children with disabilities by Alyson M Palmer

A federal appeals panel has declared that treating doctors donrsquot have the final say in how much nursing care the state must provide

children with disabilities under MedicaidOn April 24 the 11th US Circuit Court of Appeals reversed a district

judgersquos decision that had said the state must provide the amount of nursing care that a North Georgia girlrsquos doctor said she needs

Despite a slew of amicus briefs by state governments and Medicaid plan administrators the panel dispatched the case in a twoshypage unpublished unsigned opinion that came out a month after oral argument

Holland amp Knight partner Robert S Highsmith Jr who represented a proshystate friend of the court that provides managed care services for Medicaid programs said his client WellCare of Georgia had been concerned about language in US District Judge Thomas W Thrash Jrrsquos ruling that suggested anything ordered by a treating physician is medically necessary under the law ldquoThat one sentence just had to get reversedrdquo said Highsmith ldquoWe are very excited that they saw and reversed that clear errorrdquo

But an advocate for the teenage girl at the center of the case Atlanta Legal Aid Society General Counsel David A Webster said Monday that the decision ldquodoesnrsquot mean muchrdquo and says little about the relationship between the state and the treating physician ldquoThatrsquos going to be open for future litigationrdquo said Webster Webster said the case of his client Anna C Moore will go back to Thrash for the judge to consider the

11th Circuit Rules cont on page 15

Oklahoma Department of Human Services 9 Developmental Disabilities Services Division

I N TERFACE

ImaginingEverest The Story of LaelBy Adrienne Benz

ldquoI prayed for God to open the eyes of my understanding and the pieces began to fall into place Mollyrsquos future had been planned since she was a young girl she would marry andhave a bright healthy family known for their intelligence andkindness However the birth of her first born quickly dispelled the myth of the stereotypically perfect family as Molly learns her son Lael has Down syndrome Struggling to accept the disconcerting news and understand Godrsquos perfect plan Molly faces a challenge no more daunting than the climbing of the greatMt Everest she often dreamed of as a child Guilt hope grief and happiness take Molly and Lael across rocky terrain and risky edges but faith and the resonant voice of God bring mother and son up the emotional mountain 30 years in the making ndash a mountain that revealed the aptitude of Mollyrsquos beloved son and the kindness of others By Imagining Everest Molly and Lael forge a unique and amazing relationship which allows them to overcome even the most intimidating ascension into the unknownrdquo

Molly Mathewrsquos son Lael currently receives services through the OKDHSDDSD community waiver program

264 pages shy $1499 (paperback) This book is available online through Tate Publishing wwwtatepublishingcombookstore

Health and Human Services rescinds Medicaid regulations affecting case management

Department of Health and Human Services (HHS) Secretary

Kathleen Sebelius announed June 29 that the administration will rescind all or part of three Medicaid regulations that were previously

issued and delay the enforcement of a fourth regulation Each of these

rules in whole or in part had been subject to Congressional moratoria

set to expire on July 1 2009ldquoThese regulations if left in place would have potentially adverse

consequences for Medicaid beneficiaries some of our nationrsquos most vulnerable peoplerdquo said Secretary Sebelius ldquoBy rescinding

these rules we can expect that children will continue receiving

services through their schools beneficiaries will be able to

access all available case management resources to help them

better manage their health care and outpatient hospital and

clinic services can continue to be covered in the most efficient mannerrdquo

This ruling was crucial to Oklahomarsquos Developmental Disabilities Services as the state could have lost the ability

to bill Medicaid for 100 percent of the cost of providing

case management services to waiver service recipients which totals approximately $22 million per year

ldquoThe actions we are taking today are necessary to

ensure that the states have the flexibility they need to

fully serve Medicaidshyeligible individualsrdquo said

Secretary Sebelius

The Centers for Medicare amp Medicaid

Services (CMS) and HHS arebull Rescinding provisions of an interim final rule

published Dec 4 2007 which would have restricted beneficiary access to case management services These provisions appeared to in practice restrict beneficiary access to needed covered case management services and limit state flexibility in determining efficient and effective delivery systems for case management services

Regulations Expiring cont on page 11

Oklahoma Department of Human Services 10 Developmental Disabilities Services Division

SUMMER 2 0 0 9

Regulations Expiring cont from page 10

bull Rescinding a final rule published Dec 28 2007 that would have eliminated reimbursement for schoolshybased administrative costs and costs of transportation to and from schools The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students

bull Rescinding a rule published Nov 7 2008 that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories resulting in great impact than previously anticipated

bull Delaying until June 30 2010 the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance CMS may also further review the potential impact of the regulation and give additional consideration to alternative approaches InterFace NEWSLETTER

Waiting and HopingBy Adrienne Benz

Sad is like sitting here when I donrsquot have a home to run away to

So there on the street just waiting for something to eat somewhere to stay and a bed to sleep on and someone to hold

And hoping Irsquom still there the next day

They have to get up from the street in the park sitting on a cold chair in the dark

Just waiting for someone to take them in their home Waiting to open up and talk about their hidden feelings

like they canrsquot wait any longer

Adrienne Benz was a child in state custody when she wrote this poem She is now an adult reunited with her family

Oklahoma Department of Human Services 11 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

Nickrsquos Law

I N T E R F A C E

Insurance Mandates for autism treatments fail once again to pass Oklahoma legislature

For the second consecutive year bills that would have mandated insurance companies to cover

treatments for autism failed to pass through the Republicanshycontrolled legislatureIn February the House Economic Development and

Financial Services Committee voted down House Bill 1312 also known as ldquoNickrsquos Lawrdquo which would have required insurance providers to cover autism treatment The only autismshyrelated bills that did receive enough

support to pass were House Bill 2027 and its companion Senate Bill 135 The Senate version made it through the legislative process and will enact a licensing process for national board certified behavior analysts and enhance existing state programs that would train doctors to diagnose and treat autism Critics of this bill question whether it will actually produce

significant new services if insurance doesnrsquot cover the cost of treatment and parents canrsquot afford to pay the bill

ldquoSadly this bill will do nothing to relieve the pressure on families struggling to care for children with autismrdquo said Sen Jay Paul Gumm author of lsquoNickrsquos Lawrsquo legislation ldquoThis measure was designed to relieve political pressure on legislators who refuse to even consider Nickrsquos Lawrdquo

When Governor Henry signed Senate Bill 135 he said the measure was just a small step in the effort to help affected Oklahoma families He urged lawmakers to pass legislation to mandate insurance coverage for the treatment of autism

ldquoThere is nothing wrong with this bill just like there is nothing wrong with a pack of shingles at a construction siterdquo said Sen Gumm ldquoIf you try to put the shingles on before you pour the foundation you are doomed to failure As Governor Henry wisely noted when he signed the bill the foundation is insurance coverage of autism Absent that Senate Bill 135 is doomed to failurerdquo

Republican legislative leaders oppose insurance mandates saying they drive up the cost of health insurance despite reports from states with similar insurance mandates that show no significant increase in the cost of premiums

Republicans attempted to pass House Bill 1975 which would only allow insurance legislation to be introduced in oddshynumbered years and approved in evenshynumbered years The bill would have also required a 75 percent supershymajority vote to do away with the mandate in the case of an emergency

Henry vetoed that bill and said it would have unreasonably ldquotied the hands of state policy makers on a very important issuerdquo

ldquoThis would empower a small minority of legislators to thwart legitimate state efforts to address a pressing public policy issue and ensure that the restriction would rarely if ever be liftedrdquo Henry said

Henry also questioned why HB 1975 restrictions were only applied to a single issue area saying it raised legitimate concerns regarding why only one subject would be singled out for special treatment

Autism cont on page 9

Oklahoma Department of Human Services 8 Developmental Disabilities Services Division

SUMMER 2009

Autism cont from page 8

ldquoOklahoma and its citizens are better served when policy makers are allowed the freedom to address any pressing issue in the Legislature without the hindrance of arbitrary restrictionsrdquo Henry said Democrats offered a compromise mdash to put autism coverage in highshy

risk insurance pools as a last resort for families who canrsquot afford the coverage elsewhere Republicans again declined and instead went forward with SB 135 This year three more states enacted Autism Mandate legislation bringing

the total to 11 states that now require insurance companies to cover treatment for autism InterFace NEWSLETTER

Proudly displaying their CPR (Cardio Pulmonary Resuscitation) certificates are (From Left) Guy Bivens Allen Larimore Steve Sposato Andy Edwards Joshua Johnson and Tino Hensley residents of the Independence House

Residents of the Independence House at the Home of Hope in Vinita recently became CPR certified after a fellow resident had a heart attack A staff member used CPR to save Allen Larimorersquos life and he has since received a pacemaker Although staff members must be CPR certified this event inspired Larimorersquos housemates to take the class so they could also be prepared ndash just in case Donna Marlow a CPR trainer from the OKDHS Developmental Disabilities Services Division held the class free of charge at the agency and was proud that all the men passed their tests with flying colors

11th Circuit Rules Doctors donrsquot trump state on Medicaid care for children with disabilities by Alyson M Palmer

A federal appeals panel has declared that treating doctors donrsquot have the final say in how much nursing care the state must provide

children with disabilities under MedicaidOn April 24 the 11th US Circuit Court of Appeals reversed a district

judgersquos decision that had said the state must provide the amount of nursing care that a North Georgia girlrsquos doctor said she needs

Despite a slew of amicus briefs by state governments and Medicaid plan administrators the panel dispatched the case in a twoshypage unpublished unsigned opinion that came out a month after oral argument

Holland amp Knight partner Robert S Highsmith Jr who represented a proshystate friend of the court that provides managed care services for Medicaid programs said his client WellCare of Georgia had been concerned about language in US District Judge Thomas W Thrash Jrrsquos ruling that suggested anything ordered by a treating physician is medically necessary under the law ldquoThat one sentence just had to get reversedrdquo said Highsmith ldquoWe are very excited that they saw and reversed that clear errorrdquo

But an advocate for the teenage girl at the center of the case Atlanta Legal Aid Society General Counsel David A Webster said Monday that the decision ldquodoesnrsquot mean muchrdquo and says little about the relationship between the state and the treating physician ldquoThatrsquos going to be open for future litigationrdquo said Webster Webster said the case of his client Anna C Moore will go back to Thrash for the judge to consider the

11th Circuit Rules cont on page 15

Oklahoma Department of Human Services 9 Developmental Disabilities Services Division

I N TERFACE

ImaginingEverest The Story of LaelBy Adrienne Benz

ldquoI prayed for God to open the eyes of my understanding and the pieces began to fall into place Mollyrsquos future had been planned since she was a young girl she would marry andhave a bright healthy family known for their intelligence andkindness However the birth of her first born quickly dispelled the myth of the stereotypically perfect family as Molly learns her son Lael has Down syndrome Struggling to accept the disconcerting news and understand Godrsquos perfect plan Molly faces a challenge no more daunting than the climbing of the greatMt Everest she often dreamed of as a child Guilt hope grief and happiness take Molly and Lael across rocky terrain and risky edges but faith and the resonant voice of God bring mother and son up the emotional mountain 30 years in the making ndash a mountain that revealed the aptitude of Mollyrsquos beloved son and the kindness of others By Imagining Everest Molly and Lael forge a unique and amazing relationship which allows them to overcome even the most intimidating ascension into the unknownrdquo

Molly Mathewrsquos son Lael currently receives services through the OKDHSDDSD community waiver program

264 pages shy $1499 (paperback) This book is available online through Tate Publishing wwwtatepublishingcombookstore

Health and Human Services rescinds Medicaid regulations affecting case management

Department of Health and Human Services (HHS) Secretary

Kathleen Sebelius announed June 29 that the administration will rescind all or part of three Medicaid regulations that were previously

issued and delay the enforcement of a fourth regulation Each of these

rules in whole or in part had been subject to Congressional moratoria

set to expire on July 1 2009ldquoThese regulations if left in place would have potentially adverse

consequences for Medicaid beneficiaries some of our nationrsquos most vulnerable peoplerdquo said Secretary Sebelius ldquoBy rescinding

these rules we can expect that children will continue receiving

services through their schools beneficiaries will be able to

access all available case management resources to help them

better manage their health care and outpatient hospital and

clinic services can continue to be covered in the most efficient mannerrdquo

This ruling was crucial to Oklahomarsquos Developmental Disabilities Services as the state could have lost the ability

to bill Medicaid for 100 percent of the cost of providing

case management services to waiver service recipients which totals approximately $22 million per year

ldquoThe actions we are taking today are necessary to

ensure that the states have the flexibility they need to

fully serve Medicaidshyeligible individualsrdquo said

Secretary Sebelius

The Centers for Medicare amp Medicaid

Services (CMS) and HHS arebull Rescinding provisions of an interim final rule

published Dec 4 2007 which would have restricted beneficiary access to case management services These provisions appeared to in practice restrict beneficiary access to needed covered case management services and limit state flexibility in determining efficient and effective delivery systems for case management services

Regulations Expiring cont on page 11

Oklahoma Department of Human Services 10 Developmental Disabilities Services Division

SUMMER 2 0 0 9

Regulations Expiring cont from page 10

bull Rescinding a final rule published Dec 28 2007 that would have eliminated reimbursement for schoolshybased administrative costs and costs of transportation to and from schools The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students

bull Rescinding a rule published Nov 7 2008 that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories resulting in great impact than previously anticipated

bull Delaying until June 30 2010 the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance CMS may also further review the potential impact of the regulation and give additional consideration to alternative approaches InterFace NEWSLETTER

Waiting and HopingBy Adrienne Benz

Sad is like sitting here when I donrsquot have a home to run away to

So there on the street just waiting for something to eat somewhere to stay and a bed to sleep on and someone to hold

And hoping Irsquom still there the next day

They have to get up from the street in the park sitting on a cold chair in the dark

Just waiting for someone to take them in their home Waiting to open up and talk about their hidden feelings

like they canrsquot wait any longer

Adrienne Benz was a child in state custody when she wrote this poem She is now an adult reunited with her family

Oklahoma Department of Human Services 11 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

SUMMER 2009

Autism cont from page 8

ldquoOklahoma and its citizens are better served when policy makers are allowed the freedom to address any pressing issue in the Legislature without the hindrance of arbitrary restrictionsrdquo Henry said Democrats offered a compromise mdash to put autism coverage in highshy

risk insurance pools as a last resort for families who canrsquot afford the coverage elsewhere Republicans again declined and instead went forward with SB 135 This year three more states enacted Autism Mandate legislation bringing

the total to 11 states that now require insurance companies to cover treatment for autism InterFace NEWSLETTER

Proudly displaying their CPR (Cardio Pulmonary Resuscitation) certificates are (From Left) Guy Bivens Allen Larimore Steve Sposato Andy Edwards Joshua Johnson and Tino Hensley residents of the Independence House

Residents of the Independence House at the Home of Hope in Vinita recently became CPR certified after a fellow resident had a heart attack A staff member used CPR to save Allen Larimorersquos life and he has since received a pacemaker Although staff members must be CPR certified this event inspired Larimorersquos housemates to take the class so they could also be prepared ndash just in case Donna Marlow a CPR trainer from the OKDHS Developmental Disabilities Services Division held the class free of charge at the agency and was proud that all the men passed their tests with flying colors

11th Circuit Rules Doctors donrsquot trump state on Medicaid care for children with disabilities by Alyson M Palmer

A federal appeals panel has declared that treating doctors donrsquot have the final say in how much nursing care the state must provide

children with disabilities under MedicaidOn April 24 the 11th US Circuit Court of Appeals reversed a district

judgersquos decision that had said the state must provide the amount of nursing care that a North Georgia girlrsquos doctor said she needs

Despite a slew of amicus briefs by state governments and Medicaid plan administrators the panel dispatched the case in a twoshypage unpublished unsigned opinion that came out a month after oral argument

Holland amp Knight partner Robert S Highsmith Jr who represented a proshystate friend of the court that provides managed care services for Medicaid programs said his client WellCare of Georgia had been concerned about language in US District Judge Thomas W Thrash Jrrsquos ruling that suggested anything ordered by a treating physician is medically necessary under the law ldquoThat one sentence just had to get reversedrdquo said Highsmith ldquoWe are very excited that they saw and reversed that clear errorrdquo

But an advocate for the teenage girl at the center of the case Atlanta Legal Aid Society General Counsel David A Webster said Monday that the decision ldquodoesnrsquot mean muchrdquo and says little about the relationship between the state and the treating physician ldquoThatrsquos going to be open for future litigationrdquo said Webster Webster said the case of his client Anna C Moore will go back to Thrash for the judge to consider the

11th Circuit Rules cont on page 15

Oklahoma Department of Human Services 9 Developmental Disabilities Services Division

I N TERFACE

ImaginingEverest The Story of LaelBy Adrienne Benz

ldquoI prayed for God to open the eyes of my understanding and the pieces began to fall into place Mollyrsquos future had been planned since she was a young girl she would marry andhave a bright healthy family known for their intelligence andkindness However the birth of her first born quickly dispelled the myth of the stereotypically perfect family as Molly learns her son Lael has Down syndrome Struggling to accept the disconcerting news and understand Godrsquos perfect plan Molly faces a challenge no more daunting than the climbing of the greatMt Everest she often dreamed of as a child Guilt hope grief and happiness take Molly and Lael across rocky terrain and risky edges but faith and the resonant voice of God bring mother and son up the emotional mountain 30 years in the making ndash a mountain that revealed the aptitude of Mollyrsquos beloved son and the kindness of others By Imagining Everest Molly and Lael forge a unique and amazing relationship which allows them to overcome even the most intimidating ascension into the unknownrdquo

Molly Mathewrsquos son Lael currently receives services through the OKDHSDDSD community waiver program

264 pages shy $1499 (paperback) This book is available online through Tate Publishing wwwtatepublishingcombookstore

Health and Human Services rescinds Medicaid regulations affecting case management

Department of Health and Human Services (HHS) Secretary

Kathleen Sebelius announed June 29 that the administration will rescind all or part of three Medicaid regulations that were previously

issued and delay the enforcement of a fourth regulation Each of these

rules in whole or in part had been subject to Congressional moratoria

set to expire on July 1 2009ldquoThese regulations if left in place would have potentially adverse

consequences for Medicaid beneficiaries some of our nationrsquos most vulnerable peoplerdquo said Secretary Sebelius ldquoBy rescinding

these rules we can expect that children will continue receiving

services through their schools beneficiaries will be able to

access all available case management resources to help them

better manage their health care and outpatient hospital and

clinic services can continue to be covered in the most efficient mannerrdquo

This ruling was crucial to Oklahomarsquos Developmental Disabilities Services as the state could have lost the ability

to bill Medicaid for 100 percent of the cost of providing

case management services to waiver service recipients which totals approximately $22 million per year

ldquoThe actions we are taking today are necessary to

ensure that the states have the flexibility they need to

fully serve Medicaidshyeligible individualsrdquo said

Secretary Sebelius

The Centers for Medicare amp Medicaid

Services (CMS) and HHS arebull Rescinding provisions of an interim final rule

published Dec 4 2007 which would have restricted beneficiary access to case management services These provisions appeared to in practice restrict beneficiary access to needed covered case management services and limit state flexibility in determining efficient and effective delivery systems for case management services

Regulations Expiring cont on page 11

Oklahoma Department of Human Services 10 Developmental Disabilities Services Division

SUMMER 2 0 0 9

Regulations Expiring cont from page 10

bull Rescinding a final rule published Dec 28 2007 that would have eliminated reimbursement for schoolshybased administrative costs and costs of transportation to and from schools The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students

bull Rescinding a rule published Nov 7 2008 that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories resulting in great impact than previously anticipated

bull Delaying until June 30 2010 the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance CMS may also further review the potential impact of the regulation and give additional consideration to alternative approaches InterFace NEWSLETTER

Waiting and HopingBy Adrienne Benz

Sad is like sitting here when I donrsquot have a home to run away to

So there on the street just waiting for something to eat somewhere to stay and a bed to sleep on and someone to hold

And hoping Irsquom still there the next day

They have to get up from the street in the park sitting on a cold chair in the dark

Just waiting for someone to take them in their home Waiting to open up and talk about their hidden feelings

like they canrsquot wait any longer

Adrienne Benz was a child in state custody when she wrote this poem She is now an adult reunited with her family

Oklahoma Department of Human Services 11 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

I N TERFACE

ImaginingEverest The Story of LaelBy Adrienne Benz

ldquoI prayed for God to open the eyes of my understanding and the pieces began to fall into place Mollyrsquos future had been planned since she was a young girl she would marry andhave a bright healthy family known for their intelligence andkindness However the birth of her first born quickly dispelled the myth of the stereotypically perfect family as Molly learns her son Lael has Down syndrome Struggling to accept the disconcerting news and understand Godrsquos perfect plan Molly faces a challenge no more daunting than the climbing of the greatMt Everest she often dreamed of as a child Guilt hope grief and happiness take Molly and Lael across rocky terrain and risky edges but faith and the resonant voice of God bring mother and son up the emotional mountain 30 years in the making ndash a mountain that revealed the aptitude of Mollyrsquos beloved son and the kindness of others By Imagining Everest Molly and Lael forge a unique and amazing relationship which allows them to overcome even the most intimidating ascension into the unknownrdquo

Molly Mathewrsquos son Lael currently receives services through the OKDHSDDSD community waiver program

264 pages shy $1499 (paperback) This book is available online through Tate Publishing wwwtatepublishingcombookstore

Health and Human Services rescinds Medicaid regulations affecting case management

Department of Health and Human Services (HHS) Secretary

Kathleen Sebelius announed June 29 that the administration will rescind all or part of three Medicaid regulations that were previously

issued and delay the enforcement of a fourth regulation Each of these

rules in whole or in part had been subject to Congressional moratoria

set to expire on July 1 2009ldquoThese regulations if left in place would have potentially adverse

consequences for Medicaid beneficiaries some of our nationrsquos most vulnerable peoplerdquo said Secretary Sebelius ldquoBy rescinding

these rules we can expect that children will continue receiving

services through their schools beneficiaries will be able to

access all available case management resources to help them

better manage their health care and outpatient hospital and

clinic services can continue to be covered in the most efficient mannerrdquo

This ruling was crucial to Oklahomarsquos Developmental Disabilities Services as the state could have lost the ability

to bill Medicaid for 100 percent of the cost of providing

case management services to waiver service recipients which totals approximately $22 million per year

ldquoThe actions we are taking today are necessary to

ensure that the states have the flexibility they need to

fully serve Medicaidshyeligible individualsrdquo said

Secretary Sebelius

The Centers for Medicare amp Medicaid

Services (CMS) and HHS arebull Rescinding provisions of an interim final rule

published Dec 4 2007 which would have restricted beneficiary access to case management services These provisions appeared to in practice restrict beneficiary access to needed covered case management services and limit state flexibility in determining efficient and effective delivery systems for case management services

Regulations Expiring cont on page 11

Oklahoma Department of Human Services 10 Developmental Disabilities Services Division

SUMMER 2 0 0 9

Regulations Expiring cont from page 10

bull Rescinding a final rule published Dec 28 2007 that would have eliminated reimbursement for schoolshybased administrative costs and costs of transportation to and from schools The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students

bull Rescinding a rule published Nov 7 2008 that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories resulting in great impact than previously anticipated

bull Delaying until June 30 2010 the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance CMS may also further review the potential impact of the regulation and give additional consideration to alternative approaches InterFace NEWSLETTER

Waiting and HopingBy Adrienne Benz

Sad is like sitting here when I donrsquot have a home to run away to

So there on the street just waiting for something to eat somewhere to stay and a bed to sleep on and someone to hold

And hoping Irsquom still there the next day

They have to get up from the street in the park sitting on a cold chair in the dark

Just waiting for someone to take them in their home Waiting to open up and talk about their hidden feelings

like they canrsquot wait any longer

Adrienne Benz was a child in state custody when she wrote this poem She is now an adult reunited with her family

Oklahoma Department of Human Services 11 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

SUMMER 2 0 0 9

Regulations Expiring cont from page 10

bull Rescinding a final rule published Dec 28 2007 that would have eliminated reimbursement for schoolshybased administrative costs and costs of transportation to and from schools The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students

bull Rescinding a rule published Nov 7 2008 that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories resulting in great impact than previously anticipated

bull Delaying until June 30 2010 the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance CMS may also further review the potential impact of the regulation and give additional consideration to alternative approaches InterFace NEWSLETTER

Waiting and HopingBy Adrienne Benz

Sad is like sitting here when I donrsquot have a home to run away to

So there on the street just waiting for something to eat somewhere to stay and a bed to sleep on and someone to hold

And hoping Irsquom still there the next day

They have to get up from the street in the park sitting on a cold chair in the dark

Just waiting for someone to take them in their home Waiting to open up and talk about their hidden feelings

like they canrsquot wait any longer

Adrienne Benz was a child in state custody when she wrote this poem She is now an adult reunited with her family

Oklahoma Department of Human Services 11 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

I N T E R FA C E

DDSD Fiscal Year 2010 Budget Outlook OKDHS Director Howard Hendrick

presented the agencyrsquos Fiscal Year 2010 budget to the Commission for Human Services on June 16 Hendrick emphasized that even with the additional federal stimulus money and other oneshytime funds the agencyrsquos overall funding will be approximately $50 million short of anticipated spending levels To achieve a balanced budget cuts would have to be made within each division The Developmental Disabilities Services Divisionrsquos

share of the cuts amount to approximately 3 percent of the divisionrsquos operating budget ($17 million) Another $200000 had to be identified to fund the new initiative for Applied Behavior Analysis mandated by Senate Bill 135 this legislative sessionDDSD was able to accomplish the budget cuts without

impact to any programs or services through reductionsat the Northern and Southern Oklahoma ResourceCenters The rest of the savings came from reductions in training and professional contracts the divisions holds with various entitiesOver the next year DDSD will be under a selfshyimposed hiring

freeze for all positions except for case management direct care professionals and registered nursesIf monthly state revenue collections continue to fall below

expected levels additional reductions may be required of all stateagenciesrsquo operating budgets

Interim StudiesThere will be two interim legislative studies conducted this summer that could impact DDSD and service recipients

One of these studies will investigate a possible provider feetax on agencies providing waiver community services If the provider feetax is found to be within federal Medicaid guidelines it could possibly be used to fund rate increases in waiver services

The other legislative study will look into the pros and cons of online training versus classroom training specifically for providers of DDSD community services

Money Follows the PersonAs of this date DDSD has transitioned eight people from Northern Oklahoma Resource Center of Enid and Southern Oklahoma Resource Center into community homes using the federal Money Follows the Person grant Utilizing these federal funds DDSD has been able to save approximately $21000 in the community services provided to those individuals

Oklahoma documentary on developmental disabilities history to air on OETA

an

Oklahoma

document

ary

Adocumentary showing Oklahomarsquos history serving people with intellectual and developmental disabilities is

scheduled to begin airing on OETA (Oklahomarsquos Education Television Authority) in October during national Disabilities Awareness Month

The video ldquoWagons to Waivers A Century of Changerdquo narrated by Oklahomarsquos own country music star Reba McEntire will be broadcast on the OETAshyOklahoma channel starting on Oct 24th at 5 pm and on Nov 5th at 830 pm The program will be

aired a couple times a month

The documentary takes viewers on an emotional journey from the days of the Dust Bowl and covered wagons and shows the statersquos progression from institutional services to full community inclusion for persons with intellectual disabilities Oklahomarsquos story begins in 1909

with the creation of the Institute for the Feeble Minded in Enid and includes the

tears and efforts of parents the stories ofpeople who grew up in institutions the legal struggles and the triumph of selfshyadvocacy The video was produced by the Oklahoma Department of Human Services Developmental Disabilities Services Division

OETAshyOKLA is Cox Cable channel 112 but other television carriers as well as satellite users can access the channel which is devoted to Oklahomashyspecific programming Check your local television lis tings for specific programming dates and times

Oklahoma Department of Human Services 12 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

SUMMER 2009Compassion friendship and longevity A good measure of success

The day had finally come and Danny waited anxiously on the sofa He watched quietly as the

nursing staff set up the hospital bed and made his friend Carl comfortable The minute all was clear Danny went to Carl and told him how much he had missed him and that he needed him to get better Dannyrsquos longshytime friend had just undergone surgery

to remove a malignant brain tumor Danny didnrsquot understand the procedure or Carlrsquos prognosis ndash all that mattered was that his best friend was home It just wasnrsquot home without CarlCarl is considered the head of the household that he shares

with Danny and his other friend Hershel Carl was always the one who planned their meals said the prayers at the diningroom table and got them involved in Special Olympics events When Carl became ill and went to the hospital it was Danny

who stepped up and tried to fill in ndash just until Carl came home ldquoThe Three Musketeersrdquo (thatrsquos what their staff call them) have

been friends and have lived together for more than 30 years

Danny (lef

t) spends

hours by

Carlrsquos sid

e

encourag

ing him in his

recovery

They met as boys at The Hissom Memorial Center the nowshyclosed institution in Sand Springs for persons with developmental disabilities When they aged out of Hissom the three moved about the same time to a private facility where they lived for many years

In 1993 The Musketeers were given the opportunity to move together once again into a house in their community supported through the DDSD Medicaid Community Waiver program Since

that time they have lived in the house withsome of the same staffmembers who havecared for them for morethan 20 years

The Three Musketeers Danny (left) shows his excitement over his friend Carlrsquos (right) return from the hospital after brain surgery Shy Hershel (center) wipes tears from his eyes

Carl is recoveringfrom his surgery andworking on his abilityto speak and onregaining the use of theleft side of his bodyThe staff in the home

often has to make Danny go to bed at 1 am when hersquos still sitting beside Carl encouraging him to get better so he can go back to work

All three men have jobs and love their work ndash Carlmost of all Danny somehow knows that if Carl canjust get back to work life will continue as they onceknew it

ldquoTheyrsquore like a wellshysettled familyrdquo said Gretchen Moser their DDSD case manager ldquoEven their families consider these guys a family and respect their wishesrdquo

These days there are many opinions about what constitutes a family or even success But there are stories that transcend those discussions Stories like these that remind us success can also be measured by the love and longevity of a friend InterFace NEWSLETTER

Relations

hips

Oklahoma Department of Human Services 13 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

I N T E R F A C E

StateLegislativeNews

Of the thousand or more bills filed at the beginning of the 2009 legislative session only a few made it through the entire process that will have an impact on persons with developmental disabilities families and professionals in the field They are

HB 1007 mdash Wesselhoft Leftwich Signed by the Governor Requires specific Physically Disabled person signage to be posted as a reserved area for the parking of a vehicle displaying a valid permit

HB 1019 mdash WrightSigned by the Governor Recreates the Group Homes for Persons with Developmental or Physical Disabilities Advisory Board

HB 1048 mdash Banz AldridgeSigned by the Governor Relates to the collection of delinquent real property taxes removes physically disabled from ldquoincapacitatedrdquo persons granted additional time to redeem personal items reduces time to collect excess sale proceeds by half

HB 1065 mdash Faught Crain Signed by the Governor Relates to the Continuum of Care and Assisted Living Act adds definition and requires inspection results to be posted on website

HB 1424 mdash Protor Signed by the Governor Requires treatment facilities transitional living facilities halfway houses and any house or facility that may be used for medical or nonmedical detoxification to mail notification to property owners within a quarter mile radius if zoning changes are proposed

HB 1461 mdash Sears Ford Signed by the Governor A school that does not make adequate yearly progress for two straight years shall utilize the assistance of a school support team formed by the State Department of Education EMERGENCY

HB 1581 mdash Coody Jolley Signed by the Governor School teacher candidates that wish to teach elementary early childhood education or special education programs must study the five elements of reading instruction EMERGENCY

HB 1763 mdash Enns Reynolds Signed by the Governor Requires the state Department of Education to provide special education training for process hearing officers to ensure adequate knowledge in special education laws and proceduresEMERGENCY

HB 1893 mdash Peterson Anderson Signed by the Governor Creates the Aging and Disability Resource Consortium to work with other agencies in developing and implementing a singleshypointshyofshyentry concept for aging and disability groups in Oklahoma

SB 135 mdash Johnson Mike Signed by the Governor Provides for the licensing of certain persons to practice as a licensed behavior analyst or a licensed assistant behavior analyst and to study children with autism and their behaviors directs funds to be used by the Department of Human Services Developmental Disabilities Services division for training SoonerStart providers to treat children with autism spectrum disorders provides for a behavorial analysis research pilot project provides legislative intent

SB 518 mdash Justice Osborn Signed by the Governor Adds grandparents as members of immediate family

SB 871 mdash Anderson Signed by the Governor Modifies membership of the Electronic and Information Technology Accessibility Advisory Council

Oklahoma Department of Human Services 14 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

S U M M E R 2 0 0 9

11th Circuit Rules cont from page 9

matter again Moore a teenager living in North Georgia who goes by ldquoCallierdquo has been receiving inshyhome nursing care paid for by Medicaid for about a decade The state has been trying to cut the number of hours of care she receives each week

The 11th Circuit interpreted a federal law that says states participating in the Medicaid program must provide ldquoearly and periodic screening diagnostic and treatment servicesrdquo that are necessary to ldquocorrect or ameliorate defects and physical and mental illnessesrdquo in Medicaidshyeligible children The primary ways children become eligible for Medicaid are that they come from a lowshyincome family or have a disability according to Joshua H Norris another one of Calliersquos lawyers

Georgiarsquos Department of Community Health operates a program to administer Medicaidshyfunded nursing services for several hundred children who need nursing care It delegates the decisions about approval of such services to an organization called the Georgia Medical Care Foundation

According to Thrashrsquos order Callie is disabled because of a stroke she experienced in utero and suffers from various chronic conditions including mental retardation and cerebral palsy She lives at home and according to the statersquos brief attends an elementary school in Athens Ga three days a week Her lawyers have said she requires constant care

The statersquos lawyers have said that nursing hours can be reduced when the patientrsquos medical condition stabilizes positing that a goal of the program is to teach parents and other caregivers to take care of their children on their own The Mooresrsquo lawyers have contended that the statersquos system of ldquoweaningrdquo patients off their nursing services as long as theyrsquore staying out of the hospitaland not getting worse follows a different standard than that set by federal law

In 2006 the state informed Calliersquos mother that it was reducing Calliersquos nursing hours from 94 hours a week to 84 contrary to the recommendation of Calliersquos primary care physician Calliersquos mother filed suit

The Mooresrsquo lawyers convinced Thrash that the reduction was improper Afterissuing multiple injunctions in Calliersquos favor he denied the statersquos motion for summary judgment and granted the Mooresrsquo motion in part concluding the state must provide for the amount of skilled nursing care that Calliersquos treating physician deems necessary The panel that ruled in favor of the state in its appeal was comprised of Senior 11th Circuit Judge R Lanier Anderson III 11th Circuit Judge Gerald B Tjoflat and US District Judge Lisa Godbey Wood visiting from the Southern District of Georgia

The panel said both the state and Calliersquos physician have roles in determining whatrsquos medically necessary to correct or ameliorate Calliersquos medical conditions It cited a federal regulation that says a Medicaid agency ldquomay place appropriate limits on a service based on such criteria as medical necessity or utilization control proceduresrdquo

ldquoA private physicianrsquos word on medical necessity is not dispositiverdquo the panel concluded

Assistant Attorney General Virginia B Fuller made the successful oral argument for the state last month Attorney General Thurbert E Bakerrsquos spokesman Russ Willard said in an eshymail that the state ldquois appreciative of the Court of Appeals decision recognizing the role of the Medicaid program in providing for this treatmentrdquo

Norris who also is director of legal advocacy for a nonprofit that advocates for people with disabilities said the 11th Circuit gave Thrash

an opportunity to say more about the roles of treating doctors and the state in deciding what care the state needs to provide Norris noted that Thrash wrote on the subject last year in another nursing care case about a Savannah Ga boy who nearly drowned when he was 2Thrash barred the state from enforcing a policy of not providing nursing care for patients requiring 16

to 24 hours per day for more than one week he said that criteria isnrsquot based on whatrsquos medically necessary under federal Medicaid law

On the other handThrash denied the plaintiff rsquos request based on the

treating physicianrsquos recommendation for 24shyhourshyashyday private nursing services for an

indefinite period of time Thrash deemed such a prescription ldquoan abuse of the Medicaid systemrdquo

The state has limited discretion to deny a providerrsquos request for care under the ldquoearly and periodic

screening diagnostic and treatment servicesrdquo portion of the Medicaid Act said Thrash He added that ldquo[t]he statersquos discretion is limited to a review of the request for fraud abuse of the Medicaid system and whether the service is within the reasonable

standards of medical carerdquo InterFace NEWSLETTER

Oklahoma Department of Human Services 15 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

klahoma Department of Human Services

I N T E R F A C E

DDSD Area II Project Elves get together to wrap all the presents and make sure they are delivered to the individuals before Christmas Elves work year round

to make Christmas special for DDSD clients For the past eight years individuals with

developmental disabilities who donrsquot have families or who would otherwise not receive gifts have had their Christmas wishes come true thanks to caring DDSD ldquoelvesrdquo in Area II Project Elf is the brainchild of ldquoThe Men in Recrdquo namely

Steve Pitts and Roger McDaniel DDSD Area II recreational therapists and Joe Stie DDSD case manager ldquoDDSD serves a lot of people with developmental

disabilities who donrsquot have families to celebrate the holidays withrdquo said Pitts ldquoAlthough our services meet their basic needs therersquos still a gap when it comes to those special things that families do for one anotherrdquoThat gap has been filled by The Men in Rec who work all year

long coordinating various events to raise money to buy Christmas presents for individuals ldquoWe raise all of the funds and no OKDHS money is usedrdquo said

Pitts ldquoThis year we are selling Blue and Gold sausage and Amish jams We also have an annual Christmas Carol fundraising performance which is donated to Project Elf by the American Theater Company We are given 300 tickets that we can sell and last year we sold 225rdquoDDSD coshyworkers got together and purchased 44 of those theater

tickets last year for the children who happened to be in the Laura Dester Center Shelter around the holidays ldquoWe have also set up a sponsorship program where people can purchase

the gift and return it wrapped and ready for the elf (aka case manager) to deliver This last Christmas we had 108 sponsors 30 of whom were the case managers themselvesrdquo

The Men in Rec also recruit fellow DDSD workers to help shop for the gifts and wrap themldquoWe could not accomplish this awesome Project Elf without the assistance of so many of our coshyworkers and our community volunteersrdquo he said ldquoItrsquos such a pleasure to share these gifts at Christmas time and let our customers know that they have a family through our good service to themrdquoThe Men in Rec are currently working to raise money for this yearrsquos Christmas gifts If you would like to join the rank of DDSD Elves by donating funds or becoming a sponsor please contact Steve Pitts at stevepittsokdhsorg or call918shy794shy7625 InterFace NEWSLETTER

Steve Pitts (right) DDSD Area II recreational therapist gives a donated WalshyMart gift card to case manager Roy Willett to purchase a Christmas gift for one of the people on his caseload

Oklahoma Department of Human Services 16 Developmental Disabilities Services Division

shy shyshy shy

shy shy

shy shy

shy shy

shy shy shy

shy shyshy shy

shy shyshy shy

shy shyshy shy

shy shyshy shy

Developmental Disabilities Services Area Offices and Resource Centers

CUSTER

ELLIS

BECKHAM WASHITA CADDO

McCLAIN

SEM

INO

LE HUGHES HASKELL

LE FLORELATIMER PITTSBURG

COAL

ATOKA

PONTOTOC

JOHNSTON

GARVIN

MURRAY

CARTER

LOVE

BRYAN CHOCTAW

PUSHMATAHA McCURTAIN

GRADY

KIOWA

TILLMAN

JACKSON HA

RM

ON

GREER

COTTON

JEFFERSON

STEPHENS

COMANCHE

McINTOSH

CLEVELAND

POTT

AWAT

OM

IE

DEWEY BLAINE

CANADIAN

MAJOR

GRANT KAY OSAGE

WA

SHIN

GTO

N CRAIG

ROGERS

CH

ERO

KEE

ADAIR TULSA

WAGONER

MAYES

OKMULGEE

CREEK

LINCOLN

LOGAN

PAYNE

KINGFISHER

OKLAHOMA OKFUSKEE

MUSKOGEE SEQUOYAH

DEL

AWA

RE

OTTAWA NOATTA

GARFIELD NOBLE

PAWNEE

WOODS ALFALFA HARPER BEAVER TEXASCIMARRON

WOODWARD

ROGER MILLS

MARSH

Oklahoma CityOklahoma City

Tulsa

Area II

Area III

Area I

Pauls Valley

Enid

wwwokdhsorg

State Officetoll free 1shy866shy521shy3571

AREA Itoll free 1shy800shy522shy1064

AREA IItoll free 1shy800shy522shy1075

AREA IIItoll free 1shy800shy522shy1086

Greer Center (Enid)2501 NE Delaware Enid OK 73701

580 237 10272599 FAX 580 213 2799

Northwest Oklahoma Resource Center at Enid (NORCE)2600 E Willow

Enid OK 73701

580 237 1027

FAX 580 548 2600

Southern Oklahoma Resource Center at Pauls Valley (SORC)3210 Chickasaw St

Pauls Valley OK 73075 6822

405 238 6401

FAX 405 238 8261

DDSD Area I Office (Enid)729 Overland Trail Enid OK 73703

580 548 8900 FAX 580 548 8964

DDSD Area I Office (Oklahoma City)4545 N Lincoln Blvd

Oklahoma City OK 73105 405 522 6925

FAX 405 522 6995

DDSD Area II Office (Tulsa)Laura Dester Center 1427 E 8th Tulsa OK 74120

918 560 4848 FAX 918 560 4898

DDSD Area III Office (Pauls Valley)301 S Indian Meridian Rd Pauls Valley OK 73075

405 238 4700 FAX 405 238 4740

If you would like to find out what the DevelopmentalDisabilities Services Division has to offer come and visit our Web site at

wwwokdhsorg

If you would like to find out what the Developmental Disabilities Services Division has to offer come and visit our Web site at

wwwokdhsorg

This will take you to the main Oklahoma Department of Human Services Web page From there just click on Divisions and Offices and the Developmental Disabilities Services Division On our Web site you will find information about services the division offers how to apply for services eligibility policies contract provider agencies and much more

Come visit us today You may be surprised at what you will learn

OKLAHOMA DEPARTMENT OF HUMAN SERVICES Developmental Disabilities Services DivisionPO Box 25352 Oklahoma City OK 73125