ARRM News and Public Relations

Competitive Workforce Factor: Where Are We Now?

Late on Friday, Dec. 13, the Minnesota Department of Human Services (DHS) released an update on the Competitive Workforce Factor (CWF) announcing it had not yet received a response from the federal Centers for Medicare & Medicaid Services (CMS) on whether the application of the CWF had been approved. Where does that leave providers, lead agencies, advocates and individuals served as they try to complete authorizations and compute rates for services that start in 2020?

To recap, here’s what we know so far:

• The final omnibus health and human services (HHS) bill that Gov. Walz signed into law following the 2019 special legislative session included a competitive workforce factor of 4.7% that applied to direct care awake staff. It did not apply to asleep staff, supervisory hours, or RN and LPN nursing hours.
• On October 1, 2019, DHS sent a waiver amendment application to CMS that included the CWF as well as many other changes to the existing waiver amendment. CMS has 90 days to make a formal response, which means their response could come as late as December 31, 2019. In their response, they can approve or deny it wholesale, or respond with questions and/or concerns for DHS to respond to, which would start the 90-day clock all over again upon DHS’ response.
• In October 2019, DHS released the Disability Waiver Rate System (DWRS) component values for 2020. They were identical to the 2019 values with the exception of the asleep overnight wage component increasing from $9.86 to $10.00 per hour to reflect the state’s new minimum wage, effective January 1, 2020.
• In November, 2019, DHS notified lead agencies and home and community-based service waiver providers that use the Rate Management System (RMS) within the MnCHOICES Support Plan that they would update the RMS on December 13, 2019. This RMS update would include changes to some framework component values which would affect 2020 rate calculations, and would include the CWF if CMS’ approval was received by that time.

What now?...

The rest of this article is exclusive ARRM Member content. Members, visit the members-only Daily Dispatch blog for the full article (log-on required), or contact ARRM about becoming a member.

 

Remember, if your organization has questions about the impact of the Competitive Workforce Factor and the end of rate banding in 2020, ARRM has resources. Find low cost recordings of trainings and sample worksheets on our Training Archive (available free to ARRM members), and for customized support visit www.arrm.org/CWF.

Commentary: Focus greater attention on structural barriers to inclusion for people with disabilities

By Sue Schettle

Published by the Minneapolis Star Tribune on 12/14/2019 (original publication here)

The latest article in the Chaotic Care series (Disabled Minnesotans Often Live in Costly Isolation, 12/08/2019) had the opportunity to continue the series’ constructive look into the current challenges Minnesotans with disabilities face in having the opportunity to live their best lives. Unfortunately, several core issues were glazed over, and some ignored, in exchange for painting a negative picture of group homes where hundreds of Minnesotans in fact do receive the support and services they need for a high quality of life.

Minnesota’s relatively large number of group homes is a manifestation of being one of the first states to close all state institutions housing people with disabilities. Beginning as early as the late 60’s and early 70’s, Minnesota led the nation in a commitment to the community integration of people with intellectual and developmental disabilities. Minnesota closed its institutions, establishing the alternative of group homes as the most individualized and community-based support setting conceived at the time. To this day, Minnesota is one of only 17 states with no state institutions.

However, this history is just for context, because progress never stops. Fifty years ago, the list of options for community-based services was short. Today, group homes are part of a spectrum of residence and support options for people with disabilities. This is a great advancement that offers the potential for people to customize the support they need with the independence they want.

I say potential because as the article calls out, too many still lack access to those opportunities. Yet centralizing group homes as the problem is a disservice to addressing the true factors preventing more people from living their best lives. 

The article failed to address the lack of affordable housing or discriminatory zoning ordinances and tenant policies which limit options even in the most progressive of counties.

It failed to discuss that direct support staff shortages covered in the article affect people in ALL housing situations, not just group homes. Access to stable staff is a key factor in whether a person can have the confidence to live in a more individualized setting.

The article glazed over the central role of counties and case managers in supporting transitions to more individualized homes. As the ultimate administrators of waiver funding, they are not being held accountable for their responsibilities to ensure people can access the most independent setting possible.

In the overwhelming majority of cases, structural barriers like these take the choice and opportunity out of the hands of people with disabilities. 

Finally, the article misleadingly states group homes are more costly than individualized services. Yet the scope of services being provided is drastically different in a group home setting. The majority of people living in group homes require some level of 24-hour support, while people living on their own are utilizing a fraction of that. Making this comparison is like suggesting that the retail store minute clinic is a better health care investment because getting a flu shot there costs less than a hospital stay for pneumonia.

This all boils down to two main points which the article had the chance to make, but instead, overly focused on a handful of negative group home experiences.

First, group homes do not deserve the overall negativity portrayed by this article. While they are not the right home and support setting for some, they are extremely positive options for others and exist on a spectrum of services designed to maximize a person’s independence and avoid more expensive and restrictive care settings.

Second, lack of public awareness, or will, to take action on systemic issues is the root cause of the fact that many who want to live in a different setting and have greater access to their community are not currently receiving that choice. It must be addressed. The services sector is shifting, with significant and growing numbers of programs supporting a variety of living situations for people, from organizations using a combination of innovative tools, above-and-beyond resourcefulness, and in some cases, pure grit. Yet, they are capped in their growth not because there are too many group homes, but by inconsistent county administration and case management, lack of affordable housing stock, and the demographics of those needing support outstripping those providing support by a factor of five to one.

We in the disability service sector have openly and deliberately communicated these concerns to both state officials and the media. Opportunities for Minnesotans with disabilities to live lives based on their abilities will continue to be limited until we as a state stop looking for where we can place the easy blame and start taking responsibility for addressing the real barriers.

Sue Schettle is the CEO of the Association of Residential Resources in Minnesota (ARRM), an association of more than 200 organizations representing the Home and Community-Based Services industry, from intermediate care facilities to individual home support.

Key Victory for DSP Wages in Minnesota

Session is Over, Now What?

The 2019 legislative session ended last weekend after the convening of a special session. The final Health and Human Services Omnibus Bill was released on Friday, May 24. Included in the final legislation was a Competitive Workforce Factor of 4.7%. What this means in everyday-speak is a nearly $70 million dollar investment in DSP wages and benefits over the next four years.

ARRM members can find more detailed analysis on the Competitive Workforce Factor and the overall HHS bill on our members' blog, the Daily Dispatch.

We had big wins this session, but the work isn't done yet! ARRM is already looking towards the next legislative session.

Say Thank You!

You called, you emailed, you rallied, and Minnesota's elected leaders received your message! Legislators and Gov. Walz said, "We are going to make Home and Community-Based services a priority in Minnesota." This commitment to passing a Competitive Workforce Factor for DWRS is a big step in addressing the 17 percent wage gap for DSPs.

Additionally, remember to thank yourself! Staff, family members, and self-advocates all came together to demand change. Your voices made a difference. Your stories inspire Minnesotans every single day. Thank you for your hard work and your dedication to supporting the disability services workforce!

Display your appreciation by thanking those who helped us to support your supports!

Cool Tools for Saying Thank You!

ARRM created this Thank You Video as a token of our appreciation for the efforts of both legislators and ARRM members. We had record attendance at Disability Services Day at the Capitol, there was massive turnout at the Best Life Alliance Town Hall Forum, and over 50 site visits with ARRM members were held this year. Thank you for enabling ARRM staff to make your priorities known and valued by the Minnesota government.

Share this video on Facebook and Twitter and remember to tag your legislators.

Want to say more? Well, look no further. The Best Life Alliance prepared thank you letterhead for you to send!

Communication is key and establishing strong relationships with local legislators is critical to future success at the Capitol. For more information, check out our Thank You Campaign page!

ARRM Outlines Priorities to HHS Conference Committee

Last week, ARRM sent a letter to each member of the Health and Human Services (HHS) Conference Committee, the group which will combine the House and Senate versions of HHS budget bills into one for final passage. This committee has several provisions in front of it related to critical issues for the home and community-based services (HCBS) more than 35,000 Minnesotans with disabilities utilize to support their independence and community inclusion.

ARRM, on behalf of its more than 160 provider members and the HCBS industry as a whole, sent a letter to conference committee members outlining its guidance on several issues. Two provisions stand out for our organization and many aligned stakeholders in this field:

• Workforce investments (support): Both bill versions introduce targeted re-investments in the reimbursement rates for services, directed to increase the wages of the support professionals who work directly with clients, up to a projected $133 million over the next four years (current statewide average just over $13/hr). This would begin to address the structural 17 percent wage gap between these jobs and other positions competing for similar workforce talent; ARRM strongly supports these measures, with a preference for the House language.
  
  
• Caps on support (opposed): Language in the Senate bill would place a cap on the number of qualifying people who could receive Medicaid waivers. ARRM and other aligned stakeholders strongly oppose this measure: reducing access to the primary source of financial support for people with intellectual and developmental disabilities to receive services which help them stay out of institutional settings and maximize their abilities is not the answer to solve concerns over costs or capacity.

There are several other issues ARRM is fighting for and asked the committee to consider in its letter:

• Supporting the ability for all Intermediate Care Facilities (ICF) to seek service rate exceptions for the people they support to ensure they are able to meet their changing needs
• Supporting additional investigation capacity for reviewing complaints to ensure a quality and timely process, but ensuring fee increases to pay for this are recouped in cost-of-service reimbursements and do not become additional unfunded expenses on provider organizations
• Preventing policy from passing which would reduce the capacity of adult foster care through the forced closure of resident slots

The scope of legislation related to this field currently under consideration will have significant impacts to this sector serving tens of thousands of vulnerable adults, and employing more than 100,000 statewide. We hope you will join ARRM in advocating for these issues.

Hi all, Madeleine here with some legislative updates and reminders regarding Disability Services Day at the Capitol!

Day at the Capitol (DAC) is your opportunity to make your voices heard and advocate to strengthen the disability services workforce. Howeer, we are not limiting our discussions with legislators to just DAC. ARRM members and other advocates are constantly pushing for change!

Live From the House

Yesterday, the House Health and Human Services Policy Committee held hearings on HF168, sponsored by Rep. Jennifer Schultz (07A), and HF179, sponsored by Rep. Laurie Halverson (51B). The goal of HF168 is to address the wage gap for direct care providers and the goal of HF179 is to address that gap as well as add a competitive workforce factor to DWRS. Many members of the Best Life Alliance attended the Committee meeting and a couple, such as chair and parent Judy Marder, even testified. Footage of the Committee meeting can be found here, on the Best Life Alliance Facebook Page.

Live From the Senate

Yesterday, the Senate Committee on Human Services Reform Finance and Policy also held a hearing. The Committee, led by Senator Jim Abeler, allocated time for the Best Life Alliance to testify with regard to the workforce crisis. After nine testifiers, the Senators were willing to have an open discussion about the workforce shortage of DSPs. Footage of the hearing can be found here on the ARRM Facebook page.

It is Time to Gear Up

With exactly one month until Disability Services Day at the Capitol, it is time to make sure that you have registered and submitted all designs for the Button Contest! To register, click here!

However, it is crucial that we always remain active participants in the legislative process.

 

If you have questions about DAC or the updates listed above, please contact me at [email protected].

Caregiver pay again up for discussion at Capitol, Mankato Free Press 1.10.2019

Late last week, the Mankato Free Press published an article about efforts to raise wages for Direct Support Professionals (DSPs). This includes a bill from Mankato State Representative Jack Considine (DFL) of District 19B, a staunch supporter of raising the minimum wage for caregivers in Minnesota. The Representative stated, “Frankly, I’m embarrassed we’re not paying them more.”

It also discusses the legislation from the Best Life Alliance, which seeks to close the wage gap between DSPs and other similar profession over several years through progressive increases, starting with an 8.3 percent bump in the upcoming fiscal year.

The article also quotes ARRM’s Director of Strategic Communications, Drew Henry. “We’ve got this situation where supports continue to be very good, but as the workforce shortage gets worse, there are fewer and fewer workers to offer access to these services.”

Read the full article here.

Sharing these types of articles is important to help educate people about the importance of Direct Support Professionals. Spread the word! Click below to share.

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RELEASE: Groups Sue To Halt Damaging Cuts To Disability Services

Individuals and provider advocacy organizations argue state must uphold current rates

Today, ARRM joined the Minnesota Organization for Habilitation and Rehabilitation (MOHR) and several individuals with disabilities in filing suit in federal court against Commissioner of Human Services Emily Johnson Piper, seeking an emergency injunction against the implementation of a 7 percent cut to the rates for community-based supportive services. The cut is set to go into effect on July 1.

“This cut will cause irreparable harm to our members and the people with disabilities they support as we are already in the midst of a workforce crisis due in large part to lack of wage competition,” said Sue Schettle, CEO of ARRM. “Since the complete breakdown of the legislative process failed to produce a sustainable fix to the regulatory dispute driving DHS to enact the cut, we are forced to seek injunctive relief from federal court to address this critical issue.”

The suit claims current Minnesota statute – unchanged as a result of Governor Mark Dayton’s veto of the omnibus supplemental spending bill – obligates Minnesota Department of Human Services (DHS) to continue to fully fund its obligations to the service rates paid for through the state’s Medicaid waivers, which allow people with disabilities to access an array of supports to live and work in community settings. It further claims provisions in federal law do not allow the Centers for Medicaid and Medicare Services (CMS) to withhold its matching Medicaid dollars should a court order compel the DHS to continue to fund services at existing rates.

Plaintiffs say an injunction is needed immediately because organizations and people with disabilities face devastating impacts should the cut go into effect.

Mike Burke, president of MOHR, represents more than 100 Minnesota day service providers. “All we are looking for is for some sense of long term stability,” said Burke. “Stability in a system that will allow us to pay our staff competitive wages, which ultimately helps thousands of people with disabilities across the state who rely on our services for their quality of life.”

The 7 percent cut was triggered by a CMS decision back in February to withdraw its match of a 3-year-old rate adjustment due to an inadvertent conflict with other rate changes made in 2017. The state, in turn, negated its portion of the rate adjustment, which plaintiffs argue it has no authority to do as state law still recognizes this funding obligation. Advocates tried to pass their own fix to this issue during the 2018 legislative session but the resolution was struck down as part of the Governor’s veto. Should the injunction be granted, advocates will work with legislators and the new Governor’s administration to permanently address the problem in the next legislative session.

Sam Orbovich of Fredrikson & Byron is representing the plaintiffs in their petition.

7% Cut Update: Time to take action

In an effort to keep members informed and up-to-date on what is happening with the impending 7% rate cut, ARRM will be publishing a weekly update on the status of legislation and how you can take action to help Stop The Cut! Don't forget to subscribe to catch all the updates.

Governor’s Budget does not address the 7% Cut

This last Friday, March 16^th, Governor Dayton released his 2018 Supplemental Budget. ARRM was disappointed to see that Governor Dayton did not address the 7% cut in his budget proposal. ARRM CEO Sue Schettle released this statement stating that it is now up to the legislature to protect services for people with disabilities.

New Resources Available to educate and inform on the 7% Cut

ARRM has developed a new section on its website dedicated to educating on the 7% cut and providing resources to providers, staff and family members to take action. New features include:

• 7% Cut Fact Sheet
• Best Life Alliance Grassroots One-Pager
• Regularly Updated Call To Actions
• Resources to contact media

Please share the website link www.arrm.org/stop-the-cut within your networks and encourage advocates to get involved to help STOP THE CUT!

Day at the Capitol Conversations Making a Difference

We are hearing from legislators that the conversations they had with constituents during last week’s successful ARRM/MOHR Day at the Capitol are making a difference. We need to keep the pressure on, if you haven’t done so already, reach out to your legislators and tell them to Stop the Cut. You can find more specific information on what to say to your legislators here.

Questions

If you have specific questions about the details of the 7% cut or how you can be involved, please contact Sara Grafstrom at [email protected].

Up To Legislature To Protect Services For People With Disabilities

Governor’s supplemental budget takes no action on cut to support for Minnesotans with disabilities

NEWS RELEASE

SAINT PAUL, MINN. – ARRM, an association representing more than 200 direct care providers and organizations supporting home and community-based services for people with disabilities in Minnesota, responded to Governor Dayton’s proposed supplemental budget.

“It is extremely disappointing to see the Governor’s proposed supplemental budget not address the seven percent cut to reimbursement rates many Minnesotans with disabilities use to access home and community-based services in order to live independently,” said Sue Schettle, CEO of ARRM. “Many, many stakeholders have made the administration aware of the harmful impacts this policy issue creates: tens of millions of dollars in lost aid for thousands of Minnesotans.”

The seven percent cut was created by a conflict in state policy that caused the federal Centers for Medicare and Medicaid Services to disallow an investment in quality and workforce competitiveness enhancements passed by the State Legislature three years ago. The result returned approximately $10 million to the state general fund for the current biennium, and more than $50 million for the following biennium. With $123 million remaining on the bottom line, room remains to fix the problem and restore the cuts before they go into effect.

“While ARRM applauds and encourages important investments in educational opportunities for people with disabilities proposed by the Governor, the result of the overall state budget should uphold opportunities for people throughout their lives,” said Schettle. “We understand the administration has many competing interests to address, but a top priority should be reinstating funding which for the last three years has gone towards high quality services and maintaining workforce competitiveness.”

The administration’s Office of Management and Budget projects wages across the state to rise by an average of 5.5 percent next year, a significant concern for providers of community-based services who already struggle to hire and retain direct care staff at an average wage of just over $12 per hour. With more than 95 percent of all revenue coming from the state-set Medicaid rates set to be cut in July, failure to address the issue would be a huge blow.

“Community-based service providers were counting on this revenue to make needed investments in better wages for direct care staff and program innovations to enhance independent living supports,” said Schettle. “ARRM will continue to work with legislative leaders from both parties to ensure a fix to stop these rate cuts is passed this session, and strongly urges the Governor to sign it.”

Budget Surplus Must Address Rate Cuts By Feds

NEWS RELEASE

Decision by Centers for Medicare and Medicaid Services hurts direct care workforce

ARRM, an association representing more than 200 direct care providers and supporting service providers for people with disabilities in Minnesota, released this statement from CEO Sue Schettle regarding the 2018 February Budget and Economic Forecast released by the Minnesota Office of Management and Budget: 

“The positive state budget forecast is an important opportunity to focus on significant health and human services needs for Minnesota. Particularly, taking additional action to address the pressing workforce shortage impacting the entire sector and invest in continued progress for people with disabilities to achieve independence and community integration.

Sue Schettle, ARRM CEO

“Prioritizing this has been made even more important with breaking news yesterday from the Minnesota Department of Human Services. The federal Center for Medicare and Medicaid Services (CMS) denied an amendment to the home and community-based services rate setting system for people with disabilities. This will result in a seven percent cut to the rates people with disabilities receive to access supportive services, resulting in a loss of up to thousands of dollars per person each year going towards critical supports.

“The state will need to address this cut by the federal government to honor investments in supportive services designed to improve quality and support more competitive wages for direct care staff. Not only do people with disabilities access these services to remain independent and active members of their communities, many rely on them for essential health and safety support.

"According to the Office of Management and Budget, average wages for all positions are expected to rise 5.5 percent next year and there is less than one job seeker per open position in our state. To experience a rate cut in such an economic environment could prove devastating for providers’ and individuals’ ability to hire and retain direct care staff.

“We call on the State Legislature to aggressively push back on this decision by CMS and take actions that will protect people’s ability to access critical supportive services on which they rely. Our industry supports the Best Life Alliance, which will be making recommendations to legislative leaders.”