By Bruce Nelson, ARRM Executive Director, and Barbara Fraley, ARRM Research Director
DHS Bulletins retired: DHS issued a Bulletin (#07-85-02) saying Bulletins more than two years old are obsolete and that current and future Bulletins will have an expiration date on the front page. Some elements of retired Bulletins will be continued in the Disability Services Program Manual (DSPM) and other manuals.
Obviously, this new policy can have profound implications. For example, the leave day policy for the MR/RC waiver was issued several years ago and is important in maintaining a 24-hour plan of care and needed funding. While some elements have been moved to the DSPM, we’re concerned that not all the nuances for this and other issues will be carried forward. We will be talking about this change with Disability Services Division leaders.
Here’s a key paragraph from the Bulletin:
"...DHS implemented a new policy in March 2006 that made DHS bulletins automatically obsolete from the bulletin’s issuance date. If the bulletin still contains current information, DHS employees will reissue the bulletin or incorporate the bulletin information into a DHS manual. As a result of this new policy, many old policies that were previously contained in DHS bulletins can now be found in DHS manuals (see DHS Manuals web page: http://www.dhs.state.mn.us/main/id_000103). Additionally, the DHS bulletin template was altered to include an expiration date on the front cover. The expiration date is generally 2 years from the date the bulletin is issued.”
New DSD deputy: Loraine Jensen has joined DHS’s Disability Services Division, assuming the duties of Laura Doyle, who retired this fall. Loraine was the first DHS RSS several years ago and recently has been involved in special education initiatives in the Alexandria, MN area. We spent many hours with her in the car and at CAN DO meetings the past few weeks and are developing a strong working relationship. Loraine’s title is Manager of Home and Community Living Services, which includes all the waivers.
ICF VAA and MOM investigations to the Health Dept.: As noted in an ARRM Alert (#24 – Nov. 21, 2007), ICF/MR Vulnerable Adult Act and Maltreatment of Minors investigations are – at the behest of CMS – being transferred from DHS licensing to the MDH. ARRM met with DHS Director of Licensing Jerry Kerber last week about this and other issues and will now follow-up with new players – Sue Jackson and Arnie Rosenthal – at MDH.
Another upshot from our meeting with Jerry: He will now send ARRM all licensing actions so that we can better track trends in citations, fines and conditional licensing actions with the waivers and other services still under his jurisdiction.
Interim provider standards: The interim CADI, CAC, TBI and ILS provider standards agreed to with DHS and adopted by the Legislature are on hold. County organizations are balking at the new unfunded mandate and have proposed that affected providers use 245B consolidated standards instead.
That, of course, is not an option as it would require a law change to make that requirement. Lori Dablow at DHS told ARRM that she has made that clear to counties. Indeed, the interim standards were developed as an alternative to the Department’s proposal in the Governor’s budget to put these services under 245B. ARRM vigorously and successfully opposed that move at the Legislature.
The standards would allow affected providers to use 245B if they chose, but also includes a list of benchmarks that counties would certify for each provider.
The other hang-up, according to Lori, is the mistaken use of the word “contracting” in the legislative language. Counties note that counties don’t contract for these services with providers.
Contract template: The once-mandated contract template for DD waiver providers and counties is still unresolved. Counties now want to be part of the process in developing new language. Thus, ARRM called a meeting with counties association officials to see if we could get on the same page for a hoped for final meeting with DHS and a lawyer from the Attorney General’s office on this matter. Our ARRM/county meeting appeared successful and we’re talking with Lori Dablow on pulling the group together. ARRM sent a contract proposal some weeks ago to DHS and the Attorney General.
However, now DHS is saying that the Single Audit Act must be addressed in the contract. We have concerns about this new issue as the Act wasn’t cited in any previous drafts or discussions and that the one venue we heard the Act come up was with Jon Villegas-Grubbs of (JVFA) in his presentations on county-to-provider rate setting.
Rate setting: Jon Villegas-Grubbs of JVGA had two meetings (one also with counties) with ARRM a week ago about the options he’s putting forth for counties to use, if they want. Many counties see this as a mandate, but Villegas-Grubbs told those in attendance that counties could use some, all or none of his proposed model. The trouble is very few counties were present or on a phone hook-up – so most counties still haven’t received that message.
ARRM’s Rate Setting Task Force is developing principles and will hear from Dakota County officials this week as we develop legislation for the 2008 legislative session. The group will also pore over the various JVGA documents, including the chart of accounts he uses.
Meanwhile, ARRM has contracted for a compilation of all federal and state waiver law and rule and an analysis of those provisions as a basis for moving ahead.
ICF Planning Work Progressing: A quick update on the Department's work to develop a plan for the future of ICFs/MR, headed up by Barb Nelson. On December 10th, Barb met with a group of providers, including several ARRM Members: Denise Scholljegerdes, AXIS; Carol Lee, Harry Meyering Center; Dick Lanigan, Lanigan and Kolb LLP; Jackie Meier, LRN Management-Prairie View; and Nita Hayes, REM.
Nita reported back that the meeting went well - they shared ideas and recommendations. A couple more meetings with the same group will happen over the next month and Barb Nelson also plans to meet with ARRM in early January.
The Department's Proposed Rules for SIRS: A couple November ARRM Updates reported the process for commenting and some issues ARRM members and staff raised about the Surveillance and Integrity Review Section (SIRS) rule changes the Department proposed. Both the comment and rebuttal periods have come and gone.
If you're interested in reviewing communications from the public and the Department during this process, go to: http://www.oah.state.mn.us/cases/180019127-SIRS/index.html.
The one document missing on the above Office of Administrative Hearings link is accessible by clicking a link within it under Agency Information. This leads to the DHS website for SIRS Rulemaking. Scroll to "Downloadable documents" and click "SIRS Rule 5-day Rebuttal to Comments."
In general, the Department didn't concede much and they got the last word with their rebuttal submitted on the last day. The next step is to wait for the Administrative Law Judge to complete his report - there's no clear due date for this. The Department then considers making changes to their proposed amendments based on the judge's report. ARRM will keep you posted when this information becomes available.
CAN DO meetings: The eight regional CAN DO meetings were completed last month with each action-oriented meetings being unique. Initiatives varied from purely local efforts to statewide action plans – such as developing a 21st century rule that encourages free market innovations and personal outcomes.
In all 101 action plans got started. The CAN DO Design Team, which includes ARRM, is now looking at ways to support these efforts, broaden future participation and coordinate similar initiatives. All will be posted and updated on a CAN DO web site.
Turnover Study Final Report Coming: A final report of this summer's random-sample study of 25 ARRM Organizational Members on turnover rates and costs, DSP wages and compensation, and operational-cost increases will be on its way in January. CEOs and Board Members will receive a copy by email and it will be available on our website's Resources page.
The final report will provide context for the research, additional descriptive statistics and results of various group comparisons tested. Preliminary results of the research are available on our website's Resources page, or click here: http://www.arrm.org/pdfs/DSPturnover07results.pdf.
Annual Member Survey Thanks! Thanks to all the Organizational Members who completed ARRM's Annual Member Survey! We appreciate all your time and work into this project.
The results help us track service trends, allow us to target member communications on service and local issues that arise during the year, update our database in preparation for small-sample studies we periodically conduct, and provide the latest service numbers for our Network Directory.
Also, a big thanks to Janell Walter at ARRM! She's been plugging away diligently, entering all this information into our database. One drawback, she claims, is that the data entry was leading her to snack continuously and unconsciously from the candy bowl at her desk. In case you were wondering, this is why the candy bowl now resides in the middle of the room.
ARRM Holiday party: Join us for our annual holiday party this Thursday Dec. 20th from 11:30 a.m. to 1 p.m. The ARRM Board meeting follows at 1 p.m. and, of course, members are invited to that meeting as well.
1915 (j): This just arrived from DHS:
Many of you are aware that the Disabilities Services Division of DHS has the lead in working towards the design, approval and implementation of a Consumer Directed State Plan service under 1915(j) authority of the Social Security Act.
A Consumer Directed Task Force was selected this fall and the group has been meeting monthly since September. It is time to bring in additional stakeholders to support Minnesota in designing a cutting edge service that will meet consumers’ needs in innovative ways. I am providing a link for you to complete a survey if you are interested in being a work group member. http://survey.dhs.state.mn.us/snap/dsd/1915j/1915jworkgroups.htm.
The six groups identified at this time are listed below:
- Consumer Directed Models
- Home Care - Targeted Case Management
- Medical Assistance Vendor Requirements
- Person Centered Planning
- Quality Assurance, Program Evaluation and Risk Management
- Rule for Participation
The Consumer Directed Models and Person Centered Planning groups will be meeting on January 8th from 9am – 12:30 in rooms 2222 and 2223 at the Elmer Anderson Bldg in St. Paul. The work teams will determine their schedule following the first meeting.
Start dates for the other groups have not been specifically identified at this time.
Thank you for your interest and please pass this email on to other stakeholders you think may be interested in participating.
For more information, contact Kathleen Kelly, Disability Services Division, Supervisor, at (651) 431-2389.