ARRM's Daily Dispatch

Daily Dispatch, January 30, 2009: ARRM seeks volunteers for Workforce Development Committee

As part of the ARRM Board's strategic planning held last fall, a decision was made to form a Workforce Development Committee, to:

• describe the current impact of demographic changes on the workforce of ARRM members;

• recommend strategies to mitigate the impact through the recruitment, retention and develop of high quality human resources;

• include strategies for the use of technological resources and other cost effective alternatives to supplement the use of human resources in providing supports and services.

This committee will develop and implement a research plan that reports on the characteristics of the current workforce of ARRM members; design & implement DSP training for ARRM members on current topics of interest; and promote direct service as a career to individuals with disabilities to the public and “professionalize” the practice of direct service.

Darlene Scott (Phoenix Residence) will chair this committee, which meets from 10 am to 12 noon on the second Wednesday of each month at the ARRM office in South St. Paul. 

The first meeting will be Feb. 11, 2009. ARRM is actively recruiting members for this new committee, and interested individuals should contact Barb Jacobson at ARRM and plan to attend the first meeting in February.

Daily Dispatch, January 29, 2009: ARRM's bill for reform goes before Health Care and Human Services Policy and Oversight committee today

Rep. Paul Thissen is carrying ARRM's bill for system reform, and will present it today before the Health Care and Human Services Policy and Oversight committee. Rep. Tom Huntely recently signed on as the bill's co-author.

The hearing is at 2:45 PM in room 200 State Office Building.

ARRM staff Bruce Nelson and Barb Jacobson will testify during the hearing.

The Agenda is: HF266 (Fritz) Parental fees modified for services for persons with developmental disabilities -- Informational only HF295 (Loeffler); Consumer-directed community supports modified and money appropriated;Transforming Minnesota's disability service and finance systems, ARRM report.

Make your appointments with legislators now

ARRM's Day at the Capitol in Thursday, February 12th at 10 am until approximately 10:45 am (give or take 15 minutes). We'll send out detailed talking points next week for you to share with staff, families, and local media, and we'll also hand them out at the rally.

If your legislators are unavailable that day, please attend our Day at the Capitol event, anyway. We've had good media coverage in the past, and our historically large numbers ensure that ARRM's issues are on everyone's radar screen.

Daily Dispatch, January 28, 2009: Gov’s Budget Would Cut Rates 3% -- BUT You Must Consider the Context First

Proposed moratorium on shift-staff settings could reinforce our reform elements to utilize alternative services

After all the pre-budget brouhaha about Gov. Tim Pawlenty proposing really big provider cuts in his budget, the 3% cut he did propose doesn’t sound so bad. But here are some of the “buts:”

Pawlenty’s health and human services budget would merge the general fund (which includes rates) and a totally separate fund for Minnesota Care, the Heath Care Access Fund that’s paid for through enrollee premiums and a 2% health care provider tax.

That enlarges the overall pot of money. Next his budget would cut more than 100,000 adults off Minnesota Care. The merger and 100,000-person cut aren’t going to happen.

He also sells off tobacco payments to find almost $1 billion. Give that little chance. 

So the 3% is built off, at least in DFL legislative leaders eyes, a phony inflated number. That means we have a lot of work ahead to even hold that kind of number.

A little more context: You know the economy is tanking. That means the next financial forecast in late February will push the current $4.8 billion deficit to $6 billion and very possibly more. Then add inflation that isn’t factored into the expenditure side of state forecasts. 

The Governor not only didn’t reach out across the board for cuts that would include K-12 education – his budget adds new K-12 money. As the deficit swells and if K-12, which accounts for 40% of the budget, is held harmless – that means other areas of government and government-funded programs would have to take a collective 50% cut, according to Rep. Tom Huntley, who chairs the House Health Care and Human Services Finance Committee.

This is all so huge it’s mind-boggling. And many legislators don’t understand the many really horrible votes they’ll be taking – even if K-12 is hit and taxes are increased.

At the same time, there are some things in the budget that clearly reinforce ARRM’s system reform/transformation initiative.

Given some of the context, here’s what the budget does in our neck of the woods, based on an initial quick read-through:

Rate cut

The budget includes a 3% cut for waivers, ICFs/MR and other providers and services who in good times would get a COLA. Nursing homes are cut 1.3% by eliminating rebasing – which then would result in a 5% base reduction in the next two years. Keep in mind, too, that rate cuts for nursing homes are compounded by a commensurate decrease in private pay. Add that together nursing homes should be hit about the same in the first biennium and harder the next.

Waiver growth limits and what is this “moratorium?”

At a meeting this with DHS’s Alex Bartolic and four of her managers in the Disability Services Division, she noted that 71% the DD waiver goes to SLSs with 24-hour sift staff. The budget proposal would put a moratorium on waiver services in new foster care shirt-staff settings. We see this as an opening to further one of our reform initiatives to utilize GRH – or MSA shelter needy – to fund for people in non-foster care settings. This would be cost effective to providers and the state by targeting supports to what people need, rather than the full menu of services required under foster care. Clearly we need to do a lot of work with DHS to make sure necessary money flows for needed services while providing more flexibility in providing those supports. 

The budget would also limit waiver slots to: 150 a year for TBI, 180 a year for DD and 1,140 for CADI. As for the limits imposed through unallotment, DHS said this morning that there are still 500 CADI and TBI and 100 DD in play through June 30, 2009.

ARRM has been working for several months on payment methodologies standards. Earlier this month the ARRM board endorsed an ARRM position to support a set of standards versus a single methodology. The budget calls for “a statewide uniform service rate setting structure, strengthening standards and improving provider enrollment instructions.” While the budget pages uses some scary terms, like “budget calculator,” during this morning’s meeting DHS told ARRM that their intent is not something rigid. Alex Bartolic agreed to start working with ARRM on this in the next couple weeks.

The almost ready for implementation contract would be replaced with provider agreements – again to be worked out with stakeholders. ARRM knew this development was in the works. Meanwhile the 30-day public comment period has begun on the contract template negotiated between ARRM and DHS. (More on that tomorrow.)

The budget includes funding to develop technologies that allow for increased independence and reduce the need for human assistance. The technology would reduce demand for new foster care shift-staff arrangements and provide grant money to move forward. Again, these are proposals very similar to what ARRM is proposing in our reform/transformation bill.

Comprehensive assessment

ARRM’s transformation plan noted that the trigger for many reforms to move forward is completion and implementation of the comprehensive assessment. Surprisingly the budget includes needed funding to get COMPASS, as it’s called, done and off the ground. Should that funding make it through the legislature ARRM efforts to develop a single set of standards will get a jump-start.

Licensing fees

We are now studying the 356-page DHS budget to clarify if license fee increases apply to our services. An increase in background study fees apparently does not.

ICFs/MR

DHS’s Gerry Nord confirmed this morning that many – if not all of ARRM’s policy recommendations will be in a Department Bill.

GRH

The budget would make changes in state dollar-only Difficulty of Care money to have those services authorized as part of the waiver to get a federal match. A plan would be developed for those who do not need a SKS level of care, to transition to MSA shelter needy. At this morning’s meeting we began exploring ways to allow those dollars to flow to provider owned or controlled housing.

PCA

While the Legislative Auditor didn’t call for changes in eligibility for PCA services, the Governor’s budget does. More detail is needed to determine just how, but the budget does cite four areas of PCA changes:

• Changing access to services for a $18 million savings.

• New assessment definitions.

• Recipients home care rating.

• Reduction of authorized time with 6,000 expected to see a reduction in their hours and 5,500 expected to see an increase.

• New provider standards.

Upshots

We’ll learn more tomorrow (Thursday) in two more meetings with DHS. Meanwhile, the foundation for the 3% cut is shaky, to say the least and – if there is a bright side to all this – the governor significantly opened the door for many of the reforms we’re pushing.

We’ll continue to sort through the macro and DHS budgets and factor in some political smarts to get messages out to you for your caregivers, families and yourself.

-#-

Daily Dispatch, January 27, 2009: Governor's budget comes out today

Governor Pawlenty's much anticipated budget comes out today at 1 pm. The budget documents will posted on the Minnesota Management and Budget website sometime after 1:00 pm. We'll post our analysis of the Governor's budget here on our blog on Wednesday or Thursday. 

We'll be visiting the capitol press corps this afternoon at 2:30 pm with our reaction to the budget. At this point, our main messages are:

• If you must make cuts, make them fairly and proportionately across all areas of state government, including K-12 education, which constitutes the largest piece of the budget.

• Unfair cuts to Minnesota's most vulnerable citizens could have a disastrous effect —  not only for the people they support, but for local economies and main street businesses who rely on the revenue of professional caregivers.

• Disability services are funded through Medicaid, with half the money coming from the federal government and half from the state. So, if you cut $1.00 from the state budget, people with disabilities lose $2.00 in services.

• ARRM's system reform bill will be part of the solution for the current financial crisis and for cost-effective disability services in the future.

We're hoping Rep. Pogemiller and/or Speaker Kelliher will also carry our message for us with the media. For now, we'll see how key legislators are responding to Pawlenty before we issue any alerts or calls to action. Lawmakers' responses will likely give us something to build on.

According to the Star Tribune today, it appears that Gov. Pawlenty is sticking to his formula of cutting deeply into health care while sparing K-12 schools. Read the story here: http://tinyurl.com/c6gj3w.

Other news:

• ARRM is meetying with DHS' Alex Bartolic Wednesday morning at 7:30 am to discuss a variety of issue, such as unallotment, payment methodologies, leave days, open positions. We'll let you know how this went later this week.

• The Health Care and Human Services Policy and Oversight committee, chaired by Rep. Paul Thissen, is meeting on THURSDAY, January 29, 2009 at 2:45 PM in room 200 State Office Building.
  
  The Agenda is: HF266 (Fritz) Parental fees modified for services for persons with developmental disabilities -- Informational only HF295 (Loeffler); Consumer-directed community supports modified and money appropriated;Transforming Minnesota's disability service and finance systems, ARRM report. It is not uncommon to cancel or reshuffle hearing dates and times, so check this website which has the committee's schedule often. We'll also do our best to let you know if this meeting is canceled or rescheduled.

Daily Dispatch, January 26, 2009: Governor's budget comes out tomorrow; Day at the Capitol February 12th

In anticipation of Governor Pawlenty's budget coming out tomorrow (Tuesday), we've been working on sharpening our messages to your families, staff, Board of Directors and, of course, to the media. Speaker of the House Margaret Anderson Kellihor is on Minnesota Public Radio this morning, so we'll wait and see what she says to the media -- and what Gov. Pawlenty's actual budget is -- before sending our refined talking points to you. We will likely alert you via this blog and and an email alert either Tuesday or Wednesday with our final messages.

Meanwhile, please remember to set aside February 12th to attend ARRM's Day at the Capitol rally. Our website is currently stocked to the hilt with advocacy tools, tip, and talking points. Plus, we've recently added a video to our arsenal, entitled "How to Talk to Your Legislator". You'll need Windows Media Player or QuickTime Media Player to view this ten-minute piece, which we created before last year's session.

http://www.arrm.org/advocacy/

Daily Dispatch, January 23, 2009: ARRM to present reform plan to House Committee

Next week the House Health Care and Human Services Policy and Oversight Committee will be hearing disability issues, including ARRM’s reform/transformation report. We’ll also testify on waiting list legislation. Although that bill isn’t expected to go far this year due to the deficit, we’ll use it as an opportunity to educate committee members on the economic impact of disability services in all Minnesota counties.

To see the reform/transformation plan, go to the members-only section of our website (the user name is arrm; the password is reforms): http://www.arrm.org/news/news/011309Reform.html

To see our updated economic impact report, click here: http://www.arrm.org/pdfs/EI2007.pdf

The buzz at the capitol this week centers around “mandates” and what the state can do to reduce mandates that don’t add value and therefore squander more precious than ever recourses. ARRM anticipated this last summer so we should be well positioned to make our case in being part of the solution and getting actual reforms enacted.

Other quickies:

We think some legislators don’t really understand the enormity of the fiscal crisis before them. And the $4.8 billion problem will only get worse. Revenues to the state are down since the December forecast and other benchmarks, like job losses, show a continued decline. Add inflation in and then don’t be surprised to see a deficit of around $6 billion. 

With a state biennial budget of $34.6 billion, that $6 billion is huge – about 17%, although some legislators are telling ARRM to expect overall cuts of around 20%. While the main problem is decreases in revenue (primarily taxes) we can’t even come close to taxing our way out of this mess. For example, if we raised income taxes on the wealthiest to what the highest income tax state imposes (California), we would bring in only $600 million.

Legislators, who don’t yet have a full perspective on the magnitude of the crisis, will have their eyes opened Tuesday when Gov. Tim Pawlenty releases his budget.

Rep. Tom Huntley told a group of health and human services advocates, including ARRM, that he expects the federal stimulus bill to increase the federal share of Medicaid money from 50% to 54%. Given the state deficit and constitutional requirement that Minnesota balance its budget, we doubt the state can take advantage of all that new money – probably to last for only two years

The Legislative Auditor releases his PCA report this morning. Expect new limits from the legislature as a result of the report.

Daily Dispatch, January 22, 2009: ARRM to beef up our grassroots advocacy

Last week the ARRM Board of Directors authorized a $50,000 expenditure out of reserves set aside for special projects to retain a grassroots advocacy consultant to “assist ARRM in a robust and aggressive initiative to enhance its capacity to mobilize members, their employees and client families” for grassroots advocacy.

ARRM is recognized for its strong grassroots efforts, but due to the funding emergency upon us, the Board agreed that we should take what we do well to the next level. If the impact of this effort means only a one percent difference in member rates, it will be well worth the effort.

We’ll engage the consultant for short term strategies first and then year-round long term strategies once the session is over.

Our Public Affairs Committee will develop a plan for the consultant at its meeting today.

Also going on today...

• The House human services policy committee gets an update on health care reform.

• We’re working with authors to put in a COLA bill, even though the chances of funding are dire. The COLA Coalition, made up of other disability provider and advocacy organizations, nonetheless agreed we should put the need for a COLA in the mix.

ARRM's Advocacy Arsenal is fully functional

Please visit ARRM's website for advocacy tools, tip, and talking points. We've recently added a video to our arsenal, entitled "How to Talk to Your Legislator". You'll need Windows Media Player or QuickTime Media Player to view this ten-minute piece, which we created before last year's session.

http://www.arrm.org/advocacy/

ARRM Alert and Jan. 21 Daily Dispatch: Gear up for Gov's Budget!

Gov. Tim Pawlenty will release his budget next Tuesday, January 27th. The budget will be the baseline that the legislature will work off – and we expect it to include severe cuts to disability services.

ARRM staff and our Public Affairs Committee are now preparing tactics and messages for media and members to use in response. Because we expect him to take a disproportionate share of cuts out of health and human services – including provider rates and waiver slots – ARRM and ARRM members need to respond quickly with local legislators, major media and your local media. 

If he does disproportionally hit health and human services to legislature needs to get the message to make cuts proportional across all areas of state government, and that K-12 education needs to be on the table.

We think the key will be human stories from families and caregivers. Thus, we will prepare targeted messages for:

1. Families

2. Caregivers

3. Management and you Board of Directors

So please plan to have your machinery ready to get the word out to each of these groups related to your company.

Start think about how you would handle huge cuts – like 5% to 10% and the impact on people. Indeed, if the proposed cut is so big that you would have to fold up operations – be ready to say that and back it up.

As you know much of the discussion nationally and in Minnesota is about jobs and you may have already had to lay off people. If so that’s an important message. And we’ll remind you that a 10 percent cut in state money will be a 20 percent cut to you, due to the federal Medicaid match.

Yesterday a number of health and human services advocates met with House Health Care and Human Services Finance Division Chair Tom Huntley (DFL-Duluth), who stressed the importance of making your and our comments about people – the care they get and jobs.

-#-

Daily Dispatch, January 20, 2009: PCA report to be released Friday

On this historic day with Barack Obama being sworn in as our 44th President we will be working with House Research on our reform/transformation bill. Other things of note:

This Friday the Legislative Auditor meets and releases his report on PCA services. We expect the commission to note fraud among some (non-ARRM) providers and the growth in utilization of this low funded program – especially for mental health services. For many people unable to get services through waivers and other programs, PCA services is about the only option left.

Now, with waiver slots shut down for at least a half-year – and limits sure to be put on the table for the next biennium – people will have even fewer programs to turn to if the legislature moves ahead with some of the recommendations we guess will be in the auditors report.

We know there will be several PCAs and clients at the hearing to show the need and support for these supports. The hearing will be in room 107 of the state capitol at 10:30 a.m. Friday Jan. 23rd. The report will go live on the Legislative Auditor’s website at 10:30. Here’s the link:

http://www.auditor.leg.state.mn.us/

Also going on today...

We meet with Rep. Tom Huntley with a coalition of health and human services advocates on funding targets.

The House Health Care and Human Services Policy and Oversight Committee gets the Department of Human Services overview of priority areas and outcome measures.

A group of disability advocates, including ARRM, finish a document for legislators – especially leaders – explaining why the growth in the six waivers for disabilities and the elderly is planned growth as a cost effective alternative to nursing homes and hospitals. We’ll share that document, which ARRM helped develop, as soon as it’s out.

Daily Dispatch January 19, 2008 Tax Time- Rent Credit

As we finally take a breath now that the holidays are over we must get prepared for TAX TIME.  Calls and e-mail messages have already started coming in to the ARRM office, so I thought I would use this space to share some information that may help members.

The following link will get you to the spot that can link you to forms and instructions needed for "landlords" of Adult Foster Care, ICF/DD and Assisted Living.

http://www.taxes.state.mn.us/taxes/prop_refund/index.shtml

I am also including some information that came through this same link regarding what figure to use for AFC "rent" and who is eligible for the rent credit.If your waiver program/adult foster care facility is exempt from property tax, do not give your residents CRP forms. People living in tax-exempt facilities are not eligible for the property tax refund.

Individuals who have no income other than SSI and /or MSA/GRH are not eligible for rent refunds. Do not issue CRPs to them.

Individuals who have other income are eligible only if some or all of that income goes for their rent. If none of it is used for rent, they are not eligible. Do not issue CRPs to them.

However, residents with other income, such as Social Security (other than supplemental security income), wage income or any other income other than supplemental assistance grants, may be eligible for a rent refund, as long as some or all of that income goes to pay their rent.

• For rent paid in 2008, all persons living in an adult foster care setting or a similar waiver program are deemed to have paid $670 per month for rent. Multiply the number of months, or fraction of months, the individual lived in the residence by $670 and fill in the result. (The determination that rent is a fixed amount resulted from a 2001 law change. This fixed dollar amount will be annually adjusted for inflation.)

As always, if you have questions feel free to call Barb Jacobson at the ARRM office.