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.
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.
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