ARRM's Daily Dispatch

Rate Cuts: House 0; Senate 0

Send short and simple notes to Rep. Huntley and Sen. Berglin

Sen. Linda Berglin’s proposed Health and Human Services Budget Bill zeroed out cuts to all long term care providers. Berglin, who chairs the Senate HHS funding division, released her recommendations this morning. The actual bill will not be released until Monday.

Her recommendation to not cut us comes on the heels of the House taking the same no-cut position. While decisions like these are fiscal, they ultimately are political. All your contacts with legislators made this happen! Outstanding work!

Berglin pays for this and other positive provisions through a combination of reductions in other areas and increases in Medicaid surcharges, including ICFs/MR, that draw down federal money while leaving most providers harmless. Like the House she also is counting on $408 million from and extension of the enhanced Federal Medical Assistance Percentage (FMAP). The U.S. House of Representatives has not yet acted on that extension.

There are several other positive measures in the bill:

Rehab therapies: Maintains coverage of OT, PT, and speech therapy that the governor’s budget eliminated for adults.

Critical access dental: Reinstates some of the money eliminated in the governor’s unallotment and proposed budget.

ICF/MR variable rate: Buys back the governor’s unallotment of variable rate funding for ICFs/MR.

ICF/MR surcharge: Increases the current surcharge and increases operating rates to providers. To break even providers would have to average 95 percent occupancy. While this may not seem like a good thing, it helped significantly in bringing the rate cut to zero and absolutely in getting rid of the variable rate. 

Mental health: Preserves much of the funding that the House bill reduces or eliminates. This will be a significant area for compromise when the bills get to conference committee.

PCA: The bill increases funding for additional hours. (We won’t know exactly what and how until we see the bill Monday.)

Not everything is rosy, however. While this is a very positive bill for ARRM members, there are some cuts and changes Berglin makes to achieve her target of saving $114 million in the general fund. (We speculate that the lower-than-the-House target means the Senate will make a small cut in K-12 education, most likely out of the department rather than money to schools.) 

Here are some of the bill’s downside for us:

Waiver limits: Like the House bill, the Senate imposes additional one-year limits on TBI, CADI and DD.

State Operated Services Redesign: Among the elements, the bill would set in motion the conversion of current METO beds to SOCS. The House bill takes similar action and would set up an advisory group to make redesign recommendations to the legislature by Dec. 15, 2010. The author of this provision has agreed to an amendment that would put an ARRM representative on the group.

Housing with services: Fees would be increased and new procedures would be imposed for people in transition.

Indirect hits: Some cuts (like CSSA grants to counties) would have an indirect impact on some ARRM member services.

We were surprised that the Senate didn’t impose a small cut on our rates to give Sen. Berglin additional negotiating room on the overall bill. Don’t count any chickens yet, but usually it is very difficult to make a cut that isn’t in the House or Senate bills. So, as of today, we’re in a very good position.

But, there are some wildcards that could change the picture:

• Gov. Pawlenty may very well view the surcharges in a final bill as a tax and decide to veto the entire measure.
• The Supreme Court could rule that the governor’s unallotments last June exceed his authority, throwing some or all of $2.7 billion back to the legislature.
• FMAP might not be passed in the U.S. House before the legislature has to adjourn on May 17th or, worse, ever.

ARRM is preparing a side-by-side comparison of the House and Senate bills that we will send out and post on our website.

Saying please and thank you

Our mothers taught us to say “thank you” as well as “please.” While it may seem strange to be grateful for getting nothing (like a COLA), the truth is that both Rep. Huntley and Sen. Berglin spared us from cuts. Other constituencies were not so fortunate. It never hurts to show legislators that you appreciate that they heard your message.

Our grassroots team will prepare messages for all legislators, but right now we suggest that you and your people prepare very short handwritten notes to Rep. Huntley and Sen. Berglin thanking them for sparing caregivers, providers and people with disabiites from rate cuts. Keep it simple, but say what this means to you and the individuals you support.

Rep. Tom Huntley
Minnesota House of Representatives
585 State Office Building
St. Paul, MN 55155

Sen. Linda Berglin
Minnesota Senate
309 State Capitol
St. Paul, MN 55155

House HHS bill author Rep. Huntley, HHS committee zero out rate cut

The provider rate cut to home and community based services, ICFs/MR, nursing homes and DT&Hs was removed last night from the Health and Human Services budget bill. The cut was eliminated in an amendment by committee chair Rep. Tom Huntley.

Earlier in the day Huntley included a one-time, one percent cut in the bill he presented to the committee. But by late afternoon he and the DFLers on his committee changed course. House staff speculated that this and other changes were made in order to assure enough votes to pass the bill out of committee.

The elimination $14.8 million one percent cut was paid for by increasing a surcharge on HMOs. The surcharge draws down additional federal money. It is possible however, that Gov. Tim Pawlenty would veto the bill because of the surcharge – which he may construe as a tax. 

The bill was completed in the HHS finance committee at 1 a.m. and is being heard in the full Finance Committee, which convened at 8 a.m. More amendments are expected, but it is highly unlikely that anyone would attempt to add back a rate cut.

Clearly, the elimination of the rate cut was the result of advocacy in legislators’ home districts. Thus, all of you who made those many contacts should pat yourselves on the back. Well done! 

But please do remember that there are many steps left in the process. We are off to a great start, but there are a lot of unknowns and barriers ahead. And keep in mind there were many programs that sustained cuts in the bill – including mental health. We don’t know what the Senate will do, but do expect that body to protect many of the mental health services that were reduced or eliminated in the House bill.

After the bill leaves the Finance Committee we’ll put together a summary of last night’s and today’s changes. Once the bill leaves finance, it goes to the Ways and Means Committee next week and then to the floor.

In the Senate, Sen. Linda Berglin, who chairs the HHS funding committee, has indicated that she may release her bill tomorrow.

We did report last night’s development by Twitter from the capitol. If you wish to follow us on Twitter, go to http://twitter.com/arrm.

House HHS bill would make one-time, 1% cut; after on year, rates would return to current levels

The proposed House Health and Human Services Bill would cut programs across the board to find $154 million in savings for the balance of the biennium through June 30, 2011.  A one percent, one-time only continuing care provider rate cut would make up $14.8 million of that total.  The cut would be effective July 1, 2010 through June 30, 2011 and includes home and community based services, nursing homes and day training programs.

The bad thing about the cut is we get cut.  If there is a silver lining it’s that the cut, if enacted, would not go into the base.  A permanent smaller cut – like a half percent – would set a new baseline and cost providers more over time.

Rep. Tom Huntley, Chair of the Health Care and Human Services Budget Division, uses a combination of cuts, anticipated federal money and an HMO surcharge to find $154 million in general fund money for the current biennium.  The big wildcard in his budget proposal is the assumption that Minnesota would receive $408 million from the federal government to extend the Federal Medical Assistance Percentage (FMAP) to Minnesota.  Huntley said that Minnesota might not know until fall if it gets that money.

Huntley uses a surcharge on HMOs that would leverage additional federal money for a net of $80 million to the state.  With this and other tools Huntley cut programs across the board rather than singling out a few programs for large cuts. While Huntley’s DFL bill balances the general fund, it would leave a sizable deficit in the separate Minnesota Care fund.  Huntley acknowledged that that deficit would have to be addressed in 2011.

In presenting his bill at a hearing yesterday, Huntley said it “strongly protects nursing homes and people with disabilities.”  You be the judge.  In a nutshell here’s what happens to our world in this bill:

• Rates:  Cuts one percent for one year on July 1, 2010.  Then rates go back to current levels. The cut includes all programs hit last year and nursing homes.  The proposal does not eliminate rate equalization in nursing homes.
• Slots:  New limits are the same as the governor proposed:
• TBI Waiver:  The equivalent of six new slots a month (equivalent means the amount of money typically needed for six slots – so there could be more “cheaper” new slots). One year only, effective July 1, 2010.
• CADI:  The equivalent of 60 slots a month for one year effective July 1, 2010.
• DD:  Six additional diversion slots for one year starting January 1, 2011.
• Mental health:  Hits adults and children’s mental health programs and grants harder than most other program areas.  We will continue analyzing these cuts – including the elimination of some programs – along with mental health advocates.
• Rehab therapies:  The House bill modifies the cuts to OP, PT, speech and chiropractic services that Gov. Pawlenty proposed in his budget.
• State Operated Services:  Did not make cuts proposed by Gov. Pawlenty, including dental services utilized by many ARRM members.
• Critical Access Dental:  Reinstates much of the funding that was unalloted by the governor, although the bill increased the level of these patients a dentist must treat to qualify.
• Region 10:  Allocates $100,000 for this southeast Minnesota quality assurance project.  Region 10 was zeroed out last year.
• MAEPD:  Increases premiums for Medical Assistance for Employed Persons with Disabilities (MAEPD allows working people with disabilities to use Medical Assistance for health care).
• Autism:  Mandates insurance coverage for autism and funds a coverage study.
• TEFRA:  Appears to increase fees for some parents.
• MA expansion:  Expands Medical Assistance to those already covered with state programs in order to draw down additional federal money.  This is an alternative to the GAMC deal adopted in March.
• Departments:  Cuts Human Services and Health by three percent, same as the governor. An estimated 80 FTEs at DHS would be eliminated.
• Unallotment:  Does not make permanent the governor’s unalloted items, including ICF variable rate elimination, ICF occupancy adjustments, PCA worker limit of 275 hours a month and the suspension of nursing home rebasing.
• Hospitals:  Imposes a seven percent ratable reduction, but exempts rural hospitals for one year and gives rural hospitals a one-time one-year increase.
• Counties:  Makes cuts to CSSA.
• Co-pays:  Increases prescription co-pays, putting further pressure on those who use their personal needs allowances for this cost.
• Health care reform:  Moves forward with several reform measures.  Impacts are unclear to many.

After public testimony today, the bill is scheduled to be marked up and passed in Huntley’s Division tonight.  The full Finance Committee is scheduled to hear the bill tomorrow.  The Senate has not released nor scheduled a hearing on its HHS bill.

Grassroots advocacy by the numbers: A highlight of the amazing work being done!

As the legislative session stands on hold, I thought it important to take notice of all the great grassroots work that has taken place this session.

• ARRM members have conducted over 30 site visits and attended over 10 townhall meetings throughout the session.
• During ARRM’s “Buy Back the Cut” campaign we received over 120 responses back from House Representatives and Senators. Responses from legislators came back as sympathetic and understanding to our cause, however, many stressed that with the current budget climate difficult decisions will have to be made.
• ARRM hosted CCD’s Tuesday at the Capitol on April 13th. On this day, 15-25 people attended and pulled legislators off the House and Senate floor, to tell their story.
• ARRM members met with over 140 legislators during ARRM’s Day at the Capitol, with over 700 people attending the rally!

 These numbers are a small example of the amazing work that is being done. Personal, lasting relationships are being made with legislators and with the exception of maybe a couple legislators; every member of the House and Senate has been contacted in some way by an ARRM member this session.

As the next couple weeks begin to unfold and we become aware of what the Health and Human Services budget bill will look like, please continue to be vigilant for calls to action from ARRM in the form of an action alert. It is truly all of your hard work that will make a difference as the last month of session wraps up.

--Sara Krogman

Waiver Contracts

The Provider Enrollment and Provider Standards initiative began in June 2009 to develop a statewide common provider enrollment business process across waiver services.  The transition from county/tribal contracts to the new state enrollment process will occur during the calendar year 2011.

DSD has informed Waiver Contract Managers that they need to ensure their contracts with providers remain in place until the provider re-enrolls with the state during 2011. To coordinate termination of a provider contract with re-enrollment of the provider with the state, DHS is asking all counties and tribes to include contract language that allows termination of the contract without cause.  The suggested language is as follows:

"Termination of Contract

With or Without Cause: This Contract may be terminated without cause by either party upon thirty (30) calendar days written notice to the other party.  Either party may terminate this Contract for cause by giving ten (10) business days written notice of its intent to terminate to the other party unless the other party cures the default within the 10-day period.  Notwithstanding the foregoing, termination based on noncompliance with Section 16, Conditions of the Parties' Obligations, shall occur on the date provided in the written Notice of Termination."

This language may begin to appear as contracts are renewed, or maybe added as an addendum to contracts that will run past 2011.

--Barb Jacobson, COO

HHS bills on hold – get full update tomorrow during First Friday Phone-In

Rep. Tom Huntley, Chair of the House Health Care and Human Services Finance Division, now plans to release his recommendations for the House’s HHS budget bill next Monday. The bill was to have been released yesterday.

Huntley’s target for cuts is $154 million, significantly less than the Governor’s $347 million in HHS cuts.

Typically there are few changes to the chair’s recommendations, although last year we were able to reduce his proposed rate cut from 3% to 2.58%

No plans have been announced for releasing the chair’s bill in the Senate.

We’ll provide a full update of where the money and our issues are during tomorrow’s First Friday Phone-In at 10 a.m. You can join the audio component of the call by:

1. Dailing: 866.740.1260
 
2. Entering access code: 2911086 #
 
3. You will be prompted to state your name followed by the # sign.
 
4. You will be placed on music hold until the audio conference begins.

If you can’t call in at 10 a.m. the call-in will be recorded and available on our Web site, arrm.org.

--Bruce Nelson

Attend MN-CCD "Tuesday at the Capitol" on April 13th

On Tuesday, April 13th, ARRM's Sara Krogman and Barb Brynstad will be participating in the MN CCD's "Tuesdays at the Capitol." We'll be there from 10:00 AM to 3:00 PM to help folks from the disability industry tell their stories, meet with legislators, and ensure a constant presence at the Capitol. Please join us! The agenda is below.

10:00am  Welcome and introduction with MN-CCD leaders in the State Office Building Basement Cafeteria – (right side of the room)

10:30am – 12pm Meet with your legislators and share your personal story

12:00pm – 1pm Lunch in the Department of Transportation Cafeteria

1:00pm Advocates are encouraged to attend hearings or meet with their legislators if they were unable to do so in the morning

We will ...

- Provide 'talking points' about disability services and tips on how to tell your story

- Provide a daily schedule highlighting relevant committee hearings

- Provide "Disability Matters- Independence Costs Less' stickers

- When relevant, provide materials specific to certain legislation

- Be available from 12 -1 for Q and A in the Department of Transportation Cafeteria

You will ...

- Learn how to find and meet your legislator

- Share your personal story with your legislator

- Educate yourself about disability programs and services

- Become an effective advocate for yourself and the broader disability community

Advocates are encouraged to set up meetings with legislators in advance (contact ARRM for assistance).

--Barb Brynstd and Sara Krogman