ARRM's Daily Dispatch

Nursing facility level of care waiver submitted

In 2009, the Minnesota Legislature passed legislation that changes the criteria for those being served in nursing facilities. The effect of this provision was to relocate individuals who did not need that level of care into alternative settings. It meant that there would be fewer people would be eligible for services funded by Medical Assistance, Minnesota’s version of the Medicaid program. In March of 2010, the federal government passed the Patient Protection and Affordable Care Act, the law implementing federal health care reform. That law extended the maintenance of effort requirements for states originally established as part of the federal stimulus law, not allowing them to reduce enrollment or spending in their Medicaid programs below certain levels. The final state budget in 2009 relied on savings in the FY 12-13 biennium from changing the nursing facility care criteria that was no longer allowable under federal law. 

To remedy this, the final health and human services budget from the 2011 Special Session directs the Department of Human Services to apply for a federal waiver to allow the state to implement the changes effective July 1, 2012. If federal approval isn’t granted, there would be a 1.67 percent reduction made to long-term care rates to ensure the state budget remains balanced if the waiver is not approved. 

The department submitted this waiver application to the federal government on November 28^th. You can view the announcement and associated documents here. There will be ongoing discussions between state and federal staff, but department staff has indicated they expect approval. Rates will not change unless approval is not granted or we reach July 1 of 2012 without an answer.

ARRM has been monitoring this issue and participating in a stakeholder group for implementing this policy. We will continue to update members as new developments as they occur. As always, if you have any questions, contact Craig Wieber at cwieber@arrm.org or 651-291-1086, extension 9.

--Craig Wieber, Chief Fiscal Analyst

Wheels are in motion for the 2012 ARRM Conference

Even though the 2012 ARRM Conference is nearly six months away, ARRM staff and volunteers have been busy laying the foundation for a top-notch spring event, which takes place May 23 and 24, 2012 at the Crowne Plaza St. Paul Riverfront Hotel.

The Conference Committee recently nailed down this year's conference theme: Driving Innovation. After considering many relevant titles, the committee cemented a motif that perfectly captures ARRM’s focus for 2012. Innovation and reform are two key concepts ARRM will be promoting in the coming months, and the annual spring conference will showcase innovative work and ideas produced by and used within the disability industry.

Other important conference news

The ARRM Cares nominations are now open! Last year, we had a record number of nominations -- 167. This year, we’d like to match or top that number. The awards ceremony, which will take place on May 24^th in the afternoon, is a powerful and moving tribute to those DSPs who go above and beyond the call of duty. It’s an uplifting ending to a successful conference, and a high point for those nominated as well as the agencies that honor their exemplary staff. The deadline for nominations this year is January 17, 2012. Please take some time to read the awards guidelines and complete the online nomination form to make sure your staff are duly recognized for their outstanding service.

And please don’t forget the ARRM auction when you’re shopping for gifts this holiday season. ARRM is accepting donations for the auction, which will be held on Wednesday, May 23^rd in the late afternoon/early evening. This event has always provided conference attendees a fun-filled opportunity to network, shop, and socialize. Help us make it a success by donating an item; we thank you in advance for your generosity.

--Nancy Peterson and Barb Brynstad

ARRM and Commissioner Jesson focus on legislative remedy to 10 percent cut

ARRM met with DHS commissioner Lucinda Jesson Tuesday to problem-solve solutions to the unintended impacts of the 10 percent congregate care rate reduction. With the commissioner were Assistant Commissioner Loren Colman and Alex Bartolic, Disability Services Division director.

The meeting resulted in no silver bullets in the short term, but we do have a commitment to find a resolution in the next legislative session. To that end, we provided reform ideas (that will be in ARRM’s reform bill) to provide fiscal alternatives to the cut.

The commissioner voiced surprise concerning how profound the chronic health, mental health and other disabling conditions are among many of those classified as “lower need” and subject to the reduction.

As a next step in the short term, Loren Colman offered to personally call counties that refuse to meet with providers to discuss potential service plan modifications for some individuals with reduced rates. ARRM will serve as a conduit between ARRM members and Coleman.

Thus, if a county refuses to discuss service plan modifications due to this rate reduction, please email me (bnelson@arrm.org) with the following information:

• Your name and agency
• The county and name of the county worker who declined to meet

(Put this in the subject line: “10% counties”)

When talking with counties, remember two things:

1. The county’s overall allocation was reduced by the total of the individual 10 percent cuts to recipients in that county. However, many counties still have unspent money in their allocations from the state.
2. Within the limits of that allocation counties can and do renegotiate provider rates when service needs change. They have always had that authority and situations related to the ten percent reduction are not excluded from this authority.

We’ll be talking more about this issue with the department next week. ARRM’s Executive Committee and Board of Directors will consider next steps on this issue in the very near
future.

--Bruce Nelson, CEO

ARRM weighs next steps regarding 10 percent cut

ARRM continues to pursue strategies and review options to address the 10 percent congregate care reduction. None of our options are straight forward. It is very important that we resolve the inequities in the rollout of the 10 percent cut by finding the best avenues to address the disproportionate hit on some ARRM members and individuals who are clearly not low need. These individuals include people with mental illness, chronic
health conditions and developmental disabilities.

At the same time, it is important that we maintain working relationships with all parties on this issue, rate methodologies, delicensing and reform legislation. Buying back the $12.7 million cut at the legislature would be difficult with another big deficit expected in 2012, but our reform legislation may create savings options for the legislature and the department to consider to help offset a reduction, reshifting or repeal of the 10 percent cut.

We know some parties are considering legal action. ARRM is not involved at this time as we look at the potential downsides:

• The result could be merely changing who gets cut – with different winners and losers.
• With the matter in the courts, the legislature could decide to take no action – closing the door on a legislative resolution.
• The attorney general would likely advise the commissioner and lead DHS staff to limit, if not cease, communicating and collaborating with those involved in the lawsuit
  as was the case in ARRM’s rebasing lawsuit.

So how do we fix this mess? So far our working relationship with DHS has been good as the department has responded to our concerns with clarifications to counties and changes to the client determination model, although we are disappointed that reassessments of new
people on the second list didn't have opportunities for reassessment.

Affected providers are now figuring out how to handle the reductions within their companies. Options include absorbing the cut, talking to counties about reducing services commensurate with the loss in revenue and, among other possible steps, discharging individuals. We have advised members about the client appeal process and a group of metro providers have offered training for staff to assist clients in the appeal process.
Knowing how those appeals are adjudicated will have a bearing on our overall strategy.

The ARRM Board meets tomorrow to discuss our political and legal options. ARRM has also scheduled a meeting with DHS Commissioner Lucinda Jesson next week to work toward a positive resolution to this issue. We know the department will be preparing legislation for 2012 and so will ARRM. Hopefully we will find common ground. Whatever the outcome, we will continue to engage in conversations with legislators and the governor’s staff on this and other huge issues before us in the next seven months.

We’ll continue to keep you posted.

--Bruce Nelson, ARRM CEO

Some counties erroneously saying they cannot refill SLS vacancies

ARRM has learned that some counties are telling SLS providers that they will decertify beds when a bed is vacated. They cite a provision adopted in the 2011 special session.

These counties are in error and are misreading the new law. Counties should not be decertifying these beds. Actually two sections of law govern decertification, and when and if these provisions are implemented, decertification relates only to a consumer who is reassessed and chooses to move into another community option after being presented with options for other community services.

The misinformation appears to have come from the Minnesota Association of County Social Services Administrators (MACSSA) in that association’s legislative summary. The mistake is understandable as the provisions referring to decertification are confusing and include the interaction between two new sections of law. 

In order to meet the requirements of both sections, DHS agrees that it must first develop transition and reassessment processes for the recipient to choose another service option. Neither process is underway and DHS says they are not among its priorities of things to do as a result of new laws passed in 2011. At a stakeholder meeting in September DHS affirmed this and said the Department will develop clarifying legislation.

Here are the two sections of law. Note that the first section is dependent on the second:

Chapter 9, 2011 Special Session, Article 7

Section 1 (e) When a foster care recipient moves out of a foster home that is not the primary residence of the license holder according to section 256B.49, subdivision 15, paragraph (f), the county shall immediately inform the Department of Human Services Licensing Division, and the department shall immediately decrease the licensed capacity for the home. A decreased licensed capacity according to this paragraph is not subject to appeal under this chapter.

AND

Section 40. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:
(f) At the time of reassessment, local agency case managers shall assess each recipient of community alternatives for disabled individuals or traumatic brain injury waivered services currently residing in a licensed adult foster home that is not the primary residence of the license holder, or in which the license holder is not the primary caregiver, to determine if that recipient could appropriately be served in a community-living setting. If appropriate for the recipient, the case manager shall offer the recipient, through a person-centered planning process, the option to receive alternative housing and service options. In the event that the recipient chooses to transfer from the adult foster home, the vacated bed shall not be filled with another recipient of waiver services and group residential housing, unless provided under section 245A.03, subdivision 7, paragraph (a), clauses (3) and (4), and the licensed capacity shall be reduced accordingly. If the adult foster home becomes no longer viable due to these transfers, the county agency, with the assistance of the department, shall facilitate a consolidation of settings or closure. This reassessment process shall be completed by June 30, 2012.

ARRM, DHS and legislators are all working on legislation regarding these provisions for the 2012 Legislative Session.

If you have any questions or know of any counties misinterpreting the new law, please contact me.

--Bruce Nelson, CEO

DHS announces rate setting methodology video conference

Last week, we learned that the Department of Human Services will be moving forward with the rate setting methodology process, and will introduce the new system in the form of shadow rates beginning in 2012. The agenda for this meeting is to provide an update on the overall progress of the project, how the 2012 implementation will work, information on how full implementation will proceed in 2013, and updates on the progress of related projects –- MnChoices and MN’s Centralized Waiver Provider Management System (recently known as Provider Enrollment/Provider Standards Initiative, or PEPSI).

DHS is planning a video conference for interested individuals to run through the project’s latest developments on November 15^th.  An electronic version of the flyer announcing the meeting has additional information and is available on DHS’s website. To register, go here.

--Craig Wieber, Chief Fiscal Analyst

Ten percent reduction update: ARRM requests meetings with DHS, Commissioner Jesson

ARRM is now analyzing the results from our member survey to help determine our next steps. The surveys will give us an indication of the relative needs of affected recipients, impact on provider members and steps providers are taking to manage the reduction.

In the meantime we have scheduled a meeting next week with disability services staff and DHS, and have asked Commissioner Lucinda Jesson for a meeting to explore state and provider options – hopefully before the next billing date.

Members are reminded of consumer appeal rights, and members should be aware of DHS’s instructions to counties when you are in communication with your counties. In part, DHS told counties:

Service changes or appeals

A rate reduction does not trigger an automatic appeal. The 10% reduction is a provider rate reduction for a person still receiving customized living, the CADI Waiver service of foster care or the DD Waiver service of supported living in a corporate foster care setting. Lead agencies must:

1. Discuss with individuals and the providers whether service plan modifications are necessary or if the provider is able to manage services without appreciable difference to the person.
2. Determine if they need to revise a service plan.
3. Send a notice of action to the recipient if service plan changes are required.

Take particular note of #1 above: Counties have been told to discuss with you and affected individuals “…whether service plan modifications are necessary or if the provider is able to manage services without appreciable difference to the person.”

We’ll provide further updates as we gather more information. 

--Bruce Nelson, CEO