ARRM's Daily Dispatch

As session ends, many licensing and policy changes for providers

In addition to the list of budget related issues covered in the ARRM summary dated April 25, 2012, the Legislature also adopted a number of positive licensing and policy items that will impact ARRM members and the people they serve. (We will continue preparing summaries by issue area for future blogs and, when completed, compile them in one document.)

Licensing Issues

• Foster Care Licensing Moratorium: In order to monitor the number of adult foster care beds that are included in the moratorium, license holders will need to indicate if the physical location of the foster care setting is the primary residence of the license holder. This information will be indicated on the license.

• Adult Foster Care License Capacity: The deadline for issuing licenses for five bed adult foster care is extended to June 30, 2016.  The Department of Human Services is required to submit a request by December 31, 2012 to amend the DD and CAC waiver plans to allow for payment of services in five bed settings.  The changes to the waiver plans for the BI and CADI waivers have already been approved.  Facilities will be allowed to continue to operate as five bed programs as long as they continue to comply with all requirements.  The option for operating a program with a capacity for five cannot increase the total number of adult foster care beds in the system.

• Residential Support Services: Language has been added so anyone licensed to provide child or adult foster care when the licensed site is not the primary residence of the license holder and meeting the other requirements in 256B.092 subdivision 11,  would automatically be considered registered as a provider of residential support services.

• Common Entry Point: There is a requirement for the commissioner to maintain a centralized database for the collection of all common entry point data, including maltreatment report dispositions and appeals data.

• Single Set of Standards: Because the licensing of customized living services is under the jurisdiction of the Department of Health, legislation clarified that these services are not included in the requirement for a single set of standards.

• Data Practices: When a license denial or sanction is based on the determination that the  license holder or applicant is responsible for maltreatment, the identity of the applicant or license holder is public data at the time of the license denial or sanction.  When a license denial or sanction is based on a determination that the license holder or applicant is disqualified under chapter 245C, the identity of the license holder or applicant and the reason for disqualification are public data at the time of the license denial or sanction.

• Application for Licensure: If an application is submitted that is deficient or incomplete, the commissioner must provide written notice to the applicant identifying the deficiencies.  The applicant has 45 days to submit the second complete application.  Failure to comply is a basis for license denial.  Effective January 1, 2013, the commissioner may require an applicant to demonstrate competence in applicable licensing requirements.  The focus of this provision is on applicants who have not been licensed and may lack basic understanding or knowledge of licensing requirements. Applicants for licensure for a non-individual must provide a Minnesota tax ID number, name address and social security number of controlling individuals and the date the background study was initiated for all controlling individuals.

• Background Study Violation Fines: Except for a background study violation involving the failure of a license holder to comply with an order to immediately remove an individual or to provide continuous direct supervision, the commissioner shall not issue a fine to a license holder that self-corrects a background study violation.  If a license holder exercises this provision, they may not use it again to avoid a fine unless at least 365 days have passed since the previous self-correction.

• Orientation to risk reduction plans and annual review of plans: Documentation of orientation to the risk reduction plan as well as annual reviews of the plan must be maintained in the personnel file of each mandated reporter.

Policy Issues

• County Notification: The process of “host county concurrence” has been eliminated.  If the county of financial responsibility wishes to place someone in another county, the county of financial responsibility must notify the proposed county of service and the placement is to be made cooperatively between the two counties. The county of service shall notify the county of financial responsibility if there are concerns about the chosen provider’s capacity to meet the needs of the person seeking to move to the residential services in another county within 20 days of having received the notification. This notification process applies to home and community based waiver services as well as ICF/DD placements. 

• Cost Sharing for Glasses: The $3.00 MA copayment for glasses has been eliminated.

• Terminology Change: Throughout statute the word “traumatic” will be eliminated when it comes before the word “brain”. The term TBI will be replaced with BI.

• Data practices: During an investigation on possible overpayment of public funds to a service provider, the existence and status of an investigation is public data.

Please stay tuned for future blogs that will provide summaries on legislation regarding PCA services, 245D, the comprehensive assessment and background study changes.

If you have questions feel free to contact me at bturner@arrm.org or 651-291-1086, ext. 3.

-- Barb Turner, COO

ARRM issues successfully addressed by Legislature

Health & Human Services 2012 Legislative Session budget changes (as of April 25, 2012)

Both the House and Senate passed the Health and Human Services Omnibus Finance Bill Tuesday, April 24. Gov. Mark Dayton is expected to sign the bill, which was agreed to by a House/Senate conference committee last Friday. (HF2294A)

On Monday, Gov. Dayton signed the DHS Policy Bill, which included language establishing a process for developing a new payment methodology. Chapter 216 Summary: http://www.house.leg.state.mn.us/hrd/bs/87/SF1675.html

Going into session, ARRM had a daunting list of major issues to address in a short session: undoing bed de-licensure, eliminating the 1.67 percent contingent rate reduction, reducing or eliminating the 10 percent low need cut, passing our Blueprint for Reform measures and developing a new payment methodology. 

After a lot of hard work by ARRM staff and our members, we can say, “mission accomplished,” with the caveat that a couple items are dependent on federal action.

The Legislature also adopted a number of positive licensing and policy items, including host county notification instead of concurrence that we’ll summarize in another blog post.

The Omnibus Finance Bill restores or delays several of the reductions to disability services in the 2011 session, includes revenue from health plans due to a law limiting their profits, and refinances general fund spending to the Temporary Assistance for Needy Families (TANF) fund. 

Here is how the bill addresses many of the issues we’ve been tracking throughout the session, and others impacting the disability community:

• 1.67 Rate Reduction: CORRECTION: This reduction is repealed delayed until the next biennium. The cut goes away if the federal government approves the nursing facility level of care waiver. ($22.8 million spending)

• Continuing Care Payment Delay: If the federal waiver to implement the nursing facility level of care (the proposal that was supposed provide savings in FY 12-13) is not approved, then $20.6 million worth of payments for long-term care services would be delayed until next biennium. Providers would receive payment for services provided in June 2013 a month later than normal at the same time they are paid for services provided in July 2013. Providers would have to cash-flow operations for a month until the delayed payment is made. ($20.7 million savings)

• Bed De-Licensure: Delays any bed closures until the upcoming biennium. The process for closures has changed. First, the bill adds an incentive payment for providers to voluntary close facilities. If that provision ends up closing 128 beds by June 30, 2013, then no reductions occur. If not, DHS will close beds to make up the difference by June 30, 2014, after completing a statewide assessment and needs determination process. Facilities certified as mental health providers are excluded. ($1.6 million spending)

• 10 Percent Low Needs Reduction: The reduction goes from 10 percent to 5 percent if the nursing facility level of care waiver is approved. There is also language reiterating that counties must consult with providers about adjusting services. ($3.8 million spending)

• 20 Percent Relative Care Reduction: Delays the reduction until the upcoming biennium. ($5.9 million spending)

• Medical Assistance for Employed Persons with Disabilities (MA-EPD): Includes language to allow individuals over age 65 to stay on the program. ($437,000 spending)

• State Operated Mental Health Services at Willmar: Includes funding to continue operation of specialty health services on the Willmar campus by transferring funds from another DHS account. ($3.2 million spending)

• Epilepsy: Adds grant funding for living skills training programs for persons with intractable epilepsy for transitioning to independent living. ($65,000 spending)

• Self Advocacy: Adds grant funding to establish and maintain a statewide a self-advocacy network for persons with intellectual and developmental disabilities. ($50,000 spending)

• Autism: Includes two provisions for DHS: one to study practices in other states of serving people with autism, including providing services in a campus setting; and a requirement the state work with counties to develop foster homes for individuals with autism. For the Health Dept., the bill includes a study on cultural and resource-based aspects of autism unique to the Somali community. ($177,000 spending at DHS, $200,000 spending at MDH)

• Critical Access Dental: Expands MA dental coverage to developmentally disabled adults to include house calls or extended care facility calls; behavioral management; sedation; and prevention up to four times per year. (No cost)

• Family Deductible: Adds language allowing long-term care providers to absorb the cost and not require collection from the individual. (No cost)

• Mental Health Services: Requires the department to develop recommendations to improve access to mental health services under medical assistance by utilizing physician assistants. (No cost)

• TEFRA Fees: Extends current program fees through June 30, 2015. (No cost)

• Personal Care Assistant (PCA) Licensure: DHS will study the feasibility of licensing PCA services and report recommendations by January 15, 2003. (No cost) 

The conference committee report included all negotiated provisions from ARRM’s Blueprint for Reform. These include:

• Expanding the number of individuals who can receive services in multi-family settings;
• Further opening up shelter needy allowing the service and housing providers to be the same entity with a process to transfer leases to the individual;
• Allowing daily billing for independent living services (ILS) in CADI and BI;
• Changing the approval process for using monitoring technology;
• Extending the deadline for adding a fifth bed in adult foster care;
• Allowing the addition of a fifth bed for respite;
• Adding a risk study to the work of the State Quality Council;
• Allowing signed changes to individual service plans to be incorporated into the ISP;
• Assuring protections for providers when counties fail to complete individual service plans;
• Modifying background study requirements for full-time employees in unlicensed services;
• Requiring corrections/probation officers to inform DHS of individual convictions of disqualifying crimes; and,
• Establishing a process for providers to voluntary close group homes in exchange for an enhanced payment rate.

-- Craig Wieber and Bruce Nelson

Conference committee on HHS budget begins

On Tuesday night, the process to work out differences between the House and Senate Health and Human Services budget bills began with the initial conference committee meeting. When the House and Senate pass legislation that isn’t identical, a conference committee is appointed to work through those differences and produce a compromise.

The conference committee began by reviewing the differences between the two version of the bill and adopting language that is identical in both bills or only has technical differences.

There was extensive discussion about the bed de-licensure provisions. Rep. Jim Abeler, Chair of the House HHS Finance Committee, offered an amendment to the House position on bed de-licensure. His amendment delayed any required bed closures until the next biennium. The bill includes an incentive for providers to voluntarily close beds. If the voluntary closure provision does not achieve the same savings as last year’s bed de-licensure provisions, then DHS would close beds in the next biennium to make up the difference – after conducting a statewide needs determination process. And, his provision adds the DD waiver. It only applied to the CADI and brain injury waivers before. The committee also discussed responsibility for provider enrollment and licensing moving from the county to the state.

ARRM testified about this updated approach. We like – and had worked for – the delay in mandatory reductions to give the voluntary option time to work. But we are concerned about the addition of the DD waiver. We testified that the approach in our reform bill accomplishes the goal of aligning the capacity of foster care with people’s needs.

The committee did not act on any items with funding because the members do not know how much funding is available. As part of global discussions concerning several major tax, spending and bonding issues, legislative leaders and the governor are negotiating whether to use any of the funds being returned by the health plans for items not related to health and human services. As of right now, those funds are being used to buy back reductions taken during the 2011 session. Once the committee knows how much it has to work with, the HHS budget will likely be wrapped up quickly.

As always, if you have any questions feel free to contact us via email at cwieber@arrm.org or bnelson@arrm.org, or by phone at (651) 291-1086 ext. 1 for Bruce, ext. 9 for Craig.

--Craig Wieber and Bruce Nelson

Housing with services is topic for May 7 'Lunch With the Experts'

The Service Design and Delivery Committee will host the next "Lunch With the Experts" event May 7, 2012 from noon to 1 p.m. at the ARRM office. Steve Throndson and Eric Grumdahl from Dakota County will talk about housing with services.

Please bring a brown bag lunch and join us for this presentation. Members do not need to register.

If you can’t attend, you may join us via conference call. The phone number is 1-866-740-1260; the access code is 2911086#. Please contact Barb Turner at bturner@arrm.org or 651-291-1086 ext. 3 if you have questions.

--Barb Turner, COO

DHS convenes Rule 40 Advisory Committee

As part of an agreement in the recently settled METO lawsuit, DHS will revise Rule 40. The Rule 40 Advisory Committee will study, review and advise DHS on how to revise Rule 40 to reflect current best practices. The committee will meet monthly for approximately eight months.

Steve Anderson from MORA is representing ARRM on this committee. Steve has had training in positive behavioral supports, has ties to MCCP, and does training for providers. Steve will provide regular updates to ARRM and we will share information with members.

DHS has little data about the use of aversive procedures, and it seems that there may be some misconceptions regarding providers use of aversive procedures. This week DHS sent a draft survey to a random sample of providers. The intent is to get feedback on the survey, which will eventually be sent to all providers. The survey will provide the Department with valuable policy information and data about the statewide use of restrictive aversive and deprivation procedures with people who have varying disabilities or who are elderly with various age-related impairments.

The Department is also interested in obtaining information and data about anyone receiving court-ordered Electro-Convulsive Therapy (ECT) as well as psychoactive medications and data about law enforcement intervention due to behavioral incidents.

ARRM will continue to update members as this process moves forward.

If you have questions, feel free to contact Barb Turner bturner@arrm.org or 651-291-1086 ext. 3

--Barb Turner, COO

Survey says: Satisfaction with ARRM is high

In September 2011, ARRM distributed our fourth member satisfaction survey to approximately 700 members using ARRM’s Bulletin Board list. About 17 percent of you responded, and although we'd like to see a higher response rate, we were encouraged by the positive results. Overall, members found tremendous value in the benefits we provide, especially member communications, government relations, and legislative advocacy.

To view the results, click here to download a PDF.

We will use the 2011 survey data to build a stronger, more responsive association in the months and years to come. In particular, we will pay attention to recognizing the good work you do on our committees, and make sure all members are aware of the various volunteer opportunities at ARRM.

The next satisfaction survey will come out in 2013, and our goals are to obtain a higher response rate and analyze and deliver the results to members more quickly.

Meanwhile, we appreciate your creative ideas about how to make ARRM a better association. Feel free to contact Nancy Peterson (651-291-1086, ext. 2), ARRM's director of member services and education with your constructive feedback and testimonials.

--Barb Brynstad, Communications Director