ARRM's Daily Dispatch

Legislative Auditor Calls for Reduction in SOCS

In a report released Wednesday, the Office of the Legislative Auditor (OLA) found several management and operational shortcomings in the state’s 130 facilities – from large institutions to group homes – and made 20 recommendations to DHS and/or the legislature.

Included in the wide ranging report is a recommendation for DHS to “…develop a plan for the 2014 Legislature for reducing the number of state-run group homes for individuals with developmental disabilities.” The Department’s written response noted “that it would be most useful if we are able to plan with our labor partners (and) counties…”

In presenting the findings to the Senate Health and Human Services Finance Division, Legislative Auditor Jim Nobles said, “Some people would be better served in alternatives to state operated facilities.” OLA’s Joel Alter, who led the audit project, noted that there should be a range of options for some people now served in state operated group homes and larger state institutions for more independent living through the private sector.

Indeed, the Governor’s budget calls for approximately 50 people to move from the Anoka-Metro RTC into community placements, mostly in the CADI waiver.

This issue is only one of many covered in the report that focuses on department governance and leadership; service development, delivery and management, civil commitment and the state’s Security Hospital. To see access the entire report and summaries, click here.

On Monday, Nobles told me that the current commissioner, Cindy Jesson, inherited “a mess” and that she has taken steps to address several of the problems outlined in the report. In a follow-up conversation after the Senate hearing, Nobles asked for my thoughts about the report. I told him we embrace the recommendations, but the hard part will be follow-through with implementation.

~ Bruce Nelson, CEO

ARRM’s Monday Update from the Capitol

Last Week

ARRM continued to move forward in getting bills introduced, educating legislators and tracking other bills that we may need to modify or oppose.

COLA: The COLA Coalition’s bills were introduced. The identical bills ask for a 5 percent increase in each of the next two years.

• Senate: S.F. 599: Authors: Eken with Rosen, Hoffman, Brown and Clausen as second authors.
• House: H.F. 777: Authors: Newton with Huntley, Abeler, Schomacker, Fritz, Hamilton, Norton, and as second authors.

1.67 Reduction: A COLA Coalition bill to repeal the six-month 1.67 percent rate reduction was introduced. Without getting this bill passed, the six-month cut in current law would start July 1, 2013 and end Dec. 31, 2013. The bill authors are:

• Senate: Hoffman with Eken, Clausen, Brown and Rosen as second authors.
• House: Halverson, with Fritz, Huntley, Abeler, Hamilton, Dean, Zerwas, Marquart and Schomacker as second authors.

Payment Methodologies: ARRM reviewed DHS’s bill draft with our Rate Setting Coalition. We subsequently informed legislative leaders and DHS that we will offer an alternative bill, which will included several sections from the Department bill and alternatives to other sections. We hope to continue working with DHS and Disability Waiver Rate Setting (DWRS) work groups through the session. The ARRM Board adopted a resolution calling for ARRM and the coalition to: a) continue working with DHS and the DWRS stakeholders to develop a system consistent with ARRM’s Payment Methodology Principles, and, b) advance an alternative that addresses issues not yet resolved.

DHS’s Continuing Care Bill: This policy bill (S.F. 459 - Eken) cleared one committee and is headed for another. ARRM is seeking clarification on a couple provisions, but doesn’t have any major concerns with the bill. The House bill (H.F. 767 – Morgan) has not been scheduled for a hearing yet.

This Week

Budget Forecast: The most telling benchmark of the session occurs Thursday, Feb. 28 when the Minnesota Management and Budget Department (MMB) releases the February fiscal forecast for the next biennium – July 1, 2013 through June 30, 2015 (FYs 2014 and 2015). The legislature must balance the budget for the next biennium based on this forecast. The last forecast showed a $1.1 billion deficit. If this forecast shows a bigger deficit, the likelihood of securing additional funding would be lessened.

COLA and 1.67 Percent: ARRM meets with the bill authors in preparation for hearings.

Licensing Fees: The new fees to be proposed in the Governor’s HHS Budget Bill, which will include a mixed bag for ARRM members, some having overall fees reduced and some with increases. The ARRM board provided input on how to evaluate impacts, look at what fees are buying and work with others affected by the change. In essence, 245B fees would be eliminated and replaced by fees in the new 245D – covering services not now licensed.

The $2.55 Family Co-Pay: We meet with authors of a bill we hope to amend with language that would exempt our services from the co-payment. The House bill will be heard Wednesday in committee. Our fallback is to strengthen a provision adopted last year that would allow providers to simply pay the co-pay, rather than having to go to the expense of collecting it from individuals.

Forced Closures of Corporate Foster Care Beds: We are working with legislators and DHS to determine if the requirement to close 128 beds voluntarily has been met. If it hasn’t, we’ll proceed with legislation to repeal or delay the requirement.

10 Percent Lower Need Reduction: ARRM will continue discussions started last Friday to look at repealing the cut. Current law would reduce the reduction to 5 percent if and when CMS approves a waiver to match state dollars for Alternative Care with federal Medicaid dollars.

Other DHS Bills: We expect continuing care policy, 245D, Rule 40, licensing, Reform 2020 and other department bills to be introduced within the next two weeks.

Other Bills Were Monitoring Most Closely:

• Unionizing some PCA services while creating a quality self directed council (H.F. 844 – Norton and many co-authors) (S.F. 665 – Eaton)
• Minimum wage bills
• Case management bills
• Dental access bills

We’ll post these and others in the “My Bills” section of the legislature’s website. You can access this link by clicking here and following the "My Bills" tracking link (username: "A.R.R.M."  Password: "reforms").

Day at the Capitol: We expect about 1,000 people at the Capitol. The Rally in the Rotunda at 1 p.m. March 5 and will include Gov. Dayton, a self-advocate and several key legislators.
 
~ Bruce Nelson, CEO

Rate Setting Update

DHS has released their recommended language and values for calculating rates under the new Disability Waiver Rate System (DWRS). There are several pieces of information we have received and want to share with members:

DHS draft legislative language is available here, and the values to populate the frameworks are available here. Also, a document outlining overall spending under the new system is available here, and a summary of the project they have used in meeting with legislators is available here. In conjunction, DHS updated the individual rate framework spreadsheets to match up with their language and values. Those are available on DHS’s website at this link: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_150898

In order to complete an individual’s rate, you’ll need to have a budget neutrality factor. Right now, those frameworks have budget neutrality factors set to zero. Using their most recent spending estimates, the services in each of these buckets gets the following adjustments: -0.1% for residential services, 10.4% for day, -5.9% for unit with programming, and -20.5% for unit without programming. Those values will change, but they are what providers should use for the moment to calculate rates.

Here are some of the major changes from the last update included in DHS’s recommendation:

• Banding: When the new system comes online, every individual currently receiving service will have their rates banded for three years. Individual’s rates will move up or down by no more than 1% per year for three years. That adjustment does not begin for every individual at once. The transition to the new rate is tied to each individual’s annual review. So, if that is due to occur in August 2014, that is when that individual goes into the new rate system and their banding begins. DHS is also proposing to give some additional banding protection for individuals whose needs change. Banding would accommodate changes in an individual’s needs without requiring those individual’s rates to automatically move to the new methodology.

• Administration: Previously, it was understood that county staff would enter staffing information in the rate management system. Now, DHS’s position is that providers enter staffing information and county staff provides some sort of approval or sign off. There still needs to be clarification of how or if that information can be changed, but this should improve the process of getting data entered.

• Residential Transportation: DHS has changed the values attached to transportation costs for individuals. Previously, individuals requiring services of a full-sized adapted van got an adjustment of $4,290 per year to their rate. The value is lowered to $3,000 per year.

• Deaf and Hard of Hearing Customization: The add-on for customizations is dropping from $9.70 per hour to $2.50 per hour, and tightening up the qualification standards for individuals to receive the add-on to their rate.

• Supervisor Wages for Behavioral Services: Previously, the framework values for supervisor wages in behavioral specialist and behavioral analyst services were lower than the wage for the direct care staff. DHS increased the wages for supervisor time to the same level for these two services. 

• Interim Values: To deal with issues that are unresolved or need additional work, DHS is proposing components or values in the frameworks be labeled interim. Their intention is that those values or issues will receive additional review and analysis, and will be addressed in future legislation. These include: transportation rates for day training and habilitation, transportation for adult day, structured day and prevocational services, geographic difference factor, day program facility rate, services where monitoring technology replaces staff time, shared services for independent living skills training and supported employment and billing for indirect services. This interim status is just a label, there is nothing in the language to sunset or change them at some future date.

Now that DHS has released a fully-formed recommendation, ARRM and our coalition partners are taking action. On Monday, we met and laid out a strategy to respond. Given the number of interim values and undefined processes, we will be looking at options for additional time to develop these pieces prior to implementation. Initially, the coalition will be sending a letter to DHS detailing all of our concerns with DHS’s proposal. ARRM members involved in the rate setting process have been helping draft that language, along with other coalition members. Once it’s finalized and sent to the department, we’ll pass it on to ARRM members.

Simultaneously, we’ll be drafting our own bill along with our coalition partners. At this point, the coalition includes MOHR, MnDACA, the Disability Law Center, The Arc of Minnesota, and Courage Center. The coalition informed legislative leaders and the governor in writing that we would offer an alternative bill.

Our approach will be a bit different in 2013. While significant differences still exist between our approach and DHS’s, there are fewer of them compared to last year. We’ll be using their legislation as a base, offering improvements and additions to address our specific concerns. 

Last Thursday, the ARRM board adopted a resolution taking the following positions:

• To continue working with DHS and the DWRS work groups to develop a system that meets ARRM’s Payment Methodology Principles.

• To work with the Rate Setting Coalition to assure that a system is fully implemented only when satisfied that individuals have adequate resources to meet individual needs, within the parameters of budget neutrality.

As always, if members have specific questions on any particular item at any time, please contact me directly at cwieber@arrm.org or 651-291-1086, extension 9.

~ Craig Wieber, Chief Fiscal Analyst

DHS Opens Public Comment Period on Waiver Amendments

DHS has opened the public comment period on the waiver amendments for the BI, CADI, CAC and DD waivers. The comment period closes March 18, 2013. 

ARRM is working with members of the Service Design and Delivery Committee to review the amendments and provide a response from ARRM.

Click here to review the announcement and proposed amendments for the BI, CAC, CADI and DD waivers.

You can forward your comments to Barb Turner at bturner@arrm.org for possible inclusion in ARRMs response, or you can send your comments directly to DHS at DSD.PublicComments@state.mn.us

~ Barb Turner, COO

 

SBA Launches Affordable Care Act Web Page & Blog

The U.S. Small Business Administration (SBA) today launched a new web page and blog dedicated to educating small business owners about the Affordable Care Act. The new tools will serve as a gateway for small business owners connecting them with information provided by SBA's federal partners responsible for implementing the law, including the U.S. Department of Health and Human Services.
 
"The Affordable Care Act provides small business owners with access and opportunity to provide affordable health care options for their employees," said SBA Administrator Karen G. Mills. "SBA's new Affordable  Care Act web page and blog will serve as a resource for small business owners who want learn more about how to take advantage of these benefits."
 
SBA's new web page, www.sba.gov/healthcare, breaks down the key provisions of the Act based on business size in the following categories: self-employed, fewer than 25 employees, fewer than 50 employees and more than 50 employees. 
 
The blog, entitled Health Care Business Pulse (www.sba.gov/blog), will provide small business owners with continuous updates about the implementation of the Act.

Please contact me at bturner@arrm.org if you have questions.

~ Barb Turner, COO

ARRM’s Monday Update from the Capitol

LAST WEEK

This past week ARRM focused on laying a foundation at the legislature for swinging into action on key issues in the very near future. Meanwhile, health and human services committees were focused on Affordable Care Act bills and the legislature adopted the state employee contract that provides a two percent pay increase to those workers.

COLA: The COLA Coalition (ARRM, DT&Hs, Arc) met with many legislators and, most significantly, secured authors for our bill, which asks for rate increases of five percent in FY 2014 and five percent in FY 2015. The Senate bill should be introduced today and the House bill in midweek. The authors are:
•    Senate: Eken with Rosen, Hoffman, Brown and Clausen as second authors.
•    House: Newton with Abeler signed on. Fritz, Hamilton, Norton, Halverson, Zerwas and others have indicated they want to be second authors.

1.67 Reduction: A COLA Coalition bill to repeal the six-month 1.67 percent rate reduction has been dropped in the House and Senate hoppers and should be introduced today. Without getting this bill passed the six-month cut in current law would start July 1, 2013 and end December 31, 2013. The bill authors are:
•    Senate: Hoffman with Eken, Clausen, Brown and Rosen as second authors.
•    House: Halverson, with Fritz, Huntley, Abeler and Hamilton as second authors.

Payment Methodologies: DHS released the department’s bill language Friday. ARRM staff and members, along with members of the Payment Methodology Coalition, spent time this weekend to review the bill. The Coalition meets this morning to go over the bill and discuss next steps. The ARRM Board of Directors will act on ARRM’s position(s) on payment methodologies this Thursday.

THIS WEEK

COLA and 1.67 Percent: ARRM will begin working in depth with the bill authors and continue lobbying other legislators.

Licensing Fees: We are preparing a fact sheet/analysis of the governor’s proposal. That analysis will include impacts on providers (some would pay more than they do now; some less), what licensing fee money buys, opportunities with the proposal – such us reducing the county fee on inspections. The ARRM board will discuss the ins-and-outs of the issue at its meeting Thursday to provide some guidelines for moving ahead. The new fee structure would replace 245B fees and be spread among licensed and currently unlicensed providers in the new 245D.

$2.55 Family Co-pay and Forced Closures of Corporate Foster Care Beds: We began working these issues last week and will ramp up discussions with legislators. We have developed legislative language to exempt long term care from the co-pay and repeal the force closure requirement.

DHS Bills: We expect continuing care policy, 245D, Rule 40, licensing, Reform 2020 and other department bills to be introduced within the next two weeks. ARRM plans to amend one or another of these bills with cleanup provisions (like shelter needy changes) and will be negotiating some of the department provisions with DHS and other stakeholders. For the past several months we have been working behind the scenes on several of these bills, such as 245D.

What You Can Do: You will receive an alert this week asking you to help us work with Gov. Dayton to include a disability COLA in his supplemental budget to be released in early March after the Feb. 28th budget forecast.

Stayed tuned for the alert and future updates.

~ Bruce Nelson, CEO

ARRM Task Force on Affordable Care Act Being Formed

In an attempt to assist our members as the implementation of the Affordable Care Act (ACA) moves forward, ARRM is forming a task force to focus on this issue.

ARRM is currently looking for members who are interested, knowledgeable and willing to do some work on this very important and complex issue.

The task force will be charged with the following:

1. Help ARRM members navigate through ACA issues.
2. Serve as a resource to ARRM members as it relates to ACA. 
3. Develop expertise around ACA issues.
4. Coordinate with the Public Affairs Committee to employ federal grassroots efforts regarding possible changes to ACA.

The first meeting of the task force will be March 4, 2013 from 10 a.m. to 12:00 noon at the ARRM office.

If you are interested in joining this task force, please send an email to me at bturner@arrm.org by Feb. 28, 2013.

Feel free to contact me if you have any questions.

~ Barb Turner, COO

Nomination Process for ARRM Board of Directors to Begin

The timelines for the nomination and election of new ARRM board members have been changed due to the fact that we will implement online voting this year. Nomination forms will be sent to members next week.

The ARRM board of directors is responsible for establishing goals and objectives, approving an annual budget, and monitoring the financial status of the association. The board is also responsible for establishing policies to guide the operation of ARRM.

Between 20 and 24 directors serve on the board. Each director is expected to be an active member and possibly a chair of at least one standing committee. Directors are encouraged to participate in more than one standing committee whenever possible. Additionally, directors act as representatives and liaisons for the membership as a whole and are encouraged to make themselves available to their colleagues for suggestions, responses and opinions.

Board of director terms are each three years. A board member may serve up to three consecutive three-year terms.

Please consider running for a board of director position. Contact Barb Turner at bturner@arrm.org, if you have any questions.

~ Barb Turner, COO

 

DHS Sends Announcement on Voluntary Closure Process

This week DHS sent an announcement to providers regarding the voluntary closure process. The announcement included a link to a "voluntary closure questionnaire.”

Prior to sending the questionnaire to providers, DHS shared a draft with ARRM. Two of ARRM's committees reviewed the draft and provided feedback. ARRM provided feedback to DHS. We stated that we felt that the questionnaire would not be of much assistance in moving the voluntary closure process forward. Providers interested in exploring the idea of the voluntary closure of beds may be interested in knowing what financial incentives may be available when doing so. The questionnaire is written in a way that a provider would have already decided to voluntarily close beds and then would find out later if there were any financial incentives.

Also, ARRM suggested that DHS gather data on how many beds providers have closed voluntarily since July 1, 2012.

ARRM will continue to monitor this process and provide information to members as we receive it. Contact Barb Turner at bturner@arrm.org with any questions.

~Barb Turner, COO

Update: Last Week and This Coming Week at the Capitol

Since the governor’s budget was released Jan. 22, ARRM has focused its efforts on building support for a COLA and repeal of the 1.67 percent payment shift and rate reduction. We are close to having strong House and Senate authors for both bills, have lined up solid co-authors, and had a number of productive meetings with legislators. These meetings included:

• Senators Eken, Brown, Hoffman, Rosen, Carlson and Benson.
• Representatives Norton, Huntley, Abeler, Laine, Halverson, Schomacker, Zerwas and Dean.

We have many more meetings scheduled for next week.

ARRM also testified in the Senate Health and Human Services Division of the Finance Committee, focusing on a COLA, the 1.67 percent issues and licensing fees.

While the governor didn’t include funding of an across-the-board rate increase, we were able to take advantage of that omission to spotlight the services you provide and your need for an increase.

ARRM’s Chief Fiscal Analyst, Craig Wieber, also began the arduous job of educating key legislators and legislative staff on the intricacies of and progress on payment methodology legislation, now in development by DHS. The department’s legislation is scheduled to be released Feb. 15 and it’s important that these legislators are up to speed on the complicated details that they will be considering.

Next week, we intend to continue this game plan and broaden our efforts to build support to repeal the forced closure of corporate foster care beds and the $2.55 family co-pay for medical services.

Also next week, you will receive an alert asking you to contact your legislators before our March 5 Day at the Capitol. We’re making this request for two reasons:

• Having your legislator advocating in St. Paul for a COLA helps get more money into the health and human services pots – so the health and human services committees have more to spend on you.
• It makes your visit to the Capitol on March 5th much more powerful.

Stayed tuned for the alert and future updates.

~ Bruce Nelson, CEO