ARRM's Daily Dispatch

HCBS self-assessments sent to providers

As of April 21, 2015 DHS has put the self-assessments into the MN-ITS mailboxes of enrolled providers of the following services:

• Adult day care
• Customized living
• DT&H
• Foster care (children and adults)
• Prevocational services
• Residential Care Services
• Structured day
• Supported living services (children and adults in foster care settings/community residential settings)

Providers must complete one assessment for each setting in which they deliver services.  This means a separate assessment for each individual setting, not one assessment for each type of setting.

As a part Minnesota's transition plan, the intent of the assessment is to help providers and DHS to know what might have to be done in order for settings to meet the CMS definition of "community".

DHS has extended the time line for submission of the self assessments.  They are now due Friday, May 29, 2015.

If you have not received a self-assessment contact the MHCP provider call center at 651-431-2700 or 800-366-5411.

If you have questions about the self-assessment or the new federal rule, you can get information by clicking on the following link:

http://www.mn.gov/dhs/partners-and-providers/continuing-care/reform-initiatives/hcbs-transition/

You can also contact me with questions by emailing bturner@arrm.org.

--Barb Turner, COO

House at 5% one-time increase & Senate at zero, giving us time to influence the big decisions. Watch for call to come to the capitol!

The House and Senate Health and Human Services (HHS) Omnibus Finance Bills, adopted in committees this week, are light years apart in how much and what they fund and cut.  That includes funding for our rate increase, with the House providing a five percent one-time increase on July 1, 2016 ($90 million) and nothing in the Senate. The House funding would be like a “bonus,” rather than a base increase. Overall the House reduces projected HHS spending by $1 billion and the Senate increases projected spending for the next two years by $341 million.

That massive gulf – including funding for a rate increase – will be resolved in the next couple of weeks.  While we wanted to be in a stronger position at this point, one capitol veteran noted that, in terms of legislative negotiations, “It’s still early.”

We know that there will be considerable angst among some legislators over the rate increase, including both Republicans and Democrats. 

After consulting with our rate increase authors we will send new messages with a strong call to action next week.  We will likely ask you to come to the capitol to personally send a powerful message.  So please stay tuned for that alert and be ready to take immediate action with your legislators.

The Senate omnibus bill funds a number of services that the HHS committee was unable to fund last year as almost all of the available new money went to the five percent increase.  The House bill finds money this year for a one-time increase by eliminating or reducing some large health care programs.

While we wanted to have a rate increase in both bills at this point, we do have $90 million on the table going into the global agreement negotiations with legislative leaders, Governor Dayton, and the House / Senate HHS conference committee.  And we do have the same power we had last year: you.

DWRS

The Senate Finance and House Ways and Means Committees are expected to act on positive DWRS changes in hearings today and tomorrow.  The changes, agreed to with DHS, include keeping money in the system (underspending by counties), extending banding, enhanced training and education with counties and improving the exceptions process.

One big issue - changes to budget neutrality provisions to assure money stays in the system after banding ends - is still under discussion with DHS.

Additional changes could come in the HHS conference committee in May.

Other issues:

New costs resulting from minimum wage increases was not funded by either the House or Senate.  That measure was priced out at $17.9 million.  Provisions regarding 245A and 245D and licensing sanctions await action by the full House and Senate after clearing several committees. 

We continue to monitor and amend other provisions that affect services for people with disabilities and will provide a full summary when the legislature adjourns. 

-- Bruce Nelson, CEO

House HHS budget bill released; Senate next week

The House Omnibus Health and Human Services Finance Bill was released Thursday, but was pulled back for adjustments as the total dollars didn’t line up with the total “target” dollars the HHS committee has to reach.  We don’t expect changes affecting ARRM in the next draft.  The bill will be marked –up with amendments Monday.

The HHS Committee was told to reduce projected spending by $1.1 billion. The bill covers much of that reduction – plus expenditures for any new spending – by eliminating Minnesota Care and eliminating forecasted increases for some Medicaid services.  This shouldn’t affect us as our increases are not forecasted other than for caseload growth and projected billing.

The Senate companion bill will be released early next week and will be dramatically different from the House bill. We expect it won’t find savings by eliminating Minnesota Care and forecasted programs.

So where are we in the House bill?

The 5% Campaign:  The bill provides a one-time five percent increase effective July 1, 2016 – a year from now – and would dedicate 90 percent for employee compensation. If this becomes law it would essentially increase rates for one year only, and provide employees with a bonus as no new money would go into the base.  ARRM will testify on the bill Monday and offer an amendment to reduce the 90 percent encumbrance to 75 percent.  At the same time, it is questionable if any encumbrance is workable with DHS for one-time increases.

In Thursday conversations with House members – including the five percent rate increase author Rep. Rod Hamilton – about the one-time provision, it became clear that the issue of carrying money into the next two year cycle is a problem in other funding areas as well.  Hopefully more clarity – and money – will evolve.

Stayed tuned for more updates and new calls to action and messages over the next couple weeks.

DWRS: The Disability Waiver Rate Coalition has come to agreement with DHS and other stakeholders on a number of provisions and will offer them as an amendment to the House bill Monday.  Some issues that DHS says cost additional money are still under discussion and need to be resolved before the HHS House-Senate conference committee finishes its work in about three-plus weeks. 

Minimum wage:  ARRM’s bill to cover the new costs for sleep time workers is not included in the House bill.  DHS priced it out at a much higher figure than our analysis concluded.  Not being included is not unexpected.  In early 2015 the ARRM Board noted that if this separate rate increase is not included we will use this new cost as another argument for a substantial overall rate increase.  DHS’s fiscal note said the minimum wage provisions would cost $17.9 million over the next two years, a cost we will argue, that needs to be covered in a five percent rate increase. 

245A/D and inspections/sanctions bills:  ARRM’s two bills to make needed changes in licensing (245A) and standards (245D) and licensing sanctions (like conditional licenses) cleared all House and Senate committees and await final action in both bodies. 

Other measures:  ARRM is tracking and, when needed, amending provisions proposed by DHS and others.  We will also offer an amendment Monday that would allow ICF/DD providers to be paid for therapeutic leave days when they have an open bed.  These payments are not allowed in Minnesota Rules.

-- Bruce Nelson, CEO

Gaps Analysis- DHS Requests Provider Input

DHS has posted a Provider Update titled Gaps Analysis - Provider Input Requested (MHP-15-02). 

They are seeking providers to participate and provide their perceptions about the capacity of the entire system of all home and community-based services (HCBS) and mental health services and supports to meet the needs of the following four targeted population groups:

• Older adults
• People with disabilities
• Children and youth with mental health conditions
• Adults living with mental health conditions

Providers who choose to participate will not only help to shape the analysis, but will also help to better identify the overall service gaps.  Please visit the link above for more information.

Contact Barb Turner at bturner@arrm.org with questions.

--Barb Turner, COO

Psychotropic Medication Manual

In March DHS presented a webinar on a Psychotropic Medication Manual that is being developed for release by this summer.

With the implementation of 245D, which no longer requires psychotropic medication monitoring or the use of the monitoring checklist, DHS received many questions from license holders.  The put together a group or people to develop a manual of guidelines and "best practices."

The development of this manual does not change the requirements/standards established in 245D.  Under 245D.051, when a person is prescribed a psychotropic medication and the license holder is assigned responsibility for administering that medication, the license holder must ensure the requirements for medication administration under 245D.05 Subd. 2 are met.  The license holder must also:

• Document a description of the target symptoms that the psychotropic medication is to alleviate
• Document the methods the license holder will use to monitor and measure changes in target symptoms
• Collect and report on medication and symptom-related data as instructed by the prescriber
• Provide monitoring data to the expanded support team for review every three months, or as requested by the person or their legal representative

ARRM will keep members up-to-date as the manual is completed and made available.

Contact Barb Turner at bturner@arrm.org with questions.

--Barb Turner, COO

Posting of Investigative Memorandum from DHS

ARRM has been working with DHS on an issue regarding the posting of Investigative Memorandum following the completion of a VA report. These memos go out through a listserve that individuals can sign-up to receive. 

It has been found that currently the same document is being posted multiple times.  Part of the reason is an internal IT issue and part of the reason is that under our current 245D license, individual sites are being identified under the "umbrella" license number as well as the satellite (individual site) license number.  DHS is working on addressing this issue and hopes to have a resolution in the next week or so.

Please note that when the general public uses the "Licensing Look-up" to find information on licensed programs, there is not a duplicate posting of any licensing actions. ARRM will keep members up-to-date and will continue to monitor this issue until it is resolved.

Contact Barb Turner at bturner@arrm.org with questions.

--Barb Turner, COO