By Sara Grafstrom, Director of State and Federal Policy
In mid-October, I, along with other ARRM members, had the opportunity to attend our national trade association ANCOR’s Public Policy Conference in Washington DC. Engaging on the Federal level is critical in the work that ARRM is doing to advance the priorities of our membership.
Along with a day full of important updates and information sharing between states, our Minnesota contingent was able to meet with all ten of the offices of our Congressional Delegation, share our priorities and let them know how they can be supporting Home and Community-Based Service providers back home.
Conference re-cap
The one-day conference session included speakers from CMS, Capitol Hill staffers and Medicaid experts, some of the timely information shared included:
- HCBS transition plans: CMS provided important updates, sharing that 18 states have had final approval of their plans with only 5 more states needing initial approval before all 50 states will have accomplished that milestone.
- Electronic Visit Verification (EVV): CMS also shared updates on the implementation EVV, letting attendees know that 20 states have submitted a good faith extension request with 12 being approved so far. They shared that they expect the majority of states to request an extension, but highlighted the fact that they have no authority to grant an extension beyond the one year. [Read the most recent news on Minnesota's EVV implementation on the members-only blog]
The keynote address featured Josh Trent from Leavitt Partners sharing what he considers to be the seven emerging trends in Medicaid, those include:
- Value-Based Payment trends continuing
- Increased Medicaid Coverage including states looking at Medicaid Expansion that had not participated in the past
- A lull in state innovation; many states looking at how to execute what is already in the pipeline
- External factors impacting Medicaid
- Mergers and acquisitions
- Health information technology
- Increased scrutiny in private equity
- Focus on social determents of health
- Focus on high-cost populations
- Growth in MCO; both in growth and pressures put on them
There was also important information shared around the politics of getting things done in an election year and important strategies in engaging in the upcoming election. I will be taking this information back to ARRM to make sure that our strategies for 2020 are aligning in the most effective way forward.
Important issues to track
ANCOR is pursing three major pieces of legislation this coming year to provide support to Home and Community-Based Services. Those include;
- HCBS Workforce and Infrastructure Act: This grant program would allow states to choose three of the following areas to make improvements in: workforce stability, transportation, employment supports, no wrong door- single entry system and implementation of the HCBS Settings Rule. States would be required to solicit stakeholder input and submit plans to CMS with measurable objectives and annual milestones in the chosen areas. This legislation is focused on helping states update outdated HCBS systems and grow community services.
- SOCs for DSPs: States rely heavily on Standard Occupational Classification (SOC) data, including out state of Minnesota, when setting our rates through DWRS. Currently, there is no separate SOC for DSPs at the U.S. Bureau of Labor Statistics. This information is critical not only in rate setting, but in recognizing the DSP as a profession and helping collect accurate data on the workforce needs. While typically it falls to the Bureau of Labor Statistics (BLS) to establish to SOC, that only happens every ten years. This legislation will encourage the BLS to consider a SOC for DSPs.
- Hospital Coverage for DSPs: Currently, Medicaid does not allow state waiver programs to pay for DSP supports while the person they support is in the hospital. For individuals that rely on their staff for communication, or may be experiencing mental health or anxiety symptoms, having their trusted support staff by their side can be the difference in a prolonged hospital stay. Legislation will simply allow all waivers to permit states to reimburse for DSP coverage in hospitals. This legislation will have no additional federal cost.
Congressional meetings
I, along with 13 other ARRM member representatives, were able to divide and conquer and meet with the offices of all ten members of our Congressional Delegation, including meeting in person with Senator Tina Smith and Congressman Pete Stauber (08), along with running into Congresswoman Angie Craig (02) at the elevator!
We educated staffers about Home and Community-Based Services and what is happening in Minnesota, with specific focus on the workforce crisis, as well as provided information on how they can support us, both at the state level and with the policies that ANCOR is championing.
The meetings provided us a great opportunity to further strengthen our relationships with our federal legislators, as well as hear directly from their offices about their priorities and how we can be better resources.
Don't forget to register for the Fall Business & Finance Forum, November 13, where Sara will cover these federal issues in greater detail, along with the full Legislative Agenda and additional timely topics for Minnesota Home and Community-Based Service providers.