ARRM's Daily Dispatch

Blue Ribbon Commission Meeting Update #9

Blue Ribbon Commission Meeting 9

The latest meeting of the Governor's Blue Ribbon Commission was recently heard on March 6th at DHS. This meeting focused again on cost-savings strategies—this time not directly related to disability services.  Even though the conversation didn't directly focus on disability services, we wanted to make sure ARRM members were still represented at the table as part of the larger, overall conversation and mission of the BRC.

There was a lot of discussion about the pros and cons of each of the ideas listed below: 

• Add an enhanced home care benefit in Medicare supplement plans
• Guidelines to access customized living services
• Value-based reimbursement in nursing facilities
• Repeal nursing facilities first 30 days rate adjustment

Care Providers of MN and Leading Age were front and center during these important discussions and weighed in with their recommendations. 

More to come next posting. 

Blue Ribbon Commission Meeting #8 Recap

Another full day of activity surrounded the Blue Ribbon Commission as we gathered at MDH on February 21.  The disability services sector was on the docket for the day so I was ready to go as we launched into the various topics.  Below you will find a summary of the issues and the outcome of the discussion

Curb the Growth and Use of Residential Services: This strategy included multiple sub-strategies to reduce use and curb the growth of residential services in the disability waiver programs. 

• Align corporate residential billing with rate framework: This sub-strategy would place limits on the number of billable days for Corporate Foster Care and Supportive Living Services to align with the absence factor in the rate methodology. DWRS establishes service rates through a formula comprised of cost components such as staff wages, employee benefits, programs costs and administrative costs.  The absence and utilization factor is a cost component in the DWRS frameworks intended to cover the costs incurred by a provider when the person is gone from the home and the provider cannot bill for services as planned. The factor accounts for approximately 14 absence days per year.  While the rate methodology increases the daily rate to account for these absent days a provider is able to bill the increased rate regardless of how many absent days actually occur.  If a person is in the home 365 days a year the provider can bill every day even though they receive compensation for assumed absences.  This sub-strategy would ensure that if a person was in the home for more than 351 days in a year the provider would only bill for 351 days to be consistent with the rate methodology.  I was the only BRC member who voiced opposition to keeping this on the table for further discussion.  I spoke out against this proposal but others on the BRC thought that we needed additional information before we remove it altogether so for now it remains as a strategy that we need to further explore.  Estimated savings of $20 million.
• Curb customized living service rate growth: So many questions, not enough answers. This strategy calls for placing limits on the number of discrete units allowable to determine the daily rate to prevent future rate growth from occurring.  DHS reports a double digit grown in people receiving unit based services but were not able to adequately explain where the growth is coming from or why.  DHS will investigate further and consider bringing it back this Spring for additional consideration by the BRC.  Estimated savings $1-$10 million.
• Support planning for people who want to move: Providing additional support planning assistance to people receiving disability waiver services who indicate that they prefer to move out of CFC or customized living. There was consensus that there were many barriers identified that it’s likely that this strategy is not achievable in the timeframe that the BRC has to work with so it’s unlikely that this topic will remain on the table.  Estimated savings undetermined.
• Bed closure targets and rate reform for foster care: This strategy proposed that we would need to update the rates statute to derive cost savings from individual bed closures. DHS would achieve a defined cost savings target by reducing current corporate foster care capacity and the statewide corporate foster care moratorium maximum.  I spoke out strongly against this strategy and in the end the other BRC members agreed with me and we moved this off the table for any additional discussion. 

Discontinue grant programs: There are two grants that no longer serve the purpose under which the legislature authorized them.  There was consensus from the BRC that there was merit to keeping the strategies on the table for possible inclusion in the Action Plan.

Absence factor in day services: The recommended strategy calls for a reduction in the absence factor for day services from 9.4% to 4.5% with an estimated savings of $6 million.   I voiced my concerns that were expressed in a very detailed letter submitted by MOHR as well as two day service providers (MSS and Rise).  In the end the BRC kept this strategy on the table for further consideration. 

Family Foster Care Rate Reform: This strategy calls for replacing the rate methodology with a new tiered rate structure for family foster care providers because, according to a January 2020 report from DHS, the current rate methodology does not appropriately reflect the nature of the service.  Rates would be automatically assigned to one of six tiers according to a person’s level of needs.  There was also an additional strategy that called for supporting the implementation of a new Life Sharing model.   The FFC Rate reform strategy will remain on the table for further consideration.  Estimated savings are $10-$20 million.

Sue Schettle
sschettle@arrm.org

Blue Ribbon Commission Discusses Pharmacy Spending

Meeting #7 of the Blue Ribbon Commission was held on Thursday, February 6^th in Shoreview.  The information that we are receiving is incredibly helpful in understanding the complexity of both DHS and MDH.

We kicked off the meeting with a presentation by DHS’ Health Care Integrity and Accountability Division on third-party liability and competitive price bidding.  Many, including some legislators on the BRC, learned for the first time that there is a Health Insurance Recovery Unit at DHS that focuses entirely on discovering whether other insurance is available before someone is enrolled in Medicaid. 

We got a history lesson on Medicaid population focused managed care organizations (which are health plans and county-based purchasers) and the process that DHS and MDH undertake when looking at competitive bidding proposals. 

Next up, we took a deep dive into the murky pool of pharmaceutical spending.  Minnesota spent $5.2 billion in 2017 on retail prescription drugs which was a 30.8% increase since 2012, and a 1.3% increase since 2016.  Pharmaceutical spending is one of the largest cost drivers in overall health and human services spending in MN.  So it’s not surprising then to see three pharmacy-related strategies brought forward for the BRC consideration.  Those included:

• Uniform pharmacy benefit in public healthcare programs
  • Goal: DHS administers the pharmacy benefit for Medical Assistance beginning in Jan 2022. Cost reductions are expected, increasing transparency and pricing and operations.  We’d rely on the State’s preferred drug list process.
• Pharmacy pricing: Prescription drug purchasing council
  • Goal: Establish a legislatively chartered group comprised on officials from across applicable state agencies, counties, cities and other public entities and charge them with wrapping their heads around prescription drug spending, finding was to increase MN’s leverage of drug benefit purchasing power within existing statutory authorities.  
• Pharmacy pricing: Establish a prescription affordability commission
  • Goal: Establish a Prescription Drug Affordability Commission to look at the issues related to affordability of medicines.

Going Forward: Upcoming BRC meetings will focus on long-term supports and services, which gets to our industry.  I’ve been meeting with a select group of ARRM board members to discuss the strategies that have been submitted and that fall into our space.  We are also meeting with DHS next week to understanding their thinking on some of the proposal submitted.  Stay tuned for my next blog post.

Remember, the BRC is gathering information at this time and discussing whether the various strategies submitted thus far make sense to investigate further.  We are not making recommendations yet.  We will do that in July and August with the full report due to the Legislature in October.  Between now and July there will be ample time for ARRM members to offer your thoughts on the proposals throughout early to mid-2020.  We will let you know how you can make your voice heard.  Click here to review the BRC charge and timeline of activities. 

If you’re a data-driven person, check out this slide deck.  I have found this document to be particularly helpful thus far in explaining health care spending and trends. 

 

Blue Ribbon Commission Update

By Sue Schettle, CEO

The Blue Ribbon Commission (BRC) members assembled on Thursday, January 16 at the University of St. Thomas for our 6th meeting. As a reminder, the charge of the BRC states that by October 1, 2020, the Commissioner shall develop and present to the legislature and the Governor an action plan for "transforming the health and human services system to improve program efficiencies, produce savings, and promote better outcomes for Minnesotans."

The BRC sought public input late last year and nearly 300 strategies were submitted by various individuals and stakeholders, from all segments of the population. On behalf of our members, ARRM submitted five proposed strategies.

At our meeting last week, the BRC got its first look at a pared down list of 47 strategies, which will be evaluated by the BRC in the first half of 2020. They break out as follows:

• 17 cost saving strategies in three main categories (health care, LTSS and supports for people with disabilities, and LTSS for older adults)
• 6 program integrity and waste reduction strategies
• 6 administrative efficiencies and program simplification strategies
• 6 health equity strategies
• 12 transformation strategies

We spent a couple of hours discussing the first four health care strategies under the cost savings category, which included expanding the DHS encounter alerting service (EAS), non-emergent medical transportation efficiencies, DME and supplies rate reform, and volume purchasing. BRC members provided feedback and we used this time to refine the process for how we move forward with the remaining 43 strategies.

Although the community engagement plan is not completely baked out yet, I am confident that we will see a more finalized plan of action at our next meeting on February 6th.

2019 was all about setting the foundation for the work ahead. 2020 will be intense I suspect. I'll keep you updated about the ways you can weigh in on the 47 strategies.

Update from the Blue Ribbon Commission

By Sue Schettle, CEO

The Blue Ribbon Commission on Health and Human Services (BRC on HHS) had its fourth meeting this past Thursday. To this point, much of the commission's time has been getting up to speed with the vast components, funding, and bureacracy that goes into HHS. However, this meeting to a significant dive into proposals from the public and various stakeholders for the commission to consider.

As is the usual, this meeting was jam-packed with content including very complex information ranging from the components of the DHS/MDH budgets to how forecasts are developed. The meetings move at a quick pace and all BRC members have the opportunity to offer feedback and insight into the overall narrative. 

You’ll remember that there was a very ambitious turnaround time (less than 2 weeks) for individuals and organizations to submit their reform ideas to the BRC for consideration. Despite that short turnaround time, 245 proposals were submitted by various groups including ARRM. Here is the breakdown:

203 from the general public/organizations
18 from MDH
13 from DHS
11 from the consulting group supporting the work of the BRC. 

ARRM submitted a total of 5 ideas to the commission, 4 of which came about from consultation with the chairs and co-chairs of ARRM’s Financial Resources and Service Innovations Committees, and one brought forward by a member. They included:

• Waivers: Support the Waiver Reimagine roll-out and take a long, hard look at the authority role that the counties have in administering the waivers now and in the future. Look to eliminate county waiver allocations so resources would not be going to the fragmented infrastructure for managing the allocations, eliminate inconsistency in how counties have been carrying out their role and addressing fairness issues recently highlighted in the media.
• Minnesota State Operated Community Services (MSOCS): Stop/reduce the substantial subsidy to the MSOCS program and overhaul it instead. 
• Investigations: Streamline the investigation process currently operating within DHS, MDH and OHFC. Make it consistent so providers know what to expect. Expand the Collaborative Safety Model concept currently in a pilot phase in Hennepin, St. Louis and Blue Earth counties that works to get at the root cause and prevent maltreatment reports.
• Workforce: Acknowledge the significant crisis with finding/retaining workers, and get serious about looking toward other strategies. One strategy in particular ready for expansion is greater adoption of supportive technology. Training contracted and county case managers on how people-served could really use technology and current funding and policies must be expanded and made mandatory. The principles of ARRM's Tech First proposal should be supported. Strenghten promotion of remote monitoring, particularly useful for overnight asleep staff. And expand innovation grants.
• Medication management: Pharmaceuticals are one of the highest cost drivers in Minnesota’s HHS budgets. Putting a concerted effort into place to monitor the medications that some of our folks are taking would help to alleviate adverse medication reactions, lower costs and improve efficiencies.   

The next phase of the proposal review process for the BRC will begin later this month and run into December.  The consultants hired to conduct the work of the BRC are charged with taking all of the ideas submitted by the public and governmental agencies and categorizing them in ways that will streamline our conversation.   

If you’re interested in following the work of the BRC, click here. This website contains information about meetings including the materials that we are reviewing.