ARRM's Daily Dispatch

The Latest on Electronic Visit Verification in Minnesota

By Sue Schettle, ARRM CEO

ARRM staff members have been getting a few questions about Electronic Visit Verification (EVV) so we thought we’d provide an update on where things stand. 

First, mark your calendar for an upcoming “Dial-In with DHS” that will focus on all-things EVV. Natasha Merz from DHS will be our presenter. The ARRM members-only webinar will be held at 10:00 a.m. on Friday, October 11. Watch for the login information in our Weekly Briefs and newsletters.  The webinar will also be recorded so you can watch it at a later time.

What EVV collects

Going into planning for the implementation of EVV, it’s important to note the information sought by regulators so you can assess the effectiveness of any potential system.

What information must the EVV system collect?

• Type of service performed
• Who received the service
• Date of service
• Location of service delivery
• Who provided the service
• When the service begins and ends

Who will be required to implement EVV

Not all services are going to be required to use EVV. Providers should review the list of personal care services and home health services to understand whether their business is affected. I’ve listed the services below.

In Minnesota, the personal care services that will be required to use EVV are: 

• CDCS direct support
• Crisis respite (in-home)
• Extended personal care assistance
• Homemaker-assistance with personal cares
• Independent community living support (in-person)
• In-home family support
• Personal care assistance
• Personal support
• Respite care services (in-home)
• Individual home support (in-person)

In Minnesota, the home health services that will be required to use EVV are:

• Home health aide
• Skilled nurse visits
• In-home occupational therapy
• In-home physical therapy
• In-home respiratory therapy
• In-home speech and language therapy

Minnesota is not expanding the services that are required to use EVV from “personal care services” and “home health services,” however, there are a number of waiver services that meet the CMS definition of “personal care services” that are required to use EVV.

If DHS added additional services that are subject to EVV, DHS will communicate these changes via eList and website updates. 

Timing and status in Minnesota

The national EVV implementation date is January 1, 2020, but the Minnesota Department of Human Services (DHS) has reported to ARRM it will be asking for a “Good Faith Delay” which could delay implementation of EVV here for 6-12 months, if approved.

One of the reasons DHS is asking for the delay is that it has not yet set up the exact state requirements for EVV, nor selected the state-provided EVV system. The department has selected to utilize a hybrid EVV model, meaning providers may use either the state-provided EVV system, or an alternative system of their choosing that meets state requirements.  With the hybrid model, providers may select an EVV system that works best for their business but also maintains accountability to the state by submitting data to an aggregator.

Implementation

DHS expects to implement EVV after a state-selected verification system is made available to providers. The department states is will provide ample notice via email, provider communications and updates to the DHS EVV webpage, well before the deadline for providers to implement EVV (ARRM will also assist in sharing these notifications).  DHS will select an EVV vendor through a request for proposals, although has not yet published the RFP.

Additionally, new 2019 legislative changes supported by ARRM ensure that providers will be reimbursed the full rate for services even if Minnesota is subject to a federal financial penalty related to the timing of EVV implementation.

To ensure you receive important updates on implementation, please sign up for the eList service on the DHS webpage for EVV.

What Didn't Make It In the 2019 HHS Omnibus Bill, Wins and Setbacks

Equally important as the policy items that were included in the final Health and Human Service (HHS) Omnibus bill, are policy items that were not included. ARRM counts both wins and setbacks in this category this year.

WINS

ARRM put many resources into fighting against several damaging provisions proposed during the 2019 Legislative Session which would have both harmed providers’ abilities to operate, but more importantly restricted access to the supports and services sought by Minnesotans with disabilities.

Adult Foster Care Bed Closure Proposal

Early on in session, a bill was introduced by Human Services Reform and Finance Committee Chair, Sen. Jim Abeler (R-Anoka). This proposal would automatically decrease adult foster care bed capacity by one for every two beds left vacant for longer than six months.

ARRM had serious concerns about potential un-intended consequences to this proposal and testified in opposition to bill two separate times during the Human Services Reform and Finance Committee. Our testimony highlighted:

• The destabilization of adult foster care this proposal would cause
• The lack of consideration of regional variables or provider specific services
• The lack of cost savings this proposal would bring

Despite our opposition, this proposal did end up in the Senate HHS Omnibus bill.

As soon as the final HHS Conference Committee was announced we were able to activate our members in House Conferee’s districts. Thanks to member outreach, House members spoke against this proposal during Conference Committee and the language was NOT included in the HHS Omnibus Bill.

DD and CADI Waiver Caps

Similarly to the Adult Foster Care Bed Closure proposal, a proposal to cap the number of DD and CADI waivers at June 30, 2019 levels was also included in the Senate HHS Omnibus bill.

Many advocacy groups testified against this proposal during the Human Services Reform and Finance Committee, including ARRM. Thanks to the strong outpouring of opposition, this proposal was also NOT included in the HHS Omnibus Bill.

HCBS Licensing Fee Increase

As we have seen in past years, the Department of Human Services presented, and Governor Walz included in his initial budget, a proposal to increase licensing fees for Home and Community-Based Services providers. This proposal would have raised fees for providers based on revenue with increases ranging from 20 percent all the way up to 300 percent. One of the primary purposes of this new revenue is to support additional inspectors for the Office of the Inspector General.

While ARRM supports a strong and effective investigation process, the association raised strong concerns with generating new revenue from an unfunded mandate on providers already struggling to maintain wages and operations budgets. The association proposed alternative language which would have increased DWRS rates by an amount equal to the fee increases, keeping the proposal cost neutral. This was included in the Senate Health and Human Services Omnibus bill, while the House included language similar to the Governor’s proposal. Ultimately, neither were included in the final HHS Omnibus bill.

In the end, thanks to strong advocacy against these fees from our members, and strong advocacy on our behalf from key Senators, the increase to Home and Community-Based Services licensing fees was NOT included in the final HHS Omnibus bill.

SETBACK

ICF Variable Rate and Services During the Day Legislation

One of ARRM’s top legislative priorities this session was legislation that would allow all ICFs to request a variable rate and change the Services During the Day rate from 75 percent of the DT&H rate to 100 percent of the rate.

This legislation got off to an early start, with an early hearing in the Senate. Unfortunately the bill was not able to get a hearing in the House prior to the mandated committee deadlines.

Going into the end of the legislative session, the language was included in the Senate HHS Omnibus bill and there was momentum in the House, mainly driven by members of the minority party, to do something this session to address rates for ICF providers.

Unfortunately, due to a low final conference committee target, the ICF proposal was not included in the HHS Omnibus bill. This is a disappointment for ICF providers and in the coming months the ARRM ICF Taskforce will focus on re-capping what worked and didn’t work this legislative session and begin discussing ARRM’s priorities for the 2020 legislative session.

Thank you to Members

As indicated above, many of the provisions that we were successful in defending against were due to our member’s strong advocacy voice. Thank you to members who were able to contact their legislators in opposition to these harmful proposals!

--Sara Grafstrom, Director of State and Federal Policy

Legislative Update 4/1-4/5: HHS Omnibus Bills Released

Last week saw both the House and Senate releasing their Health and Human Service Omnibus bills. While each of the bills contain quite a few changes important to Home and Community-Based Service providers, below are a couple highlights of things we support, oppose or are watching in each of the pieces of legislation.

House Health and Human Service Omnibus Bill

Changes to the Disability Waiver Rate System

• 4.7% Competitive Workforce Factor with automatic 2% changes in 2022 and 2024
• Moves the inflationary adjustment from every 5 years to every 2 years and uses the most recently available data
• Includes new workforce reporting requirements
• Includes rate encumbrance language
  • For residential providers: 66% of your rate must be used for direct care wages and employee related expenses
  • For day service providers: 45% of your rate must be used for direct care wages and employee related expenses
  • For unit based service providers; 55% of your rate must be used for direct care wages and employee related expenses

245D Licensing Fees

The bill includes the Licensing Division of the Department of Human Services’ proposal to increase licensing fees for 245D providers. The new fee schedule would raise fees based on revenue with changes ranging from 20%-300%.

Last week ARRM sent out messages to the lead contacts of members who would see their fess go up by more than 29%, with specific messaging to use when reaching out to your House member. It's important to make these contacts now, as it will increase the possibility of removing this language later in conference committee.

Senate Human Services Reform Finance and Policy Omnibus Bill

Changes to the Disability Waiver Rate System

• Includes a Competitive Workforce Factor set at 4.7%
• Moves the inflationary adjustment from every 5 years to every 2 years, using data that is 30 months old
• Includes new workforce reporting requirements for providers
• Includes encumbrance language that states any new revenue received from the Competitive Workforce Factor must be used to increase Direct Support Staff wages

ICF Legislation

• Removes the restrictions on applying for a variable rate, allowing any provider to request a variable rate for their ICF
• Changes the Services During the Day rate from 75% to 100% of the DT&H Rate

ARRM’s Policy Provision

• Moves the sunset date for adding a fifth bed to a home to 2021 (Note: The language was also changed from 5 beds to 6 beds)
• Requires an annual conversation on the use of technology
• Clarifies the Annual Training Competency based requirements
• Includes the Positive Support Professional Training changes

245D Licensing Fees

The bill does not include language that would increase licensing fees for 245D providers.

Adult Foster Care Bed Closure and DD/CADI Waiver Caps

The bill includes language that would mandate that for every two beds that are permanently vacated for over 6 moths the Commissioner would reduce adult foster care bed capacity by one. The bill also implements DD and CADI waiver caps as of June 30^th, 2019, not allowing any new waiver recipients unless someone leaves the waiver and prioritizing those waiting for waiver services by need.

ARRM’s Response

ARRM provided testimony in both the House and Senate to these bills, highlighting the provisions we support and putting on record the provisions we have concerns or are opposed to. In the House, we attempted to remove the licensing fee increase through amendment but the amendment was not adopted. We also worked in the House to draft an amendment which stated DHS would need to study the feasibility of creating a rate system for ICF/DD similar to that of DWRS. DHS testified that the amendment would have a cost and therefore it was not adopted.

We are anticipating amendments being taken in the Senate this week and will work with key Senate leaders to craft amendments that would work to address the concerns we have with the bill as drafted.

Looking Ahead

The legislature will be on break next week, coming back April 22^nd where things will begin to move very quickly on the way to adjournment on May 21^st.

Please contact me with any questions.

--Sara Grafstrom, Director of State and Federal Policy

Licensing Moratorium Exception Update - Clarifications

The deadline for applying for an exception to the Corporate AFC/CRS licensing moratorium will expire on June 30, 2018 for those programs that have been operating without a license but should have a license. This means you need to have your application in by the end of the business day on June 30, 2018. These applications should be submitted to the county with the appropriate license application fee.

ARRM has received some clarification from Minnesota DHS Licensing on a couple of items:

• Homes of 1-2 people receiving 24 hour per day services in a setting not controlled by the service provider do not need to be licensed.
• Settings of 3 or more people receiving 24 hour per day services in a setting not controlled by the service provider probably need to be licensed. Providers should contact DHS Licensing with any questions.
• DHS Disability Services Division (DSD) and DHS Licensing Division is further clarifying the exception to the moratorium for people living in unlicensed settings that require a license in Stat. §245A.03, subd. 7(a)(7). 

DHS has determined that an exception to the moratorium is available:

If a person moved into the unlicensed setting after May 1, 2017, and

The setting (bed) was occupied any time between January 1, 2017 and May 1, 2017 by a person receiving 245D services, and

The person currently living in the setting (bed) meets the criteria in paragraphs (7)(i) and (7)(ii).

DHS has determined an exception to the moratorium is not available:

If the person occupying the capacity (bed) prior to May 1, 2017 was not receiving 245D services. 

If the capacity (bed) was not occupied at all between January 1, 2017 and May 1, 2017 by a person receiving 245D services. 

If the capacity (bed) is currently vacant.

DHS has advised that when you are completing your application for a license, request the number of beds that you want (not to exceed the number you have historically been using).

If you have questions you can contact Barb Turner [email protected]

BREAKING: CMS issues Electronic Visit Verification guidance

ARRM learned today the Centers for Medicare and Medicaid Services (CMS) issued long awaited guidance to states and stakeholders regarding Electronic Visit Verification (EVV) requirements. While there are still questions remaining, ARRM’s review of the information provided shows CMS does not expect EVV to be required in traditional group homes.

It does appear that EVV will be required for any service being provided in an individual’s home when personal cares are being provided to the person. This would include at least some unit-based HCBS services.

ARRM will continue to work with Minnesota Department of Human Services officials as they interpret and utilize the guidance issued by CMS. ARRM will provide updates as more information is received. Use the links in the release from ANCOR to access the letter from CMS providing guidance as well as a document of FAQs.

Contact Barb Turner [email protected] with questions.

New Exception to Licensing Moratorium Explained at Fall BFF

Attendees to this year's Fall Business & Finance Forum on November 15 had the chance to dive into a topic that's causing some confusion around the state: the latest exception to the AFC/CRS licensing moratorium.

This most recent exception to the AFC/CRS licensing moratorium is focused on unlicensed settings that appear to meet the criteria requiring an AFC/CRS license, and licensing it.

Jill Slaikeu and Deb Amman from the Minnesota Department of Human Services (DHS) presented brief background information on the technical aspects of the exception and how the DHS Licensing Division is approaching its work on the issue.

Jill Slaikeu of the Minnesota Department of Human Services Licensing Division, presents on licensing moratorium exceptions at the 2017 Fall Business & Finance Forum.

The primary goal of the department is to ensure the necessary protections are in place where services are being provided that for all intents and purposes appear to match that of a licensed setting. They explained DHS is not attempting to look at settings where the residence is owned by the individual receiving services or a family member, nor are they looking closely at settings where one individual is receiving services. They estimate there are approximately 500 unlicensed settings they may need to license during this window.

DHS representatives answer questions about the most recent licensing moratorium exception.

Jill and Deb spent much of their time answering questions regarding the exception. For instance, one questioner asked what happens if a bed is licensed under this exception process but then the person served in that setting moves out. The DHS representatives confirmed that except in specific situations, any licenses executed under this exceptions process will remain with the provider regardless of the status of the individuals who were being served in that setting.

Still lots of questions

ARRM is still receiving reports of many questions related to this exception, as well as information coming from counties that is not always aligned with the information being provided by DHS. To help provide clarity, ARRM is bringing back Jill and Deb for a webinar for ARRM members on December 8 at 10:00 AM (ARRM Members check your email for details).

ARRM Members can also access the presentation handouts from the Fall Business & Finance Forum on the ARRM website in the members area Training Archive.

Have a question regarding this licensing exception you want answered? Post in the comments below and we'll get it answered on next week's webinar.

Regulations for Minors on Staff: Power-Driven Hoists

As our industry continues to deal with a workforce crisis, members continue to look for innovative solutions to fill shifts. One solution that some members are exploring or have already embraced is hiring minors (employees ages 16 to 17).

Minors present a great opportunity to fill critical staff roles, including in direct care. However, there are specific regulations on their employment, both in terms of the functions they can perform and their working conditions, such as weekly hours. These are by no means a barrier but must be observed carefully.

Limits on Power-Driven Hoist Operation

One area that deserves particular attention is the Department of Labor’s rules on the operation of power-driven hoists. While minors can perform many direct care functions and assist with the operation of some equipment, often they are restricted from sole operation, as is the case with power-driven hoists. This can be easily overlooked during training and day-to-day work.

The formal Department of Labor policy states: “until you are 18-years-old, you may not operate any floor-based vertical powered patient/resident lift devices, ceiling-mounted vertical powered patient/resident lift devices, or powered sit-to-stand patient/resident lift device by yourself.” Minor employees are permitted to assist a trained adult employee with the operation of these devices.

The complete bulletin can be reviewed here for further detail.

Other Limitations

There are other limitations that providers need to be aware of when hiring minors, including driving restrictions. This blog post is one in a series of posts that will detail those limitations in order to help members stay compliant with all labor standards.

Minors Are Important Labor Market

Due to the unique standards around potentially valuable labor force, the ARRM Workforce Solutions Committee is compiling an ARRM member resource outlining the pros and cons of hiring minors, reviewing rules and regulations members should know before hiring a minor, and providing marketing and recruitment resources to assist in hiring minors. The committee will also produce a webinar for members on the topic, anticipated to take place in November.

If you would like more information about the tool-kit the Workforce Solutions Committee is compiling, please contact Sara Grafstrom at [email protected].

--Sara Grafstrom, Director of Government Relations and Member Advocacy

CMS HCBS Rule: Attestation Process

While we are still waiting for final approval of Minnesota’s transition plan, Minnesota continues to move forward in the work needed to come in to compliance with the CMS HCBS Final Rule.  The next step in the process which involves all HCBS providers is the “attestation process”.  On March 7, 2017 a letter was dropped in to provider MN-ITS mailboxes.  Letter were also sent through US mail (click here for a copy of the letter).

Residential and day service providers should expect to get further information in April with the expectation to complete the required information by May 31, 2017.  All providers will need to come in to compliance with the HCBS Final Rule by September 1, 2017, unless an extension has been granted.

Members should watch their MN-ITS mailboxes for further information from DHS.

-- Barb Turner, Vice President, External Affairs