ARRM's Daily Dispatch

ARRM CEO Update: April 3

Hi everyone,

Thank you for all you are doing.  We know that our lives have been upended – personally and professionally – by the COVID-19 virus.  It’s so challenging right now because there are so many unknowns.  And we are inundated with news about really terrifying projections that will impact the lives of people.  At the same time we have come to the realization that we have PPE shortages and we are scared about what that means.  I want you to know that we hear you, we see you, and we understand that it’s a really scary time.  We want you to know that we are here to support you and your teams as we weather this pandemic together. 

Please know that we are trying our best to keep on top of the information that is coming out of the MN Department of Health, MN Department of Human Services, the Governor’s office and the Legislature.  We are partnering with national organizations like ANCOR who are working hard too, watching what’s happening in Congress.  Thanks to all of you who have responded to our action alerts and engaged with your legislators.  Our work is not done yet so please keep an eye out for ways that you can continue to stay engaged.

ARRM Web Resources: We know that you are thirsty for information.  ARRM is providing daily updates to our members through newsletters.  We have created a separate web page devoted entirely to COVID-19 (www.ARRMcovid19.com).  We update that routinely with important links and information from our state and national partners. 

Q&A with DHS Call: We are also holding the weekly calls with DHS—every Wednesday at 11:00 am.  We greatly appreciate the availability of the DHS staff to hop on these calls with ARRM and MOHR members.  It’s been an incredibly important resource for our members.  Not only do we have the recordings available on the ARRM COVID website, we also transcribe the conversation so you can have a written record of what was talked about.

ARRM in the News: ARRM is actively working with the media to tell your stories -- what are people seeing in disability services, where are the pain points, what challenges are rapidly approaching. In the last week, ARRM board members and I have had media spots on WCCO Radio, KSTP, and Finance & Commerce talking about the workforce shortages we are all seeing and how unemployed Minnesotans can find a career in our industry. 

Best Life Alliance: In line with that, the ARRM-backed Best Life Alliance is rebooting its public awareness campaign highlighting the need for workers.  Our new hashtag is #MeettheNeedMN.  Our goal is to encourage folks who are not currently working to join us in supporting people with disabilities.  This effort was highlighted in the Governor’s press conference a couple of days ago and we have received calls from numerous reporters so we are trying to raise the profile of the need.  Our job board has been rebooted to support DSP openings. 

ARRM and MOHR have leadership check-ins 3x a week so we can stay connected and work together.

We have a template contractual document that residential providers and day providers can use to work toward sharing staffing during this time.

Using Tech During COVID-19: ARRM recently met with DHS Deputy Assistant Commissioner Annett to figure out ways that we could use ARRM’s Technology Resource Center to help providers understand how to use technology during this time of crisis.  We are developing a webinar that would include a panel of DHS staff, vendors and providers who are utilizing technology now to help folks understand the basics of how to use technology and what you need to do to get reimbursed for it.  Watch for more information on that.

Lastly, we are doing our best to answer your questions.  We might not know the answer right away but we are committed to helping you get what you need. If you have any questions, please don't hesitate to send us an email at info@arrm.org.

Stay safe,

Sue Schettle, CEO

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.  

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

Weekly Legislative Update: We are off and running!

The 2018 Legislative Session kicked off this last Tuesday, February 20, and is constitutionally required to adjourn at midnight, Monday, May 21, leaving exactly 90 days of the legislative session.

ARRM’s Government Relations team hit the ground running, making strides forward with our 2018 Policy Bill, the Best Life Alliance Coalition and updating information on our website.

Policy Bill Update

ARRM’s Policy Bill was introduced in the House and the Senate, HF 2911/SF 2483. Our bill this year builds on the important reforms that were passed last year by broadening the requirement for a discussion about technology, fixing a date within the language that allows providers to add a fifth bed to a home and changing some requirements for Behavior Professionals, Behavior Analyst and Behavior Specialist.

The legislation has its first hearing scheduled for this coming Monday, February 26 in the Human Services Reform Finance and Policy Committee where we intend to add an amendment extending the moratorium exception deadline for un-licensed settings by one year and addressing what happens when providers have an open bed during the time of being licensed.

Best Life Alliance Legislation

The Best Life Alliance legislative proposal was officially approved by ARRM’s Board of Directors during our February meeting. The legislation has moved its way through the coalition and is now in the process of being drafted. Documents for grassroots advocates as well as higher level, grasstops advocates are going through final stages of editing and should be released next week for folks to use when speaking with their legislators. Look for more specific information about the Best Life Alliance proposal from ARRM next week.

Visit ARRM’s Public Policy Section on the web

The public policy section of ARRM’s website has now been updated with our 2018 Legislative Agenda and 2018 Policy Bill fact sheet. Additionally, the Grassroots Messages section has been updated to reflect updated talking points for advocates to use this legislative session. Please contact Sara Grafstrom at sgrafstrom@arrm.org if there are any resources you are in need of, but not finding on the website.

--Sara Grafstrom

Director of Member Advocacy and Government Relations

 

Have questions or ideas about this year's legislative session? Share them in the comments below.

Coleman Institute/ANCOR Technology Conference Report

Barb Turner, along with a number of ARRM members, attended the Coleman Institute and ANCOR Technology Conference in Broomfield, CO last week.  Like ARRM, ANCOR has decided that this will be the last year that they will hold a separate Technology Conference.  In the future they will incorporate technology in to the other conferences they hold each year.

The conference was full of new ideas as well as reinforcement of the success of the use of technology in many settings and with people with a wide variety of strengths and needs. ARRM will be working to see how we can best expand the use of technology in providing person-centered services and will continue with discussions with DHS regarding how they can support providers in this area.

 

Registration for the 2016 ARRM Technology Conference & Showcase is now open! Register now to learn about actual implementations of technology by ARRM providers all across Minnesota.

Minnesota represented at ANCOR Technology Conference

Last week ANCOR, our national trade association, partnered with The Coleman Institute for Cognitive Disabilities for a conference focused on technology used in the provision of services to people with disabilities. 

The conference took place just outside of Denver, Colorado. It included the latest in technology products, success stories from around the country and presentations on other topics including assessments, funding, and legal and ethical issues.

I was asked to present on the use of technology in Minnesota as part of a panel.  I was very proud to share Minnesota's draft policy and current practices with other states.  Minnesota is ahead of the national curve in the use of technology and there was much interest in how our state is using technology to increase the independence of people who are being supported.

The ANCOR Conference was an opportunity to get ideas and re-energized as we begin planning for ARRM's Technology Conference & Showcase in 2016.

Feel free to contact me at bturner@arm.org if you have any questions.

--Barb Turner, COO

DHS issues bulletin on 1% rate increase effective July 1, 2015

On Friday May 29, 2015 DHS issued Bulletin #15-69-02 providing information on the implementation of the Long Term Services and Supports 1% rate increase effective July 1, 2015.

The 1% increase is considered a quality add-on rate increase and a quality improvement plan is required. Along with other LTSS services, all of the disability waivers, the elderly waiver and ICFs/DD are affected by the rate change.  DHS will be adjusting rates through the MMIS system to increase all rates by 1%.  DHS will also update the Rate Management System to reflect the 1% quality add-on rate increase.

Providers must submit a quality improvement project to DHS by December 31, 2015.  These quality improvement projects must be implemented by June 30, 2016 and address one of the goals listed in the Bulletin.  Providers who previously submitted a plan through the Quality Improvement Tool must submit either an update of continued work for their ongoing project or submit a new quality improvement plan.  DHS may recoup one-half of one percent of Medical Assistance revenues from providers who do not submit a new Quality Improvement Tool.

Beginning July 1, 2015, the link for the 2015 Quality Improvement Tool will be available at mn.gov/dhs/ltss-rates/.

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

--Barb Turner, COO

Free training: Make your website accessible to all

On July 16, 2014 MAP for Nonprofits is offering a free training on how to make your website accessible to those with a visual, auditory or gross-motor disability. The session is open to both profits and nonprofits and will specifically cover:

• 5 quick and easy tests for web accessibility
• 5 issues you can fix today
• Resources for further learning

Training Details & Registration

What:  Mission: Accessible – Make Your Website Accessible to All!
When:  July 16 at 9:00 am - 11:00 am, Free
Location: McKnight Foundation, 710 S 2nd St, #400, Minneapolis, MN 55401

For more information and to register to attend, visit: http://maptechworks.org/event/mission-accessible-share-connect-online-with-everybody/

--Nancy Peterson, Director of Member Services and Education

First-ever ARRM Technology Showcase a big hit

ARRM's inaugural Technology Showcase held earlier this week was a resounding success, with 222 providers, family memebrs, state and county staff, vendors and speakers in attendance. A full two days of panel presentations, breakout sessions and roundtable discussions provided a wealth of information about how technology can be used to create person-centered supports for people with disabilities.

Many thanks to the Technology Showcase workgroup, whose insights and hard work made this event such a success: Lisbeth Armstrong (Hammer), Tom Gillespie (Hammer), Denny Theede (Home and Community Options), Jon Nelson (RSI), Sandy Henry (Sengistix), Jen Kari (Dungarvin), Stephanie Kohl (MORA), Doug Annett (Opportunity Partners), Nate Tyler (Opportunity Partners)Barb Turner (ARRM).

The workgroup will meet soon to debrief and to pick a date for a Technology Showcase in 2013. Meanwhile, we'll send an email to attendees that contains a survey about the conference, links to speaker PPT presentations, a participant list, and a certificate of attendance.

Watch for more information regarding next year's event as well as regular updates about how technology is changing the way disability services are delivered.

--Barb Turner, COO