Legislative Update for Disability Services

1
Legislative Update for Disability Services

• Age and Disabilities Odyssey
• August 17, 2009

2
Todays Agenda

• Overview of the environment this session
• Legislation that affects the Disability Services
  Division

3
Budget Background

• FY 10 11 State Deficit
• 6.1 billion starting point
• (1.4) short term stimulus funding
• 4.7 billion remaining deficit to solve
• Health and Human Services Omnibus bill reduced
  DHS budget by 594 million General Fund

4
Principles that Guided Budget Changes

• Increasing program sustainability
• Balancing where and how funding reductions would
  be made a broad-based approach
• Rates
• Benefits
• Eligibility
• Preserving critical services

5
The work ahead . . .

• We have important work ahead and a
  responsibility to the people who use these
  services to
• Understand these program changes
• Learn how to implement the changes
• Assist in evaluating how our overall service
  delivery system is functioning

6
Communication to stakeholders

• Consumer notices
• General notice
• PCA system-generated notice
• Provider notices
• State Register notice June 29
• DSD Listserv notices (lead agency and
  stakeholder)
• Bulletins

7
CCA Legislation Implementation Timeline (See
separate handout)
8
Corporate Foster Care (CFC) Moratorium

• Moratorium on Corporate Foster Care
• Reduce reliance on shift staff model and develop
  alternative strategies to support people
• Not primary residence of the license holder
• Services paid as foster care or supported living
  services
• Family foster care and homes registered under
  Minn. Stat. chapter 144D are exempt
• Authority for exceptions
• Effective July 1, 2009

9
CFC Licenses In-process

• Until August 1, 2009, a provider may continue
  with corporate foster care license application
  if
• 1.) Each persons care plan reflects their
  decision to
• live in the setting
• 2.) The provider has purchased or made a
  financial
• investment in the property
• 3.) The lead agency has approved the plans,
  including
• the costs for residential setting for each
  person

10
CFC Licenses In-process cont.

• Until August 1, 2009, a provider may continue
  with corporate foster care license application
  if
• 4.) The licensing process, including
  inspections,
• is the only component to be completed
  prior to
• providing services
• 5.) The needs of individuals cannot be served
• within the existing capacity of that
  county

11
Lead Agency Actions for In-Process
Licenses

• The lead agency manager/supervisor and licensor
  will work together to verify a provider met all
  conditions.
• A simple one-page form along with documentation
  of financial investment will be signed and
  submitted by close of business 8-1-09

12
Exceptions to Moratorium

• Settings that are licensed under Minnesota
  Statutes, chapter 144D,
• (housing with services)
• Licenses that replace an existing license and are
  determined to be needed in that community
• Licenses needed due to the closure of an ICF./MR,
  nursing facility, or regional treatment center

13
Exceptions to Moratorium cont.

• 4.) Licenses needed due to persons who
• require a hospital level of care
• 5.) Licenses needed due to PCA Reform for
  targeted groups to access HCBS waiver services

14
5-bed Capacity for Foster Care

• Temporary Increase to Five Beds
• Exception for five beds allowable
• Requires federal approval
• Amendment must be submitted by December 2009

15
5-bed Capacity for Foster Care cont.

• Allowable as long as 5th bed does not violate
  moratorium capacity, and
• - the facility was licensed for adult CFC
  before 3-1-09
• - arrangement is specified for each resident
  in their plan
• - meets physical location requirements of
  licensing rule
• - provider obtains written and signed
  informed consent
• - provider and lead agency negotiated cost
  neutral rate
• - the level of services maintained while
  mitigating the
• legislative rate reduction

16
PCA July 1, 2009

• Limit number of hours a PCA can work to 275 per
  month
• Clearance of individual PCA background study
  prior to beginning work
• Lead agencies must send PCA service plan to the
  recipient and provider within 10 working days
  following assessment
• For PCAs ages 16 or 17
• Qualified professional supervision required every
  60 days
• Must be employed by only one PCA provider agency

17
Provider Rate Reductions

• Long-Term Care Provider 2.58 Rate Reductions
• Reduction from current levels
• Applies to all HCBS providers
• Effective July 1, 2009
• 5 Reduction in Rates over 95
• Applies to adult foster care and supported living
  services payments in disability waivers
• Under 600 people affected
• Effective July 1, 2009

18
Limited Growth in Disability Waivers

• CADI 95 / month
• Effective July 1, 2009
• TBI 12.5 / month
• Effective July 1, 2009
• DD 15 / month
• Effective January 1, 2010

19
Questions?
20
Policy

• Expand Use of Shelter Needy Benefit
• Assist with relocation to services without
  24-hour supervision by giving Group Residential
  Housing equivalent
• Self Directed Option 1915(j)
• Eliminate requirement for targeted case
  management
• Limit enrollment to current PCA recipients with
  maximums identified for biennium
• Fetal Alcohol Spectrum Disorder
• Specify as a potential related condition
• Individuals must meet all related conditions
  requirements

21
ICF/MR Policy Changes

• Variable rate quarterly report changed to annual
  report
• Removal of quality improvement plan from contract
  provisions
• Unallotment changes
• Limit variable rates
• Suspend occupancy rate adjustment

22
Statewide priorities for disability waivers (CAC,
CADI, DD, TBI)

• Replaces county priorities established in the
  allocation policies and procedures
• Establishes consistency across the state
• Counties and tribes continue to be responsible
  for managing the aggregate allocation
• Implemented January 1, 2010

23
PCA January 1, 2010

• PCA Providers cannot control housing and services
• PCAs must complete required training
• PCAs must be supervised by a Qualified
  Professions
• Recipients must be dependent in 1 ADL or have
  Level 1 behavior(s)
• New time determination processes will be
  implemented

24
Certified Assessors

• Throughout 2010, training will be implemented
• Effective for all assessments (LTCC, DD, PDN,
  PCA) beginning January 1, 2011
• Recertified every 3 years
• Each lead agency must ensure they have a
  sufficient number of certified assessors

25
Minimum certified assessor requirements

• Bachelors degree in social work
• Bachelors degree in nursing with a PHN
  certificate
• Bachelors degree in other closely related field
  with at least one year of home and
  community-based experience OR
• 2-year RN degree with 3 years of home and
  community-based experience

26
Changes to NF Level of Care

• Effective 1/1/11
• Changes will affect EW, AC, CADI, TBI and NF
  program participation
• Essential community supports will target those in
  transition
• Reasonable operationalization of current
  decision-making by professionals

27
Federal Compliance Rate-setting Methodologies

• Create rate setting methodologies
• Abide by principles of transparency and
  equitability
• Uniform process of structuring rates
• Must promote quality and participant choice
• Manage rates with Web-based technology
• Calculate rates based on standardized costs for
  service
• Store rate data
• Effective January 1, 2011

28
Federal Compliance Provider Enrollment and
Provider Standards

• Requires enhanced standards for MA provider
  enrollment for waiver providers
• Eliminate county contracts
• County role with provider enrollment, quality
  assurance and assessment of community capacity to
  assure access
• Effective January 1, 2011

29
PCA January 1, 2011

• Recipients must be dependent in 2 ADLs to receive
  PCA services
• Implementation plan for alternative to PCA for
  mental health and behaviors

30
PCA July 1, 2011

• Complete implementation of the 2 ADL requirement
• Begin implementation of the alternative to PCA
  for mental health and behaviors

31
Questions?
32
Contact Information

• Heidi Hamilton
• heidi.hamilton_at_state.mn.us
• [phone]