The Disability Waiver Rate System (DWRS), passed by the 2013 Minnesota Legislature, is a new way to determine rates for people who get services funded by four of the Home and Community-Based Waivers (CAC, CADI, DD, & TBI).
The need for the DWRS came from the Centers for Medicare and Medicaid Services (the federal Medicaid agency) requiring the Department of Human Services to use a consistent statewide rate methodology in order to remain eligible for federal financial participation(FFP). FFP means that the federal government funds 50% of waivered services here in Minnesota, so it was important for DHS to comply.
Launched on January 1, 2014, the DWRS is being phased in over a 5-year “banding period,” with full compliance by January 1, 2019. During this banding period, the rate paid to providers cannot change, either up or down, more than half of one percent in 2014 and 2015; and no more than one percent in 2016, 2017, and 2018. The intent of the banding period is to give providers time to make the operational and budget adjustments needed for this dramatic shift in how they are paid. For day services (such as DT and H) and residential services (such as group homes) providers will have to change from a shared service rate to individual rates for each client receiving a service. If we applied this methodology to schools, it would be like going from a nine-month rate for each student to one daily or hourly rate for each student based on their attendance, class schedule, and ability to learn. This is not how schools operate and, in this author’s view, not how human service programs should be funded either.
Still, at present this is the plan being implemented. To generate a waiver recipient’s rate, the County of Financial Responsibility enters data into the system for the service being renewed or requested (via hopkins). It seems most counties intend for their case managers to complete this task throughout 2014 during the person’s annual team meeting. Once the data is entered, a “screen shot” is generated and sent to the appropriate provider confirming services, units, and rates approved for a specific period of time.
During the 2014 session, a coalition of waiver service providers developed a list of legislative changes to clarify and/or correct some problem areas in the 2013 DWRS legislation. This group presented the suggested changes to DHS for review and discussion so they could be introduced at the legislature without objection. Most but not all of these changes were included in the Omnibus bill that was passed.
If you, or someone you know, are a recipient of waiver services you can expect that the DWRS will be part of your 2014 annual meeting. As you prepare for this meeting it is important that you are clear on what services and units are desired under your definition of a quality life; and to expect the case manager to explain what will be authorized. For people receiving waivered services before 12/31/13, the 2013 legislation prohibits any reduction in your services and your rights to appeal have not changed.
John Wayne Barker is Executive Director of Merrick, Inc and a member of DWRS Advisory Committee.