What we gained, what remains

Editor’s note: Access Press asked several disability community leaders to comment on the 2012 session of the Minnesota Legislature. On many fronts, Minnesotans with disabilities and their families made gains, especially in light of the numerous cuts and changes made during the 2011 special session. But much work is ahead to preserve those gains and make some actions permanent. What We Gained, What Remains is a look back and a look forward.

The Association of Residential Resources in Minnesota (ARRM) came into the 2012 legislative session with a long list of things to undo from last summer’s special session, a counter proposal to the Minnesota Department of Human Services’ (DHS) new payment methodology legislation and a package of reforms.

In the end our gains mitigated a lot of the special session damage and helped define what remains in the fast-changing disability service system.

The issues successfully changed from special session included:

  • Delaying the 1.67 percent reduction that is contingent on Center for Medicare and Medicaid (CMS) approval of Minnesota’s nursing home level of care waiver request. The cut— if needed—was shifted into the next biennium by delaying the final year-end payments into the next biennium.
  • Reducing the 10 percent lower need congregate care reduction to five percent, contingent on CMS’s approving nursing home level of care request.
  • Delaying the personal care attendant (PCA) relative care reduction to the next biennium.

 

ARRM and others helped define how Minnesota will approach what remains

ARRM’s rate methodology bill became a coalition bill with advocates and day training and habilitation services providers as we worked out critical details before being introduced. The coalition bill differed significantly from DHS and, with the urging of Rep. Jim Abeler (R-Anoka) and Sen. David Hann (R-Eden Prairie), the parties negotiated the final bill.

The result was successful with implementation of new methodologies delayed, a specific list of issues of concern to be researched in the interim, protections and a transition period for individuals already being served, and a requirement that DHS propose specific legislation before any implementation of new rates. Payment methodology issues will be on our agenda for years to come as we move from county-based methodologies to a statewide system.

ARRM’s Blueprint for Reform legislation included provisions that find savings and allow innovation (such as monitoring technology) within adult foster care and facilitate people’s choices to move into other community settings that meet their individual needs at a lower cost. Examples include: daily billing for independent living services in the CADI and BI waivers, allowing a higher concentration of people in multi-family settings with the provision that recipients would assume the lease, breaking down the barrier to get housing money in unlicensed setting through the shelter needy program and providing cost effective financial incentives for providers to help people move out of foster care.

Other policy provisions such as host county notification (rather than concurrence), background study and licensing changes and new 245D standards for unlicensed services create a new backdrop for further system change. Among those changes will be the incorporation of Quality Outcome Standards and the consolidation of duplicate standards now in 245B, 245D and the Supervised Living Facility rule—into a package that will help direct focuses standards on quality. 

These gains helped set the stage to make what remains more focused on quality, individual choices and outcomes and savings in the system. 

Bruce Nelson is executive director of ARRM.

 

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