Below you will find information on the 2019 Health and Human Service Omnibus Bill.
HCO is excited that the 2019 Legislative Session listened to concerns and are working to find solutions that help address provider financial stability.
Below is information from ARRM on both the HHS Omnibus Bill and additional details regarding the Competitive Workforce Factor. As you can read, the competitive workforce factor has many stipulations including CMS approval, banding, and each individual rate calculations. During the next two months we will be learning more from ARRM, DHS and CMS how each of these changes will impact HCO and our services.
HCO is committed to quality services and competitive wages. We will continue to work with our legislators, stakeholders and staff to fulfill these commitments and our HCO Mission.
If you have any questions, please contact Suzanne R. Horstman (SuzanneH@hco.org).
It’s hundreds and hundreds of pages long, spends billions of dollars, and regulates thousands of state programs and private organizations. If you’re thinking of the Health and Human Services Omnibus Budget Bill, you’re right on!
ARRM has completed its review of this massive piece of legislation. This article walks through what’s in, and what’s out, and how it matches up with the association’s priorities. Our team will be breaking down key provisions in an ongoing series of fact sheets and articles, but this provides your general overview. Items that are italicized will be featured in future blog posts in the coming two weeks with a more thorough background and analysis, items with an asterisk were included on ARRM’s 2019 Legislative Agenda.
If you have any questions about any of the items listed below, please feel free to reach out to Sara Grafstrom at email@example.com.
Included in the Health and Human Service Bill that we SUPPORT
- * Competitive Workforce Factor for DWRS at 4.7%: A Competitive Workforce Factor has been added to the DWRS framework at 4.7%. This adjustment will cost the state $34 million in 2020 and 2021 and $30 million in 2022 and 2023 and represents about a 4% increase in DWRS rates.
- * Change to the inflationary adjustment from every 5 years to every 2 years: Beginning in 2022, component factors will automatically be adjusted ever 2 years, using 30 month and 1 day old data.
- * Requirement of an annual conversation on technology: At annual planning meetings, providers must have a conversation about how technology may be used as a part of someone’s services.
- * Changes to the training requirements and qualifications for the Positive Support Professional, Positive Support Analyst and Positive Support Specialist position: Many changes were made to this service; one highlight is that the Positive Support Specialist and Positive Support Analyst now have 90 days to get their required training.
- * Removal of the hourly requirements for Annual Training: The hourly requirements that were in statute for the annual training requirement have been removed. Annual training and Orientation training is now competency based.
- Creation of a Technology First Advisory Council:A Technology First Advisory Council has been created with ARRM being granted a seat on the council. The goal of the council is to advise the commissioner on strategies to increase the use of supportive technology in services and programs.
- Direction to the commissioner for a Value-Based Models study: The commissioner, in consultation with stakeholders shall study value-based models and outcome-based payment strategies with a report due by October 1st, 2020.
Not Included in the Health and Human Service Bill that we SUPPORT
- No caps to the DD and CADI waivers: A proposal that would have capped the DD and CADI waiver at June 30th, 2019 levels was not adopted.
- No increase to HCBS Licensing Fees: A proposal that would have increased 245D provider licensing fees from 25-300% was not adopted.
- No new language relating to the closure of Adult Foster Care beds: A proposal that would have permanently closed one adult foster care bed for every two that are vacant for six months or more was not adopted.
Included in the Health and Human Service Bill that we OPPOSE
- New definition of shared respite: New language states that for shared respite, the rate shall be the total payment for one individual divided by the number receiving the service, not to exceed three.
- Removal of the ILS Specialist Service from the framework: The ILS Specialist Service has been removed from the framework and no longer available for providers to provide.
Not Included in the Health and Human Service Bill that we OPPOSE
- * No language allowing for the expansion of variable rates for ICFs and an increase in the reimbursement for Services During the Day: ARRM’s legislative proposal that would have allowed all ICFs to request a variable rate and would have changed the Services During the Day reimbursement rate from 75% of the DT&H rate to 100% of the DT&H rate was not included.
- * No extension of the licensing moratorium exception for adding a 5thbed: During committee, the Senate amended our language around the 5 bed moratorium extension to 6 beds and removed the sunset language. There was opposition from the advocacy community around the 6 bed proposal and because of that, the entire proposal, including our language to extend the 5 bed sunset date was not adopted.
Included in the Health and Human Service Bill that we are NEUTRALon and Impacts Members
- New definition provided for Residential program: A new definition of residential program has been added to 245A.02
- New HCBS Documentation and Billing standards: New documentation and billing requirements have been added to 256B.4912. ARRM worked closely with the department on this language over the last several years to ensure that this language is the least burdensome to providers.
- New language around change in ownership: The language provides direction and clarity for licensing and providers when a change in ownership occurs
- Electronic Visit Verification Language: Language allowing the department to move forward with EVV was adopted. The language states that any penalty that the department receives due to not coming into Federal compliance cannot be passed along to providers.
- New Labor Market Reporting Requirements: On an annual basis providers will be required to submit labor market data. Language is included in the bill directing the commissioner to streamline reporting as much as possible.
- Report and Proposal requirements for Waiver Re-imagine: A report and proposal to move forward to streamline the four waivers to two is required to the legislature by 2021.
Broader Disability Community Initiatives
- TEFRA Parental Fees Reduced by 15%
- MA Spend down for individuals with a disability eliminated
- Allowance of CDCS shared services
- PCA SEIU Labor Contracts ratified
- Bulk purchasing incontinence product program repealed
- MSOCS Operating adjustment
June 07, 2019
The 2019 Legislative Session delivered many changes which impact Home and Community-Based Service (HCBS) rate setting, including key provisions targeting the workforce shortage issue. These changes will benefit HCBS providers’ financial stability and ability to invest in the Direct Support Professional (DSP) workforce both in the short- and long-term. It will also require organizations to adjust the way they forecast revenue and the data they need to collect and report to the Minnesota Department of Human Services (DHS).
Competitive Workforce Factor
As previously reported in “What You Need To Know About Competitive Workforce Factor”(05/28/2019), a new Competitive Workforce Factor (CWF) of 4.7 percent has been added to the Disability Waiver Rate Setting system (DWRS). This policy, a key priority of ARRM and the Best Life Alliance, was crafted and passed by legislators with the explicit intention of supporting wage increases for DSPs. It’s important to keep this in mind as we walk through how CWF will work.
System wide, the CWF will add an estimated $64.2 million to HCBS waiver revenue over the next four years, or an average 4 percent increase to service rates.
But wait…we said the CWF is 4.7 percent; why the difference? Because CWF is a component factor of the DWRS formula which applies only to direct staffing costs and not a flat rate increase. Therefore, it will generate a different increase for each individual rate based on the specific direct staffing costs associated with that service agreement and the other factors which compose the overall rate. To determine how much new revenue will be generated by the CWF, providers should:
- Look at the DWRS framework worksheet for an individual rate
- Insert the 4.7 percent CWF after the direct support costs are compiled, but before any other service factors are added
- Complete the rate worksheet and calculate the difference between the new final rate and the current rate
- Repeat for each rate under contract
Encumbrance, or lack thereof
Beyond understanding the business impact, why is it important for providers to start calculating this?
Remember how we said earlier that the intent of this provision was to support DSP wage increases?
- While the new legislation DOES NOT REQUIRE an encumbrance of any new revenue for DSP wages and benefits…
- It DOES REQUIRE providers to identify what additional revenues are generated from the CWF and prepare a written distribution plan for them, which must then be available and accessible to all direct care staff for at least a year.
DHS is also directed to provide an analysis of the CWF to the legislature every two years, and the department will certainly be tracking the comparison of revenue increases from CWF to changes in wages during that time (as will ARRM).
To ensure your organization stays ahead of questions from legislators, DHS, and your staff, it will be important to complete these internal analyses. ARRM is developing a webinar for additional guidance this issue which will be free for members and tentatively scheduled for July 19. Watch for more details.
The CWF will not change any rates until at least January 1, 2020. After that date, two milestones must have occurred for the CWF to begin delivering increases to a service rate:
- The federal Centers for Medicaid and Medicare Services must have approved the new DWRS changes, including the CWF
- That particular rate must not still be banded (because banding will officially end for all rates in 2020, this will only apply to individuals with banded rates who have not yet had their 2020 service renewal)
Because the timing of these two factors will vary, again we cannot say exactly when providers will begin to see revenue increases but still encourage all providers to begin analyzing what the impact will be once CWF goes into full effect.