Advocacy

Legislative Update: HHS Omnibus Bills Released

April 10, 2019 By HCO

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 things that ARRM is 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 contacted members who would see their fees go up by more than 29%, with specific messaging to use when reaching out to their House member.

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 that 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 changes to the Positive Support Professional Training

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 six months, the Commissioner would reduce adult foster care bed capacity by one. The bill also implements DD and CADI waiver caps as of June 30, 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 they support and putting on record the provisions that they have concerns or are opposed to. In the House, ARRM attempted to remove the licensing fee increase through amendment, but the amendment was not adopted. ARRM also worked in the House to draft an amendment which stated that 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.

ARRM is anticipating that amendments will be taken in the Senate this week and will work with key Senate leaders to craft amendments that would work to address the concerns they have with the bill as drafted.

ARC/ARRM Days at the Capitol

March 25, 2019 By HCO

HCO self-advocates, staff, and family members recently visited the Minnesota State Capitol to attend disability services rallies for ARC and ARRM Days at the Capitol. Two buses of 45 people (90 total) signed up to attend one (or both) of the trips. Advocates attended and spoke in support of the Best Life Alliance Bill SF6/HF179. On both trips, advocates: attended the rally in the rotunda, held appointments with local legislators, and dropped off information packets to those who were unavailable to meet.

ARC Day: Tuesday, February 19th

During meetings with legislators at their morning appointments, various HCO representatives shared their experiences and concerns:

Two individuals and one support staff spoke on their specific care needs and how staff assist them in their daily lives
One individual living independently talked about the importance of the few hours of service she receives each week and how it helps her to remain independent
One staff spoke on supporting an individual with end of life care and the toll it takes on staff (watch the video here)

ARRM Day: Tuesday, March 12th

At ARRM Day, an individual served by HCO introduced Senator Miller at the rally on stage in front of over 1,000 people! When meeting with legislators at their afternoon appointments, HCO representatives spoke on numerous topics:

One individual shared how they are able to live independently because of staff support
One staff spoke on her experiences currently supporting 13 individuals who live independently and how the people she has supported for the past 18 years have impacted her life. She now has two daughters that also work for the agency.
One staff spoke on providing care to a young man with challenging behaviors and how they support him in order to keep him out of crisis so that he can continue to live in his community

Video Link for ARRM Day at the Capitol/Best Life Alliance can be found here.

February Legislative Update

February 15, 2019 By HCO

After the Minnesota Department of Human Services (DHS) reviewed and denied requests for a contested case proceeding to appeal the 7% rate adjustment under the Disability Waiver Rate System (DWRS), ARRM, MOHR, and 4 individual waiver recipients returned to the federal appeals court to file suit again. The case was back before Judge Wilhelmina Wright to review, and she had 60 days to respond with a verdict. On February 15th, Judge Wright dismissed the lawsuit, citing that there were multiple points where plaintiffs lacked the standing to push the case forward in federal court – particularly centered on whether irreparable harm from the cuts was truly significant and unavoidable. She did not, however, issue a ruling as to whether the overall action by DHS overstepped its authority or the law, leaving the possibility open for future litigation in either state or federal court.

From ARRM:

Business is speeding up dramatically at the State Capitol on a host of legislative priorities for ARRM, as well as new related legislation.

On Monday, February 11^th, the Best Life Alliance Legislation (HF 179) was heard in the House Health and Human Service Policy Committee. ARRM author, Rep. Laurie Halverson, presented the bill and Judy Marder, chair of the Best Life Alliance group, provided testimony in support of the bill. The bill was referred to the Ways and Means Committee through a unanimous roll call vote and has now been re-referred to the Health and Human Services Finance Committee.

In addition to the Best Life Alliance proposal, an alternative proposal was also heard during committee on Monday. HF 168, which is carried by Rep. Jennifer Schultz, was heard and amended. The amendment does the following:

Moves the inflationary adjustment from every 5 years to every 2 years and accesses the most recently available data when making the adjustment
Officially removes the 7% from statute, effective retroactively to July 1, 2018
Requires providers to pay Direct Support Professionals, at a minimum, the amount that is listed in the Base Wage within DWRS for that particular service
Puts new reporting requirements on providers focused on workforce

As written, ARRM and the Best Life Alliance have concerns with the amendment because it puts new requirements on providers for compensation but does not provide any new funding. The bill’s author has indicated that additional amendments will be presented during future committee meetings that work to address these concerns.

During committee, ARRM and MOHR members were able to testify and bring forth their concerns about the bill as drafted. ARRM member Butch Karcher of Karcher Foster Services offered testimony on the workforce crisis and the struggles he, along with other providers, are facing around staffing. MOHR member Lynne Noren of Rise provided testimony outlining concerns with the mechanics and implementation of the bill language as written.

Workforce Hearing in the Senate
Also on Monday, Senator Jim Abeler held a hearing in his committee, Human Services Reform, Finance and Policy, focused on the workforce crisis in long term care services. ARRM staff and members provided testimony. Additional testimony was taken from the advocacy community and the older adults community. While there was no direct outcome from this hearing, it was a good opportunity to be able to get important messaging in front of the committee and continue to push for legislation to help address the workforce crisis.

You can watch clips of the hearing on ARRM’s Facebook page.

Progress on other ARRM Bills
ARRM’s ICF bill (SF 909) was heard in the Senate Human Services Reform, Finance and Policy Committee. ARRM’s Director of State and Federal Policy, Sara Grafstrom, testified on behalf of the bill along with lead author, Sen. Bruce Anderson. The bill was laid on the table until a formal fiscal note is available.

ARRM’s Policy bill (HF1256) was introduced in the House on Thursday; carried by Rep. Hunter Cantrell. ARRM is working with leadership to obtain a hearing for this bill in both the House and Senate.

Looking Ahead to Next Week
On Tuesday, February 19^th, the Governor’s budget will be released. Please watch for information from ARRM and the Best Life Alliance on any potential actions that may be needed from our grassroots advocates in response.

Stay tuned for more updates as they become available through HCO’s Grassroots Blog or at ARRM’s website.

ARRM: January Legislative Recap

January 23, 2019 By HCO

Best Life Alliance Legislation: (SF 6/HF 179)

The Best Life Alliance bill has been introduced in both the Senate and the House. The bill received its first hearing this past Wednesday in the Senate Human Services Reform and Finance Committee. ARRM Board member Cindy Ostrowski from Hiawatha Homes offered testimony to the importance of ending the 7% cut.

In addition to the Best Life Alliance legislation, alternative legislation has been introduced in both the House and Senate. SF 92/HF 168 would set the Competitive Workforce Factor at 4.55% which would buy back about 3.8% of the 7% cut. SF 92 was also heard in the Senate Human Services Reform and Finance Committee this past Wednesday.

It is important to remember that while there are alternative proposals being introduced, the Best Life Alliance, as well as ARRM is committed to advocating for the full buy back of the 7% cut. Please watch for future action alerts for guidance on how you can lend your voice to the efforts!

ARRM Policy Bill: (SF 174/HF XXX)

ARRM is once again bringing forward a policy bill that contains similar provision to the bill that was contained within the Supplemental Spending bill last year and was vetoed by Governor Dayton. The bill was introduced in the Senate this last week and will hopefully be introduced in the House next week.

In addition to the stand-alone bill, Senator Abeler has introduced SF 74, which is a “mini omnibus” bill of policy provisions from last session that had agreement on. All of the policy provisions that ARRM brought forward last session are also contained within SF 74 – ARRM will continue to monitor the progress of that bill.

ICF Legislation and Unfunded Mandate Legislation:

ARRM is in the process of gathering authors for these two pieces of legislation and they hope to have them introduced within the next couple weeks.

Service Termination Legislation:

ARRM has a small group of members that are working on service termination legislation. The legislation would tighten the timelines for judicial review when a service termination is appealed and clean-up language within the current service termination statute. They are still in the process of meeting with stakeholders about this legislation and addressing concerns with the language that are being brought to them. ARRM hopes to move this language forward to the drafting process within the next few weeks.

Stay tuned for more updates as they become available through HCO’s Grassroots Blog or at ARRM’s website.

HCO Acknowledges 2018 Self-Advocate of the Year: Milton Topness

December 11, 2018 By HCO

Milton and Guests

Home and Community Options is excited to honor an individual who has been a leader in self-advocacy for many years: Milton Topness.

Milton has become a recognized self-advocate within many circles of self-advocacy. He remains one of the longest standing members of the Winona People 1^stgroup, spanning over 20 years. Milton has served as a member of the SAM SE (Self Advocates of Minnesota- SE Region) for almost 10 years. In 2010, he received the Self-Advocate of the Year award from ARC Southeastern Minnesota. He is also an active member of the Home and Community Options-Grassroots Advocacy Task Force which has been in place for many years.

Milton is modest but not shy when it comes to speaking up. He wants to be heard, and expresses what is important to him. Milton understands the importance of the voices of the self-advocacy movement and the need for our legislators and state representatives to hear these voices. He is strong in his beliefs, while at the same time sees himself as a learner who welcomes input and ideas from others. He is very proud of how far he has come in his self advocacy and enjoys the many connections he has made with other self-advocates around the state.

Milton has served in a variety of capacities within the self-advocacy circles. He has been a member of the SAM leadership council and has served as the Media and Legislative Specialist and the Sargent of Arms. He currently is taking a step back from elected positions as he feels others need to step up and have the opportunities he has had, but he continues to work diligently in helping to plan many regional and state self-advocacy conferences. Milton continues to be an eager leader within the People 1^stof Winona group and will often volunteer to lead the meetings, provide input, and assist others.

Home and Community Options has a long-standing history of self-advocates who are actively engaged in advocacy at both the local and state level. While Home and Community Options has had a strong self-advocacy presence for many years, this is the first year for this Self-Advocacy award.

September Update: DHS Denies HCO appeals

September 10, 2018 By HCO

The Minnesota Department of Human Services (DHS) reviewed HCO’s request for a contested case proceeding to appeal the July 1, 2018, 7% rate adjustment under the Disability Waiver Rate System (DWRS). DHS determined that Minnesota Statutes do not authorize a contested case proceeding in this circumstance, and have denied the request.

We are currently working to determine future courses of action, which may include potentially returning to the federal appeals court to file suit. HCO continues to work closely with ARRM and MOHR to explore all avenues available to address the 7% adjustment, and more information will be released as it’s made available.

7% Cut: Update

August 6, 2018 By HCO

HCO’s August Update:

The appeal for an emergency injunction was denied by the Judge, in part because she determined that providers must pursue state administrative remedies before seeking extraordinary relief. HCO will use the administrative appeal process to contest the 7% cut.

Rate cuts, along with the staffing shortage and the increased number of unfunded mandates have had a huge impact on services. For the past five years, HCO has shouldered the brunt of these expenses. HCO teams are diligently working to develop modified service plans to maintain unit-based programming. This will impact the minimum length of shifts or the need to come to licensed sites for services.

We hope that by making these modifications, we will be able to mitigate the effect of the 7% cut and other issues to continue to provide quality services to the individuals we support.

August 17th:

Senator Abler was recently interviewed on the Capitol Report and shared the importance of restoring funding for disability services

You can find additional information about the 7% cut and how you can get involved at:
Best Life Alliance
ARRM

Get to know William. Despite some challenges, William is thriving.

March 10, 2018 By HCO

William has been self-employed for over 30 years. At 65 years old, he does all his own repairs on lawn and snow equipment, as well as on his own vehicles. He runs his own mowing and plowing business and has provided this service to his customers for many years. Though he is active in the community, he also has some challenging medical needs. William has diabetes and stage 3 chronic kidney disease.

William’s support staff, Jeni, has worked with him for 12 years. Jeni works diligently to ensure he gets to his numerous medical appointments, helps him monitor his blood sugar levels, and makes sure he takes his daily medications at the appropriate times. She assists him in filling out his MA paperwork every 6 months, and also helps him establish and maintain his own health care directives. Because he owns his own business, Jeni helps William track his income and expenses so that he can do his taxes at the end of the year, and she also acts as his rep payee for Social Security. William comments:

“I’m so happy and pleased to have Jeni. She is a wonderful help to me.”

There’s something you should know:

If William didn’t have the 4 hours of support he receives each week, he would not be able to live on his own. He would most likely have to move in with his closest relative, who lives almost 2 hours away. He does not want to leave the life he has built here in Winona, or say goodbye to those he has formed relationships with over the years.

Achieving Independence

February 16, 2018 By HCO

When Eric first began receiving services from Home and Community Options, he moved in to a 24 hour residential home with roommates. He flourished with the support he received, and decided that his long term goal was to be able to move out and live on his own some day. Eric worked hard to build skills of independence, and was later able to transition to a semi-independent living program that utilizes remote monitoring on site.

HCO’s remote monitoring programs offer opportunities for increased self-sufficiency and are a great service to transition individuals to more independent living settings. Individuals who live in remote monitored programs do not have staff during overnight hours and utilize call buttons, alarms, and other various devices to receive the assistance they need. After becoming more independent, Eric was able to move into a single apartment and his support needs continue to decrease as he adapts to living on his own.

There’s something you should know:

The impact of Eric’s transition to independent living affects more than just him. Eric’s move provided the opportunity for another individual to move in to the remote monitoring site he left, and they now can continue to work towards their own goals of increasing independence. That opened up another opportunity for a third individual to begin receiving support at a different residential program. This domino effect continues to occur as more and more individuals build skills and work towards reaching their long term goals.

2016-17 Bills Watched and outcomes

July 24, 2017 By HCO

Best Life Alliance:
SF 669| HF 873

Description: There are currently 8,700 unfilled caregiver positions in Minnesota. Failure to maintain community-based disability services will lead to more costly scenarios, like hospitalizations or mental health crises. This bill gives 4% wage increases in 2017 and 2018 to help address current workforce issues and build long term solutions for funding health insurance for direct care workers.

2017 Legislative Session Outcome:
The Best Life Alliance proposed a wage increase of 4% in 2017 and 4% in 2018 for Direct Support Professionals. Unfortunately, the proposed legislation was not passed this year, resulting in no immediate increase for DSPs.

Disability Waiver Rate System:
SF 727 | HF 814

Description: Unfunded mandates and dramatic changes in reimbursement rates are having a profoundly negative impact on providers. This bill addresses unfunded mandates impacting service providers, reforms unit based service reimbursement, and minimizes drastic rate changes, giving providers more capability to adjust and plan for staffing impacts or level of services.

2017 Legislative Session Outcome:
The final Health and Human Services Omnibus bill contained many of the proposals from the DWRS. Changes include:

Addition of a 7th year of banding (contingent on Federal approval)
Tying the sleep staff rate to minimum wage (effective 2019)
Tying the RN and Supervisory rate to the BLS (effective 2019)
New language on a provider cost audit
Moving respite to a market based service