In the past week, two proposals have been offered by the governor and the Minnesota Department of Human Services (DHS) impacting all home and community-based services providers. With limited budget detail, we can provide an estimate of the governor’s budget proposal after the release of the revised budget forecast on Monday, February 28. These items are listed under the waiver headings below. The DHS policy proposals were unveiled at an “invitation only” meeting with stakeholders on Friday, February 25. While the DHS policy proposals document is marked at the top as a draft document pending final sign off, it does represent what DHS intends to present to the legislature in upcoming weeks. After each description of DHS proposals, we give the page numbers where the proposals are listed in the document linked above.

All Housing with Services Providers, Public and Private Pay

Changes in Housing with Services Contracts

Seeks to define which services in section 144D.01 subdivision 5. Supportive Services and subdivision 6. Health-related services or any other services are included in a base rate, which is defined as payment required when services are included with rent. Rent is then defined as a means of payment for occupancy of a property and may only include the following, when specified in a lease—utilities such as heat, etc.; access to common areas and amenities; vehicle parking; building maintenance; front desk service; and whether the establishment requires as a condition of tenancy the purchase of services with the rent. The effective date for this provision would be March 1, 2012 (pages 79-82).

Two associate member attorneys who have reviewed this language are very confused about what this language means and how it would be implemented. By way of background, changes were made to legislation in 2010. The Long-Term Care Imperative produced a guide on compliance with Minnesota Statute 144 D that incorporated the changes in the 2010 legislation. You can access this document on our website.

Provider of Elderly Waiver

• (24 Hour) Customized Living rates are decreased by 2%, not 10% as originally proposed.

Provider of CAC, CADI, DD, TBI Waivers

• (24 Hour) Customized Living rates are decreased by 2%, not 4.5% as originally proposed.

• Reductions of 10% in dollars available for services for individuals with lower needs are withdrawn.

Expedited Rule Making Process for Implementation of Administration, Rate Setting Methodology and Provider Certification Fee for the CAC, CADI, DD and TBI Waivers

Seeks authority for DHS to adopt expedited rule making, whereby DHS would publish notice of its proposed rules in the State Register and then allow at least 30 days for comment, but no public hearing. Then an administrative law judge would approve the form and legality of the rule, at which point it would be adopted. In summary, expedited rule making means that none of the provisions would be subject to legislative approval. The deadline for the completion of the expedited rule making process is January 1, 2012 (page 38).

Providers will need to re-enroll with the state as county contracts no longer are used, and they will be paying a fee to subsidize the certification of providers, subsidization of federally compliant statewide monitoring, review and tracking, discovery, remediation, and improvement and state and federal program reporting activity. The fee would include a base provider review and monitoring rate, with incremental fee adjustments for small, medium and large providers. DHS would evaluate the possibility of extending the home and community-based provider certification to fee-for-service personal care assistance providers delivering services under the state plan, but not the medical assistance home and community-based waivers. A licensed provider would pay a certification only for standards that are not part of licensure. DHS would not provide an estimate on the amount of fees they were considering (pages 36-37).

The counties would perform certification functions such as monitoring and reviewing home and community-based services providers and assessment of the home and community-based waiver service capacity and development to identify service gaps (page 37).

Foster Care Provider

Changes in Licensing Moratorium

• Adds downsizing to closure of a nursing facility, ICF/MR or regional treatment center as an exception to foster care licensing moratorium (page 9).

Clarification of Family Foster Care Providers

• Language enables DHS to identify when a foster care provider is a family foster care provider (page 11).

• Implementation of Residential Support Services and Quality Outcome Standards is moved from January 15, 2011 to January 15, 2012 (page 11).

Phil Manz
952.851.2484
pmanz@careproviders.org

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