The Minnesota Department of Human Services (DHS) has identified 1,756 participants in the CADI program whose rates are to be reduced by 10% effective November 1, 2011. Approximately 1,000 of these participants are newly identified since the first list of cuts was issued on August 19. Approximately 50 individuals will be identified later when they can be linked up with a county of financial responsibility. DHS communicated the list of affected participants to the counties on Friday, September 30 and will be informing providers of their specific list of impacted community alternatives for disabled individuals (CADI) participants through MN-ITS this week. Read the three-page DHS description of this rate reduction here.

Below are:

A) the methodology used to identify the low needs clients,

B) a classification system to compare/contrast the clients originally identified on August 19 with those identified on September 30, and

C) the DHS perspective on service changes and appeals.

A) Methodology used: A three-step process to identify those to be impacted by the 10% rate reduction:

1) Identify individual’s case mix score

Case mix A – need assistance with a low number of activities of daily living (ADLs) (2-3 ADLs)

• Any combination of 2 or 3 ADL dependencies or a single dependency in toileting, mobility or positioning

• Person does not have behavioral needs or special nursing needs

Case mix B – low ADLs and behaviors

Low ADLs includes the same ADL description as above. Behaviors include individuals that scored a 2 or less according to the long-term care screening document behavior field #46 (G.13):

00 • Behavior requires no intervention.
01 • Needs and receives occasional staff intervention in the form of cues because the person is anxious, irritable, lethargic or demanding. Person responds to cues.
02 • Needs and receives regular staff intervention in the form of redirection because the person has episodes of disorientation, hallucinates, wanders, is withdrawn or exhibits similar behaviors. Person may be resistive, but responds to redirection.

2) EXCLUDE any individual who had entered the waiver in the past 24 months from an ICF/DD, nursing facility, certified board and care or correctional facility.

3) EXCLUDE any individual who had entered the waiver in the past 24 months and received adult crisis response, assertive community treatment (ACT), child crisis response and emergency department or mental health intensive residential treatment (IRTS) services

B) Classification of clients:

Lead agencies received specific information that identifies four groups of individuals. The groups are:

• Group A – Individual was on the reduction list in August and remains on the list: apply 10% reduction.

• Group B – Individual was on the reduction list in August but is no longer on the list: apply 1.5% reduction.

• Group C – Individual was not on the reduction list in August but now is on the list, with a service agreement line prior to Sept. 1, 2011: apply 10% reduction.

• Group D – Individual was not on the reduction list in August but now is on the list, without a service agreement line prior to Sept. 1, 2011: apply 8.5% reduction (assumes the 1.5% reduction was already applied).

Lead agencies must apply the following provider rate reductions and have 60 days from the effective date of Nov. 1, 2011, to revise provider contracts to reflect the November 1 rates:

1. Groups A and C: 10% rate reduction.
2. Group B is no longer targeted to receive a 10% reduction. Therefore, lead agencies implement the 1.5% rate reduction.
3. Group D has already received a 1.5 % partial reduction. Therefore, lead agencies implement an 8.5% reduction to the current rate.

C) DHS Perspective on Changes or Appeals

In the rate reduction announcement, DHS offered the following perspective:

A rate reduction does not trigger an automatic appeal. The 10% reduction is a provider rate reduction for a person still receiving customized living, the CADI Waiver service of foster care or the DD Waiver service of supported living in a corporate foster care setting. Lead agencies must:

1. Discuss with individuals and the providers whether service plan modifications are necessary or if the provider is able to manage services without appreciable difference to the person.
2. Determine if they need to revise a service plan.
3. Send a notice of action https://edocs.dhs.state.mn.us/lfserver/Public/DHS-2828-ENG to the recipient if service plan changes are required.

Because over half of the people impacted by the 10% cut in rates are newly identified in this round of communication, we realize there will be questions. We encourage members to contact Phil Manz with those questions at pmanz@careproviders.org or 952-851-2484.

Phil Manz
952.851.2484
pmanz@careproviders.org

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