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Long-Term Services & Supports Update - September 2018

Key Highlights This Month:  

Workforce Shortage discussion – Guests: Sue Schettle, Barb Turner – ARRM

  • Discuss implications/trends across agencies – shared understanding
  • Brainstorm solutions
  • Identify next steps

Information from Sue and Barb – Trade organization representing approximately 154 providers (agencies and family providers)

Even if there was high paid positions, there are not enough ‘bodies’ to fill the positions.

In the current situation – providers can meet health and safety, it is an issue of ‘quality of life’, things people would like to do.

Technology to enhance or in some cases substitute supervision.

                https://www.arrm.org/technology

Need for further support and exploration of technology – it isn’t just cameras.  ARRM is looking to have engagement from counties.  Willing to come out to counties to discuss/educate.

Some providers are finding that if they limit the amount of direct care a supervisor/manager does they are more successful – the supervisor role is to find/train/support the staff in order to work successfully at retention.  Use of cross training for short term/need to fill a shift situation. Just filling a shift with a ‘body’ isn’t a successful technique.

Need for a balance between when a provider may not be able to deliver some one to one time and how to ‘make up for’ when it doesn’t occur.  Need for providers to be a as transparent as possible about what they can and cannot commit to do and for the case manager to be as clear and about expectations as possible.  Example:  Swimming for the person – flexible case plan of X times per month vs. every Tuesday.  Be as realistic as possible about what is needed vs. what is desired as well.  Also transparent to people served and their families.  Compromise – example: two people from a home go home twice a month, can this be coordinated as it would help with workforce/shifts for the home.

DHS is conducting a survey with ARRM/MORH/providers staff to hear what is working, what is going well and where work/resources could be directed.

Challenge: how to engage more informal support/natural supports and balance risk.

Need to engage guardians/families in the discussion regarding workforce shortage and how technology can enhance service/support. Need to be honest about what the workforce shortage means.

Counties give consideration to a home or person or two within their service responsibility to focus on to see successful use of technology. Selection of individuals to try this for the ‘easy sell’.  With success in the local community, these can be the ‘model’ to view.

Technology can/should be a part of the conversation at all meetings.

 HCBS CSWG Charter Update Discussion

Changes:

  • Terms.
  • Physical presence at a minimum of 50% (5) of the meetings.
  • Whether the association(s) director/representative is the director or a designee.
  • Focus is higher level/policy level work vs. ‘boots on the ground’ – this would be managed at a workgroup level.

 Charter will move forward as presented.

 DSD Legislative Proposals Discussion

  • Workforce and recommendations from an Olmstead subcabinet workgroup
    • Increase the wage and tiers
    • Minneapolis minimum wage at 15/hour
    • PCA rate
      • Working with stakeholders to build a rate framework
      • Looking at the minimum requirements for the work – comparable positions are 20% higher
      • The rate package will be very large – 500 million
  • Disability waiver rate system (related to the 7%)
  • Looking to add a competitive workforce value which will increase the rate and should lead to increased salaries.  Varies some by the service. 
  • Waiver reimagine project reports to the legislature
    • Early discussion with the contractor – DSD emphasis on benefit set
    • Looking at restructuring the service/benefit set
      • Services for which the provider has responsibility (licensed settings like Corp FC)
      • Three tiers:
        • Those for people living in their own home (like ILS, individualized home support)
        • Habilitation services – teaching
        • Delivered in a family setting
    • Day Training and Habilitation – restructure
      • Center based that can continue for those that have it and want it
      • Different expectation for those entering services – graduation HS
    • Customized living for those under 55 – service change.

 

  • Help individuals understand the cost of services – individualized budgets.
  • Looking at CDCS as not an all or nothing – ability to use part of budget to purchase traditional services and then part as CDCS
  • LifeCourse Curriculum (U of Missouri Kansas City) 
  • Life Sharing – as a service.  Need to determine rates for this service and that it is tax exempt.  (Adult FFC and Life Sharing)
  • SILS County share change.  Currently at 30% to reduce to 15% in order to facilitate authorizing and spending funds.  Some counties are significantly underspent.
  • Breakout the skilled nurse rate – one for RN one for LPN
  • Statewide aggregator
  • MnCHOICES – revisit 2018 language
  • CFSS – conversion language changes to bring this up
  • Proposal for contract and in-house staff to address issues identified as needs via GAPs analysis/needs assessment

 County State Role Discussion

GAPS analysis on a regional basis – DHS responsibility.

County role regarding ‘crisis’ with regarding to providers (such as a license being revoked) – DHS putting protocols together and will review with CSWG.

Role of DHS delegation of QI management to counties – what would the roles be, authority, and resources. Concern whether or not the counties would take on the responsibility even if there was funding.  What would need to be in place if the county were delegated.  Needs more ‘research’

Continue with the workgroup (Louella, Gena, Evan [Dakota]) to further explore.

 New Employment Services: 

 The new employment services are in use and current service recipients began the transition from traditional services to the new services on September 1.  The process of translating the previous services to the new ones has come with challenges and needed clarifications from DHS to both lead agencies and providers.  DHS has offered regional workshops for service providers and case managers throughout the state to work through different scenarios together as a large group.  Attached is information regarding remaining sessions in your area.   Questions can continue to be routed to your lead agency mentor who will submit formal inquiry requests to DHS if they are unable to find an answer.  Continue to check DHS’s Employment First website.  Information and forms have been updated on a regular basis.  A few notable clarifications:

  • ICF-DD and the Employment Services:  The new services only apply to waiver recipients.  If someone’s services are being funded by the ICF they can continue to receive the same services and don’t transition to the new employment services.  For example:  If someone is working in a group setting (enclave) under DTH they would need to transition to Employment Support Service-Group at their annual renewal.  However, if that person is living in an ICF they will continue to work at their enclave funded through DTH. 
  • Second Jobs and 6790:  If someone is working two integrated jobs they will need two separate 6790’s that include the job specific details.  If someone is working for multiple enclaves all paid for by the service provider only one 6790 is needed. 
  • You may find service providers limiting or eliminating the use of group employment sites due to reimbursement rates being low.  Ensuring case managers give other options for employment with supports will be important to ensure individuals aren’t shifted from employment settings to rec/leisure due to lack of knowledge about other options. 

 Transportation & Employment Services: 

Waiver transportation will be used to accompany the new employment services.  This is a change for many lead agencies that didn’t use waiver transportation often.  Any ride to and from a person’s house can now be provided using HCPC T2003-UC.  A briefcase document has been created to help a lead agency determine when and how to use waiver transportation when authorizing the new employment services.  Note:  Waiver transportation is a market rate service.  A lead agency is able to work with a service provider to determine a rate.  DHS has brought in an agency to make recommendations regarding more consistent rate frameworks for transportation.  More to come prior to 2019.   http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs-305044

 DHS is also conducting a study on transportation for people receiving Home and Community Based Services.  More detail can be found at: https://public.navigant.com/sites/MNTranspStudy/SitePages/Rate%20Study.aspx

Day Training and Habilitation/Prevocational Services Update:

DHS held an Employment and Day Services stakeholder meeting in August and provided draft documents regarding additional employment and day changes coming.  Two distinct services will be used to redefine what occurs currently in DTH and PreVoc Settings.  Each of the new services will be available across all the disability waivers.

  • Day Support Services will replace the current DTH.  It will encompass community based training and support for people with disabilities to help develop and maintain personally enriching life skills, social skills, independent living, community access, etc.   
  • Prevocational Services will be used to teach elemental work skills and strengthen work capacity.  It will also include all center based employment.  Time limits will be used for individuals receiving Pre-Voc.  People receiving Pre-Voc prior to 7/1/2019 will be able to remain in PreVoc but must also receive another employment service or Day Support Services in conjunction with PreVoc.  People who are new to PreVoc on or after 7/1/19 can receive PreVoc for 3 years or 36 consecutive months and must also receive another employment service or Day Support Service.  There is a possibility for a one-time 12 month extension in certain circumstances. 

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Legislative proposals related to LTSS

If MACSSA would like a more detailed update and conversation regarding the new employment service we, alongside DHS, would be happy to come present on the matter for those interested.  If any counties need more technical assistance from a county perspective feel free to reach out to Megan.Zeilinger@co.dakota.mn.usContact(s): Andrea Zuber, Megan Zeilinger, Colleen Fodness  - Dakota County

Supporting Materials:  

Contact(s):  Deb Sjostrom, Paul Bukovich

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