2012 SESSION UPDATEMN CONSORTIUM FOR CITIZENS

WITH DISABILITIES

July 11, 2012

Anne L. Henry

Minnesota Disability Law Centerwww.mndlc.org

alhenry@mylegalaid.org

Intake: 612-334-5970

1-800-292-4150

TDD: 612-332-4668

1

I. DISABILITY SERVICES FUNDING CHANGES

A. 2011 Budget Cuts Modified in 20121. Delay of 20% Relative Personal Care

Assistant (PCA) Rate Cut until

July 1, 2013 - Cost $5.9M

- Affects 6,500 PCAs serving 5,900 recipients

- Cost to repeal during 2013 Session about $24M - For PCA Agencies, No Pay Back of 20% from

Oct 2011 to March 23, 2012 related to court case.

2

Delay 1 yr

2. Delay of 2011 Licensed Bed Closure

Budget Cut

• Avoids closing at least some of the 128 beds through unused licenses and voluntary closures first

• Statewide process (GAPS) Analysis and Need Determination to determine services needs for children, adults with disabilities and mental illnesses

3

3. Continuing Care Provider Rate Reduction

Contingent Delay until July 2013• 1.67%• Contingent on NF-LOC waiver

4. Family Deductible Can Be Paid By Providers if Allowed by DHS

5. Congregate Living 10% Rate Cut• Contingent Modification• Related to NF-LOC waiver – federal

match for state-funded Alternative Care Program

4

B. 2012 Budget Items1. Medical Assistance For Employed Persons With

Disabilities (MA-EPD)• Can continue working under MA-EPD rules

after 65• MA-EPD Assets disregarded upon retirement

after age 65- If on MA-EPD, 20 of 24 months before age 65

until 2014- If on MA-EPD, 24 of 24 months before age 65

beginning in 2014 for future years• Spouse’s Income Disregard after age 65

– If enrolled 24 consecutive months before turning age 65

5

2. Advocating Change Together- self-advocacy training funding $50,000

one time

3. Epilepsy Skills Training

- $65,000 per year, ongoing

6

II. ADULT AND CHILD FOSTERCARE CHANGES

A. Planned Closure for Corporate Adult

Foster Care (AFC)- Costs $98,000 in ‘12-’13 and

saves about $1M ’14-’15

- 43 DD+33 CADI beds estimated to close separate from the 128 beds (see I.2.)

B. Corporate Adult Foster Care Mental Health Certification - Costs $102,000 ‘12–’13, $399,000 ‘14–’15

- Certification exempts home from de-licensure

7

C. Foster Care for Individuals with Autism • DHS to work with counties on foster licenses for children currently in out of home placement

D. 5th Bed for Respite in AFC Allowed

with Variance• Also existing 5th bed capacity variance authority

extended to 2016• Costs $53,000 ‘12–‘13 and $60,000 ‘14–’15

E. Variance for Alternative Overnight

Supervision Modifications• Set timelines for DHS approval/denial• Defines supervision• Overnight caregiver unless documented

8

III. HOME AND COMMUNITY-BASEDSERVICES (HCBS)

A. Consumer-Directed CommunityCommunity Supports (CDCS)

-> Budget Change• 20% Budget Increase• For those who:

– turn age 21 and– graduate from high school– in 2013 and 2014

9

B. Disability HCBS Settings• Defined

– includes no more than 4 units or 25% in multifamily building of more than 4 units

C. Community Living Setting and Shelter

Needy Change• Allows 2-year transition lease from provider

to person with variance option for longer period

10

D. HCBS License Requirements• all residential and non-residential HCBS must be

licensed by January 2014

E. Payment Methodology for Disability HCBS• Statewide payment methodologies under

development• Legislation for 2013 Session• Implementation January 2014

11

IV. HOME CARE CHANGES (PCA, PDN)A. Personal Care Assistance (PCA) Technical Changes

• Nebulizer added to self-administered medication• Intermittent catheterization added to complex health

conditions• Behavior must interfere with ADL’s to qualify for

more time• Phone supervision by Qualified Professionals allowed

B. Time to Request PCA Services Pending Appeal• Changed from 30 days to 10 days

C. Private Duty Nursing (PDN) Matrix• Changes to be proposed based on matrix data

next session

12

IV. HOME CARE CHANGES

D.Removes PCA From Excluded Time Provision• Affects County of Financial Responsibility• Effective August 1, 2012

E. PCA Licensure Study• Report to Legislature January 15, 2013• Requires draft Legislation for Licensure and

Oversight

13

V. ASSESSMENT, CASE MANAGEMENT, SERVICE COORDINATION

A. MNCHOICES

Assessment will replace:• PCA• LTCC for BI, CADI, EW, NF• DD Waiver, ICF/DD Screening• Private Duty Nursing (to be included later)

B. Competitive Employment• Added to assessment

14

C. Case Management/Service Coordination• Separate administrative functions of assessment

and service authorization from case management/ service coordination functions for DD, CADI, BI, CAC and Rule 185 case management

• Effective August 1, 2012

D. Host County Concurrence Change• Notice to host county instead of concurrence when

person with DD waiver moves to another county. Effective August 1, 2012

15

VI. AUTISM-RELATED PROVISIONS

A. Autism Treatments Review• DHS Health Services Advisory Committee (HSAC)• Report due December 2012

B. Autism Housing With Supports Study• Includes Dept of Ed + Economic Development• DHS plans to seek outside contractor• Report due January 15, 2013

C. Autism Prevalence Study for Somali Community

• Minnesota Dept of Health, $200,000• Report due February 15, 2014

16

VII. REPORTS AND EVALUATIONS

A. Case Management Redesign and Study• Includes Targeted Case Management for

Vulnerable Adults, Children, Home Care and Relocation

• HCBS Case Management• DD Rule 185• Report due February 1, 2013• Legislation to be effective July 1, 2013• Also DHS Reform 2020

17

B. State Quality Council Duties• review issues involving risk

C. Disability Terminology Audit• related to METO lawsuit settlement

D. DHS and MN Department of Health• Evaluate Reorganization• Review Multiple DHS roles• For long-term care, report on client risk and

provider liability

18

VIII. ADDITIONAL PROVISIONS

A. Nonemergency Medical Transportation• DHS to implement single administrative structure

for Access and Special Transportation by July 1, 2013

• Report to Legislature by November 15, 2012

B. Out-of-State Children’s Mental Health Residential Treatment• Covered for Children who are Deaf or Hearing

Impaired

19

C. Update of Statutes on Tele-Communication Equipment• for Persons who are Deaf, Deaf/Blind, Hearing

Impaired

D. New Felony Offense for IntentionalDeprivation of a Vulnerable Adult

20

IX. DHS REFORM 2020 PROPOSALA. Develop Community First Services and Supports (CFSS)

-> Replaces PCA by Jan 2014

-> Uses federal authority under 1915K

-> Qualifies for 6% increased federal Medicaid Matching funds

-> Increases I ADL & Level I Behavior from

30 min to 90 min per day

-> Allows Self-Direction and Individual Budgets with flexibility to Buy items + services-> Stakeholder Implementation

Council required

-> Legislation to Change to CFSS Considered

Next Session, 201321

B. Many Other Changes• Elderly• Housing Stability• Mental Health and Autism Services to be

Added to MA• Employment Navigation Services• Health Reform

– Care Coordination (HCDS) - 9 organizations– Hennepin Health– Health Care Home– Medicare/Medicaid Duals Integration

• AND MORE!

YOUR INVOLVEMENT IS KEY!!!!22