2012 SESSION UPDATE MN CONSORTIUM FOR CITIZENS WITH DISABILITIES July 11, 2012

1. 2012 SESSION UPDATEMN CONSORTIUM FOR CITIZENSWITH DISABILITIESJuly 11, 2012 Anne L. Henry Minnesota Disability Law Center www.mndlc.org alhenry@mylegalaid.org Intake: 612-334-5970 1-800-292-4150 TDD: 612-332-4668

2. I. DISABILITY SERVICES FUNDING CHANGES Delay 1 yr A. 2011 Budget Cuts Modified in 2012 1. 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.

3. 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

4. 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

5. B. 2012 Budget Items 1. 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

6. Advocating Change Together • self-advocacy training funding $50,000 one time • Epilepsy Skills Training - $65,000 per year, ongoing

7. II. ADULT AND CHILD FOSTERCARE CHANGES • 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 HealthCertification -Costs $102,000 ‘12–’13, $399,000 ‘14–’15 - Certification exempts home from de-licensure

8. 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

9. III. HOME AND COMMUNITY-BASEDSERVICES (HCBS) A. Consumer-Directed Community Community Supports (CDCS) -> Budget Change • 20% Budget Increase • For those who: • turn age 21 and • graduate from high school • in 2013 and 2014

10. 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

11. 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

12. IV. HOME CARE CHANGES (PCA, PDN) • 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 • 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

13. IV. HOME CARE CHANGES • Removes PCA From Excluded Time Provision • Affects County of Financial Responsibility • Effective August 1, 2012 • PCA Licensure Study • Report to Legislature January 15, 2013 • Requires draft Legislation for Licensure and Oversight

14. 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) • Competitive Employment • Added to assessment

15. 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 • Host County Concurrence Change • Notice to host county instead of concurrence when person with DD waiver moves to another county. Effective August 1, 2012

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

17. 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

18. B. State Quality Council Duties • review issues involving risk C. Disability Terminology Audit • related to METO lawsuit settlement • DHS and MN Department of Health • Evaluate Reorganization • Review Multiple DHS roles • For long-term care, report on client risk and provider liability

19. 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 • Out-of-State Children’s Mental HealthResidential Treatment • Covered for Children who are Deaf or Hearing Impaired

20. C. Update of Statutes on Tele- Communication Equipment • for Persons who are Deaf, Deaf/Blind, Hearing Impaired D. New Felony Offense for Intentional Deprivation of a Vulnerable Adult

21. IX. DHS REFORM 2020 PROPOSAL A. 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, 2013

22. 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!!!!