[0:04] >> And operationally

[0:05] sustainable for qualified

[0:07] providers, serve individuals

[0:08] with the most complex

[0:10] disabilities, Wafa serving the

[0:12] safe, dignified community base

[0:16] choices.

[0:17] What I hope we get and I

[0:19] invited the house, our House

[0:23] counterpart. Is that how you

[0:24] say that, Peter?

[0:26] And it's about improving

[0:28] access, not creating disputes

[0:31] between the department, the

[0:33] lead agencies or providers.

[0:36] The school is collaboration

[0:37] amongst them as well as

[0:39] legislators, families and

[0:40] advocates to ensure that the

[0:42] individuals receiving those

[0:43] services remain at the center

[0:45] of the discussion. We talk all

[0:47] session long about continuity

[0:49] of care.

[0:50] And it's the focus on the

[0:51] individual disabilities to

[0:53] focus on the individual needing

[0:54] the services that we

[0:56] I have to remind us of this is

[0:58] what it's about.

[1:00] We have I lived on Gilman who

[1:03] was co-chair of the House

[1:05] committee is there. Peter

[1:07] Fisher is in here. My new is on

[1:09] his way.

[1:11] I

[1:14] Natalie Zone that she's there.

[1:18] Nice welcome. And as other

[1:21] members come on, I'll make sure

[1:22] introduce them as well. And I

[1:24] also wanted to mix things up a

[1:26] little bit.

[1:28] Last time we did a a hearing.

[1:31] I felt rushed at the end with

[1:33] him,

[1:34] the folks that receive the

[1:36] services. And so talking with

[1:38] the commissioner talking with

[1:40] the county's just I want to

[1:42] start

[1:44] this hearing hearing from

[1:46] people that are the ones

[1:49] are affected by what's

[1:50] happening right now within the

[1:51] system of change. So we haven't

[1:55] zoom

[1:57] folks in the end that are going

[1:59] to be doing it. Helen, you're

[2:01] going to be the first person

[2:02] live from Beaver Frontiers.

[2:04] Thank you for coming in to talk

[2:05] to that. And then Trisha,

[2:07] far tune and then we'll and

[2:09] with a video,

[2:12] Peter or Don, you guys want to

[2:15] say they have behalf of the

[2:16] guests of the House

[2:22] dons coming on. Can you top

[2:24] Don?

[2:26] >> Yes, care. All right.

[2:28] Welcome, thanks. All right.

[2:30] Thanks so much. Promise chair

[2:31] and again, thanks to that

[2:34] Minnesotans that are showing it

[2:35] today, too, share their

[2:36] experience. And I again, we are

[2:40] here open ears to hear what the

[2:42] solutions are going to be.

[2:44] Thank you for having us.

[2:46] >> Thank you, John. Peter

[2:47] Fisher,

[2:49] thank you. Chair Poppe and once

[2:50] again else like that. So thank

[2:52] you, everyone for taking the

[2:52] time to be here today. It is

[2:54] critical that we continue to

[2:55] remain focused on making sure

[2:56] that our people who need the

[2:58] services are continuing to get

[2:59] it and trying to fit. What is

[3:00] the best way to do that is we

[3:02] have our continuing evolving

[3:03] environment. Things that have

[3:04] worked in the past may not work

[3:06] now on things that did work in

[3:07] the past may not work. So these

[3:09] are the things that we want to

[3:09] get together and buy everyone

[3:11] coming together. Hopefully

[3:12] we'll find a better way to

[3:13] deliver services that meet

[3:14] everybody's needs. Thank you,

[3:16] Peter.

[3:18] I thought at least chair.

[3:22] >> Thank you, Mister Chair and

[3:24] I appreciate the content your

[3:26] content

[3:27] continuation.

[3:29] >> Of censoring the voices of

[3:31] the folks that are receiving

[3:33] the services, the folks that

[3:34] have been impacted the most.

[3:35] I think that

[3:38] the impact on them is is what

[3:40] has been the most devastating.

[3:42] And the stories that we've

[3:44] heard throughout the session

[3:47] has been heartbreaking at

[3:48] times. And so looking forward

[3:49] to hearing from then from that

[3:51] from the agency and seeing what

[3:53] we can do to ensure that

[3:55] continue to share as we've been

[3:56] talking about all that session.

[3:57] So thank you so much.

[3:59] >> Thank you for the reminder.

[4:00] I appreciate you. That is

[4:01] something that we do talk about

[4:03] Sanam Ahmed Senator mom is with

[4:05] this. You want to say some

[4:06] things and every on a waiting

[4:08] to do. You're good. Thank you.

[4:10] So with that, I'm Eric, the

[4:12] first folks that will be

[4:14] talking to us or Erica Larson,

[4:16] who's the chair of the Autism

[4:17] Treatment Association. If

[4:19] anything, it is in the state of

[4:20] Minnesota. Eric, you've kind of

[4:22] been the

[4:23] focal point. I remember years

[4:24] back. So it's nice to see you

[4:26] and zoom and then we'll go to

[4:28] Arlen Christensen and then

[4:31] Addison Carpenter and then

[4:33] sure, all bocken, so Mr.

[4:36] Dr Larson.

[4:38] >> Thank you. I assume you can

[4:40] hear me right now. We can.

[4:43] Yes. So chair Hoffman and

[4:45] members of the committee I'm

[4:48] presenting on the sequel to the

[4:52] revaluation challenges which

[4:54] Joel Bach and we'll cover it in

[4:56] detail.

[4:58] But at this point, pick up with

[5:01] ever since

[5:03] the December's sudden border

[5:05] from the U.S. EMS produce a

[5:07] corrective action plan for

[5:09] combating fraud. The families

[5:12] and providers of had to work

[5:13] diligently to restore the

[5:15] interrupted coverage and

[5:17] staffing that's been severely

[5:20] disrupted by a series of poorly

[5:23] implemented strategies to

[5:27] address the need for

[5:28] rehabilitation. After 8 months

[5:31] of work, we now still only have

[5:34] 2 thirds of the autism provider

[5:36] locations being re-evaluated

[5:39] for authorized coverage of

[5:41] medically necessary. The IDB I

[5:43] treatment.

[5:45] But once that hard work was

[5:47] completed, the families and

[5:49] providers have now been

[5:51] surprised and frustrated to

[5:53] discover that the state's

[5:55] authorization contractor picks

[5:57] Sentra

[5:59] was now failing to authorize

[6:01] the treatment of 1000 children,

[6:04] which is one-third of the

[6:06] entire group of children who

[6:08] receive tough road. The first

[6:10] service coverage of the eye,

[6:12] the eye in the state of

[6:13] Minnesota

[6:15] as a result of eccentrics

[6:16] failure. The providers estimate

[6:19] that they will have the income

[6:21] to continue providing services

[6:23] to the children for about 3

[6:25] months, leaving all of the

[6:27] families to worry that their

[6:29] treatment will collapse.

[6:31] All of this is despite the fact

[6:33] that the state's treatment

[6:35] manual calls for eccentric to

[6:37] process authorization request

[6:40] within 7 days because of the

[6:42] children in serious need for

[6:44] treatment.

[6:45] So it's frustrating that at

[6:47] least 800 of these children are

[6:50] only seeking authorization to

[6:52] continue the care that was

[6:54] already authorized in the prior

[6:56] 6 months.

[6:58] It's also frustrating that each

[7:00] child's licensed professional

[7:02] had spent many hours directly

[7:05] value each child and developing

[7:08] a highly individualized

[7:09] treatment plan that runs to 40

[7:12] pages detail.

[7:15] It's further frustrating,

[7:16] learned the eccentric is owned

[7:18] by the global investment for

[7:20] Carlisle. And yet they only

[7:22] spare the money to pay for to

[7:25] professionals to review and

[7:27] approve these detailed

[7:28] evaluations and treatment plans

[7:32] and to further compound the

[7:33] frustration. We learned that

[7:35] both the state of Maine and

[7:37] North Carolina when faced with

[7:39] similar eccentric delays, we're

[7:42] able to immediately clear up

[7:44] backlogs by authorizing media

[7:47] coverage for continuity of

[7:49] care.

[7:50] We ask that our children be

[7:52] able to immediately access the

[7:54] treatment as determined by

[7:56] licensed professionals of

[7:58] Minnesota who stand on their

[8:00] assessments and prescriptions

[8:02] as regulated by the state of

[8:04] Minnesota.

[8:05] These Minnesota professionals

[8:07] are highly regarded license

[8:10] behavior. Analysts love Long

[8:11] served the needy children.

[8:14] Adam Record represents 24 these

[8:18] autism treatment organizations

[8:20] serving more than 2,500

[8:23] children with autism across

[8:25] Minnesota.

[8:27] Our members provide medically

[8:29] necessary autism therapy that

[8:32] depends on regular predictable

[8:34] Medicaid reimbursement to

[8:36] remain operational.

[8:38] All of the services in question

[8:41] have already been delivered and

[8:43] the clinicians hate before the

[8:45] members submit their bills to

[8:47] the state of Minnesota.

[8:49] Yes, the ongoing interruption

[8:51] of authorization of coverage is

[8:54] not survivable for many autism

[8:56] providers, most of which are

[8:59] small businesses or nonprofit

[9:01] organizations.

[9:03] They operate on narrow margins

[9:05] and rely on the state of

[9:07] Minnesota to meet legal

[9:08] Medicaid of locations.

[9:11] When the providers will be

[9:13] forced to lay off staff and

[9:15] suspend services to the

[9:17] families, they will not be able

[9:19] to quickly resume. Once the

[9:21] determination is successfully

[9:23] appealed, it will only be then

[9:26] that they can renew their

[9:27] request for authorization,

[9:29] which is a lengthy process

[9:31] itself. An attempt to recruit

[9:34] the employees could not be

[9:35] fired.

[9:38] There is an immediate and

[9:40] appropriate solution that can

[9:42] be implemented this very day at

[9:45] no costs.

[9:46] We request that the DHS

[9:49] immediately authorize

[9:51] continuity of care to enable

[9:53] the providers to continue to

[9:55] serve the children that have

[9:57] already been authorized for

[9:59] coverage in prior intervals and

[10:02] continue to provide evidence of

[10:04] medical necessity for whatever

[10:06] time in the future, That IX

[10:08] center is able to regain its

[10:10] composure to meet its

[10:12] obligations.

[10:14] We also request that eccentric

[10:16] be required to meet its

[10:18] contractual obligations.

[10:20] And Ron, the estimable bankroll

[10:23] of Carlisle to do so.

[10:25] Minnesota can address fraud

[10:27] without dismantling these

[10:29] essential autism services.

[10:32] But this current failure will

[10:34] result in provider closures

[10:36] longer. Waitlists and children

[10:38] are losing services through no

[10:40] fault of their own.

[10:42] The I D D I for a fee for

[10:45] service program is a heavily

[10:47] regulated program that was

[10:49] developed with extensive public

[10:52] and professional input over the

[10:54] course of 30 years in

[10:55] Minnesota.

[10:57] The program was intentionally

[10:58] designed to include direct

[11:00] oversight, both within and

[11:03] external to the providers,

[11:05] as well as to purposefully

[11:07] include extensive parent

[11:09] participation.

[11:11] These features are designed to

[11:13] prevent waste, fraud and abuse.

[11:16] And the providers only seek to

[11:19] receive the authorization for

[11:21] payment for these highly

[11:23] regulated services in order to

[11:26] face this incredible backlog.

[11:28] That is frustrating all of us.

[11:32] Thank you for your attention.

[11:35] >> Thank you, doctor and images

[11:37] you may members there in your

[11:38] packet are.

[11:39] >> All the letters that we got

[11:41] as well from people. So.

[11:44] >> It's it there in the packet

[11:46] for you, Mr. Christensen,

[11:48] Arlen Christensen, Welcome to

[11:50] the committee.

[11:52] >> Thank you very much.

[11:54] Thank you for allowing me to

[11:55] speak today. Speaking on the

[11:57] topic,

[11:59] but my life and I are

[12:00] caregivers of her. 39 year-old

[12:02] son live with us.

[12:04] He is honored Cdcs under that

[12:06] the waiver

[12:08] in the past. I was an executive

[12:10] director for Arc. Can you

[12:12] county?

[12:13] I think it for over 35 years.

[12:16] My goal is to advocate for our

[12:18] son.

[12:19] True and correct assessment.

[12:23] There are many topics of

[12:24] concerns addressed today,

[12:26] but I want to touch on one

[12:27] issue that does not make sense

[12:30] in the assessment for the TD

[12:32] waiver.

[12:33] He's a variable call medical

[12:36] for 25 years. Our son is always

[12:38] ban or 3 on call next.

[12:42] Since the revision that has

[12:44] changed office visits only

[12:48] I'm not sure since our sons

[12:50] needs are hired with his

[12:53] declining health,

[12:55] the on call medical the did

[12:57] because of the need for I'm

[12:59] Cole train personnel to assist

[13:01] with the seizure disorder that

[13:03] he asks.

[13:05] The letter was given from our

[13:06] sons are all just stating he is

[13:09] a very high grass status injury

[13:13] or death.

[13:14] That's that the on call trained

[13:16] carriers,

[13:18] our son and had a history of

[13:20] status seizures.

[13:22] In the letter he stated that

[13:24] EMS its second year, the fur on

[13:28] call medical the is ASAP.

[13:32] Delaying medical treatment may

[13:34] have bad outcomes.

[13:37] Person, seizures are 8 to 12

[13:39] week.

[13:40] He is angry surgery. The NSA

[13:43] implant

[13:44] I every and I see you're met

[13:46] out there with limited success.

[13:49] Her seizure protocol is making

[13:51] sure he is safe

[13:53] time. The seizure and using our

[13:55] maintenance that we have for

[13:56] are being asked to try to stop

[13:59] the seizure if possible.

[14:01] After 2 minutes were advised to

[14:04] administer rescue medications

[14:06] that we have

[14:07] and then call EMS.

[14:09] The problem is that his

[14:10] seizures have not reach the 2

[14:13] minute to give him the rescue

[14:15] mats

[14:16] and that's per the criteria

[14:18] policy of the revision.

[14:20] The on call treats services are

[14:22] not be,

[14:24] but I think they could be any

[14:26] time.

[14:27] His seizure of a lasting 60 to

[14:29] 90 seconds

[14:31] that are all just stated.

[14:33] There are some will always have

[14:34] seizures

[14:35] because is the progression of

[14:37] the disease and our son's

[14:39] health condition

[14:41] in 2023. Her son was diagnosed

[14:44] with stage 3 colon cancer.

[14:47] 12 people treatments

[14:50] at the present. The oncology if

[14:51] he's watching some suspicious

[14:53] spots and slots.

[14:56] >> The assessor and appeal

[14:57] judge stated that since he did

[15:00] not have standing seizures in

[15:01] the past year and you cannot be

[15:04] given the code 3 on call

[15:05] medical.

[15:07] This is what is very troubling

[15:09] and wrong.

[15:11] Caregivers have to be ready in

[15:14] case a seizure call Kurz and

[15:16] fall of protocol at any time.

[15:20] Dhs is rewarding a medical

[15:23] crisis rather than prevention

[15:25] in this case.

[15:28] In closing, I will reiterate

[15:30] what was sent by my state

[15:32] representative and senator 20

[15:35] years ago in my office,

[15:37] Minnesota does short-term fix.

[15:40] But for long-term consequence,

[15:44] this is still true today.

[15:47] Please step back from any plan

[15:50] actions and think about the

[15:52] future costs instead of a

[15:55] short-term fix.

[15:57] Not to mention all of you here

[16:00] for our most vulnerable to

[16:01] this.

[16:03] Don't balance the budgets.

[16:04] Our DC

[16:06] thank you very much for many

[16:08] come and testify.

[16:09] >> Thank you. Our love. Good to

[16:10] see you. And thanks for your

[16:12] years of work.

[16:14] Addison Carpenter,

[16:15] welcome to the committee.

[16:19] >> The CEO and chairman and

[16:22] members of the committee,

[16:23] my name is Edison her.

[16:25] >> And I'm a Minnesotan who

[16:26] depends on disability and home

[16:28] and community-based services

[16:30] and putting it back for

[16:31] hospital care and other

[16:33] long-term services and supports

[16:34] creamy safely in my home and my

[16:36] community and my family.

[16:38] I am here specifically to speak

[16:40] about American University

[16:41] offers a Chanel ace because

[16:43] these are not simply

[16:44] administrative problems and

[16:46] others should delay honestly,

[16:47] almost human-like this year.

[16:49] I was just sitting in a proof

[16:51] for private gain. Your son

[16:52] services back in November of

[16:54] 2024, the services were not

[16:56] optional. They were determined

[16:57] necessary because I have

[16:59] significant medical needs

[17:00] require ongoing management

[17:02] within my home and the

[17:04] community. But they have CNN

[17:06] actually receiving most nursing

[17:08] services have been 2 very

[17:09] different stories. While the

[17:11] authorization process drags on

[17:13] it without the care I had been

[17:14] assessed as needed. There was

[17:16] no backup system of people

[17:17] working between agencies and

[17:19] government entities. I think we

[17:21] want without estate after

[17:23] meeting with us are happen.

[17:25] Are you during the 2026

[17:27] legislative session? I was

[17:28] hospitalized in the ICU with a

[17:29] severe infection. Just hours

[17:31] before disability advocacy day

[17:33] at the Capitol began, I was

[17:34] intubated a fellow disability

[17:36] advocate

[17:39] back in the 5 people I work

[17:41] alongside with Ncba then sell

[17:43] and elsewhere that I was

[17:44] frankly, my friends and family

[17:46] were called to say goodbye

[17:47] because I was not expected to

[17:48] survive that weekend. I went

[17:50] and the complete kidney and

[17:51] liver failure, developed acute

[17:53] respiratory distress and then

[17:54] and have regime islands.

[17:55] I was eventually traced.

[17:57] And when I finally woke up, I

[17:58] had to re-learn how to use my

[17:59] body, including rollover

[18:01] walking, talking and eating had

[18:03] I had the nursing services I

[18:04] desperately needed. There's a

[18:05] good chance that none of that

[18:07] would have happened.

[18:08] It can mean a difference.

[18:09] We can recognize a problem at

[18:11] home.

[18:12] I'm treating it after it

[18:14] becomes a crisis and sometimes

[18:15] it can mean the difference

[18:16] between life and death.

[18:17] Unfortunately, my story did not

[18:19] end what I survived and I am so

[18:20] without the nursing services it

[18:23] because I'm so that you're

[18:24] seeing it not truly get to live

[18:25] the life that home and

[18:26] community-based services are

[18:27] supposed to make possible.

[18:29] My life is still sent one back

[18:31] and forth the clinics,

[18:31] emergency departments and

[18:33] hospitals since June. That

[18:35] since I think that this charge

[18:36] from the long term acute care

[18:38] hospital, I had former hospital

[18:39] admissions, probably our visits

[18:41] and too many plant appointments

[18:42] account.

[18:43] I was nervous. We have the

[18:44] capital for the first time and

[18:45] Hans today to testify, but

[18:47] instead was stuck in the clinic

[18:49] in addition all morning and

[18:51] literally like just walked in

[18:52] the door

[18:53] being without using affects my

[18:54] ability to be a parent to work,

[18:56] to spend time with my family.

[18:57] For a statement, The Advocate

[18:59] for the things I'm passionate

[19:00] about and even make ordinary

[19:01] plant

[19:02] home and community-based

[19:03] services are supposed to help

[19:05] people with disabilities live

[19:06] in their communities rather

[19:07] than spend their lives and

[19:08] institutions and hospitals.

[19:10] A probe into service keeper

[19:12] does not accomplish that.

[19:13] If someone is is that the

[19:14] sitting there saying and then

[19:15] weeks, months or years for that

[19:17] authorization to actually

[19:18] result in care, this is the has

[19:20] not provided this service

[19:22] patients and families afford

[19:24] the consequences. We said

[19:25] number didn't see departments

[19:26] were hospitalized for families

[19:27] to come and pick up your rates.

[19:29] We've used pieces of our lives

[19:31] while different parts of the

[19:31] system to determine who is

[19:33] responsible.

[19:34] Hackers also observers

[19:36] consequences because emergency

[19:37] departments, hospital

[19:38] admissions, intensive care and

[19:40] repeated claims that are not

[19:42] substitutes for stable public

[19:43] nursing care

[19:45] and asking in establishing the

[19:47] full, established, meaningful

[19:49] accountability and timelines

[19:50] for nursing authorizations.

[19:52] There must be a point at which

[19:53] an authorization cannot simply

[19:54] remain pending. And there must

[19:56] be some point clearly

[19:57] responsible for resolving these

[19:58] delays.

[19:59] Please do not measure success

[20:00] by how many people have

[20:01] Anderson written for service

[20:03] plan or how many offered

[20:04] stations eventually get

[20:05] approved, measured by whether

[20:07] the person actually has unders

[20:08] walking through their door

[20:10] because an authorization is not

[20:11] access, approve mercy services

[20:13] without a nurse is not fair.

[20:15] I may have survived what

[20:16] happened

[20:17] while waiting for the charity

[20:18] that but I should not have to

[20:20] nearly die for an

[20:20] administrative process to

[20:21] demonstrate how important that

[20:23] care was and I should not.

[20:24] So we wait for the opportunity

[20:26] to live my life instead of

[20:27] continuing to manage the

[20:29] consequences of going without

[20:30] it. Thank you.

[20:32] >> Thank you, Madison and next,

[20:34] Joel Bach. Enjoy all if if use

[20:37] also sent a letter. So if you

[20:39] could, you know, give us the

[20:40] essence of the debt you're

[20:42] Larson mentioned, you would go

[20:43] into detail on something.

[20:44] I just, you know, give us the

[20:45] essence of really what

[20:47] that letters about and what

[20:49] what we're doing today. And

[20:50] then while you get up on the

[20:53] screen and Helen mater animator

[20:55] and Trisha Bridge, why don't

[20:57] you work your way to the table?

[20:58] Thank you.

[21:08] Yeah, I think you get a click

[21:09] that thingy that says turn your

[21:11] Mike a

[21:14] there you go. You're right.

[21:16] >> Good to see a show. Thank

[21:18] you.

[21:19] >> Mr. Chairman members, thank

[21:20] you for the opportunity to

[21:21] speak. To give the guard in.

[21:22] The test is providing

[21:23] validation. I'm Joe Buck and

[21:25] chief executive officer of

[21:27] Solutions. We are a community

[21:29] that the House Justin's serving

[21:31] life in a so one of our

[21:32] services is the idea of

[21:34] research to get through 6

[21:36] locations stretching from Saint

[21:38] Cloud to East Grand Forks

[21:40] Solutions is nationally

[21:42] accredited as a behavioral

[21:44] health center of excellence.

[21:46] Throughout the history

[21:47] validation process solutions

[21:49] has done everything DHS have

[21:51] asked of us. We had that every

[21:54] deadline communicated by DHS

[21:56] responded properly to requests

[21:58] for additional information.

[22:01] Yet today, only one of our 60 I

[22:04] ddi sites has been we've

[22:06] allocated and that approval

[22:08] approve within the last week.

[22:10] The consequences are

[22:11] significant

[22:13] because of locations, not

[22:14] re-evaluated. We are unable to

[22:16] Bill for services provided for

[22:17] nearly 50 staff members were

[22:20] unable to Kate to obtain

[22:22] service authorizations for 30

[22:24] on the book children with

[22:25] Autism.

[22:27] The state is grossly thing like

[22:29] with Pierre of claims for

[22:30] services provided to our

[22:32] children

[22:33] if Minnesota where it is and

[22:35] instead of a government it we

[22:37] face a massive downgrade of its

[22:39] credit rating, reputation and

[22:41] borrowing ability the amount

[22:43] just to our organization

[22:45] exceeds $800,000.

[22:49] This is not simply a ministry

[22:51] to the inconvenience. The

[22:52] services have already been

[22:54] delivered to Minnesota

[22:55] families. I qualified

[22:57] professionals. We pay salary

[22:58] benefits, rent operating

[23:00] expenses while waiting months

[23:02] for approval and payment.

[23:04] Just yesterday during an thsi

[23:07] to visit, the reviewer writes

[23:09] with information that was

[23:10] substantially in at it. For

[23:12] example, DHS records did not

[23:15] identify me to see has an

[23:18] authorized agent.

[23:20] Records show Solutions

[23:22] Solutions operating from a

[23:23] location that we close more

[23:25] than 3 years ago

[23:28] when I directed asked where the

[23:29] information came from, the

[23:30] reviewer explain that DHS staff

[23:33] use a different system than the

[23:34] one providers is to submit to

[23:36] maintain information. We're

[23:38] told the reviewer would need to

[23:40] check with minutes to verify

[23:42] what we have reported. This

[23:44] experience reflects what has

[23:45] occurred throughout the

[23:47] retaliation process. We have

[23:49] repeatedly been asked to submit

[23:51] the same information

[23:53] comes down. It contained within

[23:54] the DHS system does not appear

[23:57] to match the information

[23:58] providers Inter and maintain.

[24:01] We have 9.90, days without

[24:03] payment for many clients that

[24:05] affected locations, even with

[24:07] one site approved. We do not

[24:09] anticipate anticipate payments

[24:11] until October. Even if the

[24:13] remaining site for does it

[24:16] improve tomorrow, additional

[24:17] processing timelines make

[24:19] payment before November on

[24:21] likely we are facing

[24:22] extraordinary financial

[24:24] pressure pressure on providers

[24:26] and it will limit access to

[24:27] cheap care for children and

[24:29] families who need services.

[24:31] Since April, we have lost more

[24:33] than 30 staff members. If the

[24:35] goal is to reduce access to the

[24:37] gym, it high quality autism

[24:39] services in Minnesota. The

[24:41] current retaliation system is

[24:43] accomplishing exactly that.

[24:46] We needed just to prove the

[24:48] accuracy of provider data

[24:49] systems streamlined that we've

[24:51] allocation process, reduce

[24:53] duplicative documentation,

[24:55] request and establish

[24:56] safeguards to prevent providers

[24:59] so suffering significant

[25:00] financial harm. Well,

[25:02] applications are coming.

[25:04] I respectfully ask that this

[25:06] committee meeting established

[25:08] clear measurable benchmarks for

[25:10] us DHS to achieve in the next

[25:13] 30 to 60 days and to hold the

[25:15] leadership accountable for

[25:17] those benchmarks.

[25:18] Thank you for your time

[25:20] situation. Be happy to answer

[25:22] any questions.

[25:23] >> Thanks. So we're going to

[25:24] wait till the end and that

[25:25] stuff we know

[25:26] Senator, make Weight is joining

[25:28] this online as well. Good to

[25:30] see you, Aaron. Helen mater.

[25:34] I get that right? Yes, yes,

[25:37] Helen and Trisha Helen, Helen

[25:39] mater year, the firm Behavioral

[25:41] French airs. You came here

[25:44] to China. So welcome to the

[25:46] committee.

[25:47] >> Thank you, Sir. Thank you so

[25:48] much. Chair Hoffman and members

[25:50] of the committee for your TIME

[25:51] today. I'm Helen mater. I'm a

[25:54] board certified behavior

[25:55] analysts since 2004. I'm also

[25:58] the CEO and co-founder of

[26:00] Behavior, Frontiers and

[26:02] organization providing applied

[26:04] behavior, analysis services to

[26:06] individuals with autism.

[26:07] For 22 years,

[26:09] we've been serving children

[26:10] with autism before the IDB.

[26:12] I even became a covered benefit

[26:13] in Minnesota

[26:15] and we have been accredited

[26:16] like Juul as a behavioral

[26:18] health center of excellence for

[26:19] a decade.

[26:20] We are one of many for here,

[26:22] many experience, ethical and

[26:24] high-quality ei dbi providers

[26:27] who are serving Minnesota's

[26:28] autism community.

[26:30] And a couple of our sites are

[26:31] in the community served by

[26:33] Chair Rogers and can wrap it, I

[26:35] believe

[26:37] and our organization stands

[26:38] firmly with DHS against fraud,

[26:40] waste and abuse

[26:42] providers should be held

[26:43] accountable to standards that

[26:44] promote quality and safety.

[26:47] However, the delays caused by

[26:48] the current DHS validation and

[26:50] re validation process have had

[26:52] serious negative consequences

[26:54] for the children that we serve.

[26:56] Specifically service

[26:58] authorizations have been denied

[27:00] or postponed background checks

[27:02] stalled Q S P credentialing

[27:04] applications backlog

[27:06] and behavior technician

[27:07] approvals frozen.

[27:09] All of this has resulted in

[27:10] children not getting their

[27:11] services,

[27:13] for example, since May during

[27:15] our rehabilitation process.

[27:17] We have had 34 total staff

[27:18] leave 3 of which are Q S P's

[27:21] and we have not been able to

[27:23] replace them because of the

[27:24] pending approval process.

[27:26] And that has resulted in over

[27:27] 24 children not being able to

[27:29] start or continue their

[27:30] services with us.

[27:32] Additionally, providers have

[27:34] been waiting in some cases

[27:35] almost 2 years for their

[27:37] original site validation to be

[27:39] processed. These original

[27:41] allegations need to be

[27:42] processed and should not be

[27:44] overlooked. While the re

[27:45] validation czar being

[27:46] processed.

[27:48] I urge the committee and each s

[27:49] to improve the validation and

[27:51] the validation process to be

[27:52] efficient, consistent and

[27:55] clinically relevant while still

[27:57] focused on requirements that

[27:58] maintain high quality standards

[28:00] of care.

[28:01] Dhs could take several

[28:03] practical steps to reduce

[28:04] unnecessary delays.

[28:06] Some examples include hiring

[28:08] and training additional staff

[28:10] to process of allegations

[28:12] rebound shuns credentialing

[28:14] background checks and

[28:15] technician approvals.

[28:17] Assigning a point person for

[28:19] providers who can set forth

[28:21] clear process is for

[28:22] communication status, updates

[28:24] and escalation pathways

[28:26] and continuing to backdate

[28:28] approvals to the date of

[28:29] application so that children to

[28:31] not lose access to care due to

[28:32] administrative delays.

[28:35] We understand the importance of

[28:36] ensuring that there's a proper

[28:38] vetting process in place.

[28:40] But the unnecessary paperwork

[28:42] and red tape has only delayed

[28:43] the process and delayed

[28:45] critical services to our most

[28:46] vulnerable populations.

[28:48] Thank you so much for allowing

[28:49] me to bring this to your

[28:50] attention today.

[28:51] >> Thank you. And I got to at

[28:54] C*** Rapids to get a place in

[28:55] clear ethics as well. Yes,

[28:58] Tricia brings by welcome to the

[29:02] committee and then we get far

[29:05] tune. Looks like the the

[29:06] Patricia era, Richard Anthony

[29:08] and then we get will end with

[29:10] the Mary Turner is

[29:13] video. So this bridge by

[29:15] welcome the committee.

[29:17] >> Thank you, chair half of the

[29:18] members of the committee.

[29:19] And I want to recognize the

[29:22] efforts to put that people

[29:24] first today and allow us to

[29:26] speak that action. And for

[29:29] anyone who wants to know how to

[29:30] start

[29:32] doing, you know, partnership

[29:34] and collaborating with

[29:35] families, people, disabilities.

[29:37] That's what Senator Hofmann

[29:38] just it today is put us first

[29:40] to thank you for that.

[29:42] And as you most most of you

[29:44] know, I'm Charlie's mom and I

[29:47] am a disability advocate.

[29:48] I've been doing this for a very

[29:51] long time now.

[29:53] I want to share 3 examples of

[29:55] what happens when our Human

[29:57] Service system fails to provide

[29:59] accountability and continuity

[30:01] of care.

[30:02] Let's start with our story with

[30:03] Charlie. In November of 2025,

[30:06] I learned that Charlie

[30:08] qualified for a 30% waiver

[30:11] budget enhancement.

[30:13] That would be because of his

[30:14] high level of need. I

[30:16] immediately asked his

[30:17] contracted case manager to

[30:19] submit that

[30:21] for months I emailed and I call

[30:24] the case manager her supervisor

[30:26] and eventually the Directorate

[30:29] of the contracted agency.

[30:30] I kept hearing some version of

[30:33] we are looking into it

[30:36] after nearly 9 months and only

[30:38] after I demand that they cease

[30:39] simply resubmit the request it

[30:42] was finally submitted in July.

[30:46] I got an e-mail back with 15

[30:48] minutes later. It went through.

[30:50] It just had never been

[30:51] submitted.

[30:52] But as of today, we're still

[30:54] waiting for DHS to clarify when

[30:56] it can be implemented

[30:59] those months matter. I need

[31:01] those funds to provide care for

[31:02] Charlie over the summer.

[31:04] And when Charlie does not have

[31:05] care, I don't work.

[31:08] Second, there's Brian. Brian

[31:09] uses a wheelchair after having

[31:11] his right leg amputated and has

[31:13] a spinal injury. He was relying

[31:15] on housing stabilization

[31:17] services to move from

[31:18] homelessness into housing,

[31:20] his services and it has housing

[31:22] felt through. And police

[31:24] eventually encountered been

[31:26] sleeping outside

[31:28] near a Brooklyn, a park in

[31:30] Brooklyn Park which happens to

[31:31] be in my backyard.

[31:34] The last I knew he was wheeling

[31:36] himself down as they navigate

[31:37] with everything he owned

[31:39] hanging in the target bags from

[31:40] the back of his wheelchair.

[31:42] That is what a failure of our

[31:44] human services system can look

[31:46] like.

[31:47] Then there's a fun, a 19

[31:49] year-old with autism and

[31:50] developmental disabilities.

[31:52] His family has spent more than

[31:53] a year trying to get him

[31:55] medical assistance and waiver

[31:56] services. He has had 4

[32:00] contracted case managers in one

[32:02] year

[32:04] after reviewing a years worth

[32:05] of emails. I discovered that

[32:07] his newest case manager

[32:09] appeared this was the problem.

[32:11] She kept telling them to get a

[32:13] medical assessment. So mom went

[32:15] all the doctors got

[32:16] assessments, sent them on

[32:20] the case manager didn't know

[32:22] the difference between

[32:24] obtain a medical up sent

[32:25] assessment and apply for

[32:27] medical assistance.

[32:32] Even still does not have

[32:34] service S

[32:36] these stories illustrate

[32:37] another problem. We don't talk

[32:38] nearly enough about continuity

[32:40] of care. When case managers

[32:42] change providers disappear,

[32:43] authorizations are delayed or

[32:45] we validate Jean interrupt

[32:47] services. People don't simply

[32:49] experience an administrative

[32:51] inconvenience. They lose care

[32:54] and families become the count

[32:56] continuity of care system.

[32:58] We keep the records. We

[33:00] remember what was approved.

[33:01] We explain the history to the

[33:03] next case manager. We notice

[33:05] when paperwork disappears, we

[33:07] make the calls we fix what

[33:09] falls through the cracks.

[33:12] These are not isolated

[33:13] paperwork problems. When the

[33:15] same failures happened

[33:16] repeatedly across programs,

[33:18] providers, counties and family

[33:20] families, we have a systems

[33:21] problem.

[33:23] And when the responsibility

[33:25] continually moves between the

[33:27] HS counties, contractors of

[33:29] providers, we have an

[33:30] accountability problem

[33:32] as a member of the Waiver

[33:33] Imagine Advisory Task Force.

[33:35] I am deeply concerned that we

[33:38] are preparing to build a brand

[33:39] new waiver system on top of

[33:41] processes that are already

[33:43] already feeling the people,

[33:46] please repeal waiver, imagine

[33:48] and work with people with

[33:49] disabilities and families to

[33:51] build something better.

[33:52] Minnesotans with disabilities.

[33:54] Don't need another system

[33:55] designed around them. They need

[33:57] a system designed with them and

[33:59] system accountable to them.

[34:01] Thank you,

[34:03] Representative Fisher.

[34:05] >> Thank you. Chair Poppe in

[34:06] this Press Bay. Thank you.

[34:08] Missed this spring was told

[34:09] that I should profile and say

[34:11] thank you a time to be here

[34:12] today and highlight the issues

[34:14] wrong contract case management

[34:16] die. I understand that contract

[34:19] case mantra is usually done by

[34:20] the counties of size first 500,

[34:22] which county where you was the

[34:24] contract case management

[34:25] through.

[34:26] >> Ours is through Hennepin

[34:28] County. And what I understand

[34:30] is rather than having a case

[34:33] manager at the county,

[34:36] they contract like subcontract

[34:39] with an agency

[34:41] and these agencies are not

[34:43] supporting their staff very

[34:45] well. And I don't think they're

[34:47] getting much support from the

[34:48] county or DHS either because

[34:50] this we're looking into it is

[34:52] usually dependent on someone

[34:54] getting back to that.

[34:56] >> And Mister chair, if I could

[34:58] and if thank you, thank you,

[34:59] Mrs Brain. One of the questions

[35:02] I have is do what you went

[35:04] through. The county kind of got

[35:05] a county contract, a case

[35:07] manager to the county provided

[35:08] any information. Some things

[35:09] aren't right. You have a

[35:10] contact in the county are a way

[35:12] to appeal to the county kind of

[35:13] process that will help protect

[35:15] your right.

[35:16] It's because my.

[35:18] >> Especially in at thank you

[35:21] Chair Hofmann and I especially

[35:23] in Hennepin County

[35:25] what we get

[35:27] a letter that explains we're

[35:29] going to his contract case

[35:30] management. And if we have

[35:32] questions, we can call the H s

[35:35] team

[35:36] and it's a phone number that

[35:38] has several problems

[35:41] often doesn't work very well.

[35:43] You rarely get to speak to a

[35:44] person.

[35:47] >> Theres an official. Thank

[35:48] you. I I appreciate you sharing

[35:50] the information that you went

[35:52] through. I do know that this is

[35:53] an issue that we been trying to

[35:55] address. We had some

[35:55] legislation last session to

[35:58] take very close look and

[36:00] establish standards what's

[36:01] going on. But you're

[36:02] highlighting is a problem that

[36:05] is not only happening at a

[36:06] county us into the Ramsey

[36:07] County. I appreciate your

[36:08] coming forward. Let us know

[36:09] what you're seeing. And I do

[36:10] see that we're going to have

[36:11] the opportunity to talk about

[36:12] the slow March and we will.

[36:14] >> Thank you, Mister. Thank

[36:15] you, Representative. Thank you

[36:16] to we can make room for for to

[36:18] Wile E and Patricia Richard and

[36:21] then very Turner. So one of the

[36:22] things that Representative

[36:23] Fisher, this brings up

[36:25] specifically when when Tricia

[36:27] was talking about, I believe

[36:28] Bryan was the individual.

[36:31] There was an article that was

[36:32] done Jayla go once again did a

[36:36] a story about an individual

[36:38] that she lost her services

[36:41] because of the system that

[36:42] broke down.

[36:43] She the woman is a vulnerable

[36:45] adult who happens to have a

[36:46] baby she homeless. She's couch

[36:49] jumping the whole time. This

[36:50] last year and a half we've been

[36:52] talking. It was always about

[36:53] continuity of care. Continuity

[36:55] should who's going to assure

[36:57] that this person is receiving

[36:58] services? It broke my heart to

[37:00] see that that individual was

[37:01] part of that housing

[37:02] stabilization program. No fault

[37:05] of her own.

[37:07] It's now couch jumping with a

[37:09] little baby.

[37:10] And so we need to start to

[37:11] raise those points that we know

[37:13] exist. But what do we do about

[37:15] that? Right? But it so thank

[37:17] you with that. And that's what

[37:18] Lee welcome and who do you have

[37:21] with you?

[37:22] >> Could it have to do it?

[37:24] I kept my colleague Ryan.

[37:25] We lose 10 or so tickets are

[37:27] clients of the Senate.

[37:29] >> Thank you. Welcome to nurses

[37:31] at the table at the same time,

[37:34] public health. Sorry and I get

[37:36] there on so welcome. And if you

[37:38] could,

[37:39] let us know what's going on.

[37:41] And then you have Mary Turner

[37:43] who is also a nurse. She's

[37:45] going to be on the 2 after this

[37:47] Ole Miss. Well, go ahead.

[37:49] >> Good afternoon, chair Hopman

[37:51] member of the community.

[37:53] My name is for us to where the

[37:55] owner of Peace of Mind Care

[37:57] Center

[37:58] and that is where I provide to

[38:00] 45 dever. Also days per service

[38:02] where I could climb student

[38:04] today.

[38:05] Thank you for hearing from

[38:06] providers is the assist

[38:08] discussions. We validation of

[38:09] service agreement changes

[38:12] piece of my service. People who

[38:14] many programs are not equipped

[38:16] to serve, to serve support.

[38:19] Some are nonverbal. Kind of put

[38:21] pain on the occasion needs

[38:24] others have significant

[38:26] physical disabilities, mental

[38:28] health conditions. Mobility

[38:30] needs

[38:31] this can and will concerns

[38:33] they require are in care most

[38:36] the time exemption to train

[38:39] staff for professional care,

[38:41] behavioral support and

[38:43] emergencies.

[38:44] I'm very proud of my focus is

[38:47] that of created I employees may

[38:49] discover possible

[38:51] approximately 90% of our

[38:53] immigrant women, 70% are women

[38:56] of color. They bring language

[38:59] to cultural understanding and

[39:01] patients and trusted relation

[39:04] with people who have complex

[39:06] needs as many of you know,

[39:08] where it came from and some out

[39:09] American on the problem.

[39:11] We don't have institutions to

[39:13] put our people with

[39:14] disabilities so we take care no

[39:16] matter what and keep them in

[39:17] the community.

[39:19] These individuals have work.

[39:21] They have our staff to have

[39:24] difficulty with compact.

[39:26] They do have difficulty with

[39:28] compassion and professional

[39:30] professionalism. They support

[39:32] too

[39:34] people who are really not for

[39:35] one very fiscal most of the

[39:37] time violence.

[39:38] One example, you saw the

[39:40] pictures I give you. I cannot

[39:42] provide that in public. 2 of

[39:44] the crimes that I want to talk

[39:46] up. I had a severe that the

[39:48] rush, I cannot show the public

[39:50] what the pictures look like

[39:52] that client, a young gentleman

[39:55] needed acute support foreigners

[39:58] because of his severe diaper

[40:00] Russian burnout that he had

[40:03] when we tried to charge nurse

[40:04] and as partners we were told it

[40:06] was not a meat Royce. Therefore

[40:08] we cannot support you and

[40:10] provide on the service was

[40:11] denied.

[40:14] Yeah. Also decision that's in

[40:15] effect on the level of any we

[40:17] support. So the nurse was

[40:18] refused. Another cried a little

[40:20] bit of some severe. You also

[40:22] saw

[40:23] she was had a severe abuse and

[40:26] beaten up, but she's acting and

[40:28] nonverbal. Her parents today,

[40:31] Putin com moms have initial do

[40:32] surgery and that is taking care

[40:34] of our time. Patty, what I want

[40:36] to be here today, they send

[40:37] their apologies. But I mean,

[40:39] you have for them. I'm not just

[40:40] a business owner. I think it as

[40:42] well.

[40:44] Also that individual we weren't

[40:45] paid their sense of giving did

[40:47] not come soon as of route.

[40:49] 22 6, I keep sued by step and I

[40:52] pay them to bank loans and 2

[40:54] other support needs

[40:56] peace of mind to continue

[40:57] serving these clients without

[40:59] pay. I've to probe the kind of

[41:01] continue to support. The kind

[41:03] to lose is they're talking to

[41:05] the health and safety needs to

[41:07] not optional for staff and

[41:08] preferences. Minnesota waiver

[41:11] wait long to recognize

[41:13] individuals, staff any direct

[41:16] nurse hours and establish

[41:18] euros. The S P is up, sir,

[41:21] that coming some following the

[41:23] communications. I was told when

[41:25] I so we need to knows who Luke

[41:27] Raley Michael. We'll talk about

[41:29] psychiatric medications, people

[41:31] who are on chemotherapy that

[41:33] needs support. I was told we'll

[41:35] train. You do see some of them

[41:37] administer the medication,

[41:38] which of course I would not do

[41:40] that

[41:41] without proper support, pain

[41:43] and medication problems.

[41:45] It does sometimes come become

[41:46] crisis. You didn't its creation

[41:49] injuries, hospitalization this

[41:52] chart and his 2 shutout

[41:53] placement disabilities. So it

[41:56] does not cause violence.

[41:58] Risk increases when needed care

[42:00] is missing.

[42:01] Do you support services exist

[42:03] to keep people engaged safe,

[42:05] including in the community to

[42:07] live?

[42:08] I respect the hospital

[42:11] to reserve to issues with my

[42:13] other cars with just voted,

[42:15] talked about many issues.

[42:17] So save the time, exception

[42:19] rates. Very important to

[42:22] support people. It needs nurse

[42:25] units, nerves providing

[42:26] services are very, very

[42:28] critical. And I hope that these

[42:31] needs are met. I would give my

[42:33] friend and colleague to speak a

[42:34] few minutes. Thank you.

[42:36] >> Thank you so much. And

[42:37] that's the nursing peace.

[42:40] And I did see the it's the

[42:43] parents shared the photos that

[42:47] again, it's just as

[42:49] it's us

[42:52] hurting has seen that photo as

[42:55] the person who is now homeless

[42:57] because of

[42:58] somethings. Something just

[43:00] wasn't working right now.

[43:01] And and the who who needs to

[43:04] make sure that something is

[43:05] happening, maybe we'll get an

[43:07] answer later on. It looks like

[43:10] a rally. A U.S.

[43:12] you are a nurse. Yes, I am.

[43:14] Welcome to the committee.

[43:15] Thank you so much. Good

[43:17] afternoon and community

[43:18] members.

[43:19] >> My name is family and I'm

[43:21] right to 7 access peace of mind

[43:24] center.

[43:25] >> I wanted just to give you a

[43:27] small picture of all of these

[43:29] services and our client, us

[43:32] news

[43:38] and I my heroes to us here

[43:41] today to speak,

[43:42] seeking that data to the

[43:44] effect. This is the safety,

[43:46] the committee quality of care

[43:49] that we provide for our clients

[43:52] that need for Medicaid, nursing

[43:54] staffing at the U.S.

[43:57] off. My sent a Manila folder

[43:59] kind to stuff company. Expedia

[44:02] and emotional needs and some

[44:04] are able to verbalize that what

[44:08] they experience on what they

[44:10] need

[44:12] the behavior and maybe only

[44:15] wait that the committee key

[44:17] because

[44:18] they can be on shows like 10

[44:20] well of uncomfortable of

[44:25] in distress.

[44:27] That is the way they

[44:28] communicate and tell us what

[44:30] they experienced. It is

[44:33] experiences and patient fix it

[44:37] and we shun and that's us.

[44:39] And that host episodes of

[44:41] violence and dispensing

[44:43] behavior.

[44:45] This situation is contained to

[44:47] bank. We can I think wide-scale

[44:49] nursing assistant assessment

[44:51] coast upset of patients

[44:53] candy in the nation to do next

[44:56] in a special dances. And the

[44:59] explanation

[45:01] next, the staff must be

[45:02] constantly says changes in

[45:05] behavior. Nice but to shoot 2

[45:08] cubs.

[45:10] The tenement, what in the

[45:12] nation is a puppy

[45:15] money to the client service

[45:17] Ponce and communicate different

[45:19] chains

[45:20] to the into DC discipline.

[45:23] Any team

[45:24] without coup with information

[45:26] can allow a patient to escalate

[45:29] into a completion of a violent

[45:32] increase in the risk of

[45:34] entrapment to the client, to

[45:36] our other client. This also

[45:38] staff

[45:39] and it could mess and stopping

[45:41] a Lowe's asked to intervene

[45:43] every the fun of the situation

[45:46] becomes

[45:47] us to be in crisis gauges as

[45:50] ability ability to recognize

[45:53] warning signs of it to be 12

[45:56] last part, the escalate

[45:59] behavior to safety protected

[46:01] the thinking that of our

[46:02] clients.

[46:04] Some nurses makes us from 7

[46:06] that it's not only the response

[46:08] when the crisis have been.

[46:09] It's my responsibility is to

[46:12] prevent crisis what ever this

[46:14] possible. I want to kind to the

[46:17] center. Can that safe timely?

[46:21] We'll come back to me. And the

[46:23] defeat was I strongly believe

[46:27] that ethic and their son,

[46:28] the staffing is and central.

[46:31] It is not not right. And it's

[46:33] not an option

[46:35] to make think the safety and

[46:37] quality of our clients. I spoke

[46:41] to me asking the community to

[46:42] recognize the combo sits at the

[46:45] of our client us needs but only

[46:48] messes to provide the safe and

[46:50] effective cap.

[46:52] So I wonder why this is so

[46:55] NASA's train to respond.

[46:58] Sonar of entities collation

[47:01] that kind of stuff, provide

[47:04] better care and nes U.S. and

[47:06] its investment in safety and

[47:09] dignity and quality of care.

[47:11] Thank you so much.

[47:13] Thank you, too.

[47:14] >> And with that will end with

[47:17] the

[47:18] Mary Turner.

[47:24] >> Back in in my name is Mary

[47:26] Turner.

[47:27] >> And I would love to bend

[47:29] there today, but I had a arts

[47:31] telling where my brother was a

[47:34] veteran is being very today.

[47:36] Anyway, I wear many hats, one

[47:39] national nurses, United

[47:40] president and the region at the

[47:42] university and chair of the

[47:44] board of this year. However,

[47:46] today I'm here in the most

[47:47] important role and that is as a

[47:49] registered nurse in the great

[47:51] state of Minnesota.

[47:53] >> Minnesota has one of the

[47:54] best nurse practice acts in the

[47:56] country. And under that

[47:58] document, all registered nurses

[48:00] in Minnesota.

[48:01] >> We have the right and duty

[48:03] to assess delegate and a value.

[48:07] >> In our mission to care for

[48:08] the health of all, Minnesota,

[48:09] us

[48:10] our main focus no matter where

[48:12] we practice our profession is

[48:14] patients safety and prevents

[48:18] nowhere. Is this more or in our

[48:21] in our establishments that are

[48:23] designed to help her patients

[48:25] stay out of corporate

[48:26] facilities and in the

[48:28] community.

[48:30] >> I refer to our day care and

[48:32] our group homes

[48:34] to fail to keep our clients in

[48:36] the community where they can

[48:38] have happier fuller lives.

[48:40] It is imperative that they have

[48:41] supervision

[48:43] over there. Help from a

[48:45] registered nurse whose job

[48:48] under the terms packets act

[48:49] remember is to once again

[48:51] assess delegate and a value

[48:53] that

[48:55] the registered nurses trained

[48:56] to look at the whole picture

[48:58] from diagnosis and medication

[49:01] lists.

[49:01] >> Disabilities and not go

[49:03] health issues. Most

[49:05] importantly.

[49:06] >> We catch issues before they

[49:08] become acute and

[49:09] hospitalization is required.

[49:12] Which brings me to the point of

[49:14] cost

[49:15] basically the cost of a few

[49:17] hours a week for a services of

[49:19] a registered nurse. It is

[49:21] nothing compared to the cost of

[49:23] an ice. You stay in the

[49:25] hospital.

[49:26] Did you know that the average

[49:28] stay just for the bad in ICU

[49:31] right now in the Twin Cities is

[49:33] $12,000 to gay and that is just

[49:36] for the bat.

[49:38] So this is a no-brainer, folks.

[49:40] >> Not only do we get to keep

[49:41] our people in the community.

[49:44] >> But we also do a much lower

[49:47] cost to the taxpayer. So I urge

[49:50] you I urge you to allow

[49:53] registered nurses to be able to

[49:55] do the job that they are that

[49:57] they are educated to do.

[49:58] And that is to look out for our

[50:00] people in the community so they

[50:02] can stay in the community.

[50:04] Thank you.

[50:07] >> So with that members, let's

[50:11] move on. Thank you, everybody

[50:13] for letting me to this. First.

[50:16] I again, the last time we had a

[50:18] hearing, I just felt rushed at

[50:20] the end. And so I think it's

[50:24] good for us to understand

[50:25] what's happening, the impact of

[50:27] what is happening to the people

[50:29] that

[50:32] any comments from members

[50:33] before we go to the

[50:34] commissioner.

[50:38] I don't see anybody. Enlai were

[50:41] good. John Connolly and Chris

[50:44] Teague wrong.

[50:48] Thank you for allowing me to

[50:50] the

[50:56] to where it is flexible.

[50:59] Did you did that? Give you time

[51:00] to increase to to get your

[51:02] thing too

[51:04] set up to the system? Does it

[51:06] will see TBD.

[51:09] So before we do that,

[51:11] Commissioner Connelly hearing

[51:13] from people before

[51:15] the key to that, really

[51:17] that move me and it did proud

[51:20] of, you know, the conversation

[51:22] in my mind about, you know,

[51:24] what I've seen happen to

[51:25] individuals right in that the

[51:27] amount of phone calls that just

[51:30] my office alone, our staff are

[51:33] doing. They're doing casework.

[51:36] As I look down at other

[51:38] offices. I don't see anybody

[51:40] else doing casework rate.

[51:41] And so, but that's because

[51:43] there are so many people

[51:44] relying on us to get it right.

[51:46] And so, you know,

[51:49] that's why we've had these

[51:50] conversations on going to get

[51:51] it right. So

[51:54] thank you for being here and

[51:55] thank you for giving us is an

[51:57] update of where you're at and

[52:00] and really focused. My essence

[52:02] of ways is this continuity of

[52:04] care. So thank you,

[52:06] commissioner, for being here.

[52:07] Thank you as crown for being

[52:09] here

[52:10] 2 years.

[52:12] >> Thank you, Chair Hoffman and

[52:13] thank you to everyone who

[52:15] testified already today,

[52:17] community members, providers,

[52:18] nurses, those who are doing the

[52:21] essential work in the

[52:22] community. I want to start a

[52:24] little off script and just say,

[52:25] I think building upon what the

[52:27] chair just said,

[52:29] DHS is it in a very difficult

[52:31] moment as we've heard that you

[52:33] are so please know that we

[52:35] heard you

[52:36] and that

[52:38] our mission and this is on my

[52:41] my badge right now is to help

[52:43] people live their healthiest,

[52:44] enforce lives and community.

[52:46] And I heard that from you all

[52:47] today. We are here. We exist to

[52:49] do that in partnership with

[52:51] you. And we've heard the

[52:52] feedback about the difficulties

[52:54] and the challenges and know

[52:56] that

[52:58] we serve the community and in

[53:02] support of that mission and

[53:03] that we never seek to harm

[53:06] people in our programs or

[53:08] legitimate providers.

[53:09] And I understand those words

[53:13] are words at this point.

[53:14] We'll have a lot more to say

[53:15] here in the presentation about

[53:17] what we are doing with respect

[53:18] to the different program,

[53:20] integrity and interventions

[53:23] that we are implementing and

[53:26] certainly directed to implement

[53:27] and just know that this has

[53:30] been a very difficult year and

[53:32] a half to 2 years at this

[53:33] point, particularly since the

[53:36] engagement of the federal

[53:37] government at the end of last

[53:38] year in December. And we have

[53:40] undertaken a number of

[53:41] processes in ways that

[53:43] we would not have chosen

[53:45] processes that were broader and

[53:47] more expensive than any

[53:48] Medicaid program has ever

[53:49] undertaken in terms of provider

[53:51] a validation to, of course,

[53:53] respond to to fraud and program

[53:56] integrity, concerns that are

[53:58] real. But at the same time

[54:01] being under extraordinary

[54:02] pressure to do this in a way

[54:03] that it's been never been done

[54:05] before. So with that said, we

[54:08] appeared here earlier this

[54:10] summer. We were appearing, of

[54:11] course, during session and are

[54:13] appearing again today to

[54:15] receive the feedback to provide

[54:16] updates. We will continue to be

[54:18] here with you all and the

[54:19] community too, to to engage

[54:22] again except the feedback and

[54:24] we will enter to flee adjust

[54:25] how we are doing this work in

[54:27] the ways that we can

[54:29] recognizing that we are under

[54:31] some requirements and direction

[54:33] from the federal government.

[54:34] That is extraordinary. So just

[54:37] know that we are we are

[54:38] grappling with those 2

[54:39] imperatives. It is always true

[54:41] that our imperative this to

[54:42] provide continuity of and

[54:44] access to care that people

[54:45] need, but also ensure that we

[54:47] have the highest possible

[54:48] program, integrity as we are

[54:50] accountable to the people in

[54:51] our programs, but also the

[54:52] taxpayers of the state of

[54:54] Minnesota.

[54:55] That said on the slide here

[54:58] that we start with this Israel,

[54:59] the statement of the broad

[55:00] impact of the Medicaid program,

[55:03] 20.9 billion dollars in 2024,

[55:06] roughly one-third of the state

[55:08] budget overall, 40,000

[55:09] providers involved in the

[55:11] Medicaid program. Overall,

[55:12] that's organizations that

[55:13] individuals over 300,000

[55:15] individual providers and 1.2

[55:17] million program members.

[55:19] So the Medicaid program really

[55:21] serves as the foundation of the

[55:23] healthcare system in Minnesota.

[55:26] And we know that it's essential

[55:27] for people, with disabilities,

[55:28] for children, for families,

[55:30] for older adults, for those

[55:32] during pregnancy at the

[55:34] beginning at the end of life,

[55:35] all of the above. And if you

[55:36] aren't in Medicaid right now at

[55:39] some point in your life,

[55:40] you may be and chances are

[55:41] great that, you know, someone

[55:42] who is this is really in a

[55:44] central program for so many.

[55:45] It's a lifeline for Minnesota,

[55:47] both for the individuals,

[55:48] but also for our health care

[55:50] delivery system. And as we root

[55:51] out fraud, waste and abuse, we

[55:53] know that we have an imperative

[55:55] to maintain continuity of care

[55:57] and access to service.

[56:00] That said, as I mentioned in my

[56:01] opening comments, we are under

[56:03] some extraordinary and in fact

[56:05] unprecedented circumstances.

[56:07] I know we are all tired of that

[56:08] word in Minnesota,

[56:09] unprecedented. But

[56:10] unfortunately, that is where we

[56:11] are.

[56:12] We are still dealing with

[56:13] potentially 2 billion dollars

[56:14] in cuts and another 550 million

[56:17] dollars and freezes. And of

[56:19] course, the 2 billion dollars

[56:20] in potential cuts is is what it

[56:22] is this associated with are

[56:25] tied to this review allegation

[56:26] effort that has been

[56:27] extraordinary faster and more

[56:29] expensive or fix expansive

[56:31] rather than any state has ever

[56:33] undertaken. And we should note

[56:35] that this 550 million dollars

[56:37] that is frozen that could

[56:39] eventually be clawed back.

[56:41] And the federal government has

[56:42] indicated the Centers for

[56:43] Medicare, Medicaid Services

[56:44] have indicated that it is

[56:46] possible they could claw back a

[56:47] number that is greater than the

[56:49] 550 million dollars that has

[56:51] been frozen. So just to

[56:52] underscore the great threat and

[56:55] the risk that we are grappling

[56:56] with in the reason for doing

[56:59] some of the work that we've

[56:59] been doing.

[57:02] So with respect to Minnesota,

[57:03] to validate all a review,

[57:05] some of what we talked about

[57:06] earlier in the summer in this

[57:07] forum, the federal Centers for

[57:09] Medicare and Medicaid Services

[57:11] required this effort to be done

[57:13] by May 31st as a part of our

[57:15] corrective action plan. And

[57:16] they directed us to undertake

[57:18] both in in a letter from the

[57:20] Administrator, Dr Oz in

[57:22] December and again in January,

[57:25] under great pressure to do it

[57:26] as quickly as we could. And

[57:27] with great public criticism for

[57:29] the time that we that we we

[57:31] requested to complete this

[57:33] effort. And again, this this

[57:35] 2 billion dollars that's a

[57:36] threat associated with this

[57:38] effort. And the broader

[57:39] corrective action plan is about

[57:40] one 3rd of annual disability

[57:41] waiver spending. I just want to

[57:43] know that the bottom of this

[57:44] slide, other states have now

[57:45] been given 2 years to do what

[57:47] we have done in 5 months,

[57:49] though, we continue to process

[57:50] the appeals as a result of that

[57:52] effort. And again, I'll just

[57:55] say that we've heard the

[57:57] feedback it or did lead

[57:58] throughout this process through

[57:59] a number of forums,

[58:01] communications engagement with

[58:02] providers and of a number of

[58:03] different ways and will

[58:05] continue to to revise and to

[58:08] adjust the way that we are

[58:09] doing the work to be responsive

[58:11] to what's being experienced in

[58:12] the community,

[58:15] moving on to what we've done to

[58:17] meet this moment. So given the

[58:19] extraordinary circumstances

[58:20] presented to us in the

[58:21] direction presented by the

[58:22] federal government, we set up

[58:24] an incident command within the

[58:26] department, bringing in 100

[58:27] staff from across the state

[58:29] enterprise and other

[58:30] departments to help us,

[58:31] particularly with the site.

[58:32] Visit portion of this work made

[58:35] nearly 10,000 calls to

[58:36] providers, including 4,000

[58:39] through the provider, a call

[58:39] center and of course, doing

[58:41] weekly, provide around tables,

[58:43] producing a number of

[58:44] resources, whether it be

[58:45] webinars paper.

[58:48] >> In addition to additional

[58:49] meetings, office hours and

[58:51] in-person meetings and

[58:53] different meetings with

[58:54] provider associations to again

[58:55] hear feedback and to adjust as

[58:57] we went, given the

[58:58] extraordinary direction from

[59:00] the federal government. It

[59:02] feels important for me to say

[59:03] what I said it on July 1st at

[59:05] this hearing, which is we

[59:07] understand this is not been

[59:08] perfect. We are not perfect at

[59:10] the departments. And again,

[59:11] we've sought to engage and will

[59:13] continue to seek feedback.

[59:15] It just communicate

[59:16] proactively. And of course,

[59:18] we'll do that with advocates

[59:19] and legislators, lead agencies,

[59:21] including tribal nations,

[59:22] counties and managed care

[59:24] organizations. And today we're

[59:25] here to continue that effort

[59:27] knowing there's no finish line

[59:28] here that program, integrity

[59:30] and Medicaid, the work of

[59:32] government is continuous

[59:33] improvement. That is the

[59:34] essence of what we do

[59:36] with respect to a quick update

[59:37] here on the numbers. The total

[59:39] number of providers out of the

[59:42] roughly 5800 that were read

[59:43] elevated total read audited

[59:45] providers to date is about

[59:47] almost 3600. So we're we have a

[59:49] majority who are retaliated

[59:52] a little over 1500 are still an

[59:54] appeal.

[59:55] Excuse me. Those appeals are

[59:56] completed. So of the 30 to the

[59:59] 35 87, 1500 have had their

[1:00:03] appeals completed. They are we

[1:00:04] validated remaining incue in

[1:00:06] the process are a little under

[1:00:08] 1200 providers and we are

[1:00:10] continuing to work through the

[1:00:11] through those the major

[1:00:13] challenge that we haven't.

[1:00:14] We heard the feedback from

[1:00:16] those that testified at the

[1:00:17] beginning of the hearing here

[1:00:19] about the paperwork, the

[1:00:21] difficulties they've

[1:00:21] experienced, the delays.

[1:00:23] We understand that we are aware

[1:00:25] of that and we're doing our

[1:00:26] best to minimize those issues.

[1:00:28] I will note we are we are doing

[1:00:31] our best to it or Dudley work

[1:00:33] with providers to address the

[1:00:35] gaps in the documentation

[1:00:37] they're submitting to make this

[1:00:39] more streamlined. But again, if

[1:00:41] we're continuing to grapple

[1:00:43] with issues with the

[1:00:43] documentation, we cannot

[1:00:45] approve 3 validation. That is,

[1:00:47] of course, our charge as the

[1:00:49] Medicaid agency. We owe these

[1:00:51] these certain requirements to

[1:00:53] be in place with respect to

[1:00:54] qualified staff insurance,

[1:00:57] background checks, checks, et

[1:00:58] cetera, for the people that we

[1:01:00] serve. In addition to, I think

[1:01:02] the public that expects these

[1:01:03] things to be upheld and

[1:01:05] reviewed. So we will do our

[1:01:06] best to do that in a way that

[1:01:08] that supports providers.

[1:01:09] I will note it's just incumbent

[1:01:11] on me to say that CMS has been

[1:01:14] as question to the number of

[1:01:15] times that we have worked with

[1:01:17] providers to get this right.

[1:01:18] So we are definitely under

[1:01:20] examination scrutiny for how we

[1:01:21] are handling this. But again,

[1:01:23] our aim is to to help put an

[1:01:25] end to providers, get re

[1:01:26] validated, to provide service,

[1:01:28] to maintain access to service

[1:01:30] in the program. Again, hearing

[1:01:31] what's been what's been stated

[1:01:33] here today from community

[1:01:34] members and providers.

[1:01:36] I'm a little bit more about the

[1:01:39] I think the points that were

[1:01:40] made from some that testified

[1:01:41] about the balance between the

[1:01:43] re validation Worth's

[1:01:44] extraordinary effort that we

[1:01:46] did in 5 months and the regular

[1:01:48] provider enrollment work that

[1:01:49] is backlogged. We did set aside

[1:01:52] the bulk of the work with

[1:01:53] respect to provider enrollment

[1:01:55] compliance work streams to

[1:01:57] prioritize the validation were

[1:01:59] given the tremendous figures

[1:02:00] that you saw in the earlier

[1:02:01] slides with respect to federal

[1:02:03] dollars that are at risk.

[1:02:04] That said, we have heard from

[1:02:06] community and from legislators,

[1:02:08] some of them are present here

[1:02:09] today that we need to rebalance

[1:02:11] that work. So we have begun to

[1:02:12] do that. We have expanded the

[1:02:15] number of staff that are

[1:02:16] working on regular provider

[1:02:17] enrollment work and reduced to

[1:02:19] a degree of allegation capacity

[1:02:23] to have a better balance

[1:02:25] between some of the the regular

[1:02:27] enrollment work hearing.

[1:02:28] The pressures that providers

[1:02:30] are under and that people are

[1:02:31] under with respect to enrolling

[1:02:33] new providers and updating

[1:02:35] records that providers have

[1:02:36] with us.

[1:02:38] In addition, we are trying to

[1:02:40] make the overall size of the

[1:02:41] provider enrollment in

[1:02:42] compliance team larger. We are

[1:02:44] hiring. We anticipate in the

[1:02:47] coming days and weeks hiring up

[1:02:49] to roughly the little under 30

[1:02:50] new people for that team to

[1:02:52] provide new capacity for both

[1:02:54] the rehabilitation work and the

[1:02:56] regular provider and Roman

[1:02:58] work. So that is and in the

[1:03:01] name of being responsive to

[1:03:02] some of the feedback we heard

[1:03:03] earlier also say again, that

[1:03:06] should help us process some of

[1:03:08] the remaining revalidation work

[1:03:10] faster.

[1:03:12] So I think with that I can

[1:03:15] pause on the rehabilitation

[1:03:16] after we have continuity of

[1:03:17] care slides here to come.

[1:03:19] I don't know, chair if you want

[1:03:20] to take questions at this point

[1:03:22] or are keeping the questions

[1:03:24] for commissioner

[1:03:28] because there's a

[1:03:30] three-second delay to anybody

[1:03:32] online.

[1:03:35] No. All right. Thank you.

[1:03:38] Go ahead, Jeff Commissioner,

[1:03:40] thank you chair often.

[1:03:42] So we'll we'll start this

[1:03:43] portion of the presentation.

[1:03:46] I think we lost the slides on

[1:03:48] the screen and the folks can

[1:03:49] see there we go. Okay.

[1:03:51] We know the continuity of care

[1:03:53] is paramount and it is

[1:03:54] essential to the way that folks

[1:03:56] experience the Medicaid program

[1:03:58] have continuity of care and

[1:03:59] also coordination among the

[1:04:01] array of services that they

[1:04:02] need again to help them live

[1:04:04] their healthiest and Phyllis

[1:04:05] lives and community and have

[1:04:07] integrated rational services

[1:04:09] that that makes sense relative

[1:04:11] to one another that they're

[1:04:12] coordinated. And as we know,

[1:04:13] and as many of stated here

[1:04:14] today, very, very articulate

[1:04:17] Lee and very well, this

[1:04:19] prevents on this unnecessary

[1:04:21] hospitalization and

[1:04:22] institutionalization and helps

[1:04:23] people live in the most

[1:04:25] community-based setting in

[1:04:26] accordance with Olmstead and of

[1:04:28] course, honors personal choice

[1:04:30] and direction of the services

[1:04:31] that people that people need

[1:04:33] and and also integrates their

[1:04:35] goals for their treatment and

[1:04:36] for their their overall lives

[1:04:38] and well-being.

[1:04:40] So the vision for continuity of

[1:04:41] care speaks to those those

[1:04:43] elements. First of all,

[1:04:44] seamless transitions between

[1:04:46] providers or different types of

[1:04:47] care, particularly from an

[1:04:48] institution into community,

[1:04:50] again, in alignment with

[1:04:52] Olmstead. That is our goal for

[1:04:53] folks to move whenever

[1:04:54] possible. And when it is with a

[1:04:57] within people's choice and

[1:04:58] goals to move into

[1:05:00] community-based settings

[1:05:01] whenever possible

[1:05:02] that we have consistent support

[1:05:04] teams, even if there's

[1:05:05] transition from one provider to

[1:05:07] another within a service that

[1:05:08] other providers, our constant,

[1:05:10] that they are coordinated,

[1:05:12] of course, coordinated plan,

[1:05:13] support plans, making sure that

[1:05:15] all of these things are

[1:05:16] aligned, whether it's housing,

[1:05:18] health services, personal care,

[1:05:20] and also integration and

[1:05:22] community so that all of those

[1:05:23] needs are accounted for and

[1:05:24] again, make sense together,

[1:05:29] most of the course.

[1:05:31] All right. So a little bit

[1:05:32] more. We want to be responsive

[1:05:34] to the request for an outline

[1:05:35] of the reimbursement or payment

[1:05:36] mechanisms for it for the

[1:05:39] services. And there are 3 major

[1:05:41] frameworks for this. Of course,

[1:05:43] the first is the disability

[1:05:45] waiver rates system framework

[1:05:46] or D WRs as it's known for

[1:05:49] those who are initiated and of

[1:05:51] course market rates. The second

[1:05:54] that all know here on the slide

[1:05:55] is community for services and

[1:05:56] supports or CFS S and that is a

[1:05:59] separate raid framework.

[1:06:01] And then 3rd, there are state

[1:06:03] plan services that have flat

[1:06:04] rates and in some cases

[1:06:05] depending on the benefit or

[1:06:06] service, there are inflationary

[1:06:08] updates so they could could be

[1:06:09] indexed in that fashion.

[1:06:11] A couple of examples or home

[1:06:12] care, nursing. And of course,

[1:06:13] the IDB I which is our benefit

[1:06:16] for youth, autism services

[1:06:20] a little bit more here on

[1:06:21] waiver rates and exceptions.

[1:06:23] So current reimbursement models

[1:06:25] are, as you see here on the

[1:06:26] slide configurable. So they are

[1:06:28] individualized rates depending

[1:06:30] on what individuals support

[1:06:32] plan includes and what their

[1:06:34] needs are. So the rates will

[1:06:37] vary from person to person

[1:06:38] depending on what their needs

[1:06:39] are and what services they

[1:06:40] require. Staffing levels are a

[1:06:42] key piece of what rates might

[1:06:44] be and again, depend on what

[1:06:46] the individual's needs are.

[1:06:47] And I think we heard a lot

[1:06:48] about this in the opening

[1:06:49] testimony about how different

[1:06:51] types of professionals

[1:06:52] clinicians are engaged,

[1:06:54] depending on what individuals

[1:06:55] needs might be.

[1:06:56] That said there is a process

[1:06:58] for providers to request an

[1:06:59] exception. If the the

[1:07:01] frameworks that we have to not

[1:07:03] yield the rate that they feel

[1:07:05] fully accounts for the needs

[1:07:07] that individual has in the

[1:07:08] services are professionals.

[1:07:09] They require so lead agencies

[1:07:12] may receive a request for an

[1:07:13] exception or exception. Excuse

[1:07:15] me. And DHS and lead agencies

[1:07:17] have 30 days to review that and

[1:07:19] then respond to the request.

[1:07:22] Providers may appeal, of

[1:07:24] course, if that rate exception

[1:07:25] is denied. So there is a

[1:07:26] process for that as well.

[1:07:28] Subsequent to that

[1:07:29] DHS, of course, we're always

[1:07:31] continuing to improve the

[1:07:32] processes by which we do the

[1:07:33] work to do it as efficiently

[1:07:35] and timely as possible, having

[1:07:37] consistency across the agencies

[1:07:39] across counties in the state

[1:07:42] and of course, want want the

[1:07:43] process to be clear and

[1:07:45] transparent to providers and to

[1:07:47] the people receiving services

[1:07:48] of the members of our programs,

[1:07:50] particularly when the approved

[1:07:52] rate is not what the providers

[1:07:53] sought.

[1:07:55] We're also implementing reforms

[1:07:56] to WRs that rate framework.

[1:08:00] Pursuant to, of course, the

[1:08:01] acts of the legislature signed

[1:08:03] by the governor, of course,

[1:08:04] after the during the last 2

[1:08:06] sessions and those include

[1:08:07] changes to approve the waiver.

[1:08:09] 8 exceptions if they are

[1:08:12] supported by documentation of

[1:08:14] the staffing need for the tool

[1:08:16] that served

[1:08:18] commissioner. Yes, I'm just a

[1:08:21] couple of things said.

[1:08:22] >> Thank you. You're going to

[1:08:23] go into what we did to 2026

[1:08:25] legislature, which led, which

[1:08:26] is leading to this

[1:08:27] conversation, Cathy Care, which

[1:08:29] is also, but on the radar

[1:08:30] exception,

[1:08:31] if I understand it right, is

[1:08:33] that

[1:08:36] need to nursing services are in

[1:08:37] need. That's basically what

[1:08:39] we're getting is the

[1:08:39] understanding of these needs

[1:08:41] nurses who says is it the

[1:08:42] contracted case manager that

[1:08:44] makes that first decision or

[1:08:46] what I feel it is to go to

[1:08:47] Kristie.

[1:08:49] I mean, think you think it

[1:08:50] that, Christine, by the way,

[1:08:51] I forward everything to her

[1:08:53] that comes to us. You do.

[1:08:54] You have no idea what what you

[1:08:56] have. So especially with the

[1:08:57] knowledge base when you study

[1:08:59] WRs,

[1:09:00] do you realize 12 years ago and

[1:09:02] we first had the dws

[1:09:03] conversation. He was Heidi

[1:09:05] Hamilton, Alec part live in.

[1:09:09] So

[1:09:10] that was something to to help

[1:09:12] me understand that piece

[1:09:14] because I can't wrap my hands

[1:09:15] around it if our

[1:09:16] responsibilities to make sure

[1:09:18] the most of our own people are

[1:09:20] getting the services they need.

[1:09:23] And here's one where an RN or a

[1:09:25] doctor has said this child or

[1:09:27] this. This adult needs this.

[1:09:30] And somebody saying no

[1:09:34] common sense would say, well,

[1:09:35] why is this any different than

[1:09:37] it was 6 months ago? So help me

[1:09:39] understand that. So give us a

[1:09:41] first pass. And then I refer to

[1:09:42] Christine because as you

[1:09:43] suggested,

[1:09:44] >> she is one of the original

[1:09:46] designers of this and knows

[1:09:48] more than I do about it.

[1:09:49] I say that freely and with

[1:09:51] great humility. So I think the

[1:09:53] answer to your question,

[1:09:54] chair Hoffman is yes. So the

[1:09:56] first pass is with the the case

[1:09:59] manager and that could be with

[1:10:00] a contracted agency. It could

[1:10:02] also be a county employee if

[1:10:05] the county is directly

[1:10:06] providing that service but they

[1:10:07] would develop the

[1:10:08] individualized support plan and

[1:10:10] the the the rate. But

[1:10:12] Christine, feel for the at what

[1:10:13] I said. That's correct.

[1:10:17] >> Our chair and committee

[1:10:18] Kristin Graham with the

[1:10:19] Department of Human Services

[1:10:21] Commissioner Kelly described it

[1:10:23] accurately. I think one of the

[1:10:24] complications here and

[1:10:25] complexities with nursing

[1:10:27] services is that fundamentally

[1:10:29] nursing services is paid for

[1:10:31] under our state plan.

[1:10:33] There are some unique

[1:10:34] situations and or waivers where

[1:10:36] the rate can be modified to

[1:10:38] account for RN or lpn duties.

[1:10:42] But under the state plan, those

[1:10:44] services can be authorized a

[1:10:46] little bit differently. Those

[1:10:47] usually happen. They they're

[1:10:48] author is typically through the

[1:10:49] Home Care nursing agency

[1:10:52] and then they go through the

[1:10:53] prior authorization process and

[1:10:55] get delivered by either home

[1:10:57] care, nursing Service or a

[1:10:59] skilled nurse, is it?

[1:11:01] >> Thank you for that. It did

[1:11:02] then answer the question that

[1:11:04] first process. So there's

[1:11:06] clearly a communications issue

[1:11:09] between the that contracted

[1:11:12] case manager to lead agency and

[1:11:14] the department on the unique

[1:11:15] needs of an individual. Not

[1:11:17] only that, but then I shared a

[1:11:18] letter that I had teen in the

[1:11:20] email where one of the contract

[1:11:22] and case managers was really

[1:11:26] basically when you say

[1:11:27] somebody, what is it? You still

[1:11:29] an ESL? You know it just it

[1:11:32] blows me away. It really gives

[1:11:33] that

[1:11:36] system of rule bad name.

[1:11:39] When I shared. I think you have

[1:11:40] a copy of that.

[1:11:42] So that would

[1:11:43] hens me to ask the question,

[1:11:45] are we doing everything we can

[1:11:46] to ensure that somebody knows

[1:11:48] the system or in the statutory

[1:11:51] system that we play step in

[1:11:52] there? And so maybe that's a

[1:11:54] conversation with Paul gets

[1:11:55] after. We could have that,

[1:11:57] you know, counties, the lead

[1:11:59] agency, the department have a

[1:12:01] consumer. Maybe we'll wait on

[1:12:02] that one. Commissioner, let you

[1:12:04] go into what we did in 2026,

[1:12:06] thank you for.

[1:12:09] >> Thank you, chair of and

[1:12:10] thank you. Christie for the

[1:12:11] assist there. And I agree she's

[1:12:14] a tremendous asset to us.

[1:12:16] All. Just all know that as

[1:12:17] well. And certainly if there

[1:12:19] are issues, we are all years to

[1:12:21] all partners about how to solve

[1:12:23] those issues and whether its

[1:12:25] legislators, yourself, the

[1:12:26] counties as well as agencies

[1:12:30] moving on to the continuity of

[1:12:31] care reforms that were passed

[1:12:33] during the last session and

[1:12:34] signed by the governor. Of

[1:12:36] course, these reforms create

[1:12:38] new requirements for the state,

[1:12:40] the lead agencies and providers

[1:12:41] themselves to ensure continuity

[1:12:43] of service. When there is an

[1:12:44] interruption in care, it could

[1:12:46] be for program integrity reason

[1:12:47] or for other reasons. But for

[1:12:50] all of the above their new

[1:12:51] requirements in place and for

[1:12:53] providers specifically, there

[1:12:55] must be a notification to the

[1:12:57] program members. So they know

[1:12:58] that there is going to be in an

[1:13:00] interruption and care for the

[1:13:01] current serving provider and

[1:13:03] they need notification needs to

[1:13:05] go to the program member before

[1:13:07] services are terminated.

[1:13:08] Lead agencies also have a few

[1:13:10] requirements here that are new.

[1:13:12] They have to inform the Butts

[1:13:13] persons office. They have to

[1:13:15] notify recipients or program

[1:13:17] members as well as they also

[1:13:19] have to assist providers in

[1:13:20] developing a continuity of care

[1:13:21] plan. If they stopped stopped,

[1:13:23] providing services are planned

[1:13:25] to rather. And then if there is

[1:13:27] an identification of a person's

[1:13:29] need to be complex, they must

[1:13:31] have a complex transition plan

[1:13:33] in place and work with the just

[1:13:35] to oversee that to ensure

[1:13:37] continuity of care.

[1:13:38] Dhs has responsibilities as

[1:13:40] well. Must make efforts to

[1:13:43] notify lead agencies if we are

[1:13:44] going to take an administrative

[1:13:45] action relative to program

[1:13:47] integrity in advance of taking

[1:13:49] that action, identify

[1:13:51] potentially impacted

[1:13:52] recipients. So we're sharing

[1:13:53] that information with the lead

[1:13:55] agency. So they know

[1:13:56] individuals that may have an

[1:13:57] interruption in service because

[1:13:58] of an administrative action and

[1:14:01] also ensure that lead agencies

[1:14:03] are taking the steps needed to

[1:14:04] ensure provision of of

[1:14:06] necessary services to

[1:14:08] coordinate care and provide

[1:14:09] continuity and ensure that

[1:14:11] there's yes, chair of it.

[1:14:12] No, I was going to tell you

[1:14:13] finish your sentence or the

[1:14:15] representative that was Liz

[1:14:17] cannot. She's a has a she's got

[1:14:19] her hand up. So when you when

[1:14:21] you get to your end of that

[1:14:22] point and will cut Natalie,

[1:14:24] sure, and I think a couple of

[1:14:25] key considerations are, of

[1:14:27] course, that individual's

[1:14:28] choice of providers respected

[1:14:30] and they have housing. Of

[1:14:31] course, that's a key

[1:14:32] consideration when providers

[1:14:35] stop providing services and of

[1:14:37] course, we have a requirement

[1:14:39] to establish a continuity of

[1:14:40] care team with resources.

[1:14:42] So thanks to the legislature

[1:14:43] for that so that we can support

[1:14:46] lead agencies in executing

[1:14:47] these transition of care plans.

[1:14:50] Thank you, Representative

[1:14:51] Tillis, the car.

[1:14:53] >> Thank you. Chair happen and

[1:14:56] thank you, Commissioner calmly

[1:14:58] and I really do appreciate how

[1:15:00] responsive even I had many

[1:15:02] questions and also too

[1:15:04] to Christiane, thank you both

[1:15:06] from how as we work through

[1:15:08] these issues. Question is on

[1:15:10] the graph that you showed on

[1:15:12] the number 3 validated

[1:15:13] providers. I know when we

[1:15:15] started, I think when we met in

[1:15:16] July, there was 5,600,

[1:15:19] something total providers.

[1:15:21] I'm going by and I don't know

[1:15:22] what the total exact was.

[1:15:24] I don't have that for me back.

[1:15:25] My question is that of the

[1:15:28] society have today? There's

[1:15:30] 1542 appeals that are

[1:15:32] completed. My question is,

[1:15:34] is there a dashboard that shows

[1:15:36] you know what, where who are

[1:15:38] the providers? What 5 into the

[1:15:40] state are they and who are they

[1:15:42] serving? Is it is it the I D D

[1:15:44] I is it. You know, assisted

[1:15:47] living is a non emergency

[1:15:49] transportation. I'm curious if

[1:15:51] we have any data, I'm you know,

[1:15:54] how are their 10 providers in

[1:15:56] each category that had been

[1:15:57] completed for the Metro,

[1:15:59] the suburbs, the central part

[1:16:00] of the state, northeast

[1:16:01] northwest and the same question

[1:16:03] for the appeals and progress.

[1:16:05] And the reason I ask this is

[1:16:07] that it appears I'm wondering,

[1:16:09] you know, when we have one or 2

[1:16:12] providers for non emergency,

[1:16:13] transportation are known to

[1:16:15] providers. You know what the

[1:16:16] plan is because it's a

[1:16:17] federally required

[1:16:19] program. And from what I can

[1:16:21] see in the part in the

[1:16:23] northeastern part of the state,

[1:16:25] I'm very concerned. I in in a

[1:16:27] specific category non-emergency

[1:16:29] transportation specifically in.

[1:16:32] So if yes, we have limited

[1:16:35] provider, says it is in

[1:16:36] nobody's re-evaluated. Then at

[1:16:39] explains to me why the nursing

[1:16:40] homes are paying $5,000 a

[1:16:42] month.

[1:16:43] And they're not gonna get that

[1:16:44] money back because we already

[1:16:45] made changes to that. They're

[1:16:47] transporting, too. I dialysis

[1:16:50] and these things. And there's

[1:16:51] no there's actually getting

[1:16:52] reimbursement for. So we're

[1:16:54] we're creating and other issues

[1:16:56] right now. And I'd love to know

[1:16:57] what that dashboard looks like.

[1:16:59] >> For for, you know.

[1:17:02] >> The ones that are still in

[1:17:03] process are the ones that are

[1:17:04] completed where they are the

[1:17:06] findings of the state and who

[1:17:08] they are. What category the

[1:17:10] falling of the 13 14 programs

[1:17:12] that were high risk.

[1:17:13] >> Thank you. Thank you.

[1:17:14] Representative was the car

[1:17:15] Commissioner

[1:17:17] Chair Hoffman representatives

[1:17:18] lets the car we share your

[1:17:19] concern about access to care,

[1:17:21] certainly in northeast

[1:17:22] Minnesota, but everywhere in

[1:17:23] Minnesota. And the answer to

[1:17:25] your question is, yes, we do

[1:17:26] have that dashboard and we will

[1:17:28] send updated numbers by region

[1:17:30] by service across the different

[1:17:32] 13 high-risk services that are

[1:17:34] going through a validation with

[1:17:36] you very shortly. So we have

[1:17:37] those data and we will share

[1:17:38] them with all of you. Thank

[1:17:40] you. Thank you, Jen follow-up,

[1:17:41] Natalie. Good

[1:17:42] and it. All right,

[1:17:44] commissioner,

[1:17:51] excuse me, chair up and just

[1:17:52] leaving back to the current

[1:17:54] slide.

[1:17:58] I think that's good. All right.

[1:17:59] So a few more things here with

[1:18:02] respect to continuity of care,

[1:18:03] implementation. So pursuant to

[1:18:05] the 2026 legislation, we're

[1:18:07] starting by looking at our own

[1:18:10] staff, our own capacity, our

[1:18:12] own infrastructure, to do this

[1:18:13] work looking inward to make

[1:18:15] sure that we have a plan for

[1:18:16] how to approach this. And of

[1:18:17] course, we want to talk to

[1:18:19] different folks, leaders within

[1:18:21] the department to do this work

[1:18:23] for the different benefits and

[1:18:24] different parts of the

[1:18:25] organization. So we need to

[1:18:26] come together, have an

[1:18:27] interdisciplinary approach

[1:18:28] that's consistent and

[1:18:30] responsive to community and

[1:18:31] providers and to to inform how

[1:18:34] we develop these functions in

[1:18:36] the spirit of the legislation

[1:18:37] that was passed and signed.

[1:18:40] The work is going to be

[1:18:41] basically the work of creating

[1:18:44] this new team to ensure that we

[1:18:46] do this in a consistent way

[1:18:47] that makes sense and is

[1:18:48] responsive, irrespective,

[1:18:49] again of the service, whether

[1:18:50] it's behavioral health, aging

[1:18:51] and disability services, health

[1:18:53] care, et cetera.

[1:18:55] And that we're also making

[1:18:57] clear what our roles are in

[1:18:58] this as an agency for specific

[1:19:00] staff doing the work and and

[1:19:02] what the expectations of the

[1:19:04] agency are for the community,

[1:19:05] that staff you empower, they

[1:19:07] know what to do. They know how

[1:19:08] to interact with external

[1:19:09] partners and that we're

[1:19:10] creating an efficient approach

[1:19:13] that's responsive and create

[1:19:14] seamless Nissen, the system for

[1:19:16] it for the people served.

[1:19:18] I also want to note, too, that

[1:19:20] housing is of particular

[1:19:22] importance here understanding,

[1:19:24] I think with the focus of the

[1:19:27] chair and others here on making

[1:19:28] sure that folks do not become

[1:19:29] unhoused as a result of, you

[1:19:32] know, interruptions in service

[1:19:33] by a provider that is funded by

[1:19:35] Medicaid. I do want to note

[1:19:37] that housing itself is not

[1:19:38] reimbursed are paid for by

[1:19:40] Medicaid, but a service

[1:19:42] components in housing settings

[1:19:44] are. And so that said DHS does

[1:19:47] have tools at its disposal with

[1:19:49] respect to housing, support the

[1:19:50] housing support program that is

[1:19:52] separate from Medicaid estate

[1:19:53] only program to support housing

[1:19:56] capacity. And so there are

[1:19:57] grants will be available coming

[1:19:59] out of the 2020 succession for

[1:20:01] a 4 counties in the agency's

[1:20:04] for this. And it expands the

[1:20:07] capacity for those grants.

[1:20:08] So a couple of updates here

[1:20:10] with respect to our

[1:20:11] implementation of those those

[1:20:12] housing capacity granted the

[1:20:14] expansion of them. We held an

[1:20:16] initial interest session with

[1:20:17] community partners in July 7th

[1:20:19] earlier this summer, soliciting

[1:20:21] feedback about the the RFP and

[1:20:23] its development. It's under

[1:20:25] review now with with DHS staff

[1:20:27] were on track. However, to to

[1:20:29] post that by the 21st of this

[1:20:31] month, we will have responders

[1:20:33] conference at the end of the

[1:20:34] month and the 30th so any

[1:20:36] interested applicants can can

[1:20:38] attend and ask questions and

[1:20:41] applications are due on

[1:20:42] November 18th. So that is the

[1:20:44] broad timeline. We expected

[1:20:46] funding decisions will be

[1:20:47] issued likely in January.

[1:20:51] So we'll have the prewar risk

[1:20:53] assessment in January decisions

[1:20:55] in December. And so funding

[1:20:57] should go out to to the Ortiz

[1:20:59] in late January, if not shortly

[1:21:01] thereafter.

[1:21:02] So I think those are my

[1:21:04] comments with respect to

[1:21:05] continuity of care. Again,

[1:21:06] sure, half. I'm not sure if

[1:21:07] your preference is to take your

[1:21:08] questions at this point or 2

[1:21:09] people.

[1:21:10] >> I think people are great.

[1:21:11] If you want to transition.

[1:21:13] I do. There's another piece.

[1:21:15] Commissioner I

[1:21:17] I sent a request out to meet

[1:21:20] with people regarding the

[1:21:21] Olmsted you'd mention on state

[1:21:23] early on in the that the

[1:21:25] proposed onsted plan. I the

[1:21:29] hearing from a lot of us.

[1:21:33] >> Feeling like they were not

[1:21:34] part of that. This is not your

[1:21:36] response to you. It's part of

[1:21:38] your responsibility. But you

[1:21:39] know that he created this

[1:21:40] Homestead

[1:21:41] Peace. And I'm concerned that

[1:21:43] this September 15th

[1:21:48] plan being adopted by the

[1:21:50] committee doesn't reflect the

[1:21:52] individuals that are receiving

[1:21:53] the services and the media and

[1:21:55] the September 11th with that,

[1:21:58] I think the housing

[1:21:58] commissioner, but it would be

[1:22:01] it would it would be nice if

[1:22:03] Christie, if somebody from your

[1:22:05] office was also able to attend.

[1:22:07] I know this year that but that

[1:22:09] just something to put out

[1:22:10] there. But somebody who

[1:22:11] understands Olmstead a

[1:22:14] it may be a decision that took

[1:22:16] Minnesota 17 years to put a

[1:22:17] plan together because of a

[1:22:19] federal judge. And Donovan

[1:22:20] Frank was amazing individual,

[1:22:22] by the way. And we're getting

[1:22:23] details on that.

[1:22:25] That is

[1:22:26] that is a concern to so.

[1:22:29] And then there was one other

[1:22:30] piece that we can talk about

[1:22:33] the the transitions. So thank

[1:22:35] you for your time members.

[1:22:37] I don't see any hands up.

[1:22:40] So thank you. Commissioner will

[1:22:41] transition to the

[1:22:44] contractor that case banishment

[1:22:46] to skate discussion. Maybe we

[1:22:48] should get Paul to come up to

[1:22:50] an end.

[1:22:51] >> Luella still with us.

[1:22:52] Thank you all the way from.

[1:22:54] >> The head of the county.

[1:22:55] And then

[1:22:58] I think Pat Meacham from Pine

[1:22:59] County is going to join us.

[1:23:01] You that you need 3 chairs up

[1:23:02] here

[1:23:03] just so we can have that this

[1:23:04] thank you for you. You can

[1:23:06] folks for letting me be

[1:23:08] flexible. I may

[1:23:10] and my in this committee today,

[1:23:28] no one wants to supply.

[1:23:30] I just, you know, Chris, Hedges

[1:23:32] that this would make sense

[1:23:33] because you and Paul have that,

[1:23:34] you know, we're having the same

[1:23:35] conversation you might as well

[1:23:37] have everybody at the table to

[1:23:38] really, you know, do that.

[1:23:40] And I and I appreciate you

[1:23:41] doing that. But Christy scrum,

[1:23:44] director of state government

[1:23:45] relations at the department,

[1:23:48] my choice because here, too.

[1:23:50] But he's going to go after you

[1:23:51] do so or during it.

[1:23:54] Thank you. Thanks for being

[1:23:55] here.

[1:23:56] >> Thank you. Mr. Chair led to

[1:23:57] participate in this discussion.

[1:24:00] So I'm going to talk briefly,

[1:24:01] but Weaver case management a

[1:24:03] little bit about quality

[1:24:04] oversight. I think we have a

[1:24:05] lot of shared goals between

[1:24:07] DHS, the legislature, counties.

[1:24:09] I'll try to move quickly.

[1:24:10] So we've got time for everyone

[1:24:11] to to give their input here.

[1:24:14] But I'm gonna go over sort of

[1:24:15] case management basics just to

[1:24:16] guide you through what I'm

[1:24:17] going to talk about and then go

[1:24:20] over some of the oversight

[1:24:21] facets of waiver case

[1:24:22] management. And then lastly,

[1:24:24] an implementation update of

[1:24:25] some of the reforms that passed

[1:24:26] last session. Thanks to all of

[1:24:27] your important work. So to

[1:24:30] start wanted to talk just about

[1:24:32] some basic some level setting

[1:24:34] on what waiver hcbs case

[1:24:36] management is. And before I get

[1:24:38] into that, I do just want to

[1:24:39] say

[1:24:41] case management is a really

[1:24:42] critical part of our waiver and

[1:24:44] ltsa system. We cannot have a

[1:24:46] fully integrated system without

[1:24:50] good case management. So this

[1:24:51] is a really important service.

[1:24:53] We are really heartened to know

[1:24:55] that the legislature standing

[1:24:56] with us and talking about

[1:24:58] reforms both here today,

[1:25:00] last session, hopefully into

[1:25:01] the future.

[1:25:02] So just to kind of give you a

[1:25:03] brief overview, hcbs case

[1:25:06] management and care

[1:25:07] coordination are supports that

[1:25:09] are provided under the

[1:25:09] disability waivers sometimes

[1:25:12] called Kat Katty, be IMDB as

[1:25:15] well as alternative care and

[1:25:16] essential community supports.

[1:25:18] So case management really helps

[1:25:20] connect people with the

[1:25:22] services that they need

[1:25:23] provides referrals for the

[1:25:24] services that they need.

[1:25:25] Authorizations chair. Half when

[1:25:28] you mentioned some of the work

[1:25:29] that occurs between when a

[1:25:30] person has a change in need,

[1:25:32] the case manager might need to

[1:25:33] authorize that service and

[1:25:35] really working with the person

[1:25:36] across the continuum to make

[1:25:38] sure they've got informed

[1:25:39] choice and that services are

[1:25:40] being delivered in a

[1:25:41] person-centered way. So this is

[1:25:44] really important, critical

[1:25:46] aspect for people to be able to

[1:25:47] navigate what is a very complex

[1:25:49] system.

[1:25:51] Informed choice is really

[1:25:53] paramount and the work that

[1:25:54] case managers do as well as due

[1:25:55] process and making sure that

[1:25:56] people know their rights, that

[1:25:57] they have a right to appeal.

[1:25:58] For example, if they don't

[1:26:00] agree with the decision,

[1:26:01] it's also important as we talk

[1:26:03] about program integrity we have

[1:26:05] found over the past couple of

[1:26:06] years as we have initiated and

[1:26:09] more program, integrity,

[1:26:10] reforms. We learn a lot about

[1:26:11] program, integrity, issues from

[1:26:13] our partners, our lead

[1:26:14] agencies, counties, tribal

[1:26:16] nations and managed care

[1:26:17] organizations. So having that

[1:26:19] person, the case manager,

[1:26:21] working closely with an

[1:26:22] individual to understand

[1:26:25] she's Christie's supposed to be

[1:26:26] getting the service, but she

[1:26:27] doesn't appear to be getting

[1:26:28] that service and having that

[1:26:30] connection is really important

[1:26:31] for people. It's really

[1:26:32] important for program integrity

[1:26:33] as well as continuity of care.

[1:26:37] So a little bit about who case

[1:26:39] managers are.

[1:26:41] We heard it stories and share

[1:26:44] half men you've shared and

[1:26:45] other members have shared

[1:26:47] negative outcomes that people

[1:26:49] are having with case

[1:26:50] management. And I think we know

[1:26:52] that those I wish Chrystia

[1:26:53] would get.

[1:26:55] >> Positive outcomes with all

[1:26:55] the e-mails I get are negative

[1:26:57] once and you knew that in the

[1:26:59] days of the committee

[1:27:00] administrative case. Yeah,

[1:27:02] that's the other thing since

[1:27:04] we're going to start it will

[1:27:05] county stuff that met Freeman

[1:27:07] is now back working with the

[1:27:08] counties. But he's not sitting

[1:27:10] in the chair that he always

[1:27:11] would sit in for years over

[1:27:13] there. I see him back there.

[1:27:14] So I just had to bring that to

[1:27:16] light. So go ahead. Well.

[1:27:18] >> March air met Mr. Freeman is

[1:27:20] welcome to come up here,

[1:27:21] too. And we can talk about, you

[1:27:23] know, assessments and

[1:27:24] reassessments in all of all of

[1:27:26] those good things.

[1:27:28] But I did just want to say that

[1:27:30] case managers that while there

[1:27:32] are issues with case

[1:27:34] management, it's not just

[1:27:35] contracted case management.

[1:27:38] It's all case management and

[1:27:40] many case managers do a great

[1:27:42] job.

[1:27:43] And I will say as a former case

[1:27:45] manager and

[1:27:48] case management can change

[1:27:49] people's lives for the better.

[1:27:50] So that's why we're talking

[1:27:51] about here today. And I just

[1:27:53] want to lift up the great work

[1:27:54] that many of our case managers

[1:27:55] are doing at the county level

[1:27:57] at the lead agency level.

[1:27:59] But really our case managers,

[1:28:00] as I mentioned, are the front

[1:28:02] face of it. Helping people

[1:28:05] navigate a incredibly complex

[1:28:07] system that we all have a hand

[1:28:09] in creating and making a

[1:28:10] complex and they have a lot of

[1:28:13] it. Expectations that are laid

[1:28:16] out in state line are Weaver

[1:28:17] plans, but effectively they're

[1:28:19] helping to translate people's

[1:28:21] assess needs and to their

[1:28:22] person center plans are

[1:28:23] authorizing services during

[1:28:25] that informed choice. They're

[1:28:26] supposed to be monitoring

[1:28:27] outcomes, adjusting plans as

[1:28:29] needed. So this is it's a lot.

[1:28:32] And we've we've been talking

[1:28:34] with the legislature with

[1:28:35] counties about making sure that

[1:28:36] we do have really clear duties

[1:28:37] for case managers. What is it

[1:28:39] that we expect as a state case

[1:28:40] managers to do and let's lift

[1:28:42] up those duties and clarify

[1:28:44] them if we need to.

[1:28:48] So when we talk about

[1:28:49] contracted case management,

[1:28:50] this is an activity that many

[1:28:52] lead agencies use increasingly

[1:28:55] to address

[1:28:56] to my slides. Go away for some

[1:28:58] reason.

[1:29:02] >> Sorry, I'm having technical

[1:29:04] issues chair to out me to just

[1:29:05] just the and you can execute.

[1:29:07] Okay. Can keep talking.

[1:29:11] I thought they were up there at

[1:29:12] the time. Accent just got

[1:29:14] questions. Ask Radio Shack just

[1:29:17] a

[1:29:26] a graduate of Saint Francis

[1:29:27] High School that I love it.

[1:29:32] >> All right. So many lead

[1:29:33] agencies use contracted case

[1:29:35] management. We've heard that

[1:29:36] here at DHS. This committee has

[1:29:37] heard it from our county

[1:29:38] partners as well over the past

[1:29:40] session or 2. And we'll hear

[1:29:42] more from the county's about

[1:29:43] why they do that. But, you

[1:29:44] know, they're always looking to

[1:29:46] create smaller case loads to

[1:29:47] supplement gaps and maybe

[1:29:48] experience or specialization.

[1:29:50] Maybe there's individuals who

[1:29:51] have a brain injury, for

[1:29:52] example, and the county's and

[1:29:55] say, you know what, this is

[1:29:56] organization and community is

[1:29:58] just better position to provide

[1:29:59] that case management for that

[1:30:00] individual.

[1:30:02] We also see quite frequently or

[1:30:04] counties more so quite see

[1:30:06] frequently where people are

[1:30:07] living in a different location

[1:30:09] in their county of financial

[1:30:11] responsibility and which case

[1:30:13] it may make sense for everyone

[1:30:15] to have a contract to case

[1:30:17] management that's closer to

[1:30:18] that individual to make sure

[1:30:19] they're fully connected.

[1:30:22] I will say that, you know,

[1:30:23] contracted case management

[1:30:24] isn't inherently a bad thing.

[1:30:27] We use subcontracted case

[1:30:28] management and targeted case

[1:30:29] management. Another kind of

[1:30:30] Medicaid case management.

[1:30:32] I think certainly at the

[1:30:33] department we do want to

[1:30:34] understand and have better

[1:30:36] sight lines into some of the

[1:30:37] quality assurances and

[1:30:39] oversight here. But it's not

[1:30:41] necessarily something that,

[1:30:43] you know, we need to fully get

[1:30:45] rid of all that. We've had some

[1:30:46] of those conversations.

[1:30:49] I just wanted to highlight that

[1:30:50] our federal federally approved

[1:30:52] a waiver plans as well as state

[1:30:54] law identifies that we do

[1:30:56] subcontracted case management

[1:30:58] that lead agencies me contract

[1:31:00] with a private entity to do

[1:31:01] that.

[1:31:04] >> Cms has to approve that.

[1:31:06] It's part of your Medicaid

[1:31:07] plan. Correct? Our Medicaid

[1:31:08] plan craft March air. That's

[1:31:10] correct. Thank you for that.

[1:31:13] >> Dhs does need to make sure

[1:31:14] that we're monitoring as those

[1:31:16] supervisors of the human

[1:31:17] services system. We do have a

[1:31:18] responsibility and

[1:31:19] accountability to monitor lead

[1:31:21] agency performance, quality

[1:31:23] compliance. And if there is a

[1:31:25] need for corrective actions, we

[1:31:26] do issue those.

[1:31:29] As we've worked with our county

[1:31:31] partners, we've seen data that

[1:31:33] indicates that the need for

[1:31:35] contact in case management has

[1:31:36] been increasing due to

[1:31:38] workforce issues and

[1:31:40] reimbursement concerns across

[1:31:43] the system.

[1:31:44] So we've heard that counties

[1:31:46] are actually expanding their

[1:31:47] use of contracted. Case

[1:31:48] management will talk more about

[1:31:50] that, I assume. And just some

[1:31:51] basic numbers I wanted to share

[1:31:53] with the committee's between

[1:31:54] May 2024 and today I have an

[1:31:57] acronym and here which I didn't

[1:31:58] fully right out. So that's my

[1:32:00] bad. La R Stands for lead

[1:32:02] agency review.

[1:32:04] Met with about 59 lead agency

[1:32:06] is and most of them are using

[1:32:08] contracted case management

[1:32:10] about 54% over that time

[1:32:11] period.

[1:32:16] All right. So let's talk a

[1:32:17] little bit more about lead

[1:32:18] agency review.

[1:32:21] So lead agency review is a

[1:32:23] process that the Department of

[1:32:24] Human Services initiated about

[1:32:26] 20 years ago.

[1:32:28] Seems like a long time ago.

[1:32:29] But we've been doing this for

[1:32:30] quite a while and continually

[1:32:31] improving. And and this is a

[1:32:34] process that is really meant to

[1:32:35] oversee

[1:32:37] and our lead agencies and how

[1:32:38] they're delivering case

[1:32:39] management services. So it

[1:32:41] applies to both regular case

[1:32:42] management and contracted case

[1:32:44] management. Increasingly,

[1:32:46] we are trying to, you know,

[1:32:47] hearing from the community

[1:32:48] hearing from this committee and

[1:32:50] members make sure that we're

[1:32:52] devoting ample attention or

[1:32:54] equal attention to contracted

[1:32:56] case management activities as

[1:32:57] well and how those are being

[1:32:58] addressed by counties.

[1:33:00] But really the main goals of

[1:33:02] lead agency review is to make

[1:33:03] sure that counties and tribal

[1:33:04] nations are compliant with all

[1:33:07] of the requirements and state

[1:33:08] and federal law. It's an

[1:33:10] opportunity to share

[1:33:11] performance on key measures and

[1:33:13] out comes to better support

[1:33:14] people. So we had dew track

[1:33:16] various Lt, assess long-term

[1:33:19] services and supports

[1:33:20] performance measures and work.

[1:33:22] Those into the discussions with

[1:33:24] lead agencies are on how

[1:33:25] they're doing and what their

[1:33:26] outcomes look like and how they

[1:33:27] compare to the rest of the

[1:33:28] state.

[1:33:29] It's also a way to promote

[1:33:31] collaboration among lead

[1:33:32] agencies and share best

[1:33:33] practices. So if DHS is hearing

[1:33:36] from one county who's really

[1:33:38] doing a great job, that's an

[1:33:40] opportunity for us to

[1:33:41] potentially share that

[1:33:42] information with other counties

[1:33:44] so that they can implement

[1:33:45] those practices as well.

[1:33:47] So this slide is just a quick

[1:33:49] overview of what the lead

[1:33:50] agency review process looks

[1:33:52] like.

[1:33:53] So it's typically about a

[1:33:55] six-month process and there's a

[1:33:57] schedule. There's a whole

[1:33:58] website on there and the DHS

[1:34:00] Web page where you can find the

[1:34:01] schedule every year which

[1:34:04] counties were reviewing.

[1:34:06] But it's a six-month process.

[1:34:08] Counties undergo this about

[1:34:09] every 3 to 4 years, depending

[1:34:11] kind of what's going on with

[1:34:12] that county. But it first

[1:34:13] involves up revisit activities,

[1:34:17] initiation or kickoff

[1:34:19] teleconference. So there's the

[1:34:20] supervisors lead agency lead

[1:34:23] agency survey go to all

[1:34:24] programs, staff and we're

[1:34:25] gathering program data from DHS

[1:34:27] Systems.

[1:34:29] Next is really the meat of the

[1:34:30] lead agency review, which is

[1:34:31] the review itself. So as a part

[1:34:33] of this, we're looking at the

[1:34:34] case file. We take a random

[1:34:36] sample of case files for each

[1:34:37] program

[1:34:39] and then we review those with

[1:34:40] the team. I think it's about

[1:34:42] 10% or so of case files that we

[1:34:44] sample and that differs

[1:34:46] depending on the total number.

[1:34:47] If there is, for example,

[1:34:48] a smaller county and there's

[1:34:49] only 10 files, we review all of

[1:34:51] them.

[1:34:52] And as I alluded to earlier,

[1:34:55] all of this review includes the

[1:34:56] case management conducted by

[1:34:57] the lead agency itself, as well

[1:34:59] as the contracted lead agency

[1:35:02] through the site review.

[1:35:03] We're going to Dana 5 practices

[1:35:04] and tools that lead agencies

[1:35:08] that contribute to, you know,

[1:35:09] potentially stronger. Maybe not

[1:35:11] so strong, technical compliance

[1:35:12] and outcomes.

[1:35:14] And the review also includes

[1:35:16] focus group meetings and

[1:35:17] meetings with supervisors and

[1:35:18] directors at the county level.

[1:35:21] And then lastly, there is a

[1:35:23] post visit activity where there

[1:35:25] might be potential remediation.

[1:35:27] So all non compliant items that

[1:35:28] were found during the review

[1:35:30] need to be remediated within 60

[1:35:32] days of the review.

[1:35:34] And the lead agency will

[1:35:35] correct each of these items and

[1:35:37] then return that information

[1:35:39] back to DHS for our review.

[1:35:42] There's also potential for

[1:35:43] corrective action so that

[1:35:46] corrective actions can occur.

[1:35:48] >> When there's a certain

[1:35:50] number of

[1:35:52] >> items that are out of

[1:35:53] compliance, more than one,

[1:35:54] for example, that really needs

[1:35:57] warrants a little bit more

[1:35:58] deeper attention. So we we will

[1:36:01] issue that corrective action.

[1:36:03] The lead agency has 10 business

[1:36:05] days to develop and submit

[1:36:06] their plan to DHS. And that

[1:36:08] needs to outline how they're

[1:36:09] going to address each of those

[1:36:10] actions. And then there's

[1:36:12] follow-up post visit activities

[1:36:14] in the follow-up survey

[1:36:16] includes the agencies reporting

[1:36:17] back on there, how things are

[1:36:20] going

[1:36:21] with that corrective action

[1:36:22] plan and whether or not they're

[1:36:23] meeting the metrics and their

[1:36:24] plan that they've worked on

[1:36:26] with us. There is potential if

[1:36:29] elite agency is still

[1:36:30] struggling to comply with that

[1:36:32] corrective action plan where we

[1:36:33] would put them into like a

[1:36:35] shorten lead agency review in

[1:36:36] the next cycle.

[1:36:38] So in a nutshell, that's what

[1:36:40] the lead agency review is.

[1:36:42] There's also a follow-up survey

[1:36:44] where counties can give us

[1:36:45] feedback on how it's going,

[1:36:47] what we need to do to improve.

[1:36:48] I will say am I mentioned this

[1:36:51] earlier and it may be on a

[1:36:53] subsequent slide here, but we

[1:36:55] are really looking into as a

[1:36:56] part of lead agency review,

[1:36:57] making sure that we're asking

[1:36:59] and provide or lead agencies to

[1:37:01] a test whether or not they have

[1:37:03] insurance policies in place and

[1:37:05] their contracts with count with

[1:37:07] entities, private entities.

[1:37:09] If they do great, we might want

[1:37:11] to take a look at some of those

[1:37:12] insurance policies. If they

[1:37:13] don't, we're going to work with

[1:37:14] the lead agency to make sure

[1:37:15] that they've got that the

[1:37:17] quality assurance built into

[1:37:18] their contracts.

[1:37:23] And I think the last thing I

[1:37:24] wanted to mention on this slide

[1:37:26] just in the interest of time

[1:37:27] was in the 2026 session.

[1:37:28] The governor did recommend a

[1:37:31] few items related to a

[1:37:32] contractor to Weaver case

[1:37:33] management. And one of the

[1:37:34] items was 2. Look at the fees

[1:37:36] out of the use of contracted

[1:37:37] case management and throughout

[1:37:40] a long period of time during

[1:37:42] which we would be to evaluate

[1:37:43] rates and the so I think the

[1:37:44] governor recommended

[1:37:46] potentially phasing out the use

[1:37:47] of contracted case management

[1:37:48] as of 2031.

[1:37:50] That item did not make it

[1:37:52] across the finish line. But the

[1:37:54] rate evaluation that we

[1:37:55] recommended and representative

[1:37:57] fishers initiatives and

[1:37:59] actually Representative Gilman,

[1:38:01] I think we're closely on those

[1:38:02] as well. Did pass a we'll talk

[1:38:03] a little bit about those to

[1:38:04] end.

[1:38:06] So the initiatives that I just

[1:38:08] alluded to that Representative

[1:38:10] Fisher and they share Gilman,

[1:38:12] worked on, wanted to lift up

[1:38:15] the waiver case management

[1:38:16] advisory working group, first

[1:38:18] of all, and then we'll talk a

[1:38:20] little bit about the case

[1:38:21] management, great evaluation

[1:38:22] and recommendations.

[1:38:28] So the waiver case management

[1:38:30] advisory working group is in

[1:38:31] the process of being

[1:38:32] implemented right now. We have

[1:38:34] appointments that have went

[1:38:36] through the secretary of state

[1:38:37] process. I believe we got about

[1:38:39] 50 individuals who want to be a

[1:38:42] part of this working group,

[1:38:43] which is really great. And

[1:38:45] initially the the interest was

[1:38:47] a little bit slow to come in.

[1:38:48] But now we're we're heartened

[1:38:50] to know we've got a lot of

[1:38:51] great broad-based support.

[1:38:54] So this is a working group

[1:38:55] that's going to look at the

[1:38:56] quality of case management

[1:38:57] Weaver, case management

[1:38:59] work for sustainability.

[1:39:00] Accountability like we've been

[1:39:02] talking about today and just

[1:39:03] long-term stability of the case

[1:39:05] management system, CBS Case

[1:39:06] Management system, statewide

[1:39:09] recommendations are due to the

[1:39:10] legislature and the beginning

[1:39:12] of September 2027.

[1:39:15] So we look forward to doing

[1:39:16] this work. It will be open if

[1:39:18] there is interest, you know,

[1:39:19] from legislative staffer or

[1:39:21] legislative members reach out

[1:39:23] to us and we can let you know

[1:39:24] how to keep keep up with those

[1:39:26] discussions. We haven't quite

[1:39:28] started meeting at because it

[1:39:29] takes a while to get the

[1:39:30] funding one session ends in our

[1:39:32] accounts and then to get those

[1:39:34] secretary of state appointments

[1:39:36] completed. But hopefully we'll

[1:39:37] be starting to me pretty

[1:39:38] quickly to have a really robust

[1:39:40] discussion about what's needed

[1:39:42] in the system.

[1:39:46] Representative Fisher.

[1:39:48] >> Thank you. Chair Oppmann,

[1:39:49] thank you. Ms ground for the

[1:39:51] presentation. One of the

[1:39:52] questions I have is I so people

[1:39:54] have some people contacted me

[1:39:56] that are not going to be on the

[1:39:57] workgroup. They wondering what

[1:39:58] is the way for them to monitors

[1:40:00] and when they have to work who

[1:40:01] has a meetings, how can the

[1:40:02] public watch what's going on or

[1:40:04] be engaged in that process?

[1:40:06] Mister a.

[1:40:07] >> Our Chair, Representative

[1:40:08] Fischer. That's a great

[1:40:09] question. I asked that myself.

[1:40:11] I don't know that we have a

[1:40:13] determined

[1:40:15] pathway for that yet. But it is

[1:40:17] this is a group that will be,

[1:40:18] you know, subject to the open

[1:40:19] meeting laws. So there will be

[1:40:20] a way for public participation

[1:40:22] and to submit comment or

[1:40:23] feedback as well. But I can

[1:40:25] follow up with the committee

[1:40:26] and make sure that you have

[1:40:27] that information before we get

[1:40:28] going with it.

[1:40:30] >> Thank you very much.

[1:40:31] Appreciate that. I've got some

[1:40:32] folks that like to share with.

[1:40:34] So thank you.

[1:40:39] >> All right, Mister Chair, so

[1:40:41] I'm going to wrap up here so

[1:40:42] you can

[1:40:44] stop listening to me, talk and

[1:40:45] get to they can get to the

[1:40:46] county presentation here.

[1:40:48] But I did just want to mention

[1:40:50] really a core part of that.

[1:40:53] This discussion is making sure

[1:40:55] that we have sustainable Weaver

[1:40:56] case management rates system.

[1:40:59] Our rates for Weaver case

[1:41:01] management have not been

[1:41:02] changed in quite some time.

[1:41:04] They are flat rates, 15 minute

[1:41:06] units and they are not

[1:41:08] sustainable.

[1:41:09] We've had growing numbers of

[1:41:11] programs we have now counties

[1:41:13] are just trying to manage

[1:41:15] overwhelming case loads.

[1:41:17] So it really shouldn't be a

[1:41:18] surprise that we're struggling

[1:41:19] as a system and to sustain

[1:41:22] these services at the level and

[1:41:23] the quality that we want to.

[1:41:25] So last session, the

[1:41:27] legislature didn't act a

[1:41:28] provision that tells DHS that

[1:41:30] we need to go out there and

[1:41:32] study and at what the rate

[1:41:33] should be, what the costs are

[1:41:35] to provide case management

[1:41:37] water, some workforce

[1:41:38] pressures. What should a case

[1:41:40] loads look like? If we want a

[1:41:41] caseload of 30 people per case

[1:41:43] manager than then what is what

[1:41:45] is the cost of that

[1:41:47] as well as qualifications and

[1:41:48] training that we want in that

[1:41:50] particular workforce? So this

[1:41:53] is work that will be informed

[1:41:55] by the advisory workgroup and

[1:41:56] must be by law. So that was

[1:41:58] smart to kind of make these to

[1:42:01] dovetail those 2 requirements

[1:42:02] together and we will be

[1:42:04] submitting recommendations.

[1:42:06] The legislature in 2028, the

[1:42:08] end of 2028 with the

[1:42:09] recommended updated payment

[1:42:11] methodology to better fund this

[1:42:13] work.

[1:42:14] So that is just something that

[1:42:16] we've heard repeatedly from at

[1:42:18] the county level in particular

[1:42:20] that the system is really on

[1:42:22] the verge of

[1:42:23] collapse and we need to address

[1:42:24] the reimbursement rates there.

[1:42:28] Thank you, scrum.

[1:42:31] >> Representative Fisher

[1:42:32] Representative Keleman are kind

[1:42:34] of like Elisa. You guys didn't

[1:42:36] put up this work. That's on

[1:42:38] that 50 people wanting to be on

[1:42:39] it to you and and put yourself

[1:42:41] in their position is, you know,

[1:42:43] let the system.

[1:42:46] >> Thank you, Kara Hoffman.

[1:42:47] I let the represent Cuban speak

[1:42:50] for herself. I know that as I

[1:42:52] was looking at, it was letting

[1:42:53] the folks to the work at hand

[1:42:55] that was asking when they make

[1:42:56] someone that smart, I want to

[1:42:58] serve. I want to hear from the

[1:42:59] people that are in the

[1:42:59] trenches, want to see what

[1:43:00] they're doing, be involved, let

[1:43:02] them let them do it. Making

[1:43:04] sure that we've got the voices

[1:43:05] of people who are

[1:43:07] >> receiving the services.

[1:43:08] That's the big thing is making

[1:43:09] sure that their centered in

[1:43:10] this conversation. Okay.

[1:43:12] Did I understand that it may be

[1:43:14] something as we're going

[1:43:15] forward? It may not be

[1:43:16] one-size-fits-all is when you

[1:43:19] take a look at the different

[1:43:19] services that may have to be

[1:43:21] something establishing

[1:43:22] depending on the type of

[1:43:23] service may be what the case

[1:43:25] but racial might be in that

[1:43:26] particular service. I

[1:43:28] appreciate the work that the

[1:43:29] county's take a look at.

[1:43:31] I do understand the need for

[1:43:33] adjusting the rates and I

[1:43:34] appreciate I think we've got a

[1:43:35] good process set up and looking

[1:43:37] forward to the work getting

[1:43:38] underway. I like where you're

[1:43:39] going. He said one size fits

[1:43:40] all. It's not.

[1:43:41] >> Because I think about like

[1:43:42] Beltrami County operates

[1:43:44] completely different than that.

[1:43:45] Hennepin County.

[1:43:47] We're talking lots of

[1:43:48] difference, right? Its capacity

[1:43:50] size stuff like that.

[1:43:52] >> And I'd like to you and on

[1:43:54] the work that you guys, you

[1:43:54] guys were the ones who are

[1:43:55] really having this conversation

[1:43:57] last session. So hats off to

[1:43:59] you represent going for that.

[1:44:00] So having said, thank you.

[1:44:02] >> Ms crowd for that. This is

[1:44:04] this is where I wanted to go

[1:44:05] with this.

[1:44:06] >> Stuber at you get that

[1:44:08] Meacham.

[1:44:09] >> And the well, a cough are

[1:44:11] welcome for everybody. Knows

[1:44:12] the Hennepin County Eye on

[1:44:14] their forget.

[1:44:15] >> Get this with the newer.

[1:44:17] And I did a town hall in time

[1:44:19] and it was on this golf with

[1:44:20] the it wasn't all glitz.

[1:44:22] New Britain know Minneapolis.

[1:44:24] It was in Minneapolis in and

[1:44:26] and it was so many questions.

[1:44:28] The pup, Christine was there to

[1:44:29] cover that Christie. And it was

[1:44:31] like I should use. That was

[1:44:32] like Phil Donahue. I could just

[1:44:34] give him the microphone to.

[1:44:35] Well, I mean, you just

[1:44:36] absolutely a wealth of

[1:44:37] information that night. I'll

[1:44:38] never forget it. It's great.

[1:44:40] And I know I have to be kind to

[1:44:42] Pat Meacham because my needs

[1:44:43] texted me

[1:44:45] prior to this committee, Paul

[1:44:48] and said, you know what,

[1:44:50] they'll have me gyms comments.

[1:44:52] He better be nice to him.

[1:44:53] So I got well, I don't want to

[1:44:55] I don't want to be in trouble

[1:44:57] with my knees. So we're good on

[1:44:59] that.

[1:45:00] So thank you for being here.

[1:45:02] Kind of talk about I mean,

[1:45:03] this this issue.

[1:45:05] I can't believe how frustrated

[1:45:06] I am when I read the emails of

[1:45:09] up contacted case manager from

[1:45:11] a certain organization say that

[1:45:13] organization out loud if you

[1:45:14] want, but I won't because you

[1:45:16] guys all know who it is.

[1:45:17] That was so inappropriate.

[1:45:20] I'm giving you a question.

[1:45:22] I'm having fun it regardless.

[1:45:24] Don't personalize my question,

[1:45:25] right? I mean, how many times

[1:45:27] we've had this conversation

[1:45:28] throughout the years? You know,

[1:45:30] I I personalize some a lot of

[1:45:33] times, you know, and it's good.

[1:45:35] You call me out on that, right?

[1:45:37] But in this case, don't

[1:45:38] personalize it in an email to

[1:45:39] somebody. It's not about you.

[1:45:41] It's about the individual.

[1:45:42] That's why it breaks my heart.

[1:45:44] When AJ Klug, you did that

[1:45:45] story of an individual that was

[1:45:46] and housing support

[1:45:48] and she now is homeless.

[1:45:49] She's couch jumping. And I ask

[1:45:52] that certainly I get one person

[1:45:53] to just come forward and say I

[1:45:55] care, I want to get this

[1:45:56] person, the services they need.

[1:45:58] That person shouldn't be caught

[1:45:59] jumping, right. I think we all

[1:46:01] agree with that. Like where did

[1:46:03] the breakdown happened within

[1:46:04] the structured system of

[1:46:05] communicating to somebody to

[1:46:07] say there it is. And maybe I

[1:46:09] need to form some work groups

[1:46:10] to understand communication and

[1:46:13] I'm getting on the workgroup

[1:46:14] step. But that is really

[1:46:16] frustrating for me, Paul and

[1:46:17] in. So we had

[1:46:20] the governor saying this is

[1:46:22] what you know he wanted to do

[1:46:24] with

[1:46:25] contracted case management.

[1:46:26] We have folks

[1:46:28] that said, you know, no, you

[1:46:30] got to rethink this. You know,

[1:46:31] I'll never forget having the

[1:46:32] conversation. Michelle say car

[1:46:34] to year who said, you know,

[1:46:35] wait, you got a look at it this

[1:46:37] way to get people that are in

[1:46:39] this envelope have the

[1:46:40] conversation. And so thank you

[1:46:43] for being a 3 and commissioner,

[1:46:45] thank you for staying here with

[1:46:47] this in Christie. Thank you for

[1:46:48] being part of this, too.

[1:46:49] So all the mice,

[1:46:51] thank you chair often.

[1:46:53] >> First, FISA as chair off and

[1:46:55] ICE have our presentation ready

[1:46:56] to start with a brief review.

[1:46:58] I the county role in the

[1:47:00] validation.

[1:47:01] >> And that's what we wanted to

[1:47:02] know what you want to be valid

[1:47:03] issue, housing going. What is

[1:47:04] the county? Because it seems to

[1:47:06] me I keep asking this and you

[1:47:07] can as chair Newel who never

[1:47:08] forget anything. I ask him the

[1:47:10] question

[1:47:11] who's responsible for doing

[1:47:12] the, you know, exception on

[1:47:13] this is a person which clearly

[1:47:15] needs some

[1:47:16] some exceptions on this.

[1:47:17] It's like I just Im confused.

[1:47:19] So thank you for doing that.

[1:47:21] >> So very quickly on the

[1:47:23] county experienced Henry

[1:47:24] validation, the first thing is

[1:47:27] a reminder and for some of you

[1:47:28] may be an explanation.

[1:47:30] Something new that counties

[1:47:32] have a dual role. One is

[1:47:35] concentrating on continuity of

[1:47:36] care, both supporting our

[1:47:38] providers and responding to the

[1:47:40] needs of our residents and

[1:47:41] communicating with DHS on

[1:47:43] providing the continuity of

[1:47:45] care.

[1:47:46] The second one is the counties

[1:47:47] themselves are providers.

[1:47:49] So on that first issue, which I

[1:47:51] know is very important to this

[1:47:52] hearing on the continuity of

[1:47:53] care, one of our biggest

[1:47:55] challenges is related to the

[1:47:57] lack of providers, particularly

[1:47:59] in rural areas and

[1:48:02] in the rural areas. When we

[1:48:04] lose a large provider, the

[1:48:07] continuity of care is very

[1:48:08] limited. This may sound

[1:48:10] simplistic, but it's important

[1:48:12] to say out loud that we can

[1:48:13] only provide care as well as we

[1:48:15] have providers available to

[1:48:17] provide it.

[1:48:19] That is one of our biggest

[1:48:20] problems. And

[1:48:23] as far as the notification

[1:48:25] from, I'm from DHS U.S. a

[1:48:27] little bit more about that

[1:48:28] later. We do get a lot of

[1:48:30] coordination. A lot of

[1:48:31] notification from DHS will talk

[1:48:33] about on the next slide

[1:48:36] as a provider. We still have

[1:48:38] some counties waiting and

[1:48:39] appeals.

[1:48:41] We've had some of the same

[1:48:42] experience that other providers

[1:48:44] have had where we thought we

[1:48:46] were done. But then there are

[1:48:47] more requirements, more

[1:48:48] paperwork,

[1:48:50] counties taken clients really

[1:48:52] seriously. And so part of the

[1:48:53] reason why it is complicated

[1:48:55] for us is that we're trying to

[1:48:56] do as well as we possibly can.

[1:48:59] So we're trying to be very good

[1:49:01] students on and good providers

[1:49:03] there.

[1:49:05] And we're frustrated that

[1:49:06] process. But again, we

[1:49:08] understand this was initiated

[1:49:09] from outside the state

[1:49:12] and we understand that purpose

[1:49:14] of it. We also understand there

[1:49:15] are no, there's not a lot of

[1:49:17] new capacity added to DHS to do

[1:49:20] this. So

[1:49:23] go on into next slide.

[1:49:26] The court nation.

[1:49:27] I'm just covering this at a

[1:49:28] very high level. We have people

[1:49:32] that have been available to the

[1:49:33] counties to ensure continuity

[1:49:35] of care. So there are people we

[1:49:38] can call if we learned that

[1:49:41] county has an important

[1:49:42] provider that is getting close

[1:49:44] to shutting down because of a

[1:49:46] lack of payment, for example.

[1:49:48] And we've been able to and use

[1:49:51] that to try to push for the try

[1:49:55] to help agencies with appeals

[1:49:57] so that building can be

[1:49:59] restarted during those appeals.

[1:50:02] And then we've also been

[1:50:03] helping each other with our own

[1:50:04] Reid allegations. We have

[1:50:06] counties doing the usual county

[1:50:08] sharing thing, helping each

[1:50:10] other with documents. I'm

[1:50:11] helping each other with the

[1:50:13] trainings and other

[1:50:14] certifications that we need to

[1:50:15] provide to the state.

[1:50:17] One thing I don't have an here

[1:50:18] for coordination that I should

[1:50:19] have added is

[1:50:21] and I mentioned this in the

[1:50:22] hearing earlier this summer,

[1:50:24] we do get weekly lists

[1:50:27] providers and where they are in

[1:50:28] the revaluation process.

[1:50:30] And in the beginning, they were

[1:50:31] unwieldy and the state has DHS

[1:50:35] has really listen to provide or

[1:50:36] input on that. And also with

[1:50:38] the weekly,

[1:50:39] the weekly meetings and

[1:50:40] updates, the webinars they've

[1:50:43] listened to lead agency needs

[1:50:45] and that information has gotten

[1:50:46] a lot easier for us to use and

[1:50:49] which makes it easier for us to

[1:50:50] monitor providers and how

[1:50:51] they're doing is very valid

[1:50:52] ation.

[1:50:54] So to sum up, Rob, our role is

[1:50:56] free of allegation. Our

[1:50:57] experience with the right now.

[1:51:00] We are like everyone else

[1:51:02] popping up will be able to

[1:51:03] finish soon. I don't think

[1:51:05] there is a party involved that

[1:51:06] does not wish for that. You

[1:51:09] have any other questions about

[1:51:09] every validation before we go

[1:51:11] on to.

[1:51:12] >> And now I'm still trying to,

[1:51:12] you know, I know I think this

[1:51:13] is good because I'm still

[1:51:14] trying to figure out just,

[1:51:17] you know, the ideal charred

[1:51:18] about okay, you're doing this

[1:51:20] in in the process. How was this

[1:51:23] in effect? Who's the go to, you

[1:51:25] know, providers getting all

[1:51:26] that me say? I don't know to

[1:51:28] talk to us on hold with this

[1:51:30] group for 2 and a half hours

[1:51:31] and serious that there was

[1:51:32] somebody on hold for 2 and a

[1:51:33] half hours and luella knows

[1:51:34] what I'm talking about. It's a

[1:51:36] book, right? Why did that

[1:51:38] happen? You know, and then what

[1:51:39] can we do to fix it? So I'm

[1:51:40] just trying to your part of the

[1:51:42] counties in the retaliation

[1:51:43] process. I'm still trying to

[1:51:44] wrap my head around

[1:51:46] that system. Did we set it up?

[1:51:48] So it's working and I think

[1:51:51] you're answering that by the

[1:51:52] fact he would back. It said the

[1:51:53] department is now.

[1:51:54] >> Pretty nice, right is been

[1:51:56] listening to our concerns and

[1:52:00] making it easier for us to keep

[1:52:02] track of our providers and see

[1:52:03] how they're doing. And,

[1:52:07] you know, I'd say about the

[1:52:08] communication with that.

[1:52:09] We share the same concerns

[1:52:11] about communication and wanting

[1:52:13] to communicate with our

[1:52:14] residents.

[1:52:15] And just as a reminder,

[1:52:17] something to remember

[1:52:18] throughout this whole

[1:52:19] presentation, the when I talk

[1:52:22] about our residents and our and

[1:52:24] our clients for summer, smaller

[1:52:26] counties, we're literally

[1:52:27] talking about their neighbors

[1:52:29] that they know very well.

[1:52:30] So it's a very one-on-one sort

[1:52:32] of situation and a lot of

[1:52:34] counties and which is to say

[1:52:37] sometimes the accountability

[1:52:39] takes place in the grocery

[1:52:40] store.

[1:52:41] And so very, very important for

[1:52:44] us. That, of course, is not the

[1:52:45] same, as you know, the systems

[1:52:48] of communication that we're

[1:52:50] accountable for to the

[1:52:51] legislature and all taxpayers.

[1:52:54] And we recognize that there are

[1:52:55] some places for that could

[1:52:56] improve. And we have continual

[1:52:58] processes for working on that

[1:53:00] with the state and others.

[1:53:01] I think well, as some doubt on

[1:53:02] that

[1:53:05] it's called for.

[1:53:07] >> Hello, I chair members of

[1:53:09] the committee luck for a night

[1:53:11] senior department administrator

[1:53:12] with Hennepin County and also

[1:53:14] work with Max and the adult

[1:53:15] services.

[1:53:17] As you were talking chair.

[1:53:18] Kind of one of the things as

[1:53:20] Paul was answering that

[1:53:21] question is I think it's

[1:53:23] important for all of us to also

[1:53:25] remember, we work in a very

[1:53:26] complicated system. We talk

[1:53:28] about even the term continuity

[1:53:29] of care. I hear you talking

[1:53:31] about something and I don't

[1:53:32] think we're always even

[1:53:33] answering the same question

[1:53:35] because there are many

[1:53:36] complicated things that people

[1:53:37] who receive our services and

[1:53:39] the providers who are delivery

[1:53:40] services are trying to operate

[1:53:42] within our complicated system.

[1:53:44] And so I do think there are

[1:53:47] there are opportunities for us

[1:53:49] to improve. But I think as far

[1:53:51] as communication, one thing

[1:53:53] that's important for all of us

[1:53:54] is to like what I've been doing

[1:53:57] is really listening to what

[1:53:58] people are talking about and

[1:54:00] take a complicated part of our

[1:54:02] system and tease that apart and

[1:54:04] resolve the the barriers

[1:54:06] because sometimes I think we

[1:54:08] shortcut what we're thinking.

[1:54:10] We're trying to resolve and we

[1:54:13] all of our jobs is really to

[1:54:15] think about the cop, the system

[1:54:16] and the complexities of it that

[1:54:17] people are trying to navigate

[1:54:19] cell. That's one thing that I

[1:54:21] think I would just add in the

[1:54:22] continuity of care,

[1:54:25] their spurt certain things

[1:54:26] around provider Ravelo the sun.

[1:54:27] But sometimes that's not

[1:54:29] actually provide a re

[1:54:30] validation that the issue is

[1:54:31] about their couple of other

[1:54:32] things going on in our system.

[1:54:35] They're our continent of care.

[1:54:38] >> Thank you all for that that

[1:54:40] you Mr. Attack and indoors.

[1:54:42] Thank you.

[1:54:44] >> Thank you. Chair up and it's

[1:54:46] another questions about the

[1:54:48] validation that all moved to

[1:54:50] the county rolls contracted

[1:54:51] case management.

[1:54:58] >> Again, nobody. I think we're

[1:54:59] good.

[1:55:02] Representative Fish. Yeah.

[1:55:05] One of the things that comes I

[1:55:07] don't know if it's an easy

[1:55:08] number to come up with this.

[1:55:09] We hear about the number of

[1:55:10] providers out there.

[1:55:11] What I'm curious is how many

[1:55:13] people are being affected by

[1:55:14] that? What are the clients that

[1:55:16] are at risks that are losing

[1:55:17] their services? You know, we

[1:55:18] always hear the number the

[1:55:19] providers, but we don't hear

[1:55:20] about the clients themselves.

[1:55:22] And I think this is one of the

[1:55:23] things that is part at least

[1:55:25] for me to know when I talked to

[1:55:26] people because it well prior,

[1:55:28] let's just provided. You don't

[1:55:30] realize how many people are

[1:55:30] connected that are risking

[1:55:32] losing the service. And so

[1:55:33] having some kind of information

[1:55:34] on that line, I think would be

[1:55:36] helpful because when people

[1:55:37] start tossed out numbers back

[1:55:39] and forth, they forget about

[1:55:40] the individuals who need it and

[1:55:42] they don't realize how many

[1:55:43] people are being impacted by.

[1:55:45] You know, we hear overall

[1:55:46] Medicaid system that 1.2

[1:55:48] million. But when we're talking

[1:55:49] about this, the personnel that

[1:55:52] we are looking at, our clients

[1:55:53] are our citizens who are in the

[1:55:56] services are being Ravelo data

[1:55:58] right now. We lose that in the

[1:55:59] process and I think it's

[1:56:01] something that could help in

[1:56:02] like people of don't understand

[1:56:05] how much more serious it is,

[1:56:06] what we're talking about,

[1:56:08] how many people might be at

[1:56:09] risk losing service to some

[1:56:10] people. I think ultimately a

[1:56:11] couple of people, it's

[1:56:12] substantially more than that.

[1:56:13] But I don't have a number I'm

[1:56:14] ever give.

[1:56:18] >> I can start with an answer

[1:56:20] and then we'll see if the

[1:56:22] college have something to tear

[1:56:23] out. They'll go ahead at the

[1:56:25] time.

[1:56:26] This has been difficult for us

[1:56:28] to to gauge in some ways.

[1:56:31] One of the reasons is that the

[1:56:32] effect and the risk is delayed.

[1:56:34] So if and the agent, if a

[1:56:36] provider was to actually go

[1:56:38] under

[1:56:40] the speed of which that happens

[1:56:41] has to do with what they have

[1:56:43] for reserves. But their

[1:56:45] tolerance for risk is

[1:56:47] some of them. Smaller providers

[1:56:50] could go faster.

[1:56:53] And so it has there is for a

[1:56:56] long time. We still weren't

[1:56:58] hearing of anyone losing

[1:56:59] services directly.

[1:57:01] But the risk of that was high

[1:57:03] enough that it, you know,

[1:57:04] is the same level of alarm that

[1:57:07] we felt regardless of that.

[1:57:10] But it is it is hard to measure

[1:57:12] just because of that delay to

[1:57:14] fact a lot of providers for use

[1:57:16] 2 different kinds delays and

[1:57:19] what they see as delays in

[1:57:20] payments, which sometimes our

[1:57:21] normal process and times and

[1:57:23] sometimes our normal processing

[1:57:25] times are behind. Also.

[1:57:27] So as the low point that it is

[1:57:29] complicated, which is a long

[1:57:31] way of not giving you a number,

[1:57:32] but

[1:57:33] we can work towards that.

[1:57:34] Thank you,

[1:57:38] commissioner.

[1:57:41] >> So we can certainly, I think

[1:57:43] to a little bit of homework

[1:57:44] here to see if we can offer

[1:57:45] numbers. It's more difficult

[1:57:47] when we're talking about ouch.

[1:57:49] A patient providers, for

[1:57:50] example, of behavioral health

[1:57:51] services relative to a

[1:57:52] residential service provider

[1:57:53] words. It's more apparent to

[1:57:55] the number of folks that

[1:57:56] they're serving any one time.

[1:57:58] Sometimes it's retrospective

[1:57:59] looking at claims data. So it's

[1:58:01] complicated, but we we can

[1:58:02] certainly engage with you about

[1:58:04] how to estimate what that might

[1:58:05] be. And certainly I think we're

[1:58:07] doing our level best to the

[1:58:09] appeals process to maintain

[1:58:10] payment, responding to some of

[1:58:12] the concerns from Dr Larson and

[1:58:13] others with respect to

[1:58:14] authorizations and issues with

[1:58:15] the Sentra, putting them on a

[1:58:17] corrective action plan using

[1:58:18] the levers of that contract.

[1:58:19] So trying to avoid that outcome

[1:58:22] whenever possible. But

[1:58:24] appreciate the question.

[1:58:25] And we can certainly call.

[1:58:27] >> Mr. Chairman, add one thing.

[1:58:29] Absolutely.

[1:58:31] Thank you. And Representative

[1:58:32] Fisher broader than just the

[1:58:34] validation. I guess there.

[1:58:36] I wanted to just remind members

[1:58:38] there is a requirement around

[1:58:39] DHS posting a dashboard and

[1:58:41] outcomes related to continuity

[1:58:43] of care. So that is work that

[1:58:45] we are actively doing at the

[1:58:46] department. And and we have

[1:58:49] some

[1:58:51] kind of a patchwork of

[1:58:52] antiquated systems that we're

[1:58:53] using to track information

[1:58:55] related to continuity of care.

[1:58:57] So we are also actively working

[1:58:58] to have a more streamlined

[1:59:00] process so that we can identify

[1:59:02] where that each individual

[1:59:03] individuals impacted and work

[1:59:06] more closely and efficiently

[1:59:07] with lead agencies.

[1:59:09] Thank you, Chris. That is

[1:59:10] correct

[1:59:12] to Brett.

[1:59:14] >> Thank you. Chair now respond

[1:59:16] to speak at the county rolling

[1:59:18] contract. Its case management

[1:59:20] specifically waiver case

[1:59:21] management.

[1:59:23] The first thing I'd like to say

[1:59:25] is I really like the way I

[1:59:27] describe how late highlighted

[1:59:29] case management

[1:59:31] case management press is

[1:59:32] absolutely foundational.

[1:59:35] It is the be the case. Managers

[1:59:37] are the people who have the

[1:59:38] most contact us with the people

[1:59:40] we serve during very difficult

[1:59:43] times in their life. So as much

[1:59:45] as possible, even more than

[1:59:47] possible, if we can, we try to

[1:59:49] do it as well as effectively

[1:59:50] and caring with parents and as

[1:59:52] we can.

[1:59:54] So some of the needs of the

[1:59:56] reasons why we use contracted

[1:59:57] waiver case management. One of

[2:00:00] them is actually budget

[2:00:02] flexibility.

[2:00:04] Case management lows can rise

[2:00:06] and fall. It can be difficult

[2:00:09] for counties, particularly

[2:00:11] right now under financial

[2:00:13] stress to be able to add

[2:00:15] full-time employees very easily

[2:00:17] or quickly.

[2:00:19] And

[2:00:21] because property taxes operate

[2:00:23] at a different speed. And

[2:00:24] they're not quite as responsive

[2:00:28] is it gives us the flexibility

[2:00:30] to ensure that we meet our

[2:00:33] mandated needs, but also just

[2:00:35] the needs we have to serve.

[2:00:37] Our residents gives us the

[2:00:39] flexibility to be able to do

[2:00:40] that. And

[2:00:42] it's very important that we

[2:00:44] have that

[2:00:45] the second one is the need for

[2:00:47] culturally specific and

[2:00:49] specialty expertise.

[2:00:52] Second, the brain injury

[2:00:53] examples that, sir, one that

[2:00:55] we've seen a number of times

[2:00:58] also we have clients who may be

[2:01:02] a part of a culture that is not

[2:01:04] as well represented where they

[2:01:05] live. And so being able to get

[2:01:07] case management from agencies

[2:01:10] that are staffed and have

[2:01:13] boards of people from that

[2:01:14] community, I can be very

[2:01:16] effective and very helpful

[2:01:18] support for them.

[2:01:20] And then lastly, we already

[2:01:23] talked about the county of

[2:01:24] financial responsibility.

[2:01:26] It's a quick way that some of

[2:01:28] the maximum, but this is we are

[2:01:29] not pay for wind chill time.

[2:01:32] And also the other thing they

[2:01:34] remind us is that for some

[2:01:35] counties and rural areas to

[2:01:38] come to to come to say the Twin

[2:01:40] cities and no, the providers is

[2:01:42] something that

[2:01:44] is very difficult for them to

[2:01:46] do. So those are the the main,

[2:01:47] the 3 largest region reasons

[2:01:50] that we use waiver contracted

[2:01:52] case management. You know, I

[2:01:53] hear.

[2:01:54] >> I just leaned over to chair

[2:01:56] during an aching its that

[2:01:58] the ability to, you know,

[2:02:01] could somebody up to speed on

[2:02:03] this complicated system.

[2:02:06] Krista, technical assistance on

[2:02:07] that. And then there's this

[2:02:09] complete

[2:02:10] turn around. There's, you know,

[2:02:12] you see it for I could lose my

[2:02:15] case manager now was my case

[2:02:16] manager. And I was like a

[2:02:17] strategy now and it all goes

[2:02:19] down to deny. The other thing

[2:02:20] that lead over in line was

[2:02:24] it makes it difficult when, you

[2:02:26] know,

[2:02:27] leadership goes into a corner

[2:02:29] office

[2:02:30] and that decides to turn around

[2:02:33] and tell us to cut 300 million

[2:02:34] dollars without going through

[2:02:36] the process that we ensure the

[2:02:37] original thing

[2:02:39] last year was terrible

[2:02:42] because there are so many fixes

[2:02:43] that we wanted to do

[2:02:47] that. We could do

[2:02:49] great, not only fix fix fix,

[2:02:51] but I mean, you know, help the

[2:02:52] system be smooth or 2

[2:02:54] because we are hindered by the

[2:02:56] fact that we had, by the way,

[2:02:58] let's just look at health and

[2:02:59] human services. The human

[2:03:00] services is a bucket of cash

[2:03:02] for everything else we pay for.

[2:03:04] I'm tired of that.

[2:03:05] Tired of the the the narrative

[2:03:08] about Minnesota fraud, waste

[2:03:11] and abuse. Yes, it became

[2:03:12] political and it should have

[2:03:13] been because of the fact that

[2:03:14] people with disabilities are

[2:03:16] the ones who are already the

[2:03:16] most on it.

[2:03:18] And we can't pay our contracted

[2:03:19] case managers or case managers,

[2:03:21] the money that they do

[2:03:24] keeps me up at night, Paul.

[2:03:26] It really does say it's because

[2:03:27] it's like, alright, who's

[2:03:28] there. And in the meantime,

[2:03:30] I just keep seeing this woman

[2:03:31] who was part of the housing

[2:03:32] stabilization program and he's

[2:03:35] received was receiving services

[2:03:37] is now couch jumping in

[2:03:39] Minneapolis.

[2:03:40] I can't give them that

[2:03:42] because that baby shouldn't

[2:03:43] become a champion.

[2:03:46] This just what you hear is

[2:03:48] exactly what we want and what

[2:03:50] we need the culturally

[2:03:51] specific, you know, specific,

[2:03:53] culturally specific and

[2:03:53] special, the expertise got to

[2:03:55] be there, right?

[2:03:57] I just wish, you know,

[2:03:59] representative newer, you know,

[2:04:02] you hear from people, you know,

[2:04:04] that's a whole we're gonna

[2:04:05] structural deficit that we're

[2:04:06] going to have to kind of get

[2:04:08] next year.

[2:04:10] Whoever is the chair of this

[2:04:11] committee next year will have

[2:04:13] that same piece. But that

[2:04:14] shouldn't stop us from

[2:04:16] there's a need, but school

[2:04:17] fulfill it.

[2:04:18] >> If we truly care about if we

[2:04:20] truly believe in the Olmsted

[2:04:21] provision, if we truly believe

[2:04:22] that ultimately the services,

[2:04:24] what if we truly believe the

[2:04:25] counties are the ones or if we

[2:04:26] truly believe that, then let's

[2:04:28] start advocating for that

[2:04:30] Representative Door.

[2:04:32] >> Thank you, Mister Chair and

[2:04:33] thank you for this

[2:04:34] presentation. I do want to jump

[2:04:37] into this conversation but

[2:04:38] looking to the offense, the

[2:04:40] statement, the budget

[2:04:42] constraints

[2:04:44] given that was shifting

[2:04:46] the responsibility from the

[2:04:48] county too

[2:04:49] contracted case management

[2:04:52] and knowing that you will be

[2:04:54] having

[2:04:56] different case loads because

[2:04:58] one of the biggest that issue

[2:04:59] that we've been seeing is

[2:05:02] contract and case management or

[2:05:03] even if it's the county,

[2:05:05] the caseload for we but case

[2:05:07] management is higher compared

[2:05:09] to

[2:05:10] anything else. So do you know

[2:05:12] on average a month how many

[2:05:15] hours do case images provide

[2:05:17] services to the recipient so

[2:05:20] participants?

[2:05:24] >> Thank you, chair in Art.

[2:05:26] I'm minding checked in here.

[2:05:27] Really quickly. Might him

[2:05:29] first? Can you answer that for

[2:05:30] your county here?

[2:05:34] >> Break that there is you get

[2:05:36] to this. It makes sense.

[2:05:37] You want the how many hours to

[2:05:40] $0.70 to? Well, well.

[2:05:43] >> Chair law. So my first

[2:05:46] thought is we need to look at

[2:05:48] the numbers to see kind of like

[2:05:49] because DHS have the Billings.

[2:05:50] We can see the number of units,

[2:05:52] for instance, like Christine

[2:05:53] talked about the the it's

[2:05:56] billed like number of units.

[2:05:57] So we could take a look at

[2:05:59] that. They tie, you know,

[2:06:00] they report their time. I would

[2:06:01] say

[2:06:02] in part like when you think

[2:06:04] about the standards for waiver

[2:06:05] case management, there's a

[2:06:07] certain number of requirements

[2:06:08] of time that we need to spend

[2:06:09] with the person so like there's

[2:06:11] meeting the requirements and

[2:06:12] the time that might go into

[2:06:13] that. But of course,

[2:06:15] representative nor part of the

[2:06:16] answer that question is I don't

[2:06:18] know if there's an average

[2:06:18] because each person's

[2:06:20] individual needs are different.

[2:06:23] And so I will say, you know,

[2:06:24] last week I was watching case

[2:06:27] managers like help people move

[2:06:29] to a new it all residential

[2:06:31] setting. And it was like they

[2:06:33] probably were putting in 40

[2:06:35] hours, you know, working with

[2:06:37] one or 2 people. That's not

[2:06:39] that's not the norm, you know,

[2:06:40] probably for the average.

[2:06:42] And so I would I think we'd

[2:06:44] have to get a sense of, you

[2:06:46] know, what is the typical to

[2:06:47] meet the basic requirements of

[2:06:50] case management and what what

[2:06:51] Keibert waiver case managers

[2:06:52] must do. But then it's really

[2:06:54] driven by the individual

[2:06:56] situation and what's kind of a

[2:06:57] priority this week and how you

[2:06:59] know how many other people

[2:07:01] they're trying to help. So we

[2:07:03] have to look for the data to

[2:07:04] give you an actual answer.

[2:07:10] >> You could go ahead. Pat.

[2:07:12] Thank you. I think that

[2:07:13] Champaign County tap each image

[2:07:15] and disability services manager

[2:07:17] Pine County.

[2:07:18] I think the question

[2:07:21] not to just say it gets more

[2:07:22] complicated by thinking example

[2:07:24] to is for waiver case managers,

[2:07:26] one of mine this year had 8

[2:07:28] individuals in and out of the

[2:07:29] hospital.

[2:07:30] This is the summer.

[2:07:32] I don't we don't stop providing

[2:07:34] care at that time, but that's

[2:07:36] not waiver. Billable time.

[2:07:37] So to just expand on, well,

[2:07:39] as point like we could run that

[2:07:41] data, we can look at the

[2:07:43] department could pull the

[2:07:44] waiver bill in time. But

[2:07:46] there's so many other things

[2:07:47] that we do that are not being

[2:07:48] reimbursable to the counties.

[2:07:49] Also care doesn't stop just

[2:07:52] based on where they are that

[2:07:53] day.

[2:07:58] >> Hearing that the kid doesn't

[2:08:00] stop and knowing that we are

[2:08:02] waiting for their weight

[2:08:03] evaluation until December 2028.

[2:08:07] And given that if you compare

[2:08:10] that to the TCM, which is based

[2:08:12] on the monthly compared to the

[2:08:13] 15 minute unit full, you know,

[2:08:17] wave a case management,

[2:08:18] how are we going to fix this

[2:08:20] issue? Because I see the

[2:08:21] biggest gap that we have is the

[2:08:22] constraints of the budget that

[2:08:25] we have a kid full. We have a

[2:08:26] case pending. That's number one

[2:08:28] issue. How do we solve that

[2:08:29] issue to make sure that we're

[2:08:30] providing an effective fission,

[2:08:33] more compassionate care for

[2:08:34] those individuals were getting

[2:08:35] with the case. Managment

[2:08:36] substance.

[2:08:39] >> Thank you. Chair Chair

[2:08:40] Hoffman. Thank you. Chair are

[2:08:41] for your question.

[2:08:44] I would say one of that.

[2:08:45] It's difficult because

[2:08:47] we absolutely cannot wait and

[2:08:50] get the perfect long-term fix.

[2:08:51] So like a lot of problems with

[2:08:53] human services were trying to

[2:08:54] find short-term games gains.

[2:08:58] Well, not giving up on our

[2:08:59] long-term goals.

[2:09:01] I would say something happened

[2:09:03] between that is the the waiver

[2:09:06] case management working group.

[2:09:08] I think because of all the

[2:09:09] parties that will be involved

[2:09:11] in that we can come up with

[2:09:12] some recommendations.

[2:09:14] And I believe that finishes its

[2:09:16] September 2027. Is the report

[2:09:18] so

[2:09:19] that actually some of that work

[2:09:22] we'll be coming up

[2:09:24] will help us informed the

[2:09:25] process. And because those are

[2:09:28] public meetings, maybe there

[2:09:30] will even be preliminary

[2:09:32] results are findings that we

[2:09:33] could work with to try and

[2:09:35] improve the process.

[2:09:38] As far as

[2:09:40] you know, one of the difficult

[2:09:41] questions is, of course,

[2:09:44] the payment.

[2:09:45] The volatility to the workforce

[2:09:48] is no surprise when you

[2:09:49] consider that our case

[2:09:52] managers, whether contractor

[2:09:54] working for the county that are

[2:09:56] case managers are

[2:09:59] underpaid for very difficult

[2:10:01] work.

[2:10:03] And that is one of the things

[2:10:04] that leads to people moving

[2:10:06] from agency to agency. Also,

[2:10:08] when people are very good case

[2:10:10] managers,

[2:10:11] I can tell you that our

[2:10:13] counties compete for them

[2:10:16] and it's because we all want to

[2:10:17] provide the best care for our

[2:10:18] counties. But it does not

[2:10:20] contribute to the says the

[2:10:21] situation. I wish I had a very

[2:10:23] easy for you to answer for you

[2:10:25] chair in our, but I'm very

[2:10:26] happy to work with you on the

[2:10:27] answer. We do have some other

[2:10:29] ideas coming

[2:10:31] from our committees and max

[2:10:33] that will share with you.

[2:10:41] One thing I want to talk about

[2:10:42] is monitoring and support

[2:10:46] contracted Baver case

[2:10:48] management is not just the same

[2:10:51] as hiring say attempt to come

[2:10:53] in to an agency to do some sort

[2:10:56] of work that is repetitive and

[2:10:58] less skilled.

[2:11:00] We have to do a lot of work to

[2:11:02] make sure that our waiver case

[2:11:04] management is not isolated

[2:11:07] and that the work they're doing

[2:11:09] fits our demands and our our

[2:11:12] principles and what we want to

[2:11:14] see from our own case managers.

[2:11:16] I'll talk a little bit more

[2:11:19] about that in a second in

[2:11:20] detail. But I would say that

[2:11:22] the through line of what ice

[2:11:24] side and checking in with our

[2:11:25] counties about this and

[2:11:27] everything that we talked about

[2:11:28] last year is that the more that

[2:11:31] contracted waiver case

[2:11:33] management providers are

[2:11:35] integrated into the normal

[2:11:37] county

[2:11:38] case management teams, the

[2:11:40] better the communication is and

[2:11:43] the better the results are for

[2:11:45] our residents. So one of the

[2:11:48] foundational believes we have

[2:11:49] is that the same? We have the

[2:11:51] same response will be a

[2:11:52] responsibility of care to

[2:11:54] clients. Whether the person is

[2:11:57] being served by waive are case

[2:11:59] managed or contract case

[2:12:01] manager or one of the county

[2:12:02] case managers. There is no

[2:12:03] difference for us.

[2:12:05] We know of some counties that

[2:12:07] and dedicate more than 20

[2:12:09] full-time equivalent simply to

[2:12:11] manage and support contracted

[2:12:13] waiver case managers, many

[2:12:16] counties are providing training

[2:12:18] that's tailored to make sure

[2:12:20] that the case managers are able

[2:12:23] to meet the same standard of

[2:12:24] care.

[2:12:26] And here are some of the

[2:12:27] examples of things that some of

[2:12:28] the counties are doing.

[2:12:31] There are monthly forms for all

[2:12:33] the supervisors where they work

[2:12:35] with the contract that in case

[2:12:37] meant and I county case

[2:12:38] managers together in the same

[2:12:40] place annual August. Of course,

[2:12:42] we have a lot of support during

[2:12:46] really important and difficult

[2:12:48] times like transfers for

[2:12:50] services.

[2:12:52] We also have lots of subject

[2:12:53] matter experts that are

[2:12:55] actually assigned to individual

[2:12:58] contracted agencies. And then

[2:13:00] we have updates that basically

[2:13:02] are the same whether or not

[2:13:04] your contracted or case

[2:13:05] management contract that our

[2:13:07] county case management, we also

[2:13:09] provide training to get them up

[2:13:12] to speed on county and DHS

[2:13:14] policies

[2:13:16] and all the county procedures

[2:13:17] are based on ditches policies.

[2:13:26] >> I was asking new are the

[2:13:28] questions. Sorry, Paul, that

[2:13:30] you keep going? I think where

[2:13:32] people think you are. We're at

[2:13:34] 2.44, we're still having this

[2:13:36] conversation. If the answer,

[2:13:37] OK, we'll just keep going for

[2:13:39] the next 5 minutes. You know?

[2:13:41] Yes, so if you mean friends for

[2:13:43] the slides?

[2:13:44] >> Yes, a very quickly on that.

[2:13:46] Again. I was back in touch with

[2:13:47] the slightest. Want to

[2:13:48] reiterate that we have found

[2:13:49] the more that the county and

[2:13:51] the contractor case managers

[2:13:53] are integrated together in

[2:13:54] teams, the better the workouts.

[2:13:59] The last thing we'd also been

[2:14:01] asked to say a few things about

[2:14:04] the rate setting process our

[2:14:06] own role in perspective in

[2:14:07] that.

[2:14:08] I'm glad that Patrick is here

[2:14:10] today might be able to answer

[2:14:11] questions more specifically

[2:14:12] about this. It's a very

[2:14:13] complicated process.

[2:14:18] The process itself was laid out

[2:14:20] well and that the DHS

[2:14:22] presentation. But just from our

[2:14:25] perspective, what we see is

[2:14:26] very simply a service provider

[2:14:29] request a re ticks requests

[2:14:31] rate exception on behalf of a

[2:14:34] client. Then the case manager

[2:14:37] reviews that then it's the

[2:14:39] county submitted to DHS and

[2:14:41] then DHS approves or denies

[2:14:44] that. And then we have a

[2:14:45] responsibility to go back to

[2:14:47] the provider and the client.

[2:14:49] It is a complicated,

[2:14:51] complicated process and we all

[2:14:54] know the complicated processes

[2:14:55] can sometime processes can slow

[2:14:57] down.

[2:14:59] One of the things that would

[2:15:01] like to remain to remind

[2:15:02] everyone is that the more we

[2:15:04] use rate exceptions, the more

[2:15:06] it can raise the cost of care

[2:15:07] in Minnesota and the cost of

[2:15:09] these services is one of the

[2:15:11] reasons why we have to have a

[2:15:12] lot of difficult conversations

[2:15:15] last session, the one before

[2:15:16] that and this coming session.

[2:15:19] We do know that there are

[2:15:20] delays in processing of both

[2:15:22] the county and state level.

[2:15:25] And

[2:15:26] we also know that there are

[2:15:28] some I learned that there are

[2:15:30] some differing interpretations

[2:15:31] of the statute between

[2:15:32] providers, counties in the

[2:15:35] state, specifically over who

[2:15:38] not to say U.S., final say, but

[2:15:39] the nature of the decision,

[2:15:41] a step in the process

[2:15:44] and counties we do. We do feel

[2:15:46] pressure to support the rate

[2:15:48] expectations

[2:15:49] and that that pressure to serve

[2:15:52] think that our residents as

[2:15:53] well as we can

[2:15:55] can make it difficult to go

[2:15:57] through these because if we see

[2:15:58] a lot of rain, exceptions being

[2:16:00] requested,

[2:16:02] then you know me that we worry

[2:16:04] about the rate or the service

[2:16:06] itself. And that is something

[2:16:07] that's hard for us to

[2:16:09] and the long term of working on

[2:16:10] it legislatively. But we have

[2:16:13] clients sitting in front of us.

[2:16:14] And so we're hoping to get the

[2:16:16] right

[2:16:17] the right information to them

[2:16:18] and make the right decision

[2:16:21] and we cannot go into questions

[2:16:22] or C.

[2:16:23] >> Yeah, I think the discussion

[2:16:24] I city they're in Christie had

[2:16:26] mentioned it earlier and I just

[2:16:28] brought it up and that's what I

[2:16:29] was leaning over to it.

[2:16:30] >> To represent new around is

[2:16:31] that, you know, is there a way

[2:16:32] we could do that? What would

[2:16:33] that look like receiver to do

[2:16:35] an interim rate increase or is

[2:16:36] there could you provide some

[2:16:37] technical assistance for

[2:16:39] all of us? You would.

[2:16:42] What? What? What would that?

[2:16:44] Look, the shaking is somewhat

[2:16:45] you answer my question.

[2:16:48] >> Mister Chair. Yes, we could

[2:16:50] provide technical assistance.

[2:16:51] I think oftentimes when we

[2:16:53] identify any rate in the

[2:16:55] Medicaid system that's in need

[2:16:56] of, you know, an increase or

[2:16:58] modification to the

[2:16:59] methodology. We oftentimes see

[2:17:00] the legislature

[2:17:02] investing some at the front end

[2:17:03] while we wait for that long

[2:17:05] term solution that Mr. Bret

[2:17:06] mentioned so if the legislature

[2:17:08] say wanted to maybe get some

[2:17:10] fiscal technical assistance,

[2:17:12] we could we could provide you

[2:17:14] that information. These are

[2:17:16] historic flat rates and I don't

[2:17:17] believe they have inflationary

[2:17:19] update. So I think I'd be

[2:17:20] pretty simple to draft that.

[2:17:22] And it would just be a matter

[2:17:23] of serve what the state can

[2:17:24] afford

[2:17:28] words. Yeah, like that.

[2:17:30] >> What options? What options

[2:17:31] exist for us this crime?

[2:17:33] So

[2:17:36] Mister Chair.

[2:17:38] >> Thank you, Mr. Chen just

[2:17:39] wanted to inquire full TCM.

[2:17:41] We may have exceptions based on

[2:17:43] the need to find individual.

[2:17:45] Do we have exceptions in wave a

[2:17:47] case management,

[2:17:48] the rates that we've thing to

[2:17:50] the case manages if it's a

[2:17:52] complex case that they're

[2:17:54] doing.

[2:17:57] >> The answer. No. Mister Chair

[2:17:58] chair in or not. To my

[2:18:00] knowledge, I double checked the

[2:18:01] fee schedule this morning and

[2:18:03] we've got a 15 minute unit for

[2:18:05] regular case management.

[2:18:07] I think there's another 15

[2:18:08] minute unit for a

[2:18:09] paraprofessional level. Right?

[2:18:11] But beyond that, there's no

[2:18:12] customization.

[2:18:14] >> We want to do. Are you

[2:18:15] going? What are you thinking of

[2:18:17] the affected? Sometimes they're

[2:18:19] working outside of the round,

[2:18:20] not billable hours. They're

[2:18:22] doing something that's really

[2:18:23] unique to the individual's

[2:18:24] needs to be headed with that.

[2:18:27] >> Yes, such and I think we I

[2:18:29] don't like knuckle assistance

[2:18:31] is to add all those factors

[2:18:32] into consideration.

[2:18:36] Thank you, everybody.

[2:18:38] I want to thank everybody for

[2:18:40] being here this. I want to see

[2:18:42] this conversation happened

[2:18:44] a lot and I'm still I'm still

[2:18:47] upset about last year or this

[2:18:48] past year, 300 million dollars

[2:18:50] all said he got a tattoo

[2:18:52] million. Doesn't help us do

[2:18:54] what you need. A commissioner

[2:18:55] Cali that's addressed for the

[2:18:58] system doesn't help us really

[2:19:01] do it. But really our citizens

[2:19:03] need

[2:19:04] it doesn't surprise me that one

[2:19:06] of the organizations that was

[2:19:07] mentioned today is of has a big

[2:19:10] investor. That's a private

[2:19:11] equity firm. The county kind of

[2:19:12] scares me. I would

[2:19:14] that why are they start to dip

[2:19:16] into the the round of our

[2:19:19] systems work? Is that become a

[2:19:21] hindrance to the system?

[2:19:22] Worked in the city? That's a

[2:19:23] question. That's not a

[2:19:24] statement.

[2:19:26] Knowing that the on the federal

[2:19:27] level the CMS is Stratton.

[2:19:30] Something's Minnesota's got a

[2:19:32] bunch of myths out there.

[2:19:34] Even Kcp 5 does it didn't

[2:19:36] article on, you know,

[2:19:37] dispelling the myth of of

[2:19:39] Minnesota. This fraud, waste

[2:19:41] and abuse. Right

[2:19:42] fries Fried is for the very

[2:19:44] first hearing. I did as chair

[2:19:46] knew or was here 4 years ago

[2:19:48] was on Friday.

[2:19:50] It's something that we've dealt

[2:19:51] with every year. This sessions,

[2:19:53] the sessions that we've had.

[2:19:54] We've always dealt with that

[2:19:56] Minnesota is a

[2:19:59] and you look at what other

[2:20:00] states compare ability

[2:20:03] Freitas Freitas pride that

[2:20:05] that. But when you compare us

[2:20:06] to New York,

[2:20:07] Florida, Texas,

[2:20:12] like Ball goes out there to the

[2:20:14] Rose Revolution. They're ready

[2:20:15] to rev up revelation of what we

[2:20:18] are doing. Great.

[2:20:21] We can do better. And I I think

[2:20:23] it's really contingent upon the

[2:20:24] counties and the and the state

[2:20:26] to and what they're doing.

[2:20:28] That work group that Gilman and

[2:20:31] Fisher, you know, put together

[2:20:32] in statute, I think will be

[2:20:34] good to see what happened.

[2:20:35] So I appreciate you all being

[2:20:37] here and thank you for allowing

[2:20:39] that flexibility and Sen

[2:20:40] Representative Moore Tu Gilman

[2:20:43] and Fisher and the rest of your

[2:20:45] team. So once the car was here

[2:20:46] to I appreciate you guys come

[2:20:48] inside

[2:20:50] a final statement, commissioner

[2:20:51] for

[2:20:53] call that the commissioner.

[2:20:55] Go ahead.

[2:20:56] >> Sheriff Man, just thanks

[2:20:56] again for the opportunity.

[2:20:57] Thanks from 2 members of the

[2:20:59] committee. And again, I just

[2:21:00] want to know we heard a great

[2:21:02] deal of feedback today.

[2:21:03] Government is continuous

[2:21:04] improvement. We will continue

[2:21:05] to engage, try to do better and

[2:21:08] I'll share a mole statement.

[2:21:10] We do want to work through this

[2:21:12] is expeditiously as possible

[2:21:13] and will continue to to engage

[2:21:15] in a problem solving fashion.

[2:21:17] 2 imperatives of continuity of

[2:21:18] care and the highest possible

[2:21:20] program integrity. Thank you

[2:21:21] all very much. Appreciate that.

[2:21:22] We are adjourned

Committee on Human Services

Agenda

Transcript