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>> And operationally

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sustainable for qualified

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providers, serve individuals

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with the most complex

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disabilities, Wafa serving the

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safe, dignified community base

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choices.

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What I hope we get and I

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invited the house, our House

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counterpart. Is that how you

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say that, Peter?

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And it's about improving

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access, not creating disputes

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between the department, the

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lead agencies or providers.

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The school is collaboration

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amongst them as well as

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legislators, families and

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advocates to ensure that the

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individuals receiving those

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services remain at the center

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of the discussion. We talk all

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session long about continuity

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of care.

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And it's the focus on the

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individual disabilities to

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focus on the individual needing

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the services that we

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I have to remind us of this is

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what it's about.

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We have I lived on Gilman who

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was co-chair of the House

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committee is there. Peter

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Fisher is in here. My new is on

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his way.

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I

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Natalie Zone that she's there.

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Nice welcome. And as other

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members come on, I'll make sure

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introduce them as well. And I

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also wanted to mix things up a

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little bit.

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Last time we did a a hearing.

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I felt rushed at the end with

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him,

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the folks that receive the

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services. And so talking with

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the commissioner talking with

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the county's just I want to

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start

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this hearing hearing from

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people that are the ones

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are affected by what's

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happening right now within the

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system of change. So we haven't

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zoom

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folks in the end that are going

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to be doing it. Helen, you're

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going to be the first person

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live from Beaver Frontiers.

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Thank you for coming in to talk

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to that. And then Trisha,

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far tune and then we'll and

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with a video,

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Peter or Don, you guys want to

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say they have behalf of the

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guests of the House

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dons coming on. Can you top

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Don?

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>> Yes, care. All right.

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Welcome, thanks. All right.

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Thanks so much. Promise chair

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and again, thanks to that

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Minnesotans that are showing it

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today, too, share their

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experience. And I again, we are

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here open ears to hear what the

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solutions are going to be.

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Thank you for having us.

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>> Thank you, John. Peter

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Fisher,

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thank you. Chair Poppe and once

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again else like that. So thank

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you, everyone for taking the

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time to be here today. It is

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critical that we continue to

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remain focused on making sure

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that our people who need the

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services are continuing to get

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it and trying to fit. What is

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the best way to do that is we

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have our continuing evolving

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environment. Things that have

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worked in the past may not work

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now on things that did work in

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the past may not work. So these

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are the things that we want to

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get together and buy everyone

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coming together. Hopefully

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we'll find a better way to

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deliver services that meet

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everybody's needs. Thank you,

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Peter.

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I thought at least chair.

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>> Thank you, Mister Chair and

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I appreciate the content your

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content

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continuation.

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>> Of censoring the voices of

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the folks that are receiving

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the services, the folks that

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have been impacted the most.

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I think that

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the impact on them is is what

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has been the most devastating.

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And the stories that we've

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heard throughout the session

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has been heartbreaking at

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times. And so looking forward

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to hearing from then from that

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from the agency and seeing what

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we can do to ensure that

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continue to share as we've been

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talking about all that session.

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So thank you so much.

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>> Thank you for the reminder.

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I appreciate you. That is

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something that we do talk about

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Sanam Ahmed Senator mom is with

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this. You want to say some

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things and every on a waiting

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to do. You're good. Thank you.

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So with that, I'm Eric, the

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first folks that will be

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talking to us or Erica Larson,

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who's the chair of the Autism

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Treatment Association. If

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anything, it is in the state of

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Minnesota. Eric, you've kind of

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been the

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focal point. I remember years

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back. So it's nice to see you

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and zoom and then we'll go to

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Arlen Christensen and then

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Addison Carpenter and then

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sure, all bocken, so Mr.

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Dr Larson.

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>> Thank you. I assume you can

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hear me right now. We can.

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Yes. So chair Hoffman and

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members of the committee I'm

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presenting on the sequel to the

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revaluation challenges which

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Joel Bach and we'll cover it in

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detail.

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But at this point, pick up with

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ever since

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the December's sudden border

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from the U.S. EMS produce a

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corrective action plan for

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combating fraud. The families

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and providers of had to work

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diligently to restore the

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interrupted coverage and

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staffing that's been severely

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disrupted by a series of poorly

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implemented strategies to

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address the need for

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rehabilitation. After 8 months

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of work, we now still only have

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2 thirds of the autism provider

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locations being re-evaluated

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for authorized coverage of

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medically necessary. The IDB I

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treatment.

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But once that hard work was

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completed, the families and

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providers have now been

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surprised and frustrated to

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discover that the state's

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authorization contractor picks

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Sentra

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was now failing to authorize

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the treatment of 1000 children,

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which is one-third of the

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entire group of children who

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receive tough road. The first

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service coverage of the eye,

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the eye in the state of

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Minnesota

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as a result of eccentrics

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failure. The providers estimate

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that they will have the income

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to continue providing services

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to the children for about 3

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months, leaving all of the

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families to worry that their

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treatment will collapse.

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All of this is despite the fact

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that the state's treatment

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manual calls for eccentric to

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process authorization request

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within 7 days because of the

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children in serious need for

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treatment.

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So it's frustrating that at

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least 800 of these children are

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only seeking authorization to

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continue the care that was

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already authorized in the prior

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6 months.

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It's also frustrating that each

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child's licensed professional

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had spent many hours directly

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value each child and developing

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a highly individualized

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treatment plan that runs to 40

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pages detail.

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It's further frustrating,

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learned the eccentric is owned

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by the global investment for

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Carlisle. And yet they only

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spare the money to pay for to

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professionals to review and

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approve these detailed

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evaluations and treatment plans

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and to further compound the

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frustration. We learned that

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both the state of Maine and

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North Carolina when faced with

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similar eccentric delays, we're

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able to immediately clear up

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backlogs by authorizing media

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coverage for continuity of

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care.

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We ask that our children be

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able to immediately access the

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treatment as determined by

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licensed professionals of

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Minnesota who stand on their

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assessments and prescriptions

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as regulated by the state of

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Minnesota.

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These Minnesota professionals

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are highly regarded license

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behavior. Analysts love Long

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served the needy children.

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Adam Record represents 24 these

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autism treatment organizations

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serving more than 2,500

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children with autism across

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Minnesota.

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Our members provide medically

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necessary autism therapy that

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depends on regular predictable

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Medicaid reimbursement to

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remain operational.

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All of the services in question

259
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have already been delivered and

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the clinicians hate before the

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members submit their bills to

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the state of Minnesota.

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Yes, the ongoing interruption

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of authorization of coverage is

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not survivable for many autism

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providers, most of which are

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small businesses or nonprofit

268
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organizations.

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They operate on narrow margins

270
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and rely on the state of

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Minnesota to meet legal

272
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Medicaid of locations.

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When the providers will be

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forced to lay off staff and

275
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suspend services to the

276
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families, they will not be able

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00:09:19,660 --> 00:09:21,450
to quickly resume. Once the

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00:09:21,450 --> 00:09:23,340
determination is successfully

279
00:09:23,340 --> 00:09:26,250
appealed, it will only be then

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00:09:26,250 --> 00:09:27,530
that they can renew their

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00:09:27,530 --> 00:09:29,530
request for authorization,

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00:09:29,770 --> 00:09:31,330
which is a lengthy process

283
00:09:31,330 --> 00:09:34,170
itself. An attempt to recruit

284
00:09:34,170 --> 00:09:35,870
the employees could not be

285
00:09:35,870 --> 00:09:37,870
fired.

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00:09:38,340 --> 00:09:40,100
There is an immediate and

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00:09:40,100 --> 00:09:42,340
appropriate solution that can

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00:09:42,340 --> 00:09:45,140
be implemented this very day at

289
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no costs.

290
00:09:46,850 --> 00:09:49,410
We request that the DHS

291
00:09:49,410 --> 00:09:51,100
immediately authorize

292
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continuity of care to enable

293
00:09:53,790 --> 00:09:55,710
the providers to continue to

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serve the children that have

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already been authorized for

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coverage in prior intervals and

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00:10:02,270 --> 00:10:04,430
continue to provide evidence of

298
00:10:04,430 --> 00:10:06,830
medical necessity for whatever

299
00:10:06,940 --> 00:10:08,480
time in the future, That IX

300
00:10:08,480 --> 00:10:10,890
center is able to regain its

301
00:10:10,890 --> 00:10:12,680
composure to meet its

302
00:10:12,680 --> 00:10:14,520
obligations.

303
00:10:14,520 --> 00:10:16,560
We also request that eccentric

304
00:10:16,560 --> 00:10:18,120
be required to meet its

305
00:10:18,120 --> 00:10:20,120
contractual obligations.

306
00:10:20,450 --> 00:10:23,180
And Ron, the estimable bankroll

307
00:10:23,180 --> 00:10:25,600
of Carlisle to do so.

308
00:10:25,600 --> 00:10:27,740
Minnesota can address fraud

309
00:10:27,740 --> 00:10:29,590
without dismantling these

310
00:10:29,590 --> 00:10:31,590
essential autism services.

311
00:10:32,300 --> 00:10:34,200
But this current failure will

312
00:10:34,200 --> 00:10:36,420
result in provider closures

313
00:10:36,560 --> 00:10:38,660
longer. Waitlists and children

314
00:10:38,660 --> 00:10:40,470
are losing services through no

315
00:10:40,470 --> 00:10:42,850
fault of their own.

316
00:10:42,850 --> 00:10:45,230
The I D D I for a fee for

317
00:10:45,230 --> 00:10:47,790
service program is a heavily

318
00:10:47,790 --> 00:10:49,790
regulated program that was

319
00:10:49,790 --> 00:10:52,400
developed with extensive public

320
00:10:52,400 --> 00:10:54,800
and professional input over the

321
00:10:54,800 --> 00:10:55,640
course of 30 years in

322
00:10:55,640 --> 00:10:57,100
Minnesota.

323
00:10:57,100 --> 00:10:58,830
The program was intentionally

324
00:10:58,830 --> 00:11:00,710
designed to include direct

325
00:11:00,710 --> 00:11:03,110
oversight, both within and

326
00:11:03,290 --> 00:11:05,690
external to the providers,

327
00:11:05,690 --> 00:11:07,710
as well as to purposefully

328
00:11:07,710 --> 00:11:09,710
include extensive parent

329
00:11:09,750 --> 00:11:11,540
participation.

330
00:11:11,540 --> 00:11:13,820
These features are designed to

331
00:11:13,820 --> 00:11:16,820
prevent waste, fraud and abuse.

332
00:11:16,960 --> 00:11:19,140
And the providers only seek to

333
00:11:19,140 --> 00:11:21,140
receive the authorization for

334
00:11:21,140 --> 00:11:23,280
payment for these highly

335
00:11:23,280 --> 00:11:26,280
regulated services in order to

336
00:11:26,410 --> 00:11:28,800
face this incredible backlog.

337
00:11:28,800 --> 00:11:32,100
That is frustrating all of us.

338
00:11:32,100 --> 00:11:35,100
Thank you for your attention.

339
00:11:35,940 --> 00:11:37,350
>> Thank you, doctor and images

340
00:11:37,350 --> 00:11:38,510
you may members there in your

341
00:11:38,510 --> 00:11:39,330
packet are.

342
00:11:39,330 --> 00:11:41,390
>> All the letters that we got

343
00:11:41,390 --> 00:11:44,370
as well from people. So.

344
00:11:44,370 --> 00:11:46,240
>> It's it there in the packet

345
00:11:46,240 --> 00:11:48,510
for you, Mr. Christensen,

346
00:11:48,510 --> 00:11:50,700
Arlen Christensen, Welcome to

347
00:11:50,700 --> 00:11:52,450
the committee.

348
00:11:52,450 --> 00:11:54,510
>> Thank you very much.

349
00:11:54,510 --> 00:11:55,750
Thank you for allowing me to

350
00:11:55,750 --> 00:11:57,940
speak today. Speaking on the

351
00:11:57,940 --> 00:11:59,350
topic,

352
00:11:59,350 --> 00:12:00,310
but my life and I are

353
00:12:00,310 --> 00:12:02,240
caregivers of her. 39 year-old

354
00:12:02,240 --> 00:12:04,210
son live with us.

355
00:12:04,210 --> 00:12:06,540
He is honored Cdcs under that

356
00:12:06,540 --> 00:12:08,290
the waiver

357
00:12:08,290 --> 00:12:10,340
in the past. I was an executive

358
00:12:10,340 --> 00:12:12,330
director for Arc. Can you

359
00:12:12,330 --> 00:12:13,840
county?

360
00:12:13,840 --> 00:12:16,660
I think it for over 35 years.

361
00:12:16,660 --> 00:12:18,400
My goal is to advocate for our

362
00:12:18,400 --> 00:12:19,950
son.

363
00:12:19,950 --> 00:12:22,350
True and correct assessment.

364
00:12:23,130 --> 00:12:24,380
There are many topics of

365
00:12:24,380 --> 00:12:26,380
concerns addressed today,

366
00:12:26,600 --> 00:12:27,750
but I want to touch on one

367
00:12:27,750 --> 00:12:30,610
issue that does not make sense

368
00:12:30,610 --> 00:12:32,200
in the assessment for the TD

369
00:12:32,200 --> 00:12:33,370
waiver.

370
00:12:33,370 --> 00:12:36,200
He's a variable call medical

371
00:12:36,200 --> 00:12:38,550
for 25 years. Our son is always

372
00:12:38,550 --> 00:12:41,550
ban or 3 on call next.

373
00:12:42,390 --> 00:12:44,540
Since the revision that has

374
00:12:44,540 --> 00:12:46,940
changed office visits only

375
00:12:48,630 --> 00:12:50,690
I'm not sure since our sons

376
00:12:50,690 --> 00:12:53,270
needs are hired with his

377
00:12:53,270 --> 00:12:55,800
declining health,

378
00:12:55,800 --> 00:12:57,300
the on call medical the did

379
00:12:57,300 --> 00:12:59,100
because of the need for I'm

380
00:12:59,100 --> 00:13:01,920
Cole train personnel to assist

381
00:13:01,920 --> 00:13:03,610
with the seizure disorder that

382
00:13:03,610 --> 00:13:05,200
he asks.

383
00:13:05,200 --> 00:13:06,490
The letter was given from our

384
00:13:06,490 --> 00:13:09,160
sons are all just stating he is

385
00:13:09,160 --> 00:13:12,760
a very high grass status injury

386
00:13:13,140 --> 00:13:14,700
or death.

387
00:13:14,700 --> 00:13:16,990
That's that the on call trained

388
00:13:16,990 --> 00:13:18,680
carriers,

389
00:13:18,680 --> 00:13:20,140
our son and had a history of

390
00:13:20,140 --> 00:13:22,140
status seizures.

391
00:13:22,690 --> 00:13:24,200
In the letter he stated that

392
00:13:24,200 --> 00:13:28,400
EMS its second year, the fur on

393
00:13:28,410 --> 00:13:31,410
call medical the is ASAP.

394
00:13:32,350 --> 00:13:34,750
Delaying medical treatment may

395
00:13:34,800 --> 00:13:36,800
have bad outcomes.

396
00:13:37,530 --> 00:13:39,560
Person, seizures are 8 to 12

397
00:13:39,560 --> 00:13:40,690
week.

398
00:13:40,690 --> 00:13:43,140
He is angry surgery. The NSA

399
00:13:43,140 --> 00:13:44,470
implant

400
00:13:44,470 --> 00:13:46,870
I every and I see you're met

401
00:13:46,870 --> 00:13:49,870
out there with limited success.

402
00:13:49,920 --> 00:13:51,730
Her seizure protocol is making

403
00:13:51,730 --> 00:13:53,540
sure he is safe

404
00:13:53,540 --> 00:13:55,760
time. The seizure and using our

405
00:13:55,760 --> 00:13:56,860
maintenance that we have for

406
00:13:56,860 --> 00:13:59,250
are being asked to try to stop

407
00:13:59,250 --> 00:14:01,650
the seizure if possible.

408
00:14:01,740 --> 00:14:04,500
After 2 minutes were advised to

409
00:14:04,500 --> 00:14:06,200
administer rescue medications

410
00:14:06,200 --> 00:14:07,270
that we have

411
00:14:07,270 --> 00:14:09,670
and then call EMS.

412
00:14:09,720 --> 00:14:10,980
The problem is that his

413
00:14:10,980 --> 00:14:13,360
seizures have not reach the 2

414
00:14:13,360 --> 00:14:15,620
minute to give him the rescue

415
00:14:15,620 --> 00:14:16,720
mats

416
00:14:16,720 --> 00:14:18,480
and that's per the criteria

417
00:14:18,480 --> 00:14:20,790
policy of the revision.

418
00:14:20,790 --> 00:14:22,850
The on call treats services are

419
00:14:22,850 --> 00:14:24,850
not be,

420
00:14:24,930 --> 00:14:26,220
but I think they could be any

421
00:14:26,220 --> 00:14:27,520
time.

422
00:14:27,520 --> 00:14:29,620
His seizure of a lasting 60 to

423
00:14:29,620 --> 00:14:31,620
90 seconds

424
00:14:31,900 --> 00:14:33,220
that are all just stated.

425
00:14:33,220 --> 00:14:34,600
There are some will always have

426
00:14:34,600 --> 00:14:35,890
seizures

427
00:14:35,890 --> 00:14:37,470
because is the progression of

428
00:14:37,470 --> 00:14:39,690
the disease and our son's

429
00:14:39,690 --> 00:14:41,680
health condition

430
00:14:41,680 --> 00:14:44,510
in 2023. Her son was diagnosed

431
00:14:44,510 --> 00:14:46,910
with stage 3 colon cancer.

432
00:14:47,740 --> 00:14:49,740
12 people treatments

433
00:14:50,250 --> 00:14:51,880
at the present. The oncology if

434
00:14:51,880 --> 00:14:53,500
he's watching some suspicious

435
00:14:53,500 --> 00:14:55,500
spots and slots.

436
00:14:56,220 --> 00:14:57,670
>> The assessor and appeal

437
00:14:57,670 --> 00:15:00,000
judge stated that since he did

438
00:15:00,000 --> 00:15:01,850
not have standing seizures in

439
00:15:01,850 --> 00:15:04,120
the past year and you cannot be

440
00:15:04,120 --> 00:15:05,960
given the code 3 on call

441
00:15:05,960 --> 00:15:07,660
medical.

442
00:15:07,660 --> 00:15:09,920
This is what is very troubling

443
00:15:09,920 --> 00:15:11,530
and wrong.

444
00:15:11,530 --> 00:15:14,310
Caregivers have to be ready in

445
00:15:14,310 --> 00:15:16,880
case a seizure call Kurz and

446
00:15:16,880 --> 00:15:20,480
fall of protocol at any time.

447
00:15:20,920 --> 00:15:23,470
Dhs is rewarding a medical

448
00:15:23,470 --> 00:15:25,870
crisis rather than prevention

449
00:15:25,880 --> 00:15:27,880
in this case.

450
00:15:28,160 --> 00:15:30,360
In closing, I will reiterate

451
00:15:30,360 --> 00:15:32,770
what was sent by my state

452
00:15:32,770 --> 00:15:34,770
representative and senator 20

453
00:15:35,300 --> 00:15:37,770
years ago in my office,

454
00:15:37,770 --> 00:15:40,170
Minnesota does short-term fix.

455
00:15:40,860 --> 00:15:43,260
But for long-term consequence,

456
00:15:44,320 --> 00:15:47,320
this is still true today.

457
00:15:47,540 --> 00:15:50,640
Please step back from any plan

458
00:15:50,640 --> 00:15:52,740
actions and think about the

459
00:15:52,740 --> 00:15:55,900
future costs instead of a

460
00:15:55,900 --> 00:15:57,900
short-term fix.

461
00:15:57,500 --> 00:16:00,180
Not to mention all of you here

462
00:16:00,180 --> 00:16:01,570
for our most vulnerable to

463
00:16:01,570 --> 00:16:03,260
this.

464
00:16:03,260 --> 00:16:04,920
Don't balance the budgets.

465
00:16:04,920 --> 00:16:06,920
Our DC

466
00:16:06,930 --> 00:16:08,340
thank you very much for many

467
00:16:08,340 --> 00:16:09,820
come and testify.

468
00:16:09,820 --> 00:16:10,750
>> Thank you. Our love. Good to

469
00:16:10,750 --> 00:16:12,990
see you. And thanks for your

470
00:16:12,990 --> 00:16:14,370
years of work.

471
00:16:14,370 --> 00:16:15,960
Addison Carpenter,

472
00:16:15,960 --> 00:16:18,360
welcome to the committee.

473
00:16:19,330 --> 00:16:22,180
>> The CEO and chairman and

474
00:16:22,180 --> 00:16:23,500
members of the committee,

475
00:16:23,500 --> 00:16:25,000
my name is Edison her.

476
00:16:25,000 --> 00:16:26,550
>> And I'm a Minnesotan who

477
00:16:26,550 --> 00:16:28,130
depends on disability and home

478
00:16:28,130 --> 00:16:30,500
and community-based services

479
00:16:30,500 --> 00:16:31,230
and putting it back for

480
00:16:31,230 --> 00:16:33,220
hospital care and other

481
00:16:33,220 --> 00:16:34,900
long-term services and supports

482
00:16:34,900 --> 00:16:36,520
creamy safely in my home and my

483
00:16:36,520 --> 00:16:38,670
community and my family.

484
00:16:38,670 --> 00:16:40,200
I am here specifically to speak

485
00:16:40,200 --> 00:16:41,460
about American University

486
00:16:41,460 --> 00:16:43,330
offers a Chanel ace because

487
00:16:43,330 --> 00:16:44,500
these are not simply

488
00:16:44,500 --> 00:16:46,300
administrative problems and

489
00:16:46,300 --> 00:16:47,440
others should delay honestly,

490
00:16:47,440 --> 00:16:49,840
almost human-like this year.

491
00:16:49,900 --> 00:16:51,580
I was just sitting in a proof

492
00:16:51,580 --> 00:16:52,590
for private gain. Your son

493
00:16:52,590 --> 00:16:54,300
services back in November of

494
00:16:54,300 --> 00:16:56,370
2024, the services were not

495
00:16:56,370 --> 00:16:57,840
optional. They were determined

496
00:16:57,840 --> 00:16:59,240
necessary because I have

497
00:16:59,240 --> 00:17:00,420
significant medical needs

498
00:17:00,420 --> 00:17:02,360
require ongoing management

499
00:17:02,360 --> 00:17:04,900
within my home and the

500
00:17:04,900 --> 00:17:06,420
community. But they have CNN

501
00:17:06,420 --> 00:17:08,400
actually receiving most nursing

502
00:17:08,400 --> 00:17:09,690
services have been 2 very

503
00:17:09,690 --> 00:17:11,310
different stories. While the

504
00:17:11,310 --> 00:17:13,300
authorization process drags on

505
00:17:13,300 --> 00:17:14,730
it without the care I had been

506
00:17:14,730 --> 00:17:16,670
assessed as needed. There was

507
00:17:16,670 --> 00:17:17,990
no backup system of people

508
00:17:17,990 --> 00:17:19,600
working between agencies and

509
00:17:19,600 --> 00:17:21,500
government entities. I think we

510
00:17:21,500 --> 00:17:23,460
want without estate after

511
00:17:23,460 --> 00:17:25,300
meeting with us are happen.

512
00:17:25,300 --> 00:17:27,340
Are you during the 2026

513
00:17:27,340 --> 00:17:28,420
legislative session? I was

514
00:17:28,420 --> 00:17:29,920
hospitalized in the ICU with a

515
00:17:29,920 --> 00:17:31,870
severe infection. Just hours

516
00:17:31,870 --> 00:17:33,700
before disability advocacy day

517
00:17:33,700 --> 00:17:34,930
at the Capitol began, I was

518
00:17:34,930 --> 00:17:36,740
intubated a fellow disability

519
00:17:36,740 --> 00:17:38,740
advocate

520
00:17:39,860 --> 00:17:41,220
back in the 5 people I work

521
00:17:41,220 --> 00:17:43,400
alongside with Ncba then sell

522
00:17:43,400 --> 00:17:44,400
and elsewhere that I was

523
00:17:44,400 --> 00:17:46,120
frankly, my friends and family

524
00:17:46,120 --> 00:17:47,300
were called to say goodbye

525
00:17:47,300 --> 00:17:48,460
because I was not expected to

526
00:17:48,460 --> 00:17:50,270
survive that weekend. I went

527
00:17:50,270 --> 00:17:51,290
and the complete kidney and

528
00:17:51,290 --> 00:17:53,230
liver failure, developed acute

529
00:17:53,230 --> 00:17:54,480
respiratory distress and then

530
00:17:54,480 --> 00:17:55,970
and have regime islands.

531
00:17:55,970 --> 00:17:57,130
I was eventually traced.

532
00:17:57,130 --> 00:17:58,370
And when I finally woke up, I

533
00:17:58,370 --> 00:17:59,450
had to re-learn how to use my

534
00:17:59,450 --> 00:18:01,400
body, including rollover

535
00:18:01,400 --> 00:18:03,290
walking, talking and eating had

536
00:18:03,290 --> 00:18:04,610
I had the nursing services I

537
00:18:04,610 --> 00:18:05,880
desperately needed. There's a

538
00:18:05,880 --> 00:18:07,130
good chance that none of that

539
00:18:07,130 --> 00:18:08,430
would have happened.

540
00:18:08,430 --> 00:18:09,690
It can mean a difference.

541
00:18:09,690 --> 00:18:11,210
We can recognize a problem at

542
00:18:11,210 --> 00:18:12,570
home.

543
00:18:12,570 --> 00:18:14,600
I'm treating it after it

544
00:18:14,600 --> 00:18:15,510
becomes a crisis and sometimes

545
00:18:15,510 --> 00:18:16,390
it can mean the difference

546
00:18:16,390 --> 00:18:17,710
between life and death.

547
00:18:17,710 --> 00:18:19,270
Unfortunately, my story did not

548
00:18:19,270 --> 00:18:20,870
end what I survived and I am so

549
00:18:20,870 --> 00:18:23,900
without the nursing services it

550
00:18:23,900 --> 00:18:24,130
because I'm so that you're

551
00:18:24,130 --> 00:18:25,740
seeing it not truly get to live

552
00:18:25,740 --> 00:18:26,700
the life that home and

553
00:18:26,700 --> 00:18:27,950
community-based services are

554
00:18:27,950 --> 00:18:29,470
supposed to make possible.

555
00:18:29,470 --> 00:18:31,200
My life is still sent one back

556
00:18:31,200 --> 00:18:31,940
and forth the clinics,

557
00:18:31,940 --> 00:18:33,500
emergency departments and

558
00:18:33,500 --> 00:18:35,360
hospitals since June. That

559
00:18:35,360 --> 00:18:36,850
since I think that this charge

560
00:18:36,850 --> 00:18:38,230
from the long term acute care

561
00:18:38,230 --> 00:18:39,730
hospital, I had former hospital

562
00:18:39,730 --> 00:18:41,900
admissions, probably our visits

563
00:18:41,900 --> 00:18:42,420
and too many plant appointments

564
00:18:42,420 --> 00:18:43,370
account.

565
00:18:43,370 --> 00:18:44,380
I was nervous. We have the

566
00:18:44,380 --> 00:18:45,960
capital for the first time and

567
00:18:45,960 --> 00:18:47,780
Hans today to testify, but

568
00:18:47,780 --> 00:18:49,300
instead was stuck in the clinic

569
00:18:49,300 --> 00:18:51,300
in addition all morning and

570
00:18:51,300 --> 00:18:52,160
literally like just walked in

571
00:18:52,160 --> 00:18:53,310
the door

572
00:18:53,310 --> 00:18:54,660
being without using affects my

573
00:18:54,660 --> 00:18:56,490
ability to be a parent to work,

574
00:18:56,490 --> 00:18:57,730
to spend time with my family.

575
00:18:57,730 --> 00:18:59,510
For a statement, The Advocate

576
00:18:59,510 --> 00:19:00,470
for the things I'm passionate

577
00:19:00,470 --> 00:19:01,960
about and even make ordinary

578
00:19:01,960 --> 00:19:02,940
plant

579
00:19:02,940 --> 00:19:03,870
home and community-based

580
00:19:03,870 --> 00:19:05,140
services are supposed to help

581
00:19:05,140 --> 00:19:06,340
people with disabilities live

582
00:19:06,340 --> 00:19:07,890
in their communities rather

583
00:19:07,890 --> 00:19:08,720
than spend their lives and

584
00:19:08,720 --> 00:19:10,640
institutions and hospitals.

585
00:19:10,640 --> 00:19:12,100
A probe into service keeper

586
00:19:12,100 --> 00:19:13,670
does not accomplish that.

587
00:19:13,670 --> 00:19:14,750
If someone is is that the

588
00:19:14,750 --> 00:19:15,870
sitting there saying and then

589
00:19:15,870 --> 00:19:17,440
weeks, months or years for that

590
00:19:17,440 --> 00:19:18,680
authorization to actually

591
00:19:18,680 --> 00:19:20,600
result in care, this is the has

592
00:19:20,600 --> 00:19:22,880
not provided this service

593
00:19:22,880 --> 00:19:24,900
patients and families afford

594
00:19:24,900 --> 00:19:25,380
the consequences. We said

595
00:19:25,380 --> 00:19:26,520
number didn't see departments

596
00:19:26,520 --> 00:19:27,830
were hospitalized for families

597
00:19:27,830 --> 00:19:29,390
to come and pick up your rates.

598
00:19:29,390 --> 00:19:31,170
We've used pieces of our lives

599
00:19:31,170 --> 00:19:31,990
while different parts of the

600
00:19:31,990 --> 00:19:33,640
system to determine who is

601
00:19:33,640 --> 00:19:34,860
responsible.

602
00:19:34,860 --> 00:19:36,240
Hackers also observers

603
00:19:36,240 --> 00:19:37,860
consequences because emergency

604
00:19:37,860 --> 00:19:38,770
departments, hospital

605
00:19:38,770 --> 00:19:40,690
admissions, intensive care and

606
00:19:40,690 --> 00:19:42,170
repeated claims that are not

607
00:19:42,170 --> 00:19:43,810
substitutes for stable public

608
00:19:43,810 --> 00:19:45,650
nursing care

609
00:19:45,650 --> 00:19:47,190
and asking in establishing the

610
00:19:47,190 --> 00:19:49,400
full, established, meaningful

611
00:19:49,400 --> 00:19:50,400
accountability and timelines

612
00:19:50,400 --> 00:19:52,120
for nursing authorizations.

613
00:19:52,120 --> 00:19:53,270
There must be a point at which

614
00:19:53,270 --> 00:19:54,750
an authorization cannot simply

615
00:19:54,750 --> 00:19:56,190
remain pending. And there must

616
00:19:56,190 --> 00:19:57,180
be some point clearly

617
00:19:57,180 --> 00:19:58,600
responsible for resolving these

618
00:19:58,600 --> 00:19:59,580
delays.

619
00:19:59,580 --> 00:20:00,820
Please do not measure success

620
00:20:00,820 --> 00:20:01,710
by how many people have

621
00:20:01,710 --> 00:20:03,800
Anderson written for service

622
00:20:03,800 --> 00:20:04,820
plan or how many offered

623
00:20:04,820 --> 00:20:05,870
stations eventually get

624
00:20:05,870 --> 00:20:07,460
approved, measured by whether

625
00:20:07,460 --> 00:20:08,810
the person actually has unders

626
00:20:08,810 --> 00:20:10,500
walking through their door

627
00:20:10,500 --> 00:20:11,520
because an authorization is not

628
00:20:11,520 --> 00:20:13,400
access, approve mercy services

629
00:20:13,400 --> 00:20:15,260
without a nurse is not fair.

630
00:20:15,260 --> 00:20:16,260
I may have survived what

631
00:20:16,260 --> 00:20:17,710
happened

632
00:20:17,710 --> 00:20:18,990
while waiting for the charity

633
00:20:18,990 --> 00:20:20,000
that but I should not have to

634
00:20:20,000 --> 00:20:20,790
nearly die for an

635
00:20:20,790 --> 00:20:21,930
administrative process to

636
00:20:21,930 --> 00:20:23,380
demonstrate how important that

637
00:20:23,380 --> 00:20:24,970
care was and I should not.

638
00:20:24,970 --> 00:20:26,300
So we wait for the opportunity

639
00:20:26,300 --> 00:20:27,550
to live my life instead of

640
00:20:27,550 --> 00:20:29,170
continuing to manage the

641
00:20:29,170 --> 00:20:30,590
consequences of going without

642
00:20:30,590 --> 00:20:32,180
it. Thank you.

643
00:20:32,180 --> 00:20:34,630
>> Thank you, Madison and next,

644
00:20:34,630 --> 00:20:37,140
Joel Bach. Enjoy all if if use

645
00:20:37,140 --> 00:20:39,350
also sent a letter. So if you

646
00:20:39,350 --> 00:20:40,800
could, you know, give us the

647
00:20:40,800 --> 00:20:42,430
essence of the debt you're

648
00:20:42,430 --> 00:20:43,750
Larson mentioned, you would go

649
00:20:43,750 --> 00:20:44,930
into detail on something.

650
00:20:44,930 --> 00:20:45,950
I just, you know, give us the

651
00:20:45,950 --> 00:20:47,670
essence of really what

652
00:20:47,670 --> 00:20:49,380
that letters about and what

653
00:20:49,380 --> 00:20:50,790
what we're doing today. And

654
00:20:50,790 --> 00:20:53,000
then while you get up on the

655
00:20:53,000 --> 00:20:55,910
screen and Helen mater animator

656
00:20:55,910 --> 00:20:57,330
and Trisha Bridge, why don't

657
00:20:57,330 --> 00:20:58,700
you work your way to the table?

658
00:20:58,700 --> 00:21:00,700
Thank you.

659
00:21:08,260 --> 00:21:09,680
Yeah, I think you get a click

660
00:21:09,680 --> 00:21:11,460
that thingy that says turn your

661
00:21:11,460 --> 00:21:13,460
Mike a

662
00:21:14,900 --> 00:21:16,740
there you go. You're right.

663
00:21:16,740 --> 00:21:18,530
>> Good to see a show. Thank

664
00:21:18,530 --> 00:21:19,500
you.

665
00:21:19,500 --> 00:21:20,180
>> Mr. Chairman members, thank

666
00:21:20,180 --> 00:21:21,190
you for the opportunity to

667
00:21:21,190 --> 00:21:22,410
speak. To give the guard in.

668
00:21:22,410 --> 00:21:23,630
The test is providing

669
00:21:23,630 --> 00:21:25,820
validation. I'm Joe Buck and

670
00:21:25,820 --> 00:21:27,690
chief executive officer of

671
00:21:27,690 --> 00:21:29,360
Solutions. We are a community

672
00:21:29,360 --> 00:21:31,170
that the House Justin's serving

673
00:21:31,170 --> 00:21:32,970
life in a so one of our

674
00:21:32,970 --> 00:21:34,770
services is the idea of

675
00:21:34,770 --> 00:21:36,950
research to get through 6

676
00:21:36,950 --> 00:21:38,580
locations stretching from Saint

677
00:21:38,580 --> 00:21:40,670
Cloud to East Grand Forks

678
00:21:40,670 --> 00:21:42,270
Solutions is nationally

679
00:21:42,270 --> 00:21:44,400
accredited as a behavioral

680
00:21:44,400 --> 00:21:46,200
health center of excellence.

681
00:21:46,200 --> 00:21:47,290
Throughout the history

682
00:21:47,290 --> 00:21:49,290
validation process solutions

683
00:21:49,380 --> 00:21:51,740
has done everything DHS have

684
00:21:51,740 --> 00:21:54,230
asked of us. We had that every

685
00:21:54,230 --> 00:21:56,630
deadline communicated by DHS

686
00:21:56,670 --> 00:21:58,660
responded properly to requests

687
00:21:58,660 --> 00:22:00,660
for additional information.

688
00:22:01,230 --> 00:22:04,380
Yet today, only one of our 60 I

689
00:22:04,380 --> 00:22:06,340
ddi sites has been we've

690
00:22:06,340 --> 00:22:08,100
allocated and that approval

691
00:22:08,100 --> 00:22:10,540
approve within the last week.

692
00:22:10,540 --> 00:22:11,940
The consequences are

693
00:22:11,940 --> 00:22:13,330
significant

694
00:22:13,330 --> 00:22:14,640
because of locations, not

695
00:22:14,640 --> 00:22:16,240
re-evaluated. We are unable to

696
00:22:16,240 --> 00:22:17,860
Bill for services provided for

697
00:22:17,860 --> 00:22:20,140
nearly 50 staff members were

698
00:22:20,140 --> 00:22:22,200
unable to Kate to obtain

699
00:22:22,200 --> 00:22:24,200
service authorizations for 30

700
00:22:24,500 --> 00:22:25,530
on the book children with

701
00:22:25,530 --> 00:22:27,700
Autism.

702
00:22:27,700 --> 00:22:29,230
The state is grossly thing like

703
00:22:29,230 --> 00:22:30,990
with Pierre of claims for

704
00:22:30,990 --> 00:22:32,690
services provided to our

705
00:22:32,690 --> 00:22:33,930
children

706
00:22:33,930 --> 00:22:35,900
if Minnesota where it is and

707
00:22:35,900 --> 00:22:37,350
instead of a government it we

708
00:22:37,350 --> 00:22:39,310
face a massive downgrade of its

709
00:22:39,310 --> 00:22:41,520
credit rating, reputation and

710
00:22:41,520 --> 00:22:43,890
borrowing ability the amount

711
00:22:43,890 --> 00:22:45,650
just to our organization

712
00:22:45,650 --> 00:22:47,650
exceeds $800,000.

713
00:22:49,130 --> 00:22:51,800
This is not simply a ministry

714
00:22:51,800 --> 00:22:52,840
to the inconvenience. The

715
00:22:52,840 --> 00:22:54,310
services have already been

716
00:22:54,310 --> 00:22:55,370
delivered to Minnesota

717
00:22:55,370 --> 00:22:57,200
families. I qualified

718
00:22:57,200 --> 00:22:58,860
professionals. We pay salary

719
00:22:58,860 --> 00:23:00,350
benefits, rent operating

720
00:23:00,350 --> 00:23:02,130
expenses while waiting months

721
00:23:02,130 --> 00:23:04,530
for approval and payment.

722
00:23:04,550 --> 00:23:07,250
Just yesterday during an thsi

723
00:23:07,250 --> 00:23:09,130
to visit, the reviewer writes

724
00:23:09,130 --> 00:23:10,350
with information that was

725
00:23:10,350 --> 00:23:12,850
substantially in at it. For

726
00:23:12,850 --> 00:23:15,500
example, DHS records did not

727
00:23:15,500 --> 00:23:18,780
identify me to see has an

728
00:23:18,780 --> 00:23:20,700
authorized agent.

729
00:23:20,700 --> 00:23:22,580
Records show Solutions

730
00:23:22,580 --> 00:23:23,960
Solutions operating from a

731
00:23:23,960 --> 00:23:25,700
location that we close more

732
00:23:25,700 --> 00:23:27,700
than 3 years ago

733
00:23:28,400 --> 00:23:29,400
when I directed asked where the

734
00:23:29,400 --> 00:23:30,780
information came from, the

735
00:23:30,780 --> 00:23:33,420
reviewer explain that DHS staff

736
00:23:33,420 --> 00:23:34,600
use a different system than the

737
00:23:34,600 --> 00:23:36,380
one providers is to submit to

738
00:23:36,380 --> 00:23:38,380
maintain information. We're

739
00:23:38,740 --> 00:23:40,570
told the reviewer would need to

740
00:23:40,570 --> 00:23:42,130
check with minutes to verify

741
00:23:42,130 --> 00:23:44,180
what we have reported. This

742
00:23:44,180 --> 00:23:45,670
experience reflects what has

743
00:23:45,670 --> 00:23:47,600
occurred throughout the

744
00:23:47,600 --> 00:23:49,380
retaliation process. We have

745
00:23:49,380 --> 00:23:51,170
repeatedly been asked to submit

746
00:23:51,170 --> 00:23:53,170
the same information

747
00:23:53,310 --> 00:23:54,910
comes down. It contained within

748
00:23:54,910 --> 00:23:57,470
the DHS system does not appear

749
00:23:57,470 --> 00:23:58,780
to match the information

750
00:23:58,780 --> 00:24:01,180
providers Inter and maintain.

751
00:24:01,980 --> 00:24:03,570
We have 9.90, days without

752
00:24:03,570 --> 00:24:05,600
payment for many clients that

753
00:24:05,600 --> 00:24:07,440
affected locations, even with

754
00:24:07,440 --> 00:24:09,690
one site approved. We do not

755
00:24:09,690 --> 00:24:11,690
anticipate anticipate payments

756
00:24:11,870 --> 00:24:13,940
until October. Even if the

757
00:24:13,940 --> 00:24:16,130
remaining site for does it

758
00:24:16,130 --> 00:24:17,700
improve tomorrow, additional

759
00:24:17,700 --> 00:24:19,130
processing timelines make

760
00:24:19,130 --> 00:24:21,180
payment before November on

761
00:24:21,180 --> 00:24:22,960
likely we are facing

762
00:24:22,960 --> 00:24:24,450
extraordinary financial

763
00:24:24,450 --> 00:24:26,530
pressure pressure on providers

764
00:24:26,530 --> 00:24:27,790
and it will limit access to

765
00:24:27,790 --> 00:24:29,800
cheap care for children and

766
00:24:29,800 --> 00:24:31,900
families who need services.

767
00:24:31,900 --> 00:24:33,800
Since April, we have lost more

768
00:24:33,800 --> 00:24:35,370
than 30 staff members. If the

769
00:24:35,370 --> 00:24:37,670
goal is to reduce access to the

770
00:24:37,670 --> 00:24:39,930
gym, it high quality autism

771
00:24:39,930 --> 00:24:41,860
services in Minnesota. The

772
00:24:41,860 --> 00:24:43,860
current retaliation system is

773
00:24:43,860 --> 00:24:45,860
accomplishing exactly that.

774
00:24:46,780 --> 00:24:48,560
We needed just to prove the

775
00:24:48,560 --> 00:24:49,940
accuracy of provider data

776
00:24:49,940 --> 00:24:51,750
systems streamlined that we've

777
00:24:51,750 --> 00:24:53,470
allocation process, reduce

778
00:24:53,470 --> 00:24:55,470
duplicative documentation,

779
00:24:55,670 --> 00:24:56,830
request and establish

780
00:24:56,830 --> 00:24:59,230
safeguards to prevent providers

781
00:24:59,240 --> 00:25:00,990
so suffering significant

782
00:25:00,990 --> 00:25:02,560
financial harm. Well,

783
00:25:02,560 --> 00:25:04,410
applications are coming.

784
00:25:04,410 --> 00:25:06,180
I respectfully ask that this

785
00:25:06,180 --> 00:25:08,110
committee meeting established

786
00:25:08,110 --> 00:25:10,510
clear measurable benchmarks for

787
00:25:10,640 --> 00:25:13,220
us DHS to achieve in the next

788
00:25:13,220 --> 00:25:15,680
30 to 60 days and to hold the

789
00:25:15,680 --> 00:25:17,350
leadership accountable for

790
00:25:17,350 --> 00:25:18,910
those benchmarks.

791
00:25:18,910 --> 00:25:20,900
Thank you for your time

792
00:25:20,900 --> 00:25:22,150
situation. Be happy to answer

793
00:25:22,150 --> 00:25:23,330
any questions.

794
00:25:23,330 --> 00:25:24,310
>> Thanks. So we're going to

795
00:25:24,310 --> 00:25:25,290
wait till the end and that

796
00:25:25,290 --> 00:25:26,930
stuff we know

797
00:25:26,930 --> 00:25:28,240
Senator, make Weight is joining

798
00:25:28,240 --> 00:25:30,200
this online as well. Good to

799
00:25:30,200 --> 00:25:33,200
see you, Aaron. Helen mater.

800
00:25:34,690 --> 00:25:37,410
I get that right? Yes, yes,

801
00:25:37,410 --> 00:25:39,600
Helen and Trisha Helen, Helen

802
00:25:39,600 --> 00:25:41,440
mater year, the firm Behavioral

803
00:25:41,440 --> 00:25:44,370
French airs. You came here

804
00:25:44,370 --> 00:25:46,700
to China. So welcome to the

805
00:25:46,700 --> 00:25:47,620
committee.

806
00:25:47,620 --> 00:25:48,610
>> Thank you, Sir. Thank you so

807
00:25:48,610 --> 00:25:50,500
much. Chair Hoffman and members

808
00:25:50,500 --> 00:25:51,370
of the committee for your TIME

809
00:25:51,370 --> 00:25:54,440
today. I'm Helen mater. I'm a

810
00:25:54,440 --> 00:25:55,690
board certified behavior

811
00:25:55,690 --> 00:25:58,900
analysts since 2004. I'm also

812
00:25:58,790 --> 00:26:00,850
the CEO and co-founder of

813
00:26:00,850 --> 00:26:02,540
Behavior, Frontiers and

814
00:26:02,540 --> 00:26:04,390
organization providing applied

815
00:26:04,390 --> 00:26:06,160
behavior, analysis services to

816
00:26:06,160 --> 00:26:07,370
individuals with autism.

817
00:26:07,370 --> 00:26:09,320
For 22 years,

818
00:26:09,320 --> 00:26:10,270
we've been serving children

819
00:26:10,270 --> 00:26:12,600
with autism before the IDB.

820
00:26:12,600 --> 00:26:13,870
I even became a covered benefit

821
00:26:13,870 --> 00:26:15,140
in Minnesota

822
00:26:15,140 --> 00:26:16,700
and we have been accredited

823
00:26:16,700 --> 00:26:18,800
like Juul as a behavioral

824
00:26:18,800 --> 00:26:19,400
health center of excellence for

825
00:26:19,400 --> 00:26:20,770
a decade.

826
00:26:20,770 --> 00:26:22,800
We are one of many for here,

827
00:26:22,800 --> 00:26:24,920
many experience, ethical and

828
00:26:24,920 --> 00:26:27,320
high-quality ei dbi providers

829
00:26:27,600 --> 00:26:28,950
who are serving Minnesota's

830
00:26:28,950 --> 00:26:30,780
autism community.

831
00:26:30,780 --> 00:26:31,870
And a couple of our sites are

832
00:26:31,870 --> 00:26:33,270
in the community served by

833
00:26:33,270 --> 00:26:35,330
Chair Rogers and can wrap it, I

834
00:26:35,330 --> 00:26:37,260
believe

835
00:26:37,260 --> 00:26:38,950
and our organization stands

836
00:26:38,950 --> 00:26:40,960
firmly with DHS against fraud,

837
00:26:40,960 --> 00:26:42,530
waste and abuse

838
00:26:42,530 --> 00:26:43,590
providers should be held

839
00:26:43,590 --> 00:26:44,900
accountable to standards that

840
00:26:44,900 --> 00:26:47,500
promote quality and safety.

841
00:26:47,500 --> 00:26:48,580
However, the delays caused by

842
00:26:48,580 --> 00:26:50,820
the current DHS validation and

843
00:26:50,820 --> 00:26:52,790
re validation process have had

844
00:26:52,790 --> 00:26:54,560
serious negative consequences

845
00:26:54,560 --> 00:26:56,490
for the children that we serve.

846
00:26:56,490 --> 00:26:58,230
Specifically service

847
00:26:58,230 --> 00:27:00,800
authorizations have been denied

848
00:27:00,800 --> 00:27:02,270
or postponed background checks

849
00:27:02,270 --> 00:27:04,390
stalled Q S P credentialing

850
00:27:04,390 --> 00:27:06,230
applications backlog

851
00:27:06,230 --> 00:27:07,500
and behavior technician

852
00:27:07,500 --> 00:27:09,210
approvals frozen.

853
00:27:09,210 --> 00:27:10,590
All of this has resulted in

854
00:27:10,590 --> 00:27:11,780
children not getting their

855
00:27:11,780 --> 00:27:13,690
services,

856
00:27:13,690 --> 00:27:15,860
for example, since May during

857
00:27:15,860 --> 00:27:17,160
our rehabilitation process.

858
00:27:17,160 --> 00:27:18,880
We have had 34 total staff

859
00:27:18,880 --> 00:27:21,770
leave 3 of which are Q S P's

860
00:27:21,770 --> 00:27:23,180
and we have not been able to

861
00:27:23,180 --> 00:27:24,290
replace them because of the

862
00:27:24,290 --> 00:27:26,150
pending approval process.

863
00:27:26,150 --> 00:27:27,830
And that has resulted in over

864
00:27:27,830 --> 00:27:29,420
24 children not being able to

865
00:27:29,420 --> 00:27:30,490
start or continue their

866
00:27:30,490 --> 00:27:32,490
services with us.

867
00:27:32,510 --> 00:27:34,300
Additionally, providers have

868
00:27:34,300 --> 00:27:35,930
been waiting in some cases

869
00:27:35,930 --> 00:27:37,260
almost 2 years for their

870
00:27:37,260 --> 00:27:39,140
original site validation to be

871
00:27:39,140 --> 00:27:41,100
processed. These original

872
00:27:41,100 --> 00:27:42,660
allegations need to be

873
00:27:42,660 --> 00:27:44,200
processed and should not be

874
00:27:44,200 --> 00:27:45,150
overlooked. While the re

875
00:27:45,150 --> 00:27:46,560
validation czar being

876
00:27:46,560 --> 00:27:48,490
processed.

877
00:27:48,490 --> 00:27:49,940
I urge the committee and each s

878
00:27:49,940 --> 00:27:51,390
to improve the validation and

879
00:27:51,390 --> 00:27:52,830
the validation process to be

880
00:27:52,830 --> 00:27:54,830
efficient, consistent and

881
00:27:55,330 --> 00:27:57,310
clinically relevant while still

882
00:27:57,310 --> 00:27:58,720
focused on requirements that

883
00:27:58,720 --> 00:28:00,490
maintain high quality standards

884
00:28:00,490 --> 00:28:01,900
of care.

885
00:28:01,900 --> 00:28:03,160
Dhs could take several

886
00:28:03,160 --> 00:28:04,730
practical steps to reduce

887
00:28:04,730 --> 00:28:06,400
unnecessary delays.

888
00:28:06,400 --> 00:28:08,470
Some examples include hiring

889
00:28:08,470 --> 00:28:10,270
and training additional staff

890
00:28:10,270 --> 00:28:12,290
to process of allegations

891
00:28:12,290 --> 00:28:14,260
rebound shuns credentialing

892
00:28:14,260 --> 00:28:15,800
background checks and

893
00:28:15,800 --> 00:28:17,800
technician approvals.

894
00:28:17,910 --> 00:28:19,370
Assigning a point person for

895
00:28:19,370 --> 00:28:21,150
providers who can set forth

896
00:28:21,150 --> 00:28:22,180
clear process is for

897
00:28:22,180 --> 00:28:24,180
communication status, updates

898
00:28:24,420 --> 00:28:26,420
and escalation pathways

899
00:28:26,580 --> 00:28:28,100
and continuing to backdate

900
00:28:28,100 --> 00:28:29,580
approvals to the date of

901
00:28:29,580 --> 00:28:31,700
application so that children to

902
00:28:31,700 --> 00:28:32,920
not lose access to care due to

903
00:28:32,920 --> 00:28:34,920
administrative delays.

904
00:28:35,360 --> 00:28:36,950
We understand the importance of

905
00:28:36,950 --> 00:28:38,710
ensuring that there's a proper

906
00:28:38,710 --> 00:28:40,550
vetting process in place.

907
00:28:40,550 --> 00:28:42,210
But the unnecessary paperwork

908
00:28:42,210 --> 00:28:43,900
and red tape has only delayed

909
00:28:43,900 --> 00:28:45,480
the process and delayed

910
00:28:45,480 --> 00:28:46,850
critical services to our most

911
00:28:46,850 --> 00:28:48,760
vulnerable populations.

912
00:28:48,760 --> 00:28:49,920
Thank you so much for allowing

913
00:28:49,920 --> 00:28:50,850
me to bring this to your

914
00:28:50,850 --> 00:28:51,800
attention today.

915
00:28:51,800 --> 00:28:54,500
>> Thank you. And I got to at

916
00:28:54,500 --> 00:28:55,510
C*** Rapids to get a place in

917
00:28:55,510 --> 00:28:58,510
clear ethics as well. Yes,

918
00:28:58,880 --> 00:29:02,270
Tricia brings by welcome to the

919
00:29:02,270 --> 00:29:05,500
committee and then we get far

920
00:29:05,500 --> 00:29:06,690
tune. Looks like the the

921
00:29:06,690 --> 00:29:08,790
Patricia era, Richard Anthony

922
00:29:08,790 --> 00:29:10,900
and then we get will end with

923
00:29:10,900 --> 00:29:12,490
the Mary Turner is

924
00:29:13,940 --> 00:29:15,550
video. So this bridge by

925
00:29:15,550 --> 00:29:17,700
welcome the committee.

926
00:29:17,700 --> 00:29:18,560
>> Thank you, chair half of the

927
00:29:18,560 --> 00:29:19,790
members of the committee.

928
00:29:19,790 --> 00:29:22,260
And I want to recognize the

929
00:29:22,260 --> 00:29:24,460
efforts to put that people

930
00:29:24,460 --> 00:29:26,480
first today and allow us to

931
00:29:26,480 --> 00:29:29,280
speak that action. And for

932
00:29:29,280 --> 00:29:30,790
anyone who wants to know how to

933
00:29:30,790 --> 00:29:32,120
start

934
00:29:32,120 --> 00:29:34,520
doing, you know, partnership

935
00:29:34,730 --> 00:29:35,710
and collaborating with

936
00:29:35,710 --> 00:29:37,710
families, people, disabilities.

937
00:29:37,770 --> 00:29:38,840
That's what Senator Hofmann

938
00:29:38,840 --> 00:29:40,930
just it today is put us first

939
00:29:40,930 --> 00:29:42,800
to thank you for that.

940
00:29:42,800 --> 00:29:44,920
And as you most most of you

941
00:29:44,920 --> 00:29:47,550
know, I'm Charlie's mom and I

942
00:29:47,550 --> 00:29:48,970
am a disability advocate.

943
00:29:48,970 --> 00:29:51,850
I've been doing this for a very

944
00:29:51,850 --> 00:29:53,540
long time now.

945
00:29:53,540 --> 00:29:55,900
I want to share 3 examples of

946
00:29:55,900 --> 00:29:57,130
what happens when our Human

947
00:29:57,130 --> 00:29:59,700
Service system fails to provide

948
00:29:59,700 --> 00:30:01,550
accountability and continuity

949
00:30:01,550 --> 00:30:02,610
of care.

950
00:30:02,610 --> 00:30:03,800
Let's start with our story with

951
00:30:03,800 --> 00:30:06,200
Charlie. In November of 2025,

952
00:30:06,940 --> 00:30:08,500
I learned that Charlie

953
00:30:08,500 --> 00:30:10,450
qualified for a 30% waiver

954
00:30:11,220 --> 00:30:13,220
budget enhancement.

955
00:30:13,310 --> 00:30:14,480
That would be because of his

956
00:30:14,480 --> 00:30:16,900
high level of need. I

957
00:30:16,900 --> 00:30:17,290
immediately asked his

958
00:30:17,290 --> 00:30:19,170
contracted case manager to

959
00:30:19,170 --> 00:30:21,170
submit that

960
00:30:21,350 --> 00:30:24,600
for months I emailed and I call

961
00:30:24,600 --> 00:30:26,910
the case manager her supervisor

962
00:30:26,910 --> 00:30:29,300
and eventually the Directorate

963
00:30:29,300 --> 00:30:30,980
of the contracted agency.

964
00:30:30,980 --> 00:30:33,700
I kept hearing some version of

965
00:30:33,700 --> 00:30:36,700
we are looking into it

966
00:30:36,250 --> 00:30:38,620
after nearly 9 months and only

967
00:30:38,620 --> 00:30:39,960
after I demand that they cease

968
00:30:39,960 --> 00:30:42,960
simply resubmit the request it

969
00:30:42,970 --> 00:30:45,970
was finally submitted in July.

970
00:30:46,840 --> 00:30:48,290
I got an e-mail back with 15

971
00:30:48,290 --> 00:30:50,430
minutes later. It went through.

972
00:30:50,430 --> 00:30:51,510
It just had never been

973
00:30:51,510 --> 00:30:52,940
submitted.

974
00:30:52,940 --> 00:30:54,600
But as of today, we're still

975
00:30:54,600 --> 00:30:56,640
waiting for DHS to clarify when

976
00:30:56,640 --> 00:30:59,400
it can be implemented

977
00:30:59,350 --> 00:31:01,490
those months matter. I need

978
00:31:01,490 --> 00:31:02,970
those funds to provide care for

979
00:31:02,970 --> 00:31:04,140
Charlie over the summer.

980
00:31:04,140 --> 00:31:05,510
And when Charlie does not have

981
00:31:05,510 --> 00:31:07,910
care, I don't work.

982
00:31:08,390 --> 00:31:09,930
Second, there's Brian. Brian

983
00:31:09,930 --> 00:31:11,390
uses a wheelchair after having

984
00:31:11,390 --> 00:31:13,250
his right leg amputated and has

985
00:31:13,250 --> 00:31:15,510
a spinal injury. He was relying

986
00:31:15,510 --> 00:31:17,300
on housing stabilization

987
00:31:17,300 --> 00:31:18,520
services to move from

988
00:31:18,520 --> 00:31:20,520
homelessness into housing,

989
00:31:20,600 --> 00:31:22,520
his services and it has housing

990
00:31:22,520 --> 00:31:24,310
felt through. And police

991
00:31:24,310 --> 00:31:26,300
eventually encountered been

992
00:31:26,300 --> 00:31:28,300
sleeping outside

993
00:31:28,200 --> 00:31:30,700
near a Brooklyn, a park in

994
00:31:30,700 --> 00:31:31,430
Brooklyn Park which happens to

995
00:31:31,430 --> 00:31:33,830
be in my backyard.

996
00:31:34,490 --> 00:31:36,300
The last I knew he was wheeling

997
00:31:36,300 --> 00:31:37,930
himself down as they navigate

998
00:31:37,930 --> 00:31:39,900
with everything he owned

999
00:31:39,900 --> 00:31:40,800
hanging in the target bags from

1000
00:31:40,800 --> 00:31:42,740
the back of his wheelchair.

1001
00:31:42,740 --> 00:31:44,550
That is what a failure of our

1002
00:31:44,550 --> 00:31:46,500
human services system can look

1003
00:31:46,500 --> 00:31:47,200
like.

1004
00:31:47,200 --> 00:31:49,700
Then there's a fun, a 19

1005
00:31:49,700 --> 00:31:50,260
year-old with autism and

1006
00:31:50,260 --> 00:31:52,200
developmental disabilities.

1007
00:31:52,200 --> 00:31:53,730
His family has spent more than

1008
00:31:53,730 --> 00:31:55,180
a year trying to get him

1009
00:31:55,180 --> 00:31:56,870
medical assistance and waiver

1010
00:31:56,870 --> 00:31:59,270
services. He has had 4

1011
00:32:00,300 --> 00:32:02,870
contracted case managers in one

1012
00:32:02,870 --> 00:32:04,370
year

1013
00:32:04,370 --> 00:32:05,790
after reviewing a years worth

1014
00:32:05,790 --> 00:32:07,300
of emails. I discovered that

1015
00:32:07,300 --> 00:32:09,350
his newest case manager

1016
00:32:09,350 --> 00:32:11,670
appeared this was the problem.

1017
00:32:11,670 --> 00:32:13,150
She kept telling them to get a

1018
00:32:13,150 --> 00:32:15,720
medical assessment. So mom went

1019
00:32:15,720 --> 00:32:16,840
all the doctors got

1020
00:32:16,840 --> 00:32:19,240
assessments, sent them on

1021
00:32:20,430 --> 00:32:22,230
the case manager didn't know

1022
00:32:22,230 --> 00:32:24,190
the difference between

1023
00:32:24,190 --> 00:32:25,690
obtain a medical up sent

1024
00:32:25,690 --> 00:32:27,930
assessment and apply for

1025
00:32:27,930 --> 00:32:29,930
medical assistance.

1026
00:32:32,300 --> 00:32:34,150
Even still does not have

1027
00:32:34,150 --> 00:32:36,400
service S

1028
00:32:36,400 --> 00:32:37,190
these stories illustrate

1029
00:32:37,190 --> 00:32:38,630
another problem. We don't talk

1030
00:32:38,630 --> 00:32:40,440
nearly enough about continuity

1031
00:32:40,440 --> 00:32:42,800
of care. When case managers

1032
00:32:42,800 --> 00:32:43,930
change providers disappear,

1033
00:32:43,930 --> 00:32:45,690
authorizations are delayed or

1034
00:32:45,690 --> 00:32:47,100
we validate Jean interrupt

1035
00:32:47,100 --> 00:32:49,150
services. People don't simply

1036
00:32:49,150 --> 00:32:51,700
experience an administrative

1037
00:32:51,700 --> 00:32:53,470
inconvenience. They lose care

1038
00:32:54,670 --> 00:32:56,540
and families become the count

1039
00:32:56,540 --> 00:32:58,820
continuity of care system.

1040
00:32:58,820 --> 00:33:00,360
We keep the records. We

1041
00:33:00,360 --> 00:33:01,820
remember what was approved.

1042
00:33:01,820 --> 00:33:03,290
We explain the history to the

1043
00:33:03,290 --> 00:33:05,210
next case manager. We notice

1044
00:33:05,210 --> 00:33:07,210
when paperwork disappears, we

1045
00:33:07,210 --> 00:33:09,330
make the calls we fix what

1046
00:33:09,330 --> 00:33:11,730
falls through the cracks.

1047
00:33:12,590 --> 00:33:13,800
These are not isolated

1048
00:33:13,800 --> 00:33:15,580
paperwork problems. When the

1049
00:33:15,580 --> 00:33:16,630
same failures happened

1050
00:33:16,630 --> 00:33:18,170
repeatedly across programs,

1051
00:33:18,170 --> 00:33:20,290
providers, counties and family

1052
00:33:20,290 --> 00:33:21,710
families, we have a systems

1053
00:33:21,710 --> 00:33:23,600
problem.

1054
00:33:23,600 --> 00:33:25,170
And when the responsibility

1055
00:33:25,170 --> 00:33:27,180
continually moves between the

1056
00:33:27,180 --> 00:33:29,200
HS counties, contractors of

1057
00:33:29,200 --> 00:33:30,200
providers, we have an

1058
00:33:30,200 --> 00:33:32,200
accountability problem

1059
00:33:32,570 --> 00:33:33,790
as a member of the Waiver

1060
00:33:33,790 --> 00:33:35,750
Imagine Advisory Task Force.

1061
00:33:35,750 --> 00:33:38,310
I am deeply concerned that we

1062
00:33:38,310 --> 00:33:39,970
are preparing to build a brand

1063
00:33:39,970 --> 00:33:41,870
new waiver system on top of

1064
00:33:41,870 --> 00:33:43,840
processes that are already

1065
00:33:43,840 --> 00:33:46,240
already feeling the people,

1066
00:33:46,980 --> 00:33:48,960
please repeal waiver, imagine

1067
00:33:48,960 --> 00:33:49,800
and work with people with

1068
00:33:49,800 --> 00:33:51,140
disabilities and families to

1069
00:33:51,140 --> 00:33:52,630
build something better.

1070
00:33:52,630 --> 00:33:54,100
Minnesotans with disabilities.

1071
00:33:54,100 --> 00:33:55,560
Don't need another system

1072
00:33:55,560 --> 00:33:57,590
designed around them. They need

1073
00:33:57,590 --> 00:33:59,460
a system designed with them and

1074
00:33:59,460 --> 00:34:01,770
system accountable to them.

1075
00:34:01,770 --> 00:34:03,770
Thank you,

1076
00:34:03,770 --> 00:34:05,770
Representative Fisher.

1077
00:34:05,900 --> 00:34:06,870
>> Thank you. Chair Poppe in

1078
00:34:06,870 --> 00:34:08,400
this Press Bay. Thank you.

1079
00:34:08,400 --> 00:34:09,990
Missed this spring was told

1080
00:34:09,990 --> 00:34:11,550
that I should profile and say

1081
00:34:11,550 --> 00:34:12,820
thank you a time to be here

1082
00:34:12,820 --> 00:34:14,590
today and highlight the issues

1083
00:34:14,590 --> 00:34:16,150
wrong contract case management

1084
00:34:16,150 --> 00:34:19,130
die. I understand that contract

1085
00:34:19,130 --> 00:34:20,290
case mantra is usually done by

1086
00:34:20,290 --> 00:34:22,430
the counties of size first 500,

1087
00:34:22,430 --> 00:34:24,300
which county where you was the

1088
00:34:24,300 --> 00:34:25,480
contract case management

1089
00:34:25,480 --> 00:34:26,610
through.

1090
00:34:26,610 --> 00:34:28,380
>> Ours is through Hennepin

1091
00:34:28,380 --> 00:34:30,110
County. And what I understand

1092
00:34:30,110 --> 00:34:33,710
is rather than having a case

1093
00:34:33,730 --> 00:34:36,130
manager at the county,

1094
00:34:36,600 --> 00:34:39,000
they contract like subcontract

1095
00:34:39,300 --> 00:34:41,400
with an agency

1096
00:34:41,400 --> 00:34:43,420
and these agencies are not

1097
00:34:43,420 --> 00:34:45,400
supporting their staff very

1098
00:34:45,400 --> 00:34:47,440
well. And I don't think they're

1099
00:34:47,440 --> 00:34:48,630
getting much support from the

1100
00:34:48,630 --> 00:34:50,990
county or DHS either because

1101
00:34:50,990 --> 00:34:52,900
this we're looking into it is

1102
00:34:52,900 --> 00:34:54,310
usually dependent on someone

1103
00:34:54,310 --> 00:34:56,170
getting back to that.

1104
00:34:56,170 --> 00:34:58,350
>> And Mister chair, if I could

1105
00:34:58,350 --> 00:34:59,800
and if thank you, thank you,

1106
00:34:59,800 --> 00:35:02,370
Mrs Brain. One of the questions

1107
00:35:02,370 --> 00:35:04,430
I have is do what you went

1108
00:35:04,430 --> 00:35:05,830
through. The county kind of got

1109
00:35:05,830 --> 00:35:07,130
a county contract, a case

1110
00:35:07,130 --> 00:35:08,650
manager to the county provided

1111
00:35:08,650 --> 00:35:09,840
any information. Some things

1112
00:35:09,840 --> 00:35:10,550
aren't right. You have a

1113
00:35:10,550 --> 00:35:12,620
contact in the county are a way

1114
00:35:12,620 --> 00:35:13,930
to appeal to the county kind of

1115
00:35:13,930 --> 00:35:15,230
process that will help protect

1116
00:35:15,230 --> 00:35:16,740
your right.

1117
00:35:16,740 --> 00:35:18,630
It's because my.

1118
00:35:18,630 --> 00:35:21,300
>> Especially in at thank you

1119
00:35:21,300 --> 00:35:23,580
Chair Hofmann and I especially

1120
00:35:23,580 --> 00:35:25,300
in Hennepin County

1121
00:35:25,300 --> 00:35:27,300
what we get

1122
00:35:27,620 --> 00:35:29,570
a letter that explains we're

1123
00:35:29,570 --> 00:35:30,880
going to his contract case

1124
00:35:30,880 --> 00:35:32,480
management. And if we have

1125
00:35:32,480 --> 00:35:35,470
questions, we can call the H s

1126
00:35:35,470 --> 00:35:36,980
team

1127
00:35:36,980 --> 00:35:38,700
and it's a phone number that

1128
00:35:38,700 --> 00:35:40,700
has several problems

1129
00:35:41,440 --> 00:35:43,500
often doesn't work very well.

1130
00:35:43,500 --> 00:35:44,860
You rarely get to speak to a

1131
00:35:44,860 --> 00:35:46,860
person.

1132
00:35:47,360 --> 00:35:48,990
>> Theres an official. Thank

1133
00:35:48,990 --> 00:35:50,780
you. I I appreciate you sharing

1134
00:35:50,780 --> 00:35:52,210
the information that you went

1135
00:35:52,210 --> 00:35:53,480
through. I do know that this is

1136
00:35:53,480 --> 00:35:55,230
an issue that we been trying to

1137
00:35:55,230 --> 00:35:55,990
address. We had some

1138
00:35:55,990 --> 00:35:58,330
legislation last session to

1139
00:35:58,330 --> 00:36:00,110
take very close look and

1140
00:36:00,110 --> 00:36:01,200
establish standards what's

1141
00:36:01,200 --> 00:36:02,630
going on. But you're

1142
00:36:02,630 --> 00:36:05,300
highlighting is a problem that

1143
00:36:05,300 --> 00:36:06,150
is not only happening at a

1144
00:36:06,150 --> 00:36:07,390
county us into the Ramsey

1145
00:36:07,390 --> 00:36:08,390
County. I appreciate your

1146
00:36:08,390 --> 00:36:09,790
coming forward. Let us know

1147
00:36:09,790 --> 00:36:10,810
what you're seeing. And I do

1148
00:36:10,810 --> 00:36:11,480
see that we're going to have

1149
00:36:11,480 --> 00:36:12,440
the opportunity to talk about

1150
00:36:12,440 --> 00:36:14,500
the slow March and we will.

1151
00:36:14,500 --> 00:36:15,150
>> Thank you, Mister. Thank

1152
00:36:15,150 --> 00:36:16,210
you, Representative. Thank you

1153
00:36:16,210 --> 00:36:18,260
to we can make room for for to

1154
00:36:18,260 --> 00:36:21,500
Wile E and Patricia Richard and

1155
00:36:21,500 --> 00:36:22,710
then very Turner. So one of the

1156
00:36:22,710 --> 00:36:23,730
things that Representative

1157
00:36:23,730 --> 00:36:25,700
Fisher, this brings up

1158
00:36:25,700 --> 00:36:27,470
specifically when when Tricia

1159
00:36:27,480 --> 00:36:28,780
was talking about, I believe

1160
00:36:28,780 --> 00:36:31,180
Bryan was the individual.

1161
00:36:31,590 --> 00:36:32,950
There was an article that was

1162
00:36:32,950 --> 00:36:36,250
done Jayla go once again did a

1163
00:36:36,250 --> 00:36:38,950
a story about an individual

1164
00:36:38,950 --> 00:36:41,900
that she lost her services

1165
00:36:41,900 --> 00:36:42,390
because of the system that

1166
00:36:42,390 --> 00:36:43,730
broke down.

1167
00:36:43,730 --> 00:36:45,400
She the woman is a vulnerable

1168
00:36:45,400 --> 00:36:46,680
adult who happens to have a

1169
00:36:46,680 --> 00:36:49,170
baby she homeless. She's couch

1170
00:36:49,170 --> 00:36:50,770
jumping the whole time. This

1171
00:36:50,770 --> 00:36:52,620
last year and a half we've been

1172
00:36:52,620 --> 00:36:53,750
talking. It was always about

1173
00:36:53,750 --> 00:36:55,910
continuity of care. Continuity

1174
00:36:55,910 --> 00:36:57,340
should who's going to assure

1175
00:36:57,340 --> 00:36:58,530
that this person is receiving

1176
00:36:58,530 --> 00:37:00,440
services? It broke my heart to

1177
00:37:00,440 --> 00:37:01,800
see that that individual was

1178
00:37:01,800 --> 00:37:02,800
part of that housing

1179
00:37:02,800 --> 00:37:05,200
stabilization program. No fault

1180
00:37:05,490 --> 00:37:07,330
of her own.

1181
00:37:07,330 --> 00:37:09,800
It's now couch jumping with a

1182
00:37:09,800 --> 00:37:10,440
little baby.

1183
00:37:10,440 --> 00:37:11,980
And so we need to start to

1184
00:37:11,980 --> 00:37:13,840
raise those points that we know

1185
00:37:13,840 --> 00:37:15,300
exist. But what do we do about

1186
00:37:15,300 --> 00:37:17,130
that? Right? But it so thank

1187
00:37:17,130 --> 00:37:18,620
you with that. And that's what

1188
00:37:18,620 --> 00:37:21,150
Lee welcome and who do you have

1189
00:37:21,150 --> 00:37:22,650
with you?

1190
00:37:22,650 --> 00:37:24,000
>> Could it have to do it?

1191
00:37:24,000 --> 00:37:25,480
I kept my colleague Ryan.

1192
00:37:25,480 --> 00:37:27,370
We lose 10 or so tickets are

1193
00:37:27,370 --> 00:37:29,500
clients of the Senate.

1194
00:37:29,500 --> 00:37:31,220
>> Thank you. Welcome to nurses

1195
00:37:31,220 --> 00:37:34,380
at the table at the same time,

1196
00:37:34,380 --> 00:37:36,140
public health. Sorry and I get

1197
00:37:36,140 --> 00:37:38,640
there on so welcome. And if you

1198
00:37:38,640 --> 00:37:39,900
could,

1199
00:37:39,900 --> 00:37:41,910
let us know what's going on.

1200
00:37:41,910 --> 00:37:43,900
And then you have Mary Turner

1201
00:37:43,900 --> 00:37:45,400
who is also a nurse. She's

1202
00:37:45,400 --> 00:37:47,340
going to be on the 2 after this

1203
00:37:47,340 --> 00:37:49,890
Ole Miss. Well, go ahead.

1204
00:37:49,890 --> 00:37:51,620
>> Good afternoon, chair Hopman

1205
00:37:51,620 --> 00:37:53,150
member of the community.

1206
00:37:53,150 --> 00:37:55,260
My name is for us to where the

1207
00:37:55,260 --> 00:37:57,000
owner of Peace of Mind Care

1208
00:37:57,000 --> 00:37:58,100
Center

1209
00:37:58,100 --> 00:38:00,300
and that is where I provide to

1210
00:38:00,300 --> 00:38:02,690
45 dever. Also days per service

1211
00:38:02,690 --> 00:38:04,800
where I could climb student

1212
00:38:04,800 --> 00:38:05,500
today.

1213
00:38:05,500 --> 00:38:06,680
Thank you for hearing from

1214
00:38:06,680 --> 00:38:08,120
providers is the assist

1215
00:38:08,120 --> 00:38:09,660
discussions. We validation of

1216
00:38:09,660 --> 00:38:11,660
service agreement changes

1217
00:38:12,600 --> 00:38:14,490
piece of my service. People who

1218
00:38:14,490 --> 00:38:16,290
many programs are not equipped

1219
00:38:16,290 --> 00:38:19,220
to serve, to serve support.

1220
00:38:19,220 --> 00:38:21,750
Some are nonverbal. Kind of put

1221
00:38:21,750 --> 00:38:24,750
pain on the occasion needs

1222
00:38:24,900 --> 00:38:26,770
others have significant

1223
00:38:26,770 --> 00:38:28,580
physical disabilities, mental

1224
00:38:28,580 --> 00:38:30,330
health conditions. Mobility

1225
00:38:30,330 --> 00:38:31,470
needs

1226
00:38:31,470 --> 00:38:33,890
this can and will concerns

1227
00:38:33,890 --> 00:38:36,910
they require are in care most

1228
00:38:36,910 --> 00:38:39,660
the time exemption to train

1229
00:38:39,660 --> 00:38:41,870
staff for professional care,

1230
00:38:41,870 --> 00:38:43,600
behavioral support and

1231
00:38:43,600 --> 00:38:44,740
emergencies.

1232
00:38:44,740 --> 00:38:47,470
I'm very proud of my focus is

1233
00:38:47,470 --> 00:38:49,970
that of created I employees may

1234
00:38:49,970 --> 00:38:51,760
discover possible

1235
00:38:51,760 --> 00:38:53,260
approximately 90% of our

1236
00:38:53,260 --> 00:38:55,660
immigrant women, 70% are women

1237
00:38:56,890 --> 00:38:59,840
of color. They bring language

1238
00:38:59,840 --> 00:39:01,980
to cultural understanding and

1239
00:39:01,980 --> 00:39:04,380
patients and trusted relation

1240
00:39:04,400 --> 00:39:06,570
with people who have complex

1241
00:39:06,570 --> 00:39:08,570
needs as many of you know,

1242
00:39:08,570 --> 00:39:09,890
where it came from and some out

1243
00:39:09,890 --> 00:39:11,790
American on the problem.

1244
00:39:11,790 --> 00:39:13,120
We don't have institutions to

1245
00:39:13,120 --> 00:39:14,700
put our people with

1246
00:39:14,700 --> 00:39:16,290
disabilities so we take care no

1247
00:39:16,290 --> 00:39:17,620
matter what and keep them in

1248
00:39:17,620 --> 00:39:19,500
the community.

1249
00:39:19,500 --> 00:39:21,450
These individuals have work.

1250
00:39:21,930 --> 00:39:24,880
They have our staff to have

1251
00:39:24,880 --> 00:39:26,680
difficulty with compact.

1252
00:39:26,680 --> 00:39:28,500
They do have difficulty with

1253
00:39:28,500 --> 00:39:30,000
compassion and professional

1254
00:39:30,000 --> 00:39:32,000
professionalism. They support

1255
00:39:32,570 --> 00:39:34,900
too

1256
00:39:34,900 --> 00:39:35,670
people who are really not for

1257
00:39:35,670 --> 00:39:37,110
one very fiscal most of the

1258
00:39:37,110 --> 00:39:38,730
time violence.

1259
00:39:38,730 --> 00:39:40,250
One example, you saw the

1260
00:39:40,250 --> 00:39:42,600
pictures I give you. I cannot

1261
00:39:42,600 --> 00:39:44,770
provide that in public. 2 of

1262
00:39:44,770 --> 00:39:46,520
the crimes that I want to talk

1263
00:39:46,520 --> 00:39:48,880
up. I had a severe that the

1264
00:39:48,880 --> 00:39:50,860
rush, I cannot show the public

1265
00:39:50,860 --> 00:39:52,580
what the pictures look like

1266
00:39:52,580 --> 00:39:55,430
that client, a young gentleman

1267
00:39:55,430 --> 00:39:57,830
needed acute support foreigners

1268
00:39:58,230 --> 00:40:00,760
because of his severe diaper

1269
00:40:00,760 --> 00:40:03,100
Russian burnout that he had

1270
00:40:03,100 --> 00:40:04,920
when we tried to charge nurse

1271
00:40:04,920 --> 00:40:06,630
and as partners we were told it

1272
00:40:06,630 --> 00:40:08,680
was not a meat Royce. Therefore

1273
00:40:08,680 --> 00:40:10,540
we cannot support you and

1274
00:40:10,540 --> 00:40:11,990
provide on the service was

1275
00:40:11,990 --> 00:40:13,990
denied.

1276
00:40:14,100 --> 00:40:15,420
Yeah. Also decision that's in

1277
00:40:15,420 --> 00:40:17,290
effect on the level of any we

1278
00:40:17,290 --> 00:40:18,580
support. So the nurse was

1279
00:40:18,580 --> 00:40:20,700
refused. Another cried a little

1280
00:40:20,700 --> 00:40:22,730
bit of some severe. You also

1281
00:40:22,730 --> 00:40:23,970
saw

1282
00:40:23,970 --> 00:40:26,810
she was had a severe abuse and

1283
00:40:26,810 --> 00:40:28,470
beaten up, but she's acting and

1284
00:40:28,470 --> 00:40:30,870
nonverbal. Her parents today,

1285
00:40:31,100 --> 00:40:32,870
Putin com moms have initial do

1286
00:40:32,870 --> 00:40:34,590
surgery and that is taking care

1287
00:40:34,590 --> 00:40:36,560
of our time. Patty, what I want

1288
00:40:36,560 --> 00:40:37,850
to be here today, they send

1289
00:40:37,850 --> 00:40:39,150
their apologies. But I mean,

1290
00:40:39,150 --> 00:40:40,930
you have for them. I'm not just

1291
00:40:40,930 --> 00:40:42,870
a business owner. I think it as

1292
00:40:42,870 --> 00:40:44,130
well.

1293
00:40:44,130 --> 00:40:45,970
Also that individual we weren't

1294
00:40:45,970 --> 00:40:47,800
paid their sense of giving did

1295
00:40:47,800 --> 00:40:49,600
not come soon as of route.

1296
00:40:49,600 --> 00:40:52,150
22 6, I keep sued by step and I

1297
00:40:52,150 --> 00:40:54,450
pay them to bank loans and 2

1298
00:40:54,450 --> 00:40:56,410
other support needs

1299
00:40:56,410 --> 00:40:57,580
peace of mind to continue

1300
00:40:57,580 --> 00:40:59,700
serving these clients without

1301
00:40:59,700 --> 00:41:01,410
pay. I've to probe the kind of

1302
00:41:01,410 --> 00:41:03,700
continue to support. The kind

1303
00:41:03,700 --> 00:41:05,930
to lose is they're talking to

1304
00:41:05,930 --> 00:41:07,340
the health and safety needs to

1305
00:41:07,340 --> 00:41:08,810
not optional for staff and

1306
00:41:08,810 --> 00:41:10,810
preferences. Minnesota waiver

1307
00:41:11,980 --> 00:41:13,220
wait long to recognize

1308
00:41:13,220 --> 00:41:15,620
individuals, staff any direct

1309
00:41:16,000 --> 00:41:18,300
nurse hours and establish

1310
00:41:18,300 --> 00:41:21,980
euros. The S P is up, sir,

1311
00:41:21,980 --> 00:41:23,470
that coming some following the

1312
00:41:23,470 --> 00:41:25,680
communications. I was told when

1313
00:41:25,680 --> 00:41:27,930
I so we need to knows who Luke

1314
00:41:27,930 --> 00:41:29,400
Raley Michael. We'll talk about

1315
00:41:29,400 --> 00:41:31,400
psychiatric medications, people

1316
00:41:31,720 --> 00:41:33,410
who are on chemotherapy that

1317
00:41:33,410 --> 00:41:35,160
needs support. I was told we'll

1318
00:41:35,160 --> 00:41:37,220
train. You do see some of them

1319
00:41:37,220 --> 00:41:38,700
administer the medication,

1320
00:41:38,700 --> 00:41:40,470
which of course I would not do

1321
00:41:40,470 --> 00:41:41,490
that

1322
00:41:41,490 --> 00:41:43,420
without proper support, pain

1323
00:41:43,420 --> 00:41:45,370
and medication problems.

1324
00:41:45,370 --> 00:41:46,950
It does sometimes come become

1325
00:41:46,950 --> 00:41:49,360
crisis. You didn't its creation

1326
00:41:49,360 --> 00:41:51,360
injuries, hospitalization this

1327
00:41:52,340 --> 00:41:53,500
chart and his 2 shutout

1328
00:41:53,500 --> 00:41:55,900
placement disabilities. So it

1329
00:41:56,220 --> 00:41:58,470
does not cause violence.

1330
00:41:58,470 --> 00:42:00,420
Risk increases when needed care

1331
00:42:00,420 --> 00:42:01,830
is missing.

1332
00:42:01,830 --> 00:42:03,560
Do you support services exist

1333
00:42:03,560 --> 00:42:05,910
to keep people engaged safe,

1334
00:42:05,910 --> 00:42:07,550
including in the community to

1335
00:42:07,550 --> 00:42:08,510
live?

1336
00:42:08,510 --> 00:42:10,910
I respect the hospital

1337
00:42:11,420 --> 00:42:13,800
to reserve to issues with my

1338
00:42:13,800 --> 00:42:15,470
other cars with just voted,

1339
00:42:15,470 --> 00:42:17,100
talked about many issues.

1340
00:42:17,100 --> 00:42:19,840
So save the time, exception

1341
00:42:19,840 --> 00:42:22,240
rates. Very important to

1342
00:42:22,800 --> 00:42:25,330
support people. It needs nurse

1343
00:42:25,330 --> 00:42:26,740
units, nerves providing

1344
00:42:26,740 --> 00:42:28,250
services are very, very

1345
00:42:28,250 --> 00:42:31,780
critical. And I hope that these

1346
00:42:31,780 --> 00:42:33,520
needs are met. I would give my

1347
00:42:33,520 --> 00:42:34,660
friend and colleague to speak a

1348
00:42:34,660 --> 00:42:36,100
few minutes. Thank you.

1349
00:42:36,100 --> 00:42:37,420
>> Thank you so much. And

1350
00:42:37,420 --> 00:42:39,820
that's the nursing peace.

1351
00:42:40,450 --> 00:42:43,640
And I did see the it's the

1352
00:42:43,640 --> 00:42:46,640
parents shared the photos that

1353
00:42:47,450 --> 00:42:49,850
again, it's just as

1354
00:42:49,990 --> 00:42:51,990
it's us

1355
00:42:52,480 --> 00:42:55,440
hurting has seen that photo as

1356
00:42:55,440 --> 00:42:57,560
the person who is now homeless

1357
00:42:57,560 --> 00:42:58,870
because of

1358
00:42:58,870 --> 00:43:00,260
somethings. Something just

1359
00:43:00,260 --> 00:43:01,350
wasn't working right now.

1360
00:43:01,350 --> 00:43:04,860
And and the who who needs to

1361
00:43:04,860 --> 00:43:05,920
make sure that something is

1362
00:43:05,920 --> 00:43:07,300
happening, maybe we'll get an

1363
00:43:07,300 --> 00:43:10,500
answer later on. It looks like

1364
00:43:10,500 --> 00:43:12,420
a rally. A U.S.

1365
00:43:12,420 --> 00:43:14,710
you are a nurse. Yes, I am.

1366
00:43:14,710 --> 00:43:15,890
Welcome to the committee.

1367
00:43:15,890 --> 00:43:17,210
Thank you so much. Good

1368
00:43:17,210 --> 00:43:18,350
afternoon and community

1369
00:43:18,350 --> 00:43:19,950
members.

1370
00:43:19,950 --> 00:43:21,720
>> My name is family and I'm

1371
00:43:21,720 --> 00:43:24,280
right to 7 access peace of mind

1372
00:43:24,280 --> 00:43:25,310
center.

1373
00:43:25,310 --> 00:43:27,190
>> I wanted just to give you a

1374
00:43:27,190 --> 00:43:29,160
small picture of all of these

1375
00:43:29,160 --> 00:43:32,900
services and our client, us

1376
00:43:32,900 --> 00:43:34,900
news

1377
00:43:38,130 --> 00:43:41,120
and I my heroes to us here

1378
00:43:41,120 --> 00:43:42,620
today to speak,

1379
00:43:42,620 --> 00:43:44,730
seeking that data to the

1380
00:43:44,730 --> 00:43:46,450
effect. This is the safety,

1381
00:43:46,450 --> 00:43:49,410
the committee quality of care

1382
00:43:49,410 --> 00:43:52,490
that we provide for our clients

1383
00:43:52,490 --> 00:43:54,860
that need for Medicaid, nursing

1384
00:43:54,860 --> 00:43:57,460
staffing at the U.S.

1385
00:43:57,460 --> 00:43:59,560
off. My sent a Manila folder

1386
00:43:59,560 --> 00:44:02,300
kind to stuff company. Expedia

1387
00:44:02,300 --> 00:44:04,550
and emotional needs and some

1388
00:44:04,550 --> 00:44:08,150
are able to verbalize that what

1389
00:44:08,490 --> 00:44:10,630
they experience on what they

1390
00:44:10,630 --> 00:44:12,290
need

1391
00:44:12,290 --> 00:44:15,700
the behavior and maybe only

1392
00:44:15,700 --> 00:44:17,600
wait that the committee key

1393
00:44:17,600 --> 00:44:18,380
because

1394
00:44:18,380 --> 00:44:20,600
they can be on shows like 10

1395
00:44:20,600 --> 00:44:23,000
well of uncomfortable of

1396
00:44:25,000 --> 00:44:27,000
in distress.

1397
00:44:27,240 --> 00:44:28,650
That is the way they

1398
00:44:28,650 --> 00:44:30,670
communicate and tell us what

1399
00:44:30,670 --> 00:44:33,700
they experienced. It is

1400
00:44:33,130 --> 00:44:36,130
experiences and patient fix it

1401
00:44:37,520 --> 00:44:39,770
and we shun and that's us.

1402
00:44:39,770 --> 00:44:41,550
And that host episodes of

1403
00:44:41,550 --> 00:44:43,550
violence and dispensing

1404
00:44:43,550 --> 00:44:45,550
behavior.

1405
00:44:45,800 --> 00:44:47,400
This situation is contained to

1406
00:44:47,400 --> 00:44:49,620
bank. We can I think wide-scale

1407
00:44:49,620 --> 00:44:51,620
nursing assistant assessment

1408
00:44:51,880 --> 00:44:53,910
coast upset of patients

1409
00:44:53,910 --> 00:44:56,530
candy in the nation to do next

1410
00:44:56,530 --> 00:44:59,170
in a special dances. And the

1411
00:44:59,170 --> 00:45:01,120
explanation

1412
00:45:01,120 --> 00:45:02,880
next, the staff must be

1413
00:45:02,880 --> 00:45:05,300
constantly says changes in

1414
00:45:05,300 --> 00:45:08,300
behavior. Nice but to shoot 2

1415
00:45:08,890 --> 00:45:10,400
cubs.

1416
00:45:10,400 --> 00:45:12,690
The tenement, what in the

1417
00:45:12,690 --> 00:45:15,700
nation is a puppy

1418
00:45:15,700 --> 00:45:17,280
money to the client service

1419
00:45:17,280 --> 00:45:19,680
Ponce and communicate different

1420
00:45:19,790 --> 00:45:20,930
chains

1421
00:45:20,930 --> 00:45:23,100
to the into DC discipline.

1422
00:45:23,100 --> 00:45:24,350
Any team

1423
00:45:24,350 --> 00:45:26,750
without coup with information

1424
00:45:26,840 --> 00:45:29,740
can allow a patient to escalate

1425
00:45:29,740 --> 00:45:32,360
into a completion of a violent

1426
00:45:32,360 --> 00:45:34,270
increase in the risk of

1427
00:45:34,270 --> 00:45:36,440
entrapment to the client, to

1428
00:45:36,440 --> 00:45:38,740
our other client. This also

1429
00:45:38,740 --> 00:45:39,870
staff

1430
00:45:39,870 --> 00:45:41,680
and it could mess and stopping

1431
00:45:41,680 --> 00:45:43,900
a Lowe's asked to intervene

1432
00:45:43,900 --> 00:45:46,100
every the fun of the situation

1433
00:45:46,100 --> 00:45:47,410
becomes

1434
00:45:47,410 --> 00:45:50,930
us to be in crisis gauges as

1435
00:45:50,930 --> 00:45:53,330
ability ability to recognize

1436
00:45:53,610 --> 00:45:56,450
warning signs of it to be 12

1437
00:45:56,450 --> 00:45:58,850
last part, the escalate

1438
00:45:59,700 --> 00:46:01,470
behavior to safety protected

1439
00:46:01,670 --> 00:46:02,970
the thinking that of our

1440
00:46:02,970 --> 00:46:04,450
clients.

1441
00:46:04,450 --> 00:46:06,360
Some nurses makes us from 7

1442
00:46:06,360 --> 00:46:08,620
that it's not only the response

1443
00:46:08,620 --> 00:46:09,990
when the crisis have been.

1444
00:46:09,990 --> 00:46:12,160
It's my responsibility is to

1445
00:46:12,160 --> 00:46:14,830
prevent crisis what ever this

1446
00:46:14,830 --> 00:46:17,400
possible. I want to kind to the

1447
00:46:17,400 --> 00:46:20,400
center. Can that safe timely?

1448
00:46:21,650 --> 00:46:23,890
We'll come back to me. And the

1449
00:46:23,890 --> 00:46:26,890
defeat was I strongly believe

1450
00:46:27,640 --> 00:46:28,930
that ethic and their son,

1451
00:46:28,930 --> 00:46:31,200
the staffing is and central.

1452
00:46:31,200 --> 00:46:33,640
It is not not right. And it's

1453
00:46:33,640 --> 00:46:35,600
not an option

1454
00:46:35,600 --> 00:46:37,000
to make think the safety and

1455
00:46:37,000 --> 00:46:40,600
quality of our clients. I spoke

1456
00:46:41,290 --> 00:46:42,850
to me asking the community to

1457
00:46:42,850 --> 00:46:45,400
recognize the combo sits at the

1458
00:46:45,400 --> 00:46:48,150
of our client us needs but only

1459
00:46:48,150 --> 00:46:50,800
messes to provide the safe and

1460
00:46:50,800 --> 00:46:52,320
effective cap.

1461
00:46:52,320 --> 00:46:55,540
So I wonder why this is so

1462
00:46:55,540 --> 00:46:57,940
NASA's train to respond.

1463
00:46:58,240 --> 00:47:00,640
Sonar of entities collation

1464
00:47:01,130 --> 00:47:04,300
that kind of stuff, provide

1465
00:47:04,300 --> 00:47:06,920
better care and nes U.S. and

1466
00:47:06,920 --> 00:47:09,350
its investment in safety and

1467
00:47:09,350 --> 00:47:11,660
dignity and quality of care.

1468
00:47:11,660 --> 00:47:13,620
Thank you so much.

1469
00:47:13,620 --> 00:47:14,990
Thank you, too.

1470
00:47:14,990 --> 00:47:17,860
>> And with that will end with

1471
00:47:17,860 --> 00:47:18,930
the

1472
00:47:18,930 --> 00:47:20,930
Mary Turner.

1473
00:47:24,630 --> 00:47:26,340
>> Back in in my name is Mary

1474
00:47:26,340 --> 00:47:27,480
Turner.

1475
00:47:27,480 --> 00:47:29,190
>> And I would love to bend

1476
00:47:29,190 --> 00:47:31,660
there today, but I had a arts

1477
00:47:31,660 --> 00:47:34,220
telling where my brother was a

1478
00:47:34,220 --> 00:47:36,450
veteran is being very today.

1479
00:47:36,450 --> 00:47:39,380
Anyway, I wear many hats, one

1480
00:47:39,380 --> 00:47:40,650
national nurses, United

1481
00:47:40,650 --> 00:47:42,600
president and the region at the

1482
00:47:42,600 --> 00:47:44,280
university and chair of the

1483
00:47:44,280 --> 00:47:46,480
board of this year. However,

1484
00:47:46,480 --> 00:47:47,820
today I'm here in the most

1485
00:47:47,820 --> 00:47:49,770
important role and that is as a

1486
00:47:49,770 --> 00:47:51,290
registered nurse in the great

1487
00:47:51,290 --> 00:47:53,290
state of Minnesota.

1488
00:47:53,290 --> 00:47:54,440
>> Minnesota has one of the

1489
00:47:54,440 --> 00:47:56,640
best nurse practice acts in the

1490
00:47:56,640 --> 00:47:58,500
country. And under that

1491
00:47:58,500 --> 00:48:00,450
document, all registered nurses

1492
00:48:00,790 --> 00:48:01,730
in Minnesota.

1493
00:48:01,730 --> 00:48:03,710
>> We have the right and duty

1494
00:48:03,710 --> 00:48:07,800
to assess delegate and a value.

1495
00:48:07,800 --> 00:48:08,230
>> In our mission to care for

1496
00:48:08,230 --> 00:48:09,560
the health of all, Minnesota,

1497
00:48:09,560 --> 00:48:10,950
us

1498
00:48:10,950 --> 00:48:12,920
our main focus no matter where

1499
00:48:12,920 --> 00:48:14,750
we practice our profession is

1500
00:48:14,750 --> 00:48:17,150
patients safety and prevents

1501
00:48:18,280 --> 00:48:21,470
nowhere. Is this more or in our

1502
00:48:21,470 --> 00:48:23,480
in our establishments that are

1503
00:48:23,480 --> 00:48:25,190
designed to help her patients

1504
00:48:25,190 --> 00:48:26,660
stay out of corporate

1505
00:48:26,660 --> 00:48:28,740
facilities and in the

1506
00:48:28,740 --> 00:48:30,210
community.

1507
00:48:30,210 --> 00:48:32,460
>> I refer to our day care and

1508
00:48:32,460 --> 00:48:34,460
our group homes

1509
00:48:34,550 --> 00:48:36,650
to fail to keep our clients in

1510
00:48:36,650 --> 00:48:38,180
the community where they can

1511
00:48:38,180 --> 00:48:40,600
have happier fuller lives.

1512
00:48:40,600 --> 00:48:41,990
It is imperative that they have

1513
00:48:41,990 --> 00:48:43,700
supervision

1514
00:48:43,700 --> 00:48:45,290
over there. Help from a

1515
00:48:45,290 --> 00:48:47,690
registered nurse whose job

1516
00:48:48,600 --> 00:48:49,780
under the terms packets act

1517
00:48:49,780 --> 00:48:51,470
remember is to once again

1518
00:48:51,470 --> 00:48:53,530
assess delegate and a value

1519
00:48:53,530 --> 00:48:55,100
that

1520
00:48:55,100 --> 00:48:56,840
the registered nurses trained

1521
00:48:56,840 --> 00:48:58,840
to look at the whole picture

1522
00:48:58,840 --> 00:49:01,700
from diagnosis and medication

1523
00:49:01,700 --> 00:49:01,760
lists.

1524
00:49:01,760 --> 00:49:03,220
>> Disabilities and not go

1525
00:49:03,220 --> 00:49:05,220
health issues. Most

1526
00:49:05,220 --> 00:49:06,320
importantly.

1527
00:49:06,320 --> 00:49:08,560
>> We catch issues before they

1528
00:49:08,560 --> 00:49:09,790
become acute and

1529
00:49:09,790 --> 00:49:11,790
hospitalization is required.

1530
00:49:12,200 --> 00:49:14,160
Which brings me to the point of

1531
00:49:14,160 --> 00:49:15,780
cost

1532
00:49:15,780 --> 00:49:17,560
basically the cost of a few

1533
00:49:17,560 --> 00:49:19,380
hours a week for a services of

1534
00:49:19,380 --> 00:49:21,160
a registered nurse. It is

1535
00:49:21,160 --> 00:49:23,640
nothing compared to the cost of

1536
00:49:23,640 --> 00:49:25,700
an ice. You stay in the

1537
00:49:25,700 --> 00:49:26,530
hospital.

1538
00:49:26,530 --> 00:49:28,550
Did you know that the average

1539
00:49:28,550 --> 00:49:31,160
stay just for the bad in ICU

1540
00:49:31,160 --> 00:49:33,110
right now in the Twin Cities is

1541
00:49:33,110 --> 00:49:36,710
$12,000 to gay and that is just

1542
00:49:36,770 --> 00:49:38,100
for the bat.

1543
00:49:38,100 --> 00:49:40,390
So this is a no-brainer, folks.

1544
00:49:40,390 --> 00:49:41,800
>> Not only do we get to keep

1545
00:49:41,800 --> 00:49:44,800
our people in the community.

1546
00:49:44,990 --> 00:49:47,360
>> But we also do a much lower

1547
00:49:47,360 --> 00:49:50,710
cost to the taxpayer. So I urge

1548
00:49:50,710 --> 00:49:53,820
you I urge you to allow

1549
00:49:53,820 --> 00:49:55,320
registered nurses to be able to

1550
00:49:55,320 --> 00:49:57,570
do the job that they are that

1551
00:49:57,570 --> 00:49:58,910
they are educated to do.

1552
00:49:58,910 --> 00:50:00,490
And that is to look out for our

1553
00:50:00,490 --> 00:50:02,160
people in the community so they

1554
00:50:02,160 --> 00:50:04,530
can stay in the community.

1555
00:50:04,530 --> 00:50:06,530
Thank you.

1556
00:50:07,180 --> 00:50:10,180
>> So with that members, let's

1557
00:50:11,820 --> 00:50:13,950
move on. Thank you, everybody

1558
00:50:13,950 --> 00:50:16,880
for letting me to this. First.

1559
00:50:16,880 --> 00:50:18,470
I again, the last time we had a

1560
00:50:18,470 --> 00:50:20,440
hearing, I just felt rushed at

1561
00:50:20,440 --> 00:50:24,200
the end. And so I think it's

1562
00:50:24,200 --> 00:50:25,830
good for us to understand

1563
00:50:25,830 --> 00:50:27,340
what's happening, the impact of

1564
00:50:27,340 --> 00:50:29,700
what is happening to the people

1565
00:50:29,700 --> 00:50:31,700
that

1566
00:50:32,150 --> 00:50:33,680
any comments from members

1567
00:50:33,680 --> 00:50:34,620
before we go to the

1568
00:50:34,620 --> 00:50:36,620
commissioner.

1569
00:50:38,810 --> 00:50:41,400
I don't see anybody. Enlai were

1570
00:50:41,400 --> 00:50:44,180
good. John Connolly and Chris

1571
00:50:44,180 --> 00:50:46,180
Teague wrong.

1572
00:50:48,310 --> 00:50:50,880
Thank you for allowing me to

1573
00:50:50,880 --> 00:50:52,880
the

1574
00:50:56,170 --> 00:50:59,170
to where it is flexible.

1575
00:50:59,330 --> 00:51:00,540
Did you did that? Give you time

1576
00:51:00,540 --> 00:51:02,300
to increase to to get your

1577
00:51:02,300 --> 00:51:04,300
thing too

1578
00:51:04,400 --> 00:51:06,390
set up to the system? Does it

1579
00:51:06,390 --> 00:51:08,390
will see TBD.

1580
00:51:09,140 --> 00:51:11,490
So before we do that,

1581
00:51:11,490 --> 00:51:13,300
Commissioner Connelly hearing

1582
00:51:13,300 --> 00:51:15,300
from people before

1583
00:51:15,650 --> 00:51:17,750
the key to that, really

1584
00:51:17,750 --> 00:51:20,430
that move me and it did proud

1585
00:51:20,430 --> 00:51:22,600
of, you know, the conversation

1586
00:51:22,600 --> 00:51:24,330
in my mind about, you know,

1587
00:51:24,330 --> 00:51:25,930
what I've seen happen to

1588
00:51:25,930 --> 00:51:27,800
individuals right in that the

1589
00:51:27,800 --> 00:51:30,230
amount of phone calls that just

1590
00:51:30,230 --> 00:51:33,260
my office alone, our staff are

1591
00:51:33,260 --> 00:51:35,660
doing. They're doing casework.

1592
00:51:36,590 --> 00:51:38,510
As I look down at other

1593
00:51:38,510 --> 00:51:40,150
offices. I don't see anybody

1594
00:51:40,150 --> 00:51:41,450
else doing casework rate.

1595
00:51:41,450 --> 00:51:43,300
And so, but that's because

1596
00:51:43,300 --> 00:51:44,270
there are so many people

1597
00:51:44,270 --> 00:51:46,570
relying on us to get it right.

1598
00:51:46,570 --> 00:51:48,970
And so, you know,

1599
00:51:49,290 --> 00:51:50,380
that's why we've had these

1600
00:51:50,380 --> 00:51:51,940
conversations on going to get

1601
00:51:51,940 --> 00:51:53,940
it right. So

1602
00:51:54,310 --> 00:51:55,770
thank you for being here and

1603
00:51:55,770 --> 00:51:57,940
thank you for giving us is an

1604
00:51:57,940 --> 00:52:00,170
update of where you're at and

1605
00:52:00,170 --> 00:52:02,570
and really focused. My essence

1606
00:52:02,570 --> 00:52:04,740
of ways is this continuity of

1607
00:52:04,740 --> 00:52:06,770
care. So thank you,

1608
00:52:06,770 --> 00:52:07,770
commissioner, for being here.

1609
00:52:07,770 --> 00:52:09,900
Thank you as crown for being

1610
00:52:09,900 --> 00:52:10,690
here

1611
00:52:10,690 --> 00:52:12,340
2 years.

1612
00:52:12,340 --> 00:52:13,630
>> Thank you, Chair Hoffman and

1613
00:52:13,630 --> 00:52:15,260
thank you to everyone who

1614
00:52:15,260 --> 00:52:17,500
testified already today,

1615
00:52:17,500 --> 00:52:18,660
community members, providers,

1616
00:52:18,660 --> 00:52:21,310
nurses, those who are doing the

1617
00:52:21,310 --> 00:52:22,700
essential work in the

1618
00:52:22,700 --> 00:52:24,600
community. I want to start a

1619
00:52:24,600 --> 00:52:25,710
little off script and just say,

1620
00:52:25,710 --> 00:52:27,490
I think building upon what the

1621
00:52:27,490 --> 00:52:29,200
chair just said,

1622
00:52:29,200 --> 00:52:31,750
DHS is it in a very difficult

1623
00:52:31,750 --> 00:52:33,490
moment as we've heard that you

1624
00:52:33,490 --> 00:52:35,750
are so please know that we

1625
00:52:35,750 --> 00:52:36,950
heard you

1626
00:52:36,950 --> 00:52:38,740
and that

1627
00:52:38,740 --> 00:52:41,220
our mission and this is on my

1628
00:52:41,220 --> 00:52:43,590
my badge right now is to help

1629
00:52:43,590 --> 00:52:44,700
people live their healthiest,

1630
00:52:44,700 --> 00:52:46,900
enforce lives and community.

1631
00:52:46,900 --> 00:52:47,160
And I heard that from you all

1632
00:52:47,160 --> 00:52:49,800
today. We are here. We exist to

1633
00:52:49,800 --> 00:52:51,640
do that in partnership with

1634
00:52:51,640 --> 00:52:52,660
you. And we've heard the

1635
00:52:52,660 --> 00:52:54,590
feedback about the difficulties

1636
00:52:54,590 --> 00:52:56,950
and the challenges and know

1637
00:52:56,950 --> 00:52:58,590
that

1638
00:52:58,590 --> 00:53:02,200
we serve the community and in

1639
00:53:02,200 --> 00:53:03,790
support of that mission and

1640
00:53:03,790 --> 00:53:06,120
that we never seek to harm

1641
00:53:06,120 --> 00:53:08,130
people in our programs or

1642
00:53:08,130 --> 00:53:09,930
legitimate providers.

1643
00:53:09,930 --> 00:53:12,930
And I understand those words

1644
00:53:13,700 --> 00:53:14,100
are words at this point.

1645
00:53:14,100 --> 00:53:15,300
We'll have a lot more to say

1646
00:53:15,300 --> 00:53:17,300
here in the presentation about

1647
00:53:17,300 --> 00:53:18,980
what we are doing with respect

1648
00:53:18,980 --> 00:53:20,860
to the different program,

1649
00:53:20,860 --> 00:53:22,860
integrity and interventions

1650
00:53:23,500 --> 00:53:26,300
that we are implementing and

1651
00:53:26,300 --> 00:53:27,950
certainly directed to implement

1652
00:53:27,950 --> 00:53:30,430
and just know that this has

1653
00:53:30,430 --> 00:53:32,560
been a very difficult year and

1654
00:53:32,560 --> 00:53:33,720
a half to 2 years at this

1655
00:53:33,720 --> 00:53:36,300
point, particularly since the

1656
00:53:36,300 --> 00:53:37,260
engagement of the federal

1657
00:53:37,260 --> 00:53:38,640
government at the end of last

1658
00:53:38,640 --> 00:53:40,390
year in December. And we have

1659
00:53:40,390 --> 00:53:41,280
undertaken a number of

1660
00:53:41,280 --> 00:53:43,300
processes in ways that

1661
00:53:43,300 --> 00:53:45,670
we would not have chosen

1662
00:53:45,670 --> 00:53:47,230
processes that were broader and

1663
00:53:47,230 --> 00:53:48,620
more expensive than any

1664
00:53:48,620 --> 00:53:49,840
Medicaid program has ever

1665
00:53:49,840 --> 00:53:51,260
undertaken in terms of provider

1666
00:53:51,260 --> 00:53:53,560
a validation to, of course,

1667
00:53:53,560 --> 00:53:56,100
respond to to fraud and program

1668
00:53:56,100 --> 00:53:58,310
integrity, concerns that are

1669
00:53:58,310 --> 00:54:01,400
real. But at the same time

1670
00:54:01,400 --> 00:54:02,600
being under extraordinary

1671
00:54:02,600 --> 00:54:03,680
pressure to do this in a way

1672
00:54:03,680 --> 00:54:05,220
that it's been never been done

1673
00:54:05,220 --> 00:54:08,820
before. So with that said, we

1674
00:54:08,860 --> 00:54:10,700
appeared here earlier this

1675
00:54:10,700 --> 00:54:11,970
summer. We were appearing, of

1676
00:54:11,970 --> 00:54:13,620
course, during session and are

1677
00:54:13,620 --> 00:54:15,400
appearing again today to

1678
00:54:15,400 --> 00:54:16,530
receive the feedback to provide

1679
00:54:16,530 --> 00:54:18,800
updates. We will continue to be

1680
00:54:18,800 --> 00:54:19,940
here with you all and the

1681
00:54:19,940 --> 00:54:22,610
community too, to to engage

1682
00:54:22,610 --> 00:54:24,000
again except the feedback and

1683
00:54:24,000 --> 00:54:25,400
we will enter to flee adjust

1684
00:54:25,400 --> 00:54:27,610
how we are doing this work in

1685
00:54:27,610 --> 00:54:29,170
the ways that we can

1686
00:54:29,170 --> 00:54:31,770
recognizing that we are under

1687
00:54:31,770 --> 00:54:33,100
some requirements and direction

1688
00:54:33,100 --> 00:54:34,230
from the federal government.

1689
00:54:34,230 --> 00:54:37,230
That is extraordinary. So just

1690
00:54:37,240 --> 00:54:38,240
know that we are we are

1691
00:54:38,240 --> 00:54:39,240
grappling with those 2

1692
00:54:39,240 --> 00:54:41,470
imperatives. It is always true

1693
00:54:41,470 --> 00:54:42,850
that our imperative this to

1694
00:54:42,850 --> 00:54:44,270
provide continuity of and

1695
00:54:44,270 --> 00:54:45,340
access to care that people

1696
00:54:45,340 --> 00:54:47,170
need, but also ensure that we

1697
00:54:47,170 --> 00:54:48,340
have the highest possible

1698
00:54:48,340 --> 00:54:50,330
program, integrity as we are

1699
00:54:50,330 --> 00:54:51,420
accountable to the people in

1700
00:54:51,420 --> 00:54:52,490
our programs, but also the

1701
00:54:52,490 --> 00:54:54,450
taxpayers of the state of

1702
00:54:54,450 --> 00:54:55,700
Minnesota.

1703
00:54:55,700 --> 00:54:58,260
That said on the slide here

1704
00:54:58,260 --> 00:54:59,360
that we start with this Israel,

1705
00:54:59,360 --> 00:55:00,970
the statement of the broad

1706
00:55:00,970 --> 00:55:03,720
impact of the Medicaid program,

1707
00:55:03,720 --> 00:55:05,720
20.9 billion dollars in 2024,

1708
00:55:06,850 --> 00:55:08,400
roughly one-third of the state

1709
00:55:08,400 --> 00:55:09,870
budget overall, 40,000

1710
00:55:09,870 --> 00:55:11,100
providers involved in the

1711
00:55:11,100 --> 00:55:12,520
Medicaid program. Overall,

1712
00:55:12,520 --> 00:55:13,560
that's organizations that

1713
00:55:13,560 --> 00:55:15,250
individuals over 300,000

1714
00:55:15,250 --> 00:55:17,250
individual providers and 1.2

1715
00:55:17,440 --> 00:55:19,440
million program members.

1716
00:55:19,540 --> 00:55:21,560
So the Medicaid program really

1717
00:55:21,560 --> 00:55:23,530
serves as the foundation of the

1718
00:55:23,530 --> 00:55:25,930
healthcare system in Minnesota.

1719
00:55:26,600 --> 00:55:27,250
And we know that it's essential

1720
00:55:27,250 --> 00:55:28,450
for people, with disabilities,

1721
00:55:28,450 --> 00:55:30,390
for children, for families,

1722
00:55:30,390 --> 00:55:32,670
for older adults, for those

1723
00:55:32,670 --> 00:55:34,350
during pregnancy at the

1724
00:55:34,350 --> 00:55:35,610
beginning at the end of life,

1725
00:55:35,610 --> 00:55:36,960
all of the above. And if you

1726
00:55:36,960 --> 00:55:39,460
aren't in Medicaid right now at

1727
00:55:39,460 --> 00:55:40,380
some point in your life,

1728
00:55:40,380 --> 00:55:41,650
you may be and chances are

1729
00:55:41,650 --> 00:55:42,760
great that, you know, someone

1730
00:55:42,760 --> 00:55:44,550
who is this is really in a

1731
00:55:44,550 --> 00:55:45,940
central program for so many.

1732
00:55:45,940 --> 00:55:47,890
It's a lifeline for Minnesota,

1733
00:55:47,890 --> 00:55:48,900
both for the individuals,

1734
00:55:48,900 --> 00:55:50,100
but also for our health care

1735
00:55:50,100 --> 00:55:51,940
delivery system. And as we root

1736
00:55:51,940 --> 00:55:53,760
out fraud, waste and abuse, we

1737
00:55:53,760 --> 00:55:55,310
know that we have an imperative

1738
00:55:55,310 --> 00:55:57,260
to maintain continuity of care

1739
00:55:57,260 --> 00:55:59,660
and access to service.

1740
00:56:00,330 --> 00:56:01,680
That said, as I mentioned in my

1741
00:56:01,680 --> 00:56:03,990
opening comments, we are under

1742
00:56:03,990 --> 00:56:05,720
some extraordinary and in fact

1743
00:56:05,720 --> 00:56:07,700
unprecedented circumstances.

1744
00:56:07,700 --> 00:56:08,560
I know we are all tired of that

1745
00:56:08,560 --> 00:56:09,360
word in Minnesota,

1746
00:56:09,360 --> 00:56:10,190
unprecedented. But

1747
00:56:10,190 --> 00:56:11,360
unfortunately, that is where we

1748
00:56:11,360 --> 00:56:12,270
are.

1749
00:56:12,270 --> 00:56:13,430
We are still dealing with

1750
00:56:13,430 --> 00:56:14,960
potentially 2 billion dollars

1751
00:56:14,960 --> 00:56:17,630
in cuts and another 550 million

1752
00:56:17,630 --> 00:56:19,480
dollars and freezes. And of

1753
00:56:19,480 --> 00:56:20,670
course, the 2 billion dollars

1754
00:56:20,670 --> 00:56:22,370
in potential cuts is is what it

1755
00:56:22,370 --> 00:56:25,360
is this associated with are

1756
00:56:25,360 --> 00:56:26,920
tied to this review allegation

1757
00:56:26,920 --> 00:56:27,680
effort that has been

1758
00:56:27,680 --> 00:56:29,430
extraordinary faster and more

1759
00:56:29,430 --> 00:56:31,520
expensive or fix expansive

1760
00:56:31,520 --> 00:56:33,180
rather than any state has ever

1761
00:56:33,180 --> 00:56:35,650
undertaken. And we should note

1762
00:56:35,650 --> 00:56:37,960
that this 550 million dollars

1763
00:56:37,960 --> 00:56:39,310
that is frozen that could

1764
00:56:39,310 --> 00:56:41,800
eventually be clawed back.

1765
00:56:41,800 --> 00:56:42,520
And the federal government has

1766
00:56:42,520 --> 00:56:43,440
indicated the Centers for

1767
00:56:43,440 --> 00:56:44,750
Medicare, Medicaid Services

1768
00:56:44,750 --> 00:56:46,280
have indicated that it is

1769
00:56:46,280 --> 00:56:47,940
possible they could claw back a

1770
00:56:47,940 --> 00:56:49,540
number that is greater than the

1771
00:56:49,540 --> 00:56:51,140
550 million dollars that has

1772
00:56:51,140 --> 00:56:52,280
been frozen. So just to

1773
00:56:52,280 --> 00:56:55,280
underscore the great threat and

1774
00:56:55,440 --> 00:56:56,600
the risk that we are grappling

1775
00:56:56,600 --> 00:56:59,400
with in the reason for doing

1776
00:56:59,400 --> 00:56:59,880
some of the work that we've

1777
00:56:59,880 --> 00:57:01,880
been doing.

1778
00:57:02,500 --> 00:57:03,420
So with respect to Minnesota,

1779
00:57:03,420 --> 00:57:05,410
to validate all a review,

1780
00:57:05,410 --> 00:57:06,340
some of what we talked about

1781
00:57:06,340 --> 00:57:07,480
earlier in the summer in this

1782
00:57:07,480 --> 00:57:09,820
forum, the federal Centers for

1783
00:57:09,820 --> 00:57:11,500
Medicare and Medicaid Services

1784
00:57:11,500 --> 00:57:13,330
required this effort to be done

1785
00:57:13,330 --> 00:57:15,600
by May 31st as a part of our

1786
00:57:15,600 --> 00:57:16,540
corrective action plan. And

1787
00:57:16,540 --> 00:57:18,520
they directed us to undertake

1788
00:57:18,520 --> 00:57:20,870
both in in a letter from the

1789
00:57:20,870 --> 00:57:22,270
Administrator, Dr Oz in

1790
00:57:22,270 --> 00:57:25,160
December and again in January,

1791
00:57:25,160 --> 00:57:26,360
under great pressure to do it

1792
00:57:26,360 --> 00:57:27,710
as quickly as we could. And

1793
00:57:27,710 --> 00:57:29,220
with great public criticism for

1794
00:57:29,220 --> 00:57:31,690
the time that we that we we

1795
00:57:31,690 --> 00:57:33,360
requested to complete this

1796
00:57:33,360 --> 00:57:35,570
effort. And again, this this

1797
00:57:35,570 --> 00:57:36,630
2 billion dollars that's a

1798
00:57:36,630 --> 00:57:38,110
threat associated with this

1799
00:57:38,110 --> 00:57:39,400
effort. And the broader

1800
00:57:39,400 --> 00:57:40,590
corrective action plan is about

1801
00:57:40,590 --> 00:57:41,980
one 3rd of annual disability

1802
00:57:41,980 --> 00:57:43,630
waiver spending. I just want to

1803
00:57:43,630 --> 00:57:44,500
know that the bottom of this

1804
00:57:44,500 --> 00:57:45,940
slide, other states have now

1805
00:57:45,940 --> 00:57:47,220
been given 2 years to do what

1806
00:57:47,220 --> 00:57:49,800
we have done in 5 months,

1807
00:57:49,800 --> 00:57:50,810
though, we continue to process

1808
00:57:50,810 --> 00:57:52,640
the appeals as a result of that

1809
00:57:52,640 --> 00:57:55,640
effort. And again, I'll just

1810
00:57:55,850 --> 00:57:57,160
say that we've heard the

1811
00:57:57,160 --> 00:57:58,200
feedback it or did lead

1812
00:57:58,200 --> 00:57:59,770
throughout this process through

1813
00:57:59,770 --> 00:58:01,240
a number of forums,

1814
00:58:01,240 --> 00:58:02,520
communications engagement with

1815
00:58:02,520 --> 00:58:03,960
providers and of a number of

1816
00:58:03,960 --> 00:58:05,670
different ways and will

1817
00:58:05,670 --> 00:58:08,530
continue to to revise and to

1818
00:58:08,530 --> 00:58:09,440
adjust the way that we are

1819
00:58:09,440 --> 00:58:11,260
doing the work to be responsive

1820
00:58:11,260 --> 00:58:12,470
to what's being experienced in

1821
00:58:12,470 --> 00:58:14,470
the community,

1822
00:58:15,360 --> 00:58:17,140
moving on to what we've done to

1823
00:58:17,140 --> 00:58:19,800
meet this moment. So given the

1824
00:58:19,800 --> 00:58:20,910
extraordinary circumstances

1825
00:58:20,910 --> 00:58:21,840
presented to us in the

1826
00:58:21,840 --> 00:58:22,920
direction presented by the

1827
00:58:22,920 --> 00:58:24,770
federal government, we set up

1828
00:58:24,770 --> 00:58:26,190
an incident command within the

1829
00:58:26,190 --> 00:58:27,880
department, bringing in 100

1830
00:58:27,880 --> 00:58:29,340
staff from across the state

1831
00:58:29,340 --> 00:58:30,410
enterprise and other

1832
00:58:30,410 --> 00:58:31,570
departments to help us,

1833
00:58:31,570 --> 00:58:32,710
particularly with the site.

1834
00:58:32,710 --> 00:58:35,100
Visit portion of this work made

1835
00:58:35,100 --> 00:58:36,320
nearly 10,000 calls to

1836
00:58:36,320 --> 00:58:38,320
providers, including 4,000

1837
00:58:39,600 --> 00:58:39,960
through the provider, a call

1838
00:58:39,960 --> 00:58:41,720
center and of course, doing

1839
00:58:41,720 --> 00:58:43,660
weekly, provide around tables,

1840
00:58:43,660 --> 00:58:44,550
producing a number of

1841
00:58:44,550 --> 00:58:45,590
resources, whether it be

1842
00:58:45,590 --> 00:58:47,590
webinars paper.

1843
00:58:48,140 --> 00:58:49,630
>> In addition to additional

1844
00:58:49,630 --> 00:58:51,710
meetings, office hours and

1845
00:58:51,710 --> 00:58:53,710
in-person meetings and

1846
00:58:53,790 --> 00:58:54,490
different meetings with

1847
00:58:54,490 --> 00:58:55,990
provider associations to again

1848
00:58:55,990 --> 00:58:57,570
hear feedback and to adjust as

1849
00:58:57,570 --> 00:58:58,720
we went, given the

1850
00:58:58,720 --> 00:59:00,250
extraordinary direction from

1851
00:59:00,250 --> 00:59:02,210
the federal government. It

1852
00:59:02,210 --> 00:59:03,340
feels important for me to say

1853
00:59:03,340 --> 00:59:05,800
what I said it on July 1st at

1854
00:59:05,800 --> 00:59:07,270
this hearing, which is we

1855
00:59:07,270 --> 00:59:08,360
understand this is not been

1856
00:59:08,360 --> 00:59:10,200
perfect. We are not perfect at

1857
00:59:10,200 --> 00:59:11,830
the departments. And again,

1858
00:59:11,830 --> 00:59:13,120
we've sought to engage and will

1859
00:59:13,120 --> 00:59:15,250
continue to seek feedback.

1860
00:59:15,250 --> 00:59:16,290
It just communicate

1861
00:59:16,290 --> 00:59:18,690
proactively. And of course,

1862
00:59:18,840 --> 00:59:19,970
we'll do that with advocates

1863
00:59:19,970 --> 00:59:21,830
and legislators, lead agencies,

1864
00:59:21,830 --> 00:59:22,950
including tribal nations,

1865
00:59:22,950 --> 00:59:24,420
counties and managed care

1866
00:59:24,420 --> 00:59:25,630
organizations. And today we're

1867
00:59:25,630 --> 00:59:27,340
here to continue that effort

1868
00:59:27,340 --> 00:59:28,590
knowing there's no finish line

1869
00:59:28,590 --> 00:59:30,710
here that program, integrity

1870
00:59:30,710 --> 00:59:32,200
and Medicaid, the work of

1871
00:59:32,200 --> 00:59:33,190
government is continuous

1872
00:59:33,190 --> 00:59:34,900
improvement. That is the

1873
00:59:34,900 --> 00:59:36,240
essence of what we do

1874
00:59:36,240 --> 00:59:37,870
with respect to a quick update

1875
00:59:37,870 --> 00:59:39,730
here on the numbers. The total

1876
00:59:39,730 --> 00:59:42,700
number of providers out of the

1877
00:59:42,700 --> 00:59:43,460
roughly 5800 that were read

1878
00:59:43,460 --> 00:59:45,820
elevated total read audited

1879
00:59:45,820 --> 00:59:47,770
providers to date is about

1880
00:59:47,770 --> 00:59:49,890
almost 3600. So we're we have a

1881
00:59:49,890 --> 00:59:52,220
majority who are retaliated

1882
00:59:52,220 --> 00:59:54,300
a little over 1500 are still an

1883
00:59:54,300 --> 00:59:55,890
appeal.

1884
00:59:55,890 --> 00:59:56,860
Excuse me. Those appeals are

1885
00:59:56,860 --> 00:59:59,540
completed. So of the 30 to the

1886
00:59:59,540 --> 01:00:01,540
35 87, 1500 have had their

1887
01:00:03,300 --> 01:00:04,480
appeals completed. They are we

1888
01:00:04,480 --> 01:00:06,680
validated remaining incue in

1889
01:00:06,680 --> 01:00:08,800
the process are a little under

1890
01:00:08,800 --> 01:00:10,220
1200 providers and we are

1891
01:00:10,220 --> 01:00:11,560
continuing to work through the

1892
01:00:11,560 --> 01:00:13,460
through those the major

1893
01:00:13,460 --> 01:00:14,550
challenge that we haven't.

1894
01:00:14,550 --> 01:00:16,200
We heard the feedback from

1895
01:00:16,200 --> 01:00:17,220
those that testified at the

1896
01:00:17,220 --> 01:00:19,370
beginning of the hearing here

1897
01:00:19,370 --> 01:00:21,500
about the paperwork, the

1898
01:00:21,500 --> 01:00:21,920
difficulties they've

1899
01:00:21,920 --> 01:00:23,160
experienced, the delays.

1900
01:00:23,160 --> 01:00:25,710
We understand that we are aware

1901
01:00:25,710 --> 01:00:26,660
of that and we're doing our

1902
01:00:26,660 --> 01:00:28,940
best to minimize those issues.

1903
01:00:28,940 --> 01:00:31,900
I will note we are we are doing

1904
01:00:31,900 --> 01:00:33,490
our best to it or Dudley work

1905
01:00:33,490 --> 01:00:35,610
with providers to address the

1906
01:00:35,610 --> 01:00:37,360
gaps in the documentation

1907
01:00:37,360 --> 01:00:39,630
they're submitting to make this

1908
01:00:39,630 --> 01:00:41,740
more streamlined. But again, if

1909
01:00:41,740 --> 01:00:43,100
we're continuing to grapple

1910
01:00:43,100 --> 01:00:43,880
with issues with the

1911
01:00:43,880 --> 01:00:45,210
documentation, we cannot

1912
01:00:45,210 --> 01:00:47,130
approve 3 validation. That is,

1913
01:00:47,130 --> 01:00:49,100
of course, our charge as the

1914
01:00:49,100 --> 01:00:51,610
Medicaid agency. We owe these

1915
01:00:51,610 --> 01:00:53,420
these certain requirements to

1916
01:00:53,420 --> 01:00:54,800
be in place with respect to

1917
01:00:54,800 --> 01:00:56,800
qualified staff insurance,

1918
01:00:57,100 --> 01:00:58,380
background checks, checks, et

1919
01:00:58,380 --> 01:01:00,400
cetera, for the people that we

1920
01:01:00,400 --> 01:01:02,110
serve. In addition to, I think

1921
01:01:02,110 --> 01:01:03,320
the public that expects these

1922
01:01:03,320 --> 01:01:05,300
things to be upheld and

1923
01:01:05,300 --> 01:01:06,730
reviewed. So we will do our

1924
01:01:06,730 --> 01:01:08,400
best to do that in a way that

1925
01:01:08,400 --> 01:01:09,890
that supports providers.

1926
01:01:09,890 --> 01:01:11,680
I will note it's just incumbent

1927
01:01:11,680 --> 01:01:14,640
on me to say that CMS has been

1928
01:01:14,640 --> 01:01:15,850
as question to the number of

1929
01:01:15,850 --> 01:01:17,700
times that we have worked with

1930
01:01:17,700 --> 01:01:18,890
providers to get this right.

1931
01:01:18,890 --> 01:01:20,240
So we are definitely under

1932
01:01:20,240 --> 01:01:21,800
examination scrutiny for how we

1933
01:01:21,800 --> 01:01:23,360
are handling this. But again,

1934
01:01:23,360 --> 01:01:25,260
our aim is to to help put an

1935
01:01:25,260 --> 01:01:26,690
end to providers, get re

1936
01:01:26,690 --> 01:01:28,640
validated, to provide service,

1937
01:01:28,640 --> 01:01:30,800
to maintain access to service

1938
01:01:30,800 --> 01:01:31,770
in the program. Again, hearing

1939
01:01:31,770 --> 01:01:33,100
what's been what's been stated

1940
01:01:33,100 --> 01:01:34,510
here today from community

1941
01:01:34,510 --> 01:01:36,450
members and providers.

1942
01:01:36,450 --> 01:01:39,470
I'm a little bit more about the

1943
01:01:39,470 --> 01:01:40,400
I think the points that were

1944
01:01:40,400 --> 01:01:41,760
made from some that testified

1945
01:01:41,760 --> 01:01:43,710
about the balance between the

1946
01:01:43,710 --> 01:01:44,820
re validation Worth's

1947
01:01:44,820 --> 01:01:46,180
extraordinary effort that we

1948
01:01:46,180 --> 01:01:48,140
did in 5 months and the regular

1949
01:01:48,140 --> 01:01:49,500
provider enrollment work that

1950
01:01:49,500 --> 01:01:52,360
is backlogged. We did set aside

1951
01:01:52,360 --> 01:01:53,870
the bulk of the work with

1952
01:01:53,870 --> 01:01:55,190
respect to provider enrollment

1953
01:01:55,190 --> 01:01:57,590
compliance work streams to

1954
01:01:57,800 --> 01:01:59,430
prioritize the validation were

1955
01:01:59,430 --> 01:02:00,710
given the tremendous figures

1956
01:02:00,710 --> 01:02:01,670
that you saw in the earlier

1957
01:02:01,670 --> 01:02:03,420
slides with respect to federal

1958
01:02:03,420 --> 01:02:04,990
dollars that are at risk.

1959
01:02:04,990 --> 01:02:06,290
That said, we have heard from

1960
01:02:06,290 --> 01:02:08,570
community and from legislators,

1961
01:02:08,570 --> 01:02:09,570
some of them are present here

1962
01:02:09,570 --> 01:02:11,470
today that we need to rebalance

1963
01:02:11,470 --> 01:02:12,930
that work. So we have begun to

1964
01:02:12,930 --> 01:02:15,280
do that. We have expanded the

1965
01:02:15,280 --> 01:02:16,190
number of staff that are

1966
01:02:16,190 --> 01:02:17,480
working on regular provider

1967
01:02:17,480 --> 01:02:19,750
enrollment work and reduced to

1968
01:02:19,750 --> 01:02:22,750
a degree of allegation capacity

1969
01:02:23,390 --> 01:02:25,100
to have a better balance

1970
01:02:25,100 --> 01:02:27,500
between some of the the regular

1971
01:02:27,500 --> 01:02:28,570
enrollment work hearing.

1972
01:02:28,570 --> 01:02:30,200
The pressures that providers

1973
01:02:30,200 --> 01:02:31,690
are under and that people are

1974
01:02:31,690 --> 01:02:33,960
under with respect to enrolling

1975
01:02:33,960 --> 01:02:35,710
new providers and updating

1976
01:02:35,710 --> 01:02:36,890
records that providers have

1977
01:02:36,890 --> 01:02:38,260
with us.

1978
01:02:38,260 --> 01:02:40,150
In addition, we are trying to

1979
01:02:40,150 --> 01:02:41,790
make the overall size of the

1980
01:02:41,790 --> 01:02:42,740
provider enrollment in

1981
01:02:42,740 --> 01:02:44,760
compliance team larger. We are

1982
01:02:44,760 --> 01:02:47,760
hiring. We anticipate in the

1983
01:02:47,890 --> 01:02:49,280
coming days and weeks hiring up

1984
01:02:49,280 --> 01:02:50,930
to roughly the little under 30

1985
01:02:50,930 --> 01:02:52,830
new people for that team to

1986
01:02:52,830 --> 01:02:54,820
provide new capacity for both

1987
01:02:54,820 --> 01:02:56,130
the rehabilitation work and the

1988
01:02:56,130 --> 01:02:58,200
regular provider and Roman

1989
01:02:58,200 --> 01:03:01,610
work. So that is and in the

1990
01:03:01,610 --> 01:03:02,800
name of being responsive to

1991
01:03:02,800 --> 01:03:03,860
some of the feedback we heard

1992
01:03:03,860 --> 01:03:06,750
earlier also say again, that

1993
01:03:06,750 --> 01:03:08,370
should help us process some of

1994
01:03:08,370 --> 01:03:10,500
the remaining revalidation work

1995
01:03:10,500 --> 01:03:12,900
faster.

1996
01:03:12,900 --> 01:03:15,100
So I think with that I can

1997
01:03:15,100 --> 01:03:16,230
pause on the rehabilitation

1998
01:03:16,230 --> 01:03:17,610
after we have continuity of

1999
01:03:17,610 --> 01:03:19,360
care slides here to come.

2000
01:03:19,360 --> 01:03:20,380
I don't know, chair if you want

2001
01:03:20,380 --> 01:03:22,900
to take questions at this point

2002
01:03:22,900 --> 01:03:24,910
or are keeping the questions

2003
01:03:24,910 --> 01:03:26,910
for commissioner

2004
01:03:28,870 --> 01:03:30,870
because there's a

2005
01:03:30,870 --> 01:03:32,580
three-second delay to anybody

2006
01:03:32,580 --> 01:03:34,580
online.

2007
01:03:35,550 --> 01:03:38,600
No. All right. Thank you.

2008
01:03:38,600 --> 01:03:40,460
Go ahead, Jeff Commissioner,

2009
01:03:40,720 --> 01:03:42,220
thank you chair often.

2010
01:03:42,220 --> 01:03:43,780
So we'll we'll start this

2011
01:03:43,780 --> 01:03:46,180
portion of the presentation.

2012
01:03:46,980 --> 01:03:48,270
I think we lost the slides on

2013
01:03:48,270 --> 01:03:49,660
the screen and the folks can

2014
01:03:49,660 --> 01:03:51,670
see there we go. Okay.

2015
01:03:51,670 --> 01:03:53,200
We know the continuity of care

2016
01:03:53,200 --> 01:03:54,750
is paramount and it is

2017
01:03:54,750 --> 01:03:56,400
essential to the way that folks

2018
01:03:56,400 --> 01:03:58,410
experience the Medicaid program

2019
01:03:58,410 --> 01:03:59,720
have continuity of care and

2020
01:03:59,720 --> 01:04:01,570
also coordination among the

2021
01:04:01,570 --> 01:04:02,950
array of services that they

2022
01:04:02,950 --> 01:04:04,610
need again to help them live

2023
01:04:04,610 --> 01:04:05,670
their healthiest and Phyllis

2024
01:04:05,670 --> 01:04:07,700
lives and community and have

2025
01:04:07,700 --> 01:04:09,700
integrated rational services

2026
01:04:09,240 --> 01:04:11,140
that that makes sense relative

2027
01:04:11,140 --> 01:04:12,600
to one another that they're

2028
01:04:12,600 --> 01:04:13,700
coordinated. And as we know,

2029
01:04:13,700 --> 01:04:14,800
and as many of stated here

2030
01:04:14,800 --> 01:04:17,200
today, very, very articulate

2031
01:04:17,700 --> 01:04:19,420
Lee and very well, this

2032
01:04:19,420 --> 01:04:21,400
prevents on this unnecessary

2033
01:04:21,400 --> 01:04:22,000
hospitalization and

2034
01:04:22,000 --> 01:04:23,960
institutionalization and helps

2035
01:04:23,960 --> 01:04:25,140
people live in the most

2036
01:04:25,140 --> 01:04:26,150
community-based setting in

2037
01:04:26,150 --> 01:04:28,100
accordance with Olmstead and of

2038
01:04:28,100 --> 01:04:30,120
course, honors personal choice

2039
01:04:30,120 --> 01:04:31,340
and direction of the services

2040
01:04:31,340 --> 01:04:33,190
that people that people need

2041
01:04:33,190 --> 01:04:35,200
and and also integrates their

2042
01:04:35,200 --> 01:04:36,800
goals for their treatment and

2043
01:04:36,800 --> 01:04:38,280
for their their overall lives

2044
01:04:38,280 --> 01:04:40,280
and well-being.

2045
01:04:40,330 --> 01:04:41,730
So the vision for continuity of

2046
01:04:41,730 --> 01:04:43,150
care speaks to those those

2047
01:04:43,150 --> 01:04:44,770
elements. First of all,

2048
01:04:44,770 --> 01:04:46,140
seamless transitions between

2049
01:04:46,140 --> 01:04:47,600
providers or different types of

2050
01:04:47,600 --> 01:04:48,720
care, particularly from an

2051
01:04:48,720 --> 01:04:50,540
institution into community,

2052
01:04:50,540 --> 01:04:52,160
again, in alignment with

2053
01:04:52,160 --> 01:04:53,810
Olmstead. That is our goal for

2054
01:04:53,810 --> 01:04:54,900
folks to move whenever

2055
01:04:54,900 --> 01:04:57,620
possible. And when it is with a

2056
01:04:57,620 --> 01:04:58,980
within people's choice and

2057
01:04:58,980 --> 01:05:00,210
goals to move into

2058
01:05:00,210 --> 01:05:01,200
community-based settings

2059
01:05:01,200 --> 01:05:02,910
whenever possible

2060
01:05:02,910 --> 01:05:04,300
that we have consistent support

2061
01:05:04,300 --> 01:05:05,110
teams, even if there's

2062
01:05:05,110 --> 01:05:07,100
transition from one provider to

2063
01:05:07,100 --> 01:05:08,810
another within a service that

2064
01:05:08,810 --> 01:05:10,790
other providers, our constant,

2065
01:05:10,790 --> 01:05:12,470
that they are coordinated,

2066
01:05:12,470 --> 01:05:13,790
of course, coordinated plan,

2067
01:05:13,790 --> 01:05:15,620
support plans, making sure that

2068
01:05:15,620 --> 01:05:16,780
all of these things are

2069
01:05:16,780 --> 01:05:18,200
aligned, whether it's housing,

2070
01:05:18,200 --> 01:05:20,420
health services, personal care,

2071
01:05:20,790 --> 01:05:22,380
and also integration and

2072
01:05:22,380 --> 01:05:23,640
community so that all of those

2073
01:05:23,640 --> 01:05:24,860
needs are accounted for and

2074
01:05:24,860 --> 01:05:27,260
again, make sense together,

2075
01:05:29,330 --> 01:05:31,150
most of the course.

2076
01:05:31,150 --> 01:05:32,310
All right. So a little bit

2077
01:05:32,310 --> 01:05:34,500
more. We want to be responsive

2078
01:05:34,500 --> 01:05:35,150
to the request for an outline

2079
01:05:35,150 --> 01:05:36,940
of the reimbursement or payment

2080
01:05:36,940 --> 01:05:39,330
mechanisms for it for the

2081
01:05:39,330 --> 01:05:41,850
services. And there are 3 major

2082
01:05:41,850 --> 01:05:43,840
frameworks for this. Of course,

2083
01:05:43,840 --> 01:05:45,570
the first is the disability

2084
01:05:45,570 --> 01:05:46,880
waiver rates system framework

2085
01:05:46,880 --> 01:05:49,000
or D WRs as it's known for

2086
01:05:49,000 --> 01:05:51,840
those who are initiated and of

2087
01:05:51,840 --> 01:05:54,000
course market rates. The second

2088
01:05:54,000 --> 01:05:55,210
that all know here on the slide

2089
01:05:55,210 --> 01:05:56,680
is community for services and

2090
01:05:56,680 --> 01:05:59,730
supports or CFS S and that is a

2091
01:05:59,730 --> 01:06:01,170
separate raid framework.

2092
01:06:01,170 --> 01:06:03,140
And then 3rd, there are state

2093
01:06:03,140 --> 01:06:04,760
plan services that have flat

2094
01:06:04,760 --> 01:06:05,810
rates and in some cases

2095
01:06:05,810 --> 01:06:06,920
depending on the benefit or

2096
01:06:06,920 --> 01:06:08,590
service, there are inflationary

2097
01:06:08,590 --> 01:06:09,910
updates so they could could be

2098
01:06:09,910 --> 01:06:11,390
indexed in that fashion.

2099
01:06:11,390 --> 01:06:12,540
A couple of examples or home

2100
01:06:12,540 --> 01:06:13,620
care, nursing. And of course,

2101
01:06:13,620 --> 01:06:16,640
the IDB I which is our benefit

2102
01:06:16,640 --> 01:06:19,400
for youth, autism services

2103
01:06:20,320 --> 01:06:21,370
a little bit more here on

2104
01:06:21,370 --> 01:06:23,110
waiver rates and exceptions.

2105
01:06:23,110 --> 01:06:25,150
So current reimbursement models

2106
01:06:25,150 --> 01:06:26,510
are, as you see here on the

2107
01:06:26,510 --> 01:06:28,370
slide configurable. So they are

2108
01:06:28,370 --> 01:06:30,370
individualized rates depending

2109
01:06:30,870 --> 01:06:32,800
on what individuals support

2110
01:06:32,800 --> 01:06:34,670
plan includes and what their

2111
01:06:34,670 --> 01:06:37,100
needs are. So the rates will

2112
01:06:37,100 --> 01:06:38,260
vary from person to person

2113
01:06:38,260 --> 01:06:39,770
depending on what their needs

2114
01:06:39,770 --> 01:06:40,770
are and what services they

2115
01:06:40,770 --> 01:06:42,770
require. Staffing levels are a

2116
01:06:42,770 --> 01:06:44,410
key piece of what rates might

2117
01:06:44,410 --> 01:06:46,230
be and again, depend on what

2118
01:06:46,230 --> 01:06:47,520
the individual's needs are.

2119
01:06:47,520 --> 01:06:48,420
And I think we heard a lot

2120
01:06:48,420 --> 01:06:49,370
about this in the opening

2121
01:06:49,370 --> 01:06:51,770
testimony about how different

2122
01:06:51,940 --> 01:06:52,870
types of professionals

2123
01:06:52,870 --> 01:06:54,330
clinicians are engaged,

2124
01:06:54,330 --> 01:06:55,550
depending on what individuals

2125
01:06:55,550 --> 01:06:56,970
needs might be.

2126
01:06:56,970 --> 01:06:58,480
That said there is a process

2127
01:06:58,480 --> 01:06:59,980
for providers to request an

2128
01:06:59,980 --> 01:07:01,970
exception. If the the

2129
01:07:01,970 --> 01:07:03,610
frameworks that we have to not

2130
01:07:03,610 --> 01:07:05,300
yield the rate that they feel

2131
01:07:05,300 --> 01:07:07,380
fully accounts for the needs

2132
01:07:07,380 --> 01:07:08,640
that individual has in the

2133
01:07:08,640 --> 01:07:09,790
services are professionals.

2134
01:07:09,790 --> 01:07:12,110
They require so lead agencies

2135
01:07:12,110 --> 01:07:13,760
may receive a request for an

2136
01:07:13,760 --> 01:07:15,580
exception or exception. Excuse

2137
01:07:15,580 --> 01:07:17,800
me. And DHS and lead agencies

2138
01:07:17,800 --> 01:07:19,660
have 30 days to review that and

2139
01:07:19,660 --> 01:07:22,390
then respond to the request.

2140
01:07:22,390 --> 01:07:24,270
Providers may appeal, of

2141
01:07:24,270 --> 01:07:25,690
course, if that rate exception

2142
01:07:25,690 --> 01:07:26,960
is denied. So there is a

2143
01:07:26,960 --> 01:07:28,200
process for that as well.

2144
01:07:28,200 --> 01:07:29,640
Subsequent to that

2145
01:07:29,640 --> 01:07:31,360
DHS, of course, we're always

2146
01:07:31,360 --> 01:07:32,400
continuing to improve the

2147
01:07:32,400 --> 01:07:33,720
processes by which we do the

2148
01:07:33,720 --> 01:07:35,520
work to do it as efficiently

2149
01:07:35,520 --> 01:07:37,210
and timely as possible, having

2150
01:07:37,210 --> 01:07:39,600
consistency across the agencies

2151
01:07:39,600 --> 01:07:42,600
across counties in the state

2152
01:07:42,130 --> 01:07:43,540
and of course, want want the

2153
01:07:43,540 --> 01:07:45,300
process to be clear and

2154
01:07:45,300 --> 01:07:47,410
transparent to providers and to

2155
01:07:47,410 --> 01:07:48,670
the people receiving services

2156
01:07:48,670 --> 01:07:50,650
of the members of our programs,

2157
01:07:50,650 --> 01:07:52,340
particularly when the approved

2158
01:07:52,340 --> 01:07:53,720
rate is not what the providers

2159
01:07:53,720 --> 01:07:55,160
sought.

2160
01:07:55,160 --> 01:07:56,850
We're also implementing reforms

2161
01:07:56,850 --> 01:07:59,850
to WRs that rate framework.

2162
01:08:00,200 --> 01:08:01,830
Pursuant to, of course, the

2163
01:08:01,830 --> 01:08:03,830
acts of the legislature signed

2164
01:08:03,830 --> 01:08:04,690
by the governor, of course,

2165
01:08:04,690 --> 01:08:06,100
after the during the last 2

2166
01:08:06,100 --> 01:08:07,910
sessions and those include

2167
01:08:07,910 --> 01:08:09,810
changes to approve the waiver.

2168
01:08:09,810 --> 01:08:12,210
8 exceptions if they are

2169
01:08:12,980 --> 01:08:14,360
supported by documentation of

2170
01:08:14,360 --> 01:08:16,300
the staffing need for the tool

2171
01:08:16,300 --> 01:08:18,300
that served

2172
01:08:18,650 --> 01:08:21,800
commissioner. Yes, I'm just a

2173
01:08:21,800 --> 01:08:22,820
couple of things said.

2174
01:08:22,820 --> 01:08:23,570
>> Thank you. You're going to

2175
01:08:23,570 --> 01:08:25,500
go into what we did to 2026

2176
01:08:25,500 --> 01:08:26,790
legislature, which led, which

2177
01:08:26,790 --> 01:08:27,590
is leading to this

2178
01:08:27,590 --> 01:08:29,900
conversation, Cathy Care, which

2179
01:08:29,900 --> 01:08:30,410
is also, but on the radar

2180
01:08:30,410 --> 01:08:31,670
exception,

2181
01:08:31,670 --> 01:08:33,470
if I understand it right, is

2182
01:08:33,470 --> 01:08:35,470
that

2183
01:08:36,100 --> 01:08:37,610
need to nursing services are in

2184
01:08:37,610 --> 01:08:39,240
need. That's basically what

2185
01:08:39,240 --> 01:08:39,990
we're getting is the

2186
01:08:39,990 --> 01:08:41,140
understanding of these needs

2187
01:08:41,140 --> 01:08:42,660
nurses who says is it the

2188
01:08:42,660 --> 01:08:44,820
contracted case manager that

2189
01:08:44,820 --> 01:08:46,310
makes that first decision or

2190
01:08:46,310 --> 01:08:47,960
what I feel it is to go to

2191
01:08:47,960 --> 01:08:49,350
Kristie.

2192
01:08:49,350 --> 01:08:50,870
I mean, think you think it

2193
01:08:50,870 --> 01:08:51,870
that, Christine, by the way,

2194
01:08:51,870 --> 01:08:53,240
I forward everything to her

2195
01:08:53,240 --> 01:08:54,390
that comes to us. You do.

2196
01:08:54,390 --> 01:08:56,180
You have no idea what what you

2197
01:08:56,180 --> 01:08:57,990
have. So especially with the

2198
01:08:57,990 --> 01:08:59,440
knowledge base when you study

2199
01:08:59,440 --> 01:09:00,820
WRs,

2200
01:09:00,820 --> 01:09:02,210
do you realize 12 years ago and

2201
01:09:02,210 --> 01:09:03,590
we first had the dws

2202
01:09:03,590 --> 01:09:05,220
conversation. He was Heidi

2203
01:09:05,220 --> 01:09:08,220
Hamilton, Alec part live in.

2204
01:09:09,600 --> 01:09:10,500
So

2205
01:09:10,500 --> 01:09:12,340
that was something to to help

2206
01:09:12,340 --> 01:09:14,410
me understand that piece

2207
01:09:14,410 --> 01:09:15,880
because I can't wrap my hands

2208
01:09:15,880 --> 01:09:16,730
around it if our

2209
01:09:16,730 --> 01:09:18,670
responsibilities to make sure

2210
01:09:18,670 --> 01:09:20,680
the most of our own people are

2211
01:09:20,680 --> 01:09:23,130
getting the services they need.

2212
01:09:23,130 --> 01:09:25,260
And here's one where an RN or a

2213
01:09:25,260 --> 01:09:27,580
doctor has said this child or

2214
01:09:27,580 --> 01:09:30,580
this. This adult needs this.

2215
01:09:30,870 --> 01:09:33,270
And somebody saying no

2216
01:09:34,390 --> 01:09:35,820
common sense would say, well,

2217
01:09:35,820 --> 01:09:37,490
why is this any different than

2218
01:09:37,490 --> 01:09:39,450
it was 6 months ago? So help me

2219
01:09:39,450 --> 01:09:41,350
understand that. So give us a

2220
01:09:41,350 --> 01:09:42,620
first pass. And then I refer to

2221
01:09:42,620 --> 01:09:43,510
Christine because as you

2222
01:09:43,510 --> 01:09:44,570
suggested,

2223
01:09:44,570 --> 01:09:46,500
>> she is one of the original

2224
01:09:46,500 --> 01:09:48,100
designers of this and knows

2225
01:09:48,100 --> 01:09:49,700
more than I do about it.

2226
01:09:49,700 --> 01:09:51,320
I say that freely and with

2227
01:09:51,320 --> 01:09:53,330
great humility. So I think the

2228
01:09:53,330 --> 01:09:54,700
answer to your question,

2229
01:09:54,700 --> 01:09:56,740
chair Hoffman is yes. So the

2230
01:09:56,740 --> 01:09:59,100
first pass is with the the case

2231
01:09:59,100 --> 01:10:00,510
manager and that could be with

2232
01:10:00,510 --> 01:10:02,830
a contracted agency. It could

2233
01:10:02,830 --> 01:10:05,140
also be a county employee if

2234
01:10:05,140 --> 01:10:06,100
the county is directly

2235
01:10:06,100 --> 01:10:07,910
providing that service but they

2236
01:10:07,910 --> 01:10:08,590
would develop the

2237
01:10:08,590 --> 01:10:10,640
individualized support plan and

2238
01:10:10,640 --> 01:10:12,360
the the the rate. But

2239
01:10:12,360 --> 01:10:13,810
Christine, feel for the at what

2240
01:10:13,810 --> 01:10:16,210
I said. That's correct.

2241
01:10:17,330 --> 01:10:18,570
>> Our chair and committee

2242
01:10:18,570 --> 01:10:19,260
Kristin Graham with the

2243
01:10:19,260 --> 01:10:21,660
Department of Human Services

2244
01:10:21,810 --> 01:10:23,340
Commissioner Kelly described it

2245
01:10:23,340 --> 01:10:24,450
accurately. I think one of the

2246
01:10:24,450 --> 01:10:25,690
complications here and

2247
01:10:25,690 --> 01:10:27,260
complexities with nursing

2248
01:10:27,260 --> 01:10:29,140
services is that fundamentally

2249
01:10:29,140 --> 01:10:31,450
nursing services is paid for

2250
01:10:31,450 --> 01:10:33,320
under our state plan.

2251
01:10:33,320 --> 01:10:34,580
There are some unique

2252
01:10:34,580 --> 01:10:36,940
situations and or waivers where

2253
01:10:36,940 --> 01:10:38,520
the rate can be modified to

2254
01:10:38,520 --> 01:10:42,120
account for RN or lpn duties.

2255
01:10:42,840 --> 01:10:44,340
But under the state plan, those

2256
01:10:44,340 --> 01:10:46,300
services can be authorized a

2257
01:10:46,300 --> 01:10:47,330
little bit differently. Those

2258
01:10:47,330 --> 01:10:48,770
usually happen. They they're

2259
01:10:48,770 --> 01:10:49,820
author is typically through the

2260
01:10:49,820 --> 01:10:52,220
Home Care nursing agency

2261
01:10:52,460 --> 01:10:53,550
and then they go through the

2262
01:10:53,550 --> 01:10:55,700
prior authorization process and

2263
01:10:55,700 --> 01:10:57,310
get delivered by either home

2264
01:10:57,310 --> 01:10:59,130
care, nursing Service or a

2265
01:10:59,130 --> 01:11:01,300
skilled nurse, is it?

2266
01:11:01,300 --> 01:11:02,960
>> Thank you for that. It did

2267
01:11:02,960 --> 01:11:04,350
then answer the question that

2268
01:11:04,350 --> 01:11:06,300
first process. So there's

2269
01:11:06,300 --> 01:11:08,430
clearly a communications issue

2270
01:11:09,350 --> 01:11:11,750
between the that contracted

2271
01:11:12,600 --> 01:11:14,500
case manager to lead agency and

2272
01:11:14,500 --> 01:11:15,350
the department on the unique

2273
01:11:15,350 --> 01:11:17,500
needs of an individual. Not

2274
01:11:17,500 --> 01:11:18,970
only that, but then I shared a

2275
01:11:18,970 --> 01:11:20,640
letter that I had teen in the

2276
01:11:20,640 --> 01:11:22,940
email where one of the contract

2277
01:11:22,940 --> 01:11:25,940
and case managers was really

2278
01:11:26,450 --> 01:11:27,710
basically when you say

2279
01:11:27,710 --> 01:11:29,140
somebody, what is it? You still

2280
01:11:29,140 --> 01:11:32,500
an ESL? You know it just it

2281
01:11:32,500 --> 01:11:33,710
blows me away. It really gives

2282
01:11:33,710 --> 01:11:35,710
that

2283
01:11:36,480 --> 01:11:39,150
system of rule bad name.

2284
01:11:39,150 --> 01:11:40,840
When I shared. I think you have

2285
01:11:40,840 --> 01:11:42,210
a copy of that.

2286
01:11:42,210 --> 01:11:43,960
So that would

2287
01:11:43,960 --> 01:11:45,510
hens me to ask the question,

2288
01:11:45,510 --> 01:11:46,850
are we doing everything we can

2289
01:11:46,850 --> 01:11:48,470
to ensure that somebody knows

2290
01:11:48,470 --> 01:11:51,340
the system or in the statutory

2291
01:11:51,340 --> 01:11:52,770
system that we play step in

2292
01:11:52,770 --> 01:11:54,220
there? And so maybe that's a

2293
01:11:54,220 --> 01:11:55,410
conversation with Paul gets

2294
01:11:55,410 --> 01:11:57,550
after. We could have that,

2295
01:11:57,550 --> 01:11:59,110
you know, counties, the lead

2296
01:11:59,110 --> 01:12:01,900
agency, the department have a

2297
01:12:01,900 --> 01:12:02,690
consumer. Maybe we'll wait on

2298
01:12:02,690 --> 01:12:04,460
that one. Commissioner, let you

2299
01:12:04,460 --> 01:12:06,730
go into what we did in 2026,

2300
01:12:06,730 --> 01:12:08,730
thank you for.

2301
01:12:09,600 --> 01:12:10,450
>> Thank you, chair of and

2302
01:12:10,450 --> 01:12:11,830
thank you. Christie for the

2303
01:12:11,830 --> 01:12:14,790
assist there. And I agree she's

2304
01:12:14,790 --> 01:12:16,200
a tremendous asset to us.

2305
01:12:16,200 --> 01:12:17,330
All. Just all know that as

2306
01:12:17,330 --> 01:12:19,490
well. And certainly if there

2307
01:12:19,490 --> 01:12:21,730
are issues, we are all years to

2308
01:12:21,730 --> 01:12:23,140
all partners about how to solve

2309
01:12:23,140 --> 01:12:25,600
those issues and whether its

2310
01:12:25,600 --> 01:12:26,720
legislators, yourself, the

2311
01:12:26,720 --> 01:12:29,720
counties as well as agencies

2312
01:12:30,230 --> 01:12:31,810
moving on to the continuity of

2313
01:12:31,810 --> 01:12:33,800
care reforms that were passed

2314
01:12:33,800 --> 01:12:34,810
during the last session and

2315
01:12:34,810 --> 01:12:36,170
signed by the governor. Of

2316
01:12:36,170 --> 01:12:38,310
course, these reforms create

2317
01:12:38,310 --> 01:12:40,000
new requirements for the state,

2318
01:12:40,000 --> 01:12:41,260
the lead agencies and providers

2319
01:12:41,260 --> 01:12:43,320
themselves to ensure continuity

2320
01:12:43,320 --> 01:12:44,310
of service. When there is an

2321
01:12:44,310 --> 01:12:46,400
interruption in care, it could

2322
01:12:46,400 --> 01:12:47,490
be for program integrity reason

2323
01:12:47,490 --> 01:12:50,900
or for other reasons. But for

2324
01:12:50,900 --> 01:12:51,330
all of the above their new

2325
01:12:51,330 --> 01:12:53,570
requirements in place and for

2326
01:12:53,570 --> 01:12:55,540
providers specifically, there

2327
01:12:55,540 --> 01:12:57,150
must be a notification to the

2328
01:12:57,150 --> 01:12:58,640
program members. So they know

2329
01:12:58,640 --> 01:13:00,270
that there is going to be in an

2330
01:13:00,270 --> 01:13:01,680
interruption and care for the

2331
01:13:01,680 --> 01:13:03,690
current serving provider and

2332
01:13:03,690 --> 01:13:05,140
they need notification needs to

2333
01:13:05,140 --> 01:13:07,110
go to the program member before

2334
01:13:07,110 --> 01:13:08,770
services are terminated.

2335
01:13:08,770 --> 01:13:10,820
Lead agencies also have a few

2336
01:13:10,820 --> 01:13:12,630
requirements here that are new.

2337
01:13:12,630 --> 01:13:13,950
They have to inform the Butts

2338
01:13:13,950 --> 01:13:15,710
persons office. They have to

2339
01:13:15,710 --> 01:13:17,280
notify recipients or program

2340
01:13:17,280 --> 01:13:19,180
members as well as they also

2341
01:13:19,180 --> 01:13:20,250
have to assist providers in

2342
01:13:20,250 --> 01:13:21,680
developing a continuity of care

2343
01:13:21,680 --> 01:13:23,800
plan. If they stopped stopped,

2344
01:13:23,800 --> 01:13:25,600
providing services are planned

2345
01:13:25,600 --> 01:13:27,930
to rather. And then if there is

2346
01:13:27,930 --> 01:13:29,670
an identification of a person's

2347
01:13:29,670 --> 01:13:31,470
need to be complex, they must

2348
01:13:31,470 --> 01:13:33,130
have a complex transition plan

2349
01:13:33,130 --> 01:13:35,500
in place and work with the just

2350
01:13:35,500 --> 01:13:37,120
to oversee that to ensure

2351
01:13:37,120 --> 01:13:38,750
continuity of care.

2352
01:13:38,750 --> 01:13:40,660
Dhs has responsibilities as

2353
01:13:40,660 --> 01:13:43,000
well. Must make efforts to

2354
01:13:43,000 --> 01:13:44,590
notify lead agencies if we are

2355
01:13:44,590 --> 01:13:45,870
going to take an administrative

2356
01:13:45,870 --> 01:13:47,190
action relative to program

2357
01:13:47,190 --> 01:13:49,270
integrity in advance of taking

2358
01:13:49,270 --> 01:13:51,270
that action, identify

2359
01:13:51,550 --> 01:13:52,630
potentially impacted

2360
01:13:52,630 --> 01:13:53,800
recipients. So we're sharing

2361
01:13:53,800 --> 01:13:55,260
that information with the lead

2362
01:13:55,260 --> 01:13:56,200
agency. So they know

2363
01:13:56,200 --> 01:13:57,470
individuals that may have an

2364
01:13:57,470 --> 01:13:58,800
interruption in service because

2365
01:13:58,800 --> 01:14:01,510
of an administrative action and

2366
01:14:01,510 --> 01:14:03,300
also ensure that lead agencies

2367
01:14:03,300 --> 01:14:04,520
are taking the steps needed to

2368
01:14:04,520 --> 01:14:06,400
ensure provision of of

2369
01:14:06,400 --> 01:14:08,400
necessary services to

2370
01:14:08,120 --> 01:14:09,330
coordinate care and provide

2371
01:14:09,330 --> 01:14:11,200
continuity and ensure that

2372
01:14:11,200 --> 01:14:12,800
there's yes, chair of it.

2373
01:14:12,800 --> 01:14:13,670
No, I was going to tell you

2374
01:14:13,670 --> 01:14:15,390
finish your sentence or the

2375
01:14:15,390 --> 01:14:17,200
representative that was Liz

2376
01:14:17,200 --> 01:14:19,480
cannot. She's a has a she's got

2377
01:14:19,480 --> 01:14:21,300
her hand up. So when you when

2378
01:14:21,300 --> 01:14:22,330
you get to your end of that

2379
01:14:22,330 --> 01:14:24,440
point and will cut Natalie,

2380
01:14:24,440 --> 01:14:25,980
sure, and I think a couple of

2381
01:14:25,980 --> 01:14:27,400
key considerations are, of

2382
01:14:27,400 --> 01:14:28,770
course, that individual's

2383
01:14:28,770 --> 01:14:30,340
choice of providers respected

2384
01:14:30,340 --> 01:14:31,800
and they have housing. Of

2385
01:14:31,800 --> 01:14:32,590
course, that's a key

2386
01:14:32,590 --> 01:14:34,590
consideration when providers

2387
01:14:35,530 --> 01:14:37,600
stop providing services and of

2388
01:14:37,600 --> 01:14:39,770
course, we have a requirement

2389
01:14:39,770 --> 01:14:40,820
to establish a continuity of

2390
01:14:40,820 --> 01:14:42,100
care team with resources.

2391
01:14:42,100 --> 01:14:43,260
So thanks to the legislature

2392
01:14:43,260 --> 01:14:46,400
for that so that we can support

2393
01:14:46,400 --> 01:14:47,900
lead agencies in executing

2394
01:14:47,900 --> 01:14:50,100
these transition of care plans.

2395
01:14:50,100 --> 01:14:51,420
Thank you, Representative

2396
01:14:51,420 --> 01:14:53,420
Tillis, the car.

2397
01:14:53,780 --> 01:14:56,200
>> Thank you. Chair happen and

2398
01:14:56,200 --> 01:14:58,100
thank you, Commissioner calmly

2399
01:14:58,100 --> 01:15:00,340
and I really do appreciate how

2400
01:15:00,340 --> 01:15:02,400
responsive even I had many

2401
01:15:02,400 --> 01:15:04,440
questions and also too

2402
01:15:04,930 --> 01:15:06,870
to Christiane, thank you both

2403
01:15:06,870 --> 01:15:08,440
from how as we work through

2404
01:15:08,440 --> 01:15:10,400
these issues. Question is on

2405
01:15:10,400 --> 01:15:12,280
the graph that you showed on

2406
01:15:12,280 --> 01:15:13,590
the number 3 validated

2407
01:15:13,590 --> 01:15:15,260
providers. I know when we

2408
01:15:15,260 --> 01:15:16,930
started, I think when we met in

2409
01:15:16,930 --> 01:15:18,930
July, there was 5,600,

2410
01:15:19,860 --> 01:15:21,310
something total providers.

2411
01:15:21,310 --> 01:15:22,930
I'm going by and I don't know

2412
01:15:22,930 --> 01:15:24,260
what the total exact was.

2413
01:15:24,260 --> 01:15:25,900
I don't have that for me back.

2414
01:15:25,900 --> 01:15:28,160
My question is that of the

2415
01:15:28,160 --> 01:15:30,600
society have today? There's

2416
01:15:30,600 --> 01:15:32,600
1542 appeals that are

2417
01:15:32,630 --> 01:15:34,650
completed. My question is,

2418
01:15:34,650 --> 01:15:36,510
is there a dashboard that shows

2419
01:15:36,510 --> 01:15:38,330
you know what, where who are

2420
01:15:38,330 --> 01:15:40,670
the providers? What 5 into the

2421
01:15:40,670 --> 01:15:42,370
state are they and who are they

2422
01:15:42,370 --> 01:15:44,910
serving? Is it is it the I D D

2423
01:15:44,910 --> 01:15:47,720
I is it. You know, assisted

2424
01:15:47,720 --> 01:15:49,600
living is a non emergency

2425
01:15:49,600 --> 01:15:51,190
transportation. I'm curious if

2426
01:15:51,190 --> 01:15:54,180
we have any data, I'm you know,

2427
01:15:54,180 --> 01:15:56,300
how are their 10 providers in

2428
01:15:56,300 --> 01:15:57,510
each category that had been

2429
01:15:57,510 --> 01:15:59,000
completed for the Metro,

2430
01:15:59,000 --> 01:16:00,470
the suburbs, the central part

2431
01:16:00,470 --> 01:16:01,420
of the state, northeast

2432
01:16:01,420 --> 01:16:03,680
northwest and the same question

2433
01:16:03,680 --> 01:16:05,510
for the appeals and progress.

2434
01:16:05,510 --> 01:16:07,110
And the reason I ask this is

2435
01:16:07,110 --> 01:16:09,790
that it appears I'm wondering,

2436
01:16:09,790 --> 01:16:12,100
you know, when we have one or 2

2437
01:16:12,100 --> 01:16:13,520
providers for non emergency,

2438
01:16:13,520 --> 01:16:15,240
transportation are known to

2439
01:16:15,240 --> 01:16:16,990
providers. You know what the

2440
01:16:16,990 --> 01:16:17,970
plan is because it's a

2441
01:16:17,970 --> 01:16:19,850
federally required

2442
01:16:19,850 --> 01:16:21,970
program. And from what I can

2443
01:16:21,970 --> 01:16:23,920
see in the part in the

2444
01:16:23,920 --> 01:16:25,140
northeastern part of the state,

2445
01:16:25,140 --> 01:16:27,860
I'm very concerned. I in in a

2446
01:16:27,860 --> 01:16:29,730
specific category non-emergency

2447
01:16:29,730 --> 01:16:31,730
transportation specifically in.

2448
01:16:32,170 --> 01:16:35,360
So if yes, we have limited

2449
01:16:35,360 --> 01:16:36,780
provider, says it is in

2450
01:16:36,780 --> 01:16:39,300
nobody's re-evaluated. Then at

2451
01:16:39,300 --> 01:16:40,550
explains to me why the nursing

2452
01:16:40,550 --> 01:16:42,500
homes are paying $5,000 a

2453
01:16:42,500 --> 01:16:43,340
month.

2454
01:16:43,340 --> 01:16:44,670
And they're not gonna get that

2455
01:16:44,670 --> 01:16:45,840
money back because we already

2456
01:16:45,840 --> 01:16:47,710
made changes to that. They're

2457
01:16:47,710 --> 01:16:50,110
transporting, too. I dialysis

2458
01:16:50,690 --> 01:16:51,470
and these things. And there's

2459
01:16:51,470 --> 01:16:52,750
no there's actually getting

2460
01:16:52,750 --> 01:16:54,340
reimbursement for. So we're

2461
01:16:54,340 --> 01:16:56,000
we're creating and other issues

2462
01:16:56,000 --> 01:16:57,680
right now. And I'd love to know

2463
01:16:57,680 --> 01:16:59,750
what that dashboard looks like.

2464
01:16:59,750 --> 01:17:02,300
>> For for, you know.

2465
01:17:02,300 --> 01:17:03,540
>> The ones that are still in

2466
01:17:03,540 --> 01:17:04,790
process are the ones that are

2467
01:17:04,790 --> 01:17:06,540
completed where they are the

2468
01:17:06,540 --> 01:17:08,580
findings of the state and who

2469
01:17:08,580 --> 01:17:10,000
they are. What category the

2470
01:17:10,000 --> 01:17:12,500
falling of the 13 14 programs

2471
01:17:12,500 --> 01:17:13,000
that were high risk.

2472
01:17:13,000 --> 01:17:14,160
>> Thank you. Thank you.

2473
01:17:14,160 --> 01:17:15,860
Representative was the car

2474
01:17:15,860 --> 01:17:17,230
Commissioner

2475
01:17:17,230 --> 01:17:18,520
Chair Hoffman representatives

2476
01:17:18,520 --> 01:17:19,980
lets the car we share your

2477
01:17:19,980 --> 01:17:21,920
concern about access to care,

2478
01:17:21,920 --> 01:17:22,830
certainly in northeast

2479
01:17:22,830 --> 01:17:23,960
Minnesota, but everywhere in

2480
01:17:23,960 --> 01:17:25,730
Minnesota. And the answer to

2481
01:17:25,730 --> 01:17:26,840
your question is, yes, we do

2482
01:17:26,840 --> 01:17:28,320
have that dashboard and we will

2483
01:17:28,320 --> 01:17:30,790
send updated numbers by region

2484
01:17:30,790 --> 01:17:32,410
by service across the different

2485
01:17:32,410 --> 01:17:34,220
13 high-risk services that are

2486
01:17:34,220 --> 01:17:36,110
going through a validation with

2487
01:17:36,110 --> 01:17:37,580
you very shortly. So we have

2488
01:17:37,580 --> 01:17:38,610
those data and we will share

2489
01:17:38,610 --> 01:17:40,110
them with all of you. Thank

2490
01:17:40,110 --> 01:17:41,380
you. Thank you, Jen follow-up,

2491
01:17:41,380 --> 01:17:42,930
Natalie. Good

2492
01:17:42,930 --> 01:17:44,490
and it. All right,

2493
01:17:44,490 --> 01:17:46,490
commissioner,

2494
01:17:51,270 --> 01:17:52,510
excuse me, chair up and just

2495
01:17:52,510 --> 01:17:54,220
leaving back to the current

2496
01:17:54,220 --> 01:17:56,220
slide.

2497
01:17:58,210 --> 01:17:59,500
I think that's good. All right.

2498
01:17:59,500 --> 01:18:02,190
So a few more things here with

2499
01:18:02,190 --> 01:18:03,630
respect to continuity of care,

2500
01:18:03,630 --> 01:18:05,160
implementation. So pursuant to

2501
01:18:05,160 --> 01:18:07,160
the 2026 legislation, we're

2502
01:18:07,940 --> 01:18:10,150
starting by looking at our own

2503
01:18:10,150 --> 01:18:12,380
staff, our own capacity, our

2504
01:18:12,380 --> 01:18:13,850
own infrastructure, to do this

2505
01:18:13,850 --> 01:18:15,790
work looking inward to make

2506
01:18:15,790 --> 01:18:16,910
sure that we have a plan for

2507
01:18:16,910 --> 01:18:17,990
how to approach this. And of

2508
01:18:17,990 --> 01:18:19,950
course, we want to talk to

2509
01:18:19,950 --> 01:18:21,410
different folks, leaders within

2510
01:18:21,410 --> 01:18:23,730
the department to do this work

2511
01:18:23,730 --> 01:18:24,850
for the different benefits and

2512
01:18:24,850 --> 01:18:25,530
different parts of the

2513
01:18:25,530 --> 01:18:26,710
organization. So we need to

2514
01:18:26,710 --> 01:18:27,610
come together, have an

2515
01:18:27,610 --> 01:18:28,840
interdisciplinary approach

2516
01:18:28,840 --> 01:18:30,170
that's consistent and

2517
01:18:30,170 --> 01:18:31,410
responsive to community and

2518
01:18:31,410 --> 01:18:34,330
providers and to to inform how

2519
01:18:34,330 --> 01:18:36,570
we develop these functions in

2520
01:18:36,570 --> 01:18:37,820
the spirit of the legislation

2521
01:18:37,820 --> 01:18:40,270
that was passed and signed.

2522
01:18:40,270 --> 01:18:41,780
The work is going to be

2523
01:18:41,780 --> 01:18:44,110
basically the work of creating

2524
01:18:44,110 --> 01:18:46,270
this new team to ensure that we

2525
01:18:46,270 --> 01:18:47,620
do this in a consistent way

2526
01:18:47,620 --> 01:18:48,440
that makes sense and is

2527
01:18:48,440 --> 01:18:49,540
responsive, irrespective,

2528
01:18:49,540 --> 01:18:50,610
again of the service, whether

2529
01:18:50,610 --> 01:18:51,720
it's behavioral health, aging

2530
01:18:51,720 --> 01:18:53,100
and disability services, health

2531
01:18:53,100 --> 01:18:55,100
care, et cetera.

2532
01:18:55,100 --> 01:18:57,200
And that we're also making

2533
01:18:57,200 --> 01:18:58,680
clear what our roles are in

2534
01:18:58,680 --> 01:19:00,620
this as an agency for specific

2535
01:19:00,620 --> 01:19:02,930
staff doing the work and and

2536
01:19:02,930 --> 01:19:04,180
what the expectations of the

2537
01:19:04,180 --> 01:19:05,920
agency are for the community,

2538
01:19:05,920 --> 01:19:07,800
that staff you empower, they

2539
01:19:07,800 --> 01:19:08,100
know what to do. They know how

2540
01:19:08,100 --> 01:19:09,120
to interact with external

2541
01:19:09,120 --> 01:19:10,670
partners and that we're

2542
01:19:10,670 --> 01:19:13,700
creating an efficient approach

2543
01:19:13,250 --> 01:19:14,600
that's responsive and create

2544
01:19:14,600 --> 01:19:16,700
seamless Nissen, the system for

2545
01:19:16,700 --> 01:19:18,840
it for the people served.

2546
01:19:18,840 --> 01:19:20,620
I also want to note, too, that

2547
01:19:20,620 --> 01:19:22,100
housing is of particular

2548
01:19:22,100 --> 01:19:24,800
importance here understanding,

2549
01:19:24,800 --> 01:19:27,190
I think with the focus of the

2550
01:19:27,190 --> 01:19:28,720
chair and others here on making

2551
01:19:28,720 --> 01:19:29,940
sure that folks do not become

2552
01:19:29,940 --> 01:19:32,460
unhoused as a result of, you

2553
01:19:32,460 --> 01:19:33,760
know, interruptions in service

2554
01:19:33,760 --> 01:19:35,230
by a provider that is funded by

2555
01:19:35,230 --> 01:19:37,140
Medicaid. I do want to note

2556
01:19:37,140 --> 01:19:38,790
that housing itself is not

2557
01:19:38,790 --> 01:19:40,200
reimbursed are paid for by

2558
01:19:40,200 --> 01:19:42,180
Medicaid, but a service

2559
01:19:42,180 --> 01:19:44,140
components in housing settings

2560
01:19:44,140 --> 01:19:47,680
are. And so that said DHS does

2561
01:19:47,680 --> 01:19:49,440
have tools at its disposal with

2562
01:19:49,440 --> 01:19:50,820
respect to housing, support the

2563
01:19:50,820 --> 01:19:52,560
housing support program that is

2564
01:19:52,560 --> 01:19:53,770
separate from Medicaid estate

2565
01:19:53,770 --> 01:19:56,230
only program to support housing

2566
01:19:56,230 --> 01:19:57,920
capacity. And so there are

2567
01:19:57,920 --> 01:19:59,520
grants will be available coming

2568
01:19:59,520 --> 01:20:01,880
out of the 2020 succession for

2569
01:20:01,880 --> 01:20:04,410
a 4 counties in the agency's

2570
01:20:04,410 --> 01:20:07,340
for this. And it expands the

2571
01:20:07,340 --> 01:20:08,920
capacity for those grants.

2572
01:20:08,920 --> 01:20:10,250
So a couple of updates here

2573
01:20:10,250 --> 01:20:11,400
with respect to our

2574
01:20:11,400 --> 01:20:12,960
implementation of those those

2575
01:20:12,960 --> 01:20:14,150
housing capacity granted the

2576
01:20:14,150 --> 01:20:16,330
expansion of them. We held an

2577
01:20:16,330 --> 01:20:17,530
initial interest session with

2578
01:20:17,530 --> 01:20:19,520
community partners in July 7th

2579
01:20:19,520 --> 01:20:21,370
earlier this summer, soliciting

2580
01:20:21,370 --> 01:20:23,850
feedback about the the RFP and

2581
01:20:23,850 --> 01:20:25,370
its development. It's under

2582
01:20:25,370 --> 01:20:27,920
review now with with DHS staff

2583
01:20:27,920 --> 01:20:29,860
were on track. However, to to

2584
01:20:29,860 --> 01:20:31,450
post that by the 21st of this

2585
01:20:31,450 --> 01:20:33,890
month, we will have responders

2586
01:20:33,890 --> 01:20:34,840
conference at the end of the

2587
01:20:34,840 --> 01:20:36,730
month and the 30th so any

2588
01:20:36,730 --> 01:20:38,540
interested applicants can can

2589
01:20:38,540 --> 01:20:41,500
attend and ask questions and

2590
01:20:41,500 --> 01:20:42,630
applications are due on

2591
01:20:42,630 --> 01:20:44,440
November 18th. So that is the

2592
01:20:44,440 --> 01:20:46,490
broad timeline. We expected

2593
01:20:46,490 --> 01:20:47,570
funding decisions will be

2594
01:20:47,570 --> 01:20:49,970
issued likely in January.

2595
01:20:51,620 --> 01:20:53,530
So we'll have the prewar risk

2596
01:20:53,530 --> 01:20:55,900
assessment in January decisions

2597
01:20:55,900 --> 01:20:57,340
in December. And so funding

2598
01:20:57,340 --> 01:20:59,720
should go out to to the Ortiz

2599
01:20:59,720 --> 01:21:01,470
in late January, if not shortly

2600
01:21:01,470 --> 01:21:02,630
thereafter.

2601
01:21:02,630 --> 01:21:04,460
So I think those are my

2602
01:21:04,460 --> 01:21:05,400
comments with respect to

2603
01:21:05,400 --> 01:21:06,450
continuity of care. Again,

2604
01:21:06,450 --> 01:21:07,380
sure, half. I'm not sure if

2605
01:21:07,380 --> 01:21:08,800
your preference is to take your

2606
01:21:08,800 --> 01:21:09,870
questions at this point or 2

2607
01:21:09,870 --> 01:21:10,750
people.

2608
01:21:10,750 --> 01:21:11,990
>> I think people are great.

2609
01:21:11,990 --> 01:21:13,460
If you want to transition.

2610
01:21:13,460 --> 01:21:15,720
I do. There's another piece.

2611
01:21:15,720 --> 01:21:17,260
Commissioner I

2612
01:21:17,260 --> 01:21:20,140
I sent a request out to meet

2613
01:21:20,140 --> 01:21:21,840
with people regarding the

2614
01:21:21,840 --> 01:21:23,310
Olmsted you'd mention on state

2615
01:21:23,310 --> 01:21:25,120
early on in the that the

2616
01:21:25,120 --> 01:21:28,120
proposed onsted plan. I the

2617
01:21:29,140 --> 01:21:32,740
hearing from a lot of us.

2618
01:21:33,730 --> 01:21:34,940
>> Feeling like they were not

2619
01:21:34,940 --> 01:21:36,820
part of that. This is not your

2620
01:21:36,820 --> 01:21:38,120
response to you. It's part of

2621
01:21:38,120 --> 01:21:39,160
your responsibility. But you

2622
01:21:39,160 --> 01:21:40,560
know that he created this

2623
01:21:40,560 --> 01:21:41,740
Homestead

2624
01:21:41,740 --> 01:21:43,950
Peace. And I'm concerned that

2625
01:21:43,950 --> 01:21:45,950
this September 15th

2626
01:21:48,310 --> 01:21:50,330
plan being adopted by the

2627
01:21:50,330 --> 01:21:52,290
committee doesn't reflect the

2628
01:21:52,290 --> 01:21:53,850
individuals that are receiving

2629
01:21:53,850 --> 01:21:55,800
the services and the media and

2630
01:21:55,800 --> 01:21:58,180
the September 11th with that,

2631
01:21:58,180 --> 01:21:58,960
I think the housing

2632
01:21:58,960 --> 01:22:01,830
commissioner, but it would be

2633
01:22:01,830 --> 01:22:03,310
it would it would be nice if

2634
01:22:03,310 --> 01:22:05,160
Christie, if somebody from your

2635
01:22:05,160 --> 01:22:07,620
office was also able to attend.

2636
01:22:07,620 --> 01:22:09,220
I know this year that but that

2637
01:22:09,220 --> 01:22:10,270
just something to put out

2638
01:22:10,270 --> 01:22:11,970
there. But somebody who

2639
01:22:11,970 --> 01:22:13,970
understands Olmstead a

2640
01:22:14,800 --> 01:22:16,290
it may be a decision that took

2641
01:22:16,290 --> 01:22:17,760
Minnesota 17 years to put a

2642
01:22:17,760 --> 01:22:19,190
plan together because of a

2643
01:22:19,190 --> 01:22:20,450
federal judge. And Donovan

2644
01:22:20,450 --> 01:22:22,250
Frank was amazing individual,

2645
01:22:22,250 --> 01:22:23,270
by the way. And we're getting

2646
01:22:23,270 --> 01:22:25,700
details on that.

2647
01:22:25,700 --> 01:22:26,590
That is

2648
01:22:26,590 --> 01:22:29,700
that is a concern to so.

2649
01:22:29,700 --> 01:22:30,970
And then there was one other

2650
01:22:30,970 --> 01:22:33,770
piece that we can talk about

2651
01:22:33,770 --> 01:22:35,700
the the transitions. So thank

2652
01:22:35,700 --> 01:22:37,790
you for your time members.

2653
01:22:37,790 --> 01:22:40,410
I don't see any hands up.

2654
01:22:40,410 --> 01:22:41,870
So thank you. Commissioner will

2655
01:22:41,870 --> 01:22:43,870
transition to the

2656
01:22:44,740 --> 01:22:46,870
contractor that case banishment

2657
01:22:46,870 --> 01:22:48,480
to skate discussion. Maybe we

2658
01:22:48,480 --> 01:22:50,210
should get Paul to come up to

2659
01:22:50,210 --> 01:22:51,180
an end.

2660
01:22:51,180 --> 01:22:52,520
>> Luella still with us.

2661
01:22:52,520 --> 01:22:54,770
Thank you all the way from.

2662
01:22:54,770 --> 01:22:55,980
>> The head of the county.

2663
01:22:55,980 --> 01:22:57,980
And then

2664
01:22:58,310 --> 01:22:59,950
I think Pat Meacham from Pine

2665
01:22:59,950 --> 01:23:01,120
County is going to join us.

2666
01:23:01,120 --> 01:23:02,310
You that you need 3 chairs up

2667
01:23:02,310 --> 01:23:03,140
here

2668
01:23:03,140 --> 01:23:04,630
just so we can have that this

2669
01:23:04,630 --> 01:23:06,620
thank you for you. You can

2670
01:23:06,620 --> 01:23:08,130
folks for letting me be

2671
01:23:08,130 --> 01:23:10,120
flexible. I may

2672
01:23:10,120 --> 01:23:13,720
and my in this committee today,

2673
01:23:28,680 --> 01:23:30,990
no one wants to supply.

2674
01:23:30,990 --> 01:23:32,320
I just, you know, Chris, Hedges

2675
01:23:32,320 --> 01:23:33,440
that this would make sense

2676
01:23:33,440 --> 01:23:34,730
because you and Paul have that,

2677
01:23:34,730 --> 01:23:35,700
you know, we're having the same

2678
01:23:35,700 --> 01:23:37,300
conversation you might as well

2679
01:23:37,300 --> 01:23:38,910
have everybody at the table to

2680
01:23:38,910 --> 01:23:40,210
really, you know, do that.

2681
01:23:40,210 --> 01:23:41,680
And I and I appreciate you

2682
01:23:41,680 --> 01:23:44,590
doing that. But Christy scrum,

2683
01:23:44,590 --> 01:23:45,700
director of state government

2684
01:23:45,700 --> 01:23:48,100
relations at the department,

2685
01:23:48,860 --> 01:23:50,880
my choice because here, too.

2686
01:23:50,880 --> 01:23:51,840
But he's going to go after you

2687
01:23:51,840 --> 01:23:54,380
do so or during it.

2688
01:23:54,380 --> 01:23:55,510
Thank you. Thanks for being

2689
01:23:55,510 --> 01:23:56,100
here.

2690
01:23:56,100 --> 01:23:57,510
>> Thank you. Mr. Chair led to

2691
01:23:57,510 --> 01:23:59,910
participate in this discussion.

2692
01:24:00,680 --> 01:24:01,890
So I'm going to talk briefly,

2693
01:24:01,890 --> 01:24:03,360
but Weaver case management a

2694
01:24:03,360 --> 01:24:04,630
little bit about quality

2695
01:24:04,630 --> 01:24:05,800
oversight. I think we have a

2696
01:24:05,800 --> 01:24:07,220
lot of shared goals between

2697
01:24:07,220 --> 01:24:09,620
DHS, the legislature, counties.

2698
01:24:09,830 --> 01:24:10,690
I'll try to move quickly.

2699
01:24:10,690 --> 01:24:11,900
So we've got time for everyone

2700
01:24:11,900 --> 01:24:14,200
to to give their input here.

2701
01:24:14,200 --> 01:24:15,450
But I'm gonna go over sort of

2702
01:24:15,450 --> 01:24:16,890
case management basics just to

2703
01:24:16,890 --> 01:24:17,660
guide you through what I'm

2704
01:24:17,660 --> 01:24:20,500
going to talk about and then go

2705
01:24:20,500 --> 01:24:21,120
over some of the oversight

2706
01:24:21,120 --> 01:24:22,420
facets of waiver case

2707
01:24:22,420 --> 01:24:24,250
management. And then lastly,

2708
01:24:24,250 --> 01:24:25,540
an implementation update of

2709
01:24:25,540 --> 01:24:26,720
some of the reforms that passed

2710
01:24:26,720 --> 01:24:27,910
last session. Thanks to all of

2711
01:24:27,910 --> 01:24:30,330
your important work. So to

2712
01:24:30,330 --> 01:24:32,630
start wanted to talk just about

2713
01:24:32,630 --> 01:24:34,170
some basic some level setting

2714
01:24:34,170 --> 01:24:36,400
on what waiver hcbs case

2715
01:24:36,400 --> 01:24:38,520
management is. And before I get

2716
01:24:38,520 --> 01:24:39,630
into that, I do just want to

2717
01:24:39,630 --> 01:24:41,280
say

2718
01:24:41,280 --> 01:24:42,570
case management is a really

2719
01:24:42,570 --> 01:24:44,160
critical part of our waiver and

2720
01:24:44,160 --> 01:24:46,520
ltsa system. We cannot have a

2721
01:24:46,520 --> 01:24:48,920
fully integrated system without

2722
01:24:50,150 --> 01:24:51,820
good case management. So this

2723
01:24:51,820 --> 01:24:53,770
is a really important service.

2724
01:24:53,770 --> 01:24:55,140
We are really heartened to know

2725
01:24:55,140 --> 01:24:56,330
that the legislature standing

2726
01:24:56,330 --> 01:24:58,440
with us and talking about

2727
01:24:58,440 --> 01:25:00,260
reforms both here today,

2728
01:25:00,260 --> 01:25:01,400
last session, hopefully into

2729
01:25:01,400 --> 01:25:02,770
the future.

2730
01:25:02,770 --> 01:25:03,910
So just to kind of give you a

2731
01:25:03,910 --> 01:25:06,310
brief overview, hcbs case

2732
01:25:06,500 --> 01:25:07,350
management and care

2733
01:25:07,350 --> 01:25:09,400
coordination are supports that

2734
01:25:09,400 --> 01:25:09,900
are provided under the

2735
01:25:09,900 --> 01:25:11,900
disability waivers sometimes

2736
01:25:12,160 --> 01:25:15,460
called Kat Katty, be IMDB as

2737
01:25:15,460 --> 01:25:16,740
well as alternative care and

2738
01:25:16,740 --> 01:25:18,740
essential community supports.

2739
01:25:18,980 --> 01:25:20,910
So case management really helps

2740
01:25:20,910 --> 01:25:22,900
connect people with the

2741
01:25:22,900 --> 01:25:23,700
services that they need

2742
01:25:23,700 --> 01:25:24,880
provides referrals for the

2743
01:25:24,880 --> 01:25:25,910
services that they need.

2744
01:25:25,910 --> 01:25:28,200
Authorizations chair. Half when

2745
01:25:28,200 --> 01:25:29,120
you mentioned some of the work

2746
01:25:29,120 --> 01:25:30,860
that occurs between when a

2747
01:25:30,860 --> 01:25:32,150
person has a change in need,

2748
01:25:32,150 --> 01:25:33,260
the case manager might need to

2749
01:25:33,260 --> 01:25:35,280
authorize that service and

2750
01:25:35,280 --> 01:25:36,560
really working with the person

2751
01:25:36,560 --> 01:25:38,740
across the continuum to make

2752
01:25:38,740 --> 01:25:39,610
sure they've got informed

2753
01:25:39,610 --> 01:25:40,900
choice and that services are

2754
01:25:40,900 --> 01:25:41,680
being delivered in a

2755
01:25:41,680 --> 01:25:44,680
person-centered way. So this is

2756
01:25:44,770 --> 01:25:46,140
really important, critical

2757
01:25:46,140 --> 01:25:47,590
aspect for people to be able to

2758
01:25:47,590 --> 01:25:49,630
navigate what is a very complex

2759
01:25:49,630 --> 01:25:51,630
system.

2760
01:25:51,980 --> 01:25:53,250
Informed choice is really

2761
01:25:53,250 --> 01:25:54,260
paramount and the work that

2762
01:25:54,260 --> 01:25:55,600
case managers do as well as due

2763
01:25:55,600 --> 01:25:56,690
process and making sure that

2764
01:25:56,690 --> 01:25:57,880
people know their rights, that

2765
01:25:57,880 --> 01:25:58,920
they have a right to appeal.

2766
01:25:58,920 --> 01:26:00,260
For example, if they don't

2767
01:26:00,260 --> 01:26:01,760
agree with the decision,

2768
01:26:01,760 --> 01:26:03,540
it's also important as we talk

2769
01:26:03,540 --> 01:26:05,360
about program integrity we have

2770
01:26:05,360 --> 01:26:06,780
found over the past couple of

2771
01:26:06,780 --> 01:26:09,230
years as we have initiated and

2772
01:26:09,230 --> 01:26:10,310
more program, integrity,

2773
01:26:10,310 --> 01:26:11,930
reforms. We learn a lot about

2774
01:26:11,930 --> 01:26:13,510
program, integrity, issues from

2775
01:26:13,510 --> 01:26:14,800
our partners, our lead

2776
01:26:14,800 --> 01:26:16,550
agencies, counties, tribal

2777
01:26:16,550 --> 01:26:17,520
nations and managed care

2778
01:26:17,520 --> 01:26:19,610
organizations. So having that

2779
01:26:19,610 --> 01:26:21,910
person, the case manager,

2780
01:26:21,910 --> 01:26:22,960
working closely with an

2781
01:26:22,960 --> 01:26:24,960
individual to understand

2782
01:26:25,500 --> 01:26:26,190
she's Christie's supposed to be

2783
01:26:26,190 --> 01:26:27,230
getting the service, but she

2784
01:26:27,230 --> 01:26:28,310
doesn't appear to be getting

2785
01:26:28,310 --> 01:26:30,160
that service and having that

2786
01:26:30,160 --> 01:26:31,410
connection is really important

2787
01:26:31,410 --> 01:26:32,210
for people. It's really

2788
01:26:32,210 --> 01:26:33,650
important for program integrity

2789
01:26:33,650 --> 01:26:37,120
as well as continuity of care.

2790
01:26:37,120 --> 01:26:39,430
So a little bit about who case

2791
01:26:39,430 --> 01:26:41,430
managers are.

2792
01:26:41,800 --> 01:26:44,800
We heard it stories and share

2793
01:26:44,800 --> 01:26:45,180
half men you've shared and

2794
01:26:45,180 --> 01:26:47,580
other members have shared

2795
01:26:47,770 --> 01:26:49,200
negative outcomes that people

2796
01:26:49,200 --> 01:26:50,100
are having with case

2797
01:26:50,100 --> 01:26:52,380
management. And I think we know

2798
01:26:52,380 --> 01:26:53,780
that those I wish Chrystia

2799
01:26:53,780 --> 01:26:55,200
would get.

2800
01:26:55,200 --> 01:26:55,670
>> Positive outcomes with all

2801
01:26:55,670 --> 01:26:57,670
the e-mails I get are negative

2802
01:26:57,670 --> 01:26:59,440
once and you knew that in the

2803
01:26:59,440 --> 01:27:00,600
days of the committee

2804
01:27:00,600 --> 01:27:02,460
administrative case. Yeah,

2805
01:27:02,460 --> 01:27:04,200
that's the other thing since

2806
01:27:04,200 --> 01:27:05,600
we're going to start it will

2807
01:27:05,600 --> 01:27:07,170
county stuff that met Freeman

2808
01:27:07,170 --> 01:27:08,570
is now back working with the

2809
01:27:08,570 --> 01:27:10,250
counties. But he's not sitting

2810
01:27:10,250 --> 01:27:11,500
in the chair that he always

2811
01:27:11,500 --> 01:27:13,300
would sit in for years over

2812
01:27:13,300 --> 01:27:14,720
there. I see him back there.

2813
01:27:14,720 --> 01:27:16,000
So I just had to bring that to

2814
01:27:16,000 --> 01:27:18,200
light. So go ahead. Well.

2815
01:27:18,200 --> 01:27:20,230
>> March air met Mr. Freeman is

2816
01:27:20,230 --> 01:27:21,260
welcome to come up here,

2817
01:27:21,260 --> 01:27:23,520
too. And we can talk about, you

2818
01:27:23,520 --> 01:27:24,740
know, assessments and

2819
01:27:24,740 --> 01:27:26,720
reassessments in all of all of

2820
01:27:26,720 --> 01:27:28,170
those good things.

2821
01:27:28,170 --> 01:27:30,700
But I did just want to say that

2822
01:27:30,700 --> 01:27:32,830
case managers that while there

2823
01:27:32,830 --> 01:27:34,000
are issues with case

2824
01:27:34,000 --> 01:27:35,740
management, it's not just

2825
01:27:35,740 --> 01:27:37,740
contracted case management.

2826
01:27:38,200 --> 01:27:40,430
It's all case management and

2827
01:27:40,430 --> 01:27:42,170
many case managers do a great

2828
01:27:42,170 --> 01:27:43,350
job.

2829
01:27:43,350 --> 01:27:45,720
And I will say as a former case

2830
01:27:45,720 --> 01:27:47,720
manager and

2831
01:27:48,300 --> 01:27:49,280
case management can change

2832
01:27:49,280 --> 01:27:50,870
people's lives for the better.

2833
01:27:50,870 --> 01:27:51,910
So that's why we're talking

2834
01:27:51,910 --> 01:27:53,400
about here today. And I just

2835
01:27:53,400 --> 01:27:54,310
want to lift up the great work

2836
01:27:54,310 --> 01:27:55,680
that many of our case managers

2837
01:27:55,680 --> 01:27:57,670
are doing at the county level

2838
01:27:57,670 --> 01:27:59,330
at the lead agency level.

2839
01:27:59,330 --> 01:28:00,700
But really our case managers,

2840
01:28:00,700 --> 01:28:02,780
as I mentioned, are the front

2841
01:28:02,780 --> 01:28:05,900
face of it. Helping people

2842
01:28:05,900 --> 01:28:07,100
navigate a incredibly complex

2843
01:28:07,100 --> 01:28:09,600
system that we all have a hand

2844
01:28:09,600 --> 01:28:10,690
in creating and making a

2845
01:28:10,690 --> 01:28:13,990
complex and they have a lot of

2846
01:28:13,990 --> 01:28:16,300
it. Expectations that are laid

2847
01:28:16,300 --> 01:28:17,770
out in state line are Weaver

2848
01:28:17,770 --> 01:28:19,420
plans, but effectively they're

2849
01:28:19,420 --> 01:28:21,600
helping to translate people's

2850
01:28:21,600 --> 01:28:22,140
assess needs and to their

2851
01:28:22,140 --> 01:28:23,430
person center plans are

2852
01:28:23,430 --> 01:28:25,360
authorizing services during

2853
01:28:25,360 --> 01:28:26,310
that informed choice. They're

2854
01:28:26,310 --> 01:28:27,260
supposed to be monitoring

2855
01:28:27,260 --> 01:28:29,000
outcomes, adjusting plans as

2856
01:28:29,000 --> 01:28:32,680
needed. So this is it's a lot.

2857
01:28:32,680 --> 01:28:34,510
And we've we've been talking

2858
01:28:34,510 --> 01:28:35,410
with the legislature with

2859
01:28:35,410 --> 01:28:36,640
counties about making sure that

2860
01:28:36,640 --> 01:28:37,980
we do have really clear duties

2861
01:28:37,980 --> 01:28:39,290
for case managers. What is it

2862
01:28:39,290 --> 01:28:40,730
that we expect as a state case

2863
01:28:40,730 --> 01:28:42,550
managers to do and let's lift

2864
01:28:42,550 --> 01:28:44,160
up those duties and clarify

2865
01:28:44,160 --> 01:28:47,160
them if we need to.

2866
01:28:48,670 --> 01:28:49,540
So when we talk about

2867
01:28:49,540 --> 01:28:50,870
contracted case management,

2868
01:28:50,870 --> 01:28:52,760
this is an activity that many

2869
01:28:52,760 --> 01:28:55,160
lead agencies use increasingly

2870
01:28:55,300 --> 01:28:56,810
to address

2871
01:28:56,810 --> 01:28:58,520
to my slides. Go away for some

2872
01:28:58,520 --> 01:29:00,520
reason.

2873
01:29:02,800 --> 01:29:04,260
>> Sorry, I'm having technical

2874
01:29:04,260 --> 01:29:05,830
issues chair to out me to just

2875
01:29:05,830 --> 01:29:07,950
just the and you can execute.

2876
01:29:07,950 --> 01:29:10,350
Okay. Can keep talking.

2877
01:29:11,940 --> 01:29:12,950
I thought they were up there at

2878
01:29:12,950 --> 01:29:14,930
the time. Accent just got

2879
01:29:14,930 --> 01:29:17,480
questions. Ask Radio Shack just

2880
01:29:17,480 --> 01:29:19,480
a

2881
01:29:26,350 --> 01:29:27,910
a graduate of Saint Francis

2882
01:29:27,910 --> 01:29:31,510
High School that I love it.

2883
01:29:32,310 --> 01:29:33,690
>> All right. So many lead

2884
01:29:33,690 --> 01:29:35,220
agencies use contracted case

2885
01:29:35,220 --> 01:29:36,390
management. We've heard that

2886
01:29:36,390 --> 01:29:37,860
here at DHS. This committee has

2887
01:29:37,860 --> 01:29:38,720
heard it from our county

2888
01:29:38,720 --> 01:29:40,800
partners as well over the past

2889
01:29:40,800 --> 01:29:42,310
session or 2. And we'll hear

2890
01:29:42,310 --> 01:29:43,160
more from the county's about

2891
01:29:43,160 --> 01:29:44,450
why they do that. But, you

2892
01:29:44,450 --> 01:29:46,140
know, they're always looking to

2893
01:29:46,140 --> 01:29:47,450
create smaller case loads to

2894
01:29:47,450 --> 01:29:48,850
supplement gaps and maybe

2895
01:29:48,850 --> 01:29:50,300
experience or specialization.

2896
01:29:50,300 --> 01:29:51,500
Maybe there's individuals who

2897
01:29:51,500 --> 01:29:52,900
have a brain injury, for

2898
01:29:52,900 --> 01:29:55,220
example, and the county's and

2899
01:29:55,220 --> 01:29:56,640
say, you know what, this is

2900
01:29:56,640 --> 01:29:58,350
organization and community is

2901
01:29:58,350 --> 01:29:59,830
just better position to provide

2902
01:29:59,830 --> 01:30:00,890
that case management for that

2903
01:30:00,890 --> 01:30:02,200
individual.

2904
01:30:02,200 --> 01:30:04,120
We also see quite frequently or

2905
01:30:04,120 --> 01:30:06,180
counties more so quite see

2906
01:30:06,180 --> 01:30:07,820
frequently where people are

2907
01:30:07,820 --> 01:30:09,800
living in a different location

2908
01:30:09,800 --> 01:30:11,500
in their county of financial

2909
01:30:11,500 --> 01:30:13,250
responsibility and which case

2910
01:30:13,250 --> 01:30:15,350
it may make sense for everyone

2911
01:30:15,350 --> 01:30:17,150
to have a contract to case

2912
01:30:17,150 --> 01:30:18,280
management that's closer to

2913
01:30:18,280 --> 01:30:19,560
that individual to make sure

2914
01:30:19,560 --> 01:30:21,560
they're fully connected.

2915
01:30:22,100 --> 01:30:23,800
I will say that, you know,

2916
01:30:23,800 --> 01:30:24,510
contracted case management

2917
01:30:24,510 --> 01:30:27,000
isn't inherently a bad thing.

2918
01:30:27,000 --> 01:30:28,490
We use subcontracted case

2919
01:30:28,490 --> 01:30:29,730
management and targeted case

2920
01:30:29,730 --> 01:30:30,850
management. Another kind of

2921
01:30:30,850 --> 01:30:32,610
Medicaid case management.

2922
01:30:32,610 --> 01:30:33,990
I think certainly at the

2923
01:30:33,990 --> 01:30:34,990
department we do want to

2924
01:30:34,990 --> 01:30:36,710
understand and have better

2925
01:30:36,710 --> 01:30:37,810
sight lines into some of the

2926
01:30:37,810 --> 01:30:39,460
quality assurances and

2927
01:30:39,460 --> 01:30:41,680
oversight here. But it's not

2928
01:30:41,680 --> 01:30:43,380
necessarily something that,

2929
01:30:43,380 --> 01:30:45,410
you know, we need to fully get

2930
01:30:45,410 --> 01:30:46,390
rid of all that. We've had some

2931
01:30:46,390 --> 01:30:48,390
of those conversations.

2932
01:30:49,230 --> 01:30:50,640
I just wanted to highlight that

2933
01:30:50,640 --> 01:30:52,510
our federal federally approved

2934
01:30:52,510 --> 01:30:54,760
a waiver plans as well as state

2935
01:30:54,760 --> 01:30:56,750
law identifies that we do

2936
01:30:56,750 --> 01:30:58,230
subcontracted case management

2937
01:30:58,230 --> 01:31:00,160
that lead agencies me contract

2938
01:31:00,160 --> 01:31:01,400
with a private entity to do

2939
01:31:01,400 --> 01:31:03,400
that.

2940
01:31:04,300 --> 01:31:06,230
>> Cms has to approve that.

2941
01:31:06,230 --> 01:31:07,420
It's part of your Medicaid

2942
01:31:07,420 --> 01:31:08,970
plan. Correct? Our Medicaid

2943
01:31:08,970 --> 01:31:10,580
plan craft March air. That's

2944
01:31:10,580 --> 01:31:13,420
correct. Thank you for that.

2945
01:31:13,420 --> 01:31:14,810
>> Dhs does need to make sure

2946
01:31:14,810 --> 01:31:16,260
that we're monitoring as those

2947
01:31:16,260 --> 01:31:17,520
supervisors of the human

2948
01:31:17,520 --> 01:31:18,880
services system. We do have a

2949
01:31:18,880 --> 01:31:19,760
responsibility and

2950
01:31:19,760 --> 01:31:21,290
accountability to monitor lead

2951
01:31:21,290 --> 01:31:23,290
agency performance, quality

2952
01:31:23,870 --> 01:31:25,280
compliance. And if there is a

2953
01:31:25,280 --> 01:31:26,630
need for corrective actions, we

2954
01:31:26,630 --> 01:31:28,630
do issue those.

2955
01:31:29,530 --> 01:31:31,210
As we've worked with our county

2956
01:31:31,210 --> 01:31:33,710
partners, we've seen data that

2957
01:31:33,710 --> 01:31:35,360
indicates that the need for

2958
01:31:35,360 --> 01:31:36,920
contact in case management has

2959
01:31:36,920 --> 01:31:38,200
been increasing due to

2960
01:31:38,200 --> 01:31:40,200
workforce issues and

2961
01:31:40,360 --> 01:31:42,360
reimbursement concerns across

2962
01:31:43,160 --> 01:31:44,690
the system.

2963
01:31:44,690 --> 01:31:46,440
So we've heard that counties

2964
01:31:46,440 --> 01:31:47,590
are actually expanding their

2965
01:31:47,590 --> 01:31:48,800
use of contracted. Case

2966
01:31:48,800 --> 01:31:50,300
management will talk more about

2967
01:31:50,300 --> 01:31:51,960
that, I assume. And just some

2968
01:31:51,960 --> 01:31:53,620
basic numbers I wanted to share

2969
01:31:53,620 --> 01:31:54,640
with the committee's between

2970
01:31:54,640 --> 01:31:57,360
May 2024 and today I have an

2971
01:31:57,360 --> 01:31:58,670
acronym and here which I didn't

2972
01:31:58,670 --> 01:32:00,170
fully right out. So that's my

2973
01:32:00,170 --> 01:32:02,900
bad. La R Stands for lead

2974
01:32:02,900 --> 01:32:04,700
agency review.

2975
01:32:04,700 --> 01:32:06,380
Met with about 59 lead agency

2976
01:32:06,380 --> 01:32:08,720
is and most of them are using

2977
01:32:08,720 --> 01:32:10,000
contracted case management

2978
01:32:10,000 --> 01:32:11,920
about 54% over that time

2979
01:32:11,920 --> 01:32:13,920
period.

2980
01:32:16,500 --> 01:32:17,440
All right. So let's talk a

2981
01:32:17,440 --> 01:32:18,820
little bit more about lead

2982
01:32:18,820 --> 01:32:20,820
agency review.

2983
01:32:21,400 --> 01:32:23,300
So lead agency review is a

2984
01:32:23,300 --> 01:32:24,950
process that the Department of

2985
01:32:24,950 --> 01:32:26,560
Human Services initiated about

2986
01:32:26,560 --> 01:32:28,280
20 years ago.

2987
01:32:28,280 --> 01:32:29,470
Seems like a long time ago.

2988
01:32:29,470 --> 01:32:30,320
But we've been doing this for

2989
01:32:30,320 --> 01:32:31,660
quite a while and continually

2990
01:32:31,660 --> 01:32:34,230
improving. And and this is a

2991
01:32:34,230 --> 01:32:35,730
process that is really meant to

2992
01:32:35,730 --> 01:32:37,600
oversee

2993
01:32:37,600 --> 01:32:38,810
and our lead agencies and how

2994
01:32:38,810 --> 01:32:39,740
they're delivering case

2995
01:32:39,740 --> 01:32:41,370
management services. So it

2996
01:32:41,370 --> 01:32:42,990
applies to both regular case

2997
01:32:42,990 --> 01:32:44,540
management and contracted case

2998
01:32:44,540 --> 01:32:46,270
management. Increasingly,

2999
01:32:46,270 --> 01:32:47,760
we are trying to, you know,

3000
01:32:47,760 --> 01:32:48,780
hearing from the community

3001
01:32:48,780 --> 01:32:50,240
hearing from this committee and

3002
01:32:50,240 --> 01:32:52,610
members make sure that we're

3003
01:32:52,610 --> 01:32:54,650
devoting ample attention or

3004
01:32:54,650 --> 01:32:56,360
equal attention to contracted

3005
01:32:56,360 --> 01:32:57,690
case management activities as

3006
01:32:57,690 --> 01:32:58,880
well and how those are being

3007
01:32:58,880 --> 01:33:00,870
addressed by counties.

3008
01:33:00,870 --> 01:33:02,350
But really the main goals of

3009
01:33:02,350 --> 01:33:03,680
lead agency review is to make

3010
01:33:03,680 --> 01:33:04,920
sure that counties and tribal

3011
01:33:04,920 --> 01:33:07,370
nations are compliant with all

3012
01:33:07,370 --> 01:33:08,500
of the requirements and state

3013
01:33:08,500 --> 01:33:10,330
and federal law. It's an

3014
01:33:10,330 --> 01:33:11,670
opportunity to share

3015
01:33:11,670 --> 01:33:13,210
performance on key measures and

3016
01:33:13,210 --> 01:33:14,540
out comes to better support

3017
01:33:14,540 --> 01:33:16,960
people. So we had dew track

3018
01:33:16,960 --> 01:33:19,220
various Lt, assess long-term

3019
01:33:19,220 --> 01:33:20,120
services and supports

3020
01:33:20,120 --> 01:33:22,520
performance measures and work.

3021
01:33:22,860 --> 01:33:24,190
Those into the discussions with

3022
01:33:24,190 --> 01:33:25,270
lead agencies are on how

3023
01:33:25,270 --> 01:33:26,610
they're doing and what their

3024
01:33:26,610 --> 01:33:27,760
outcomes look like and how they

3025
01:33:27,760 --> 01:33:28,640
compare to the rest of the

3026
01:33:28,640 --> 01:33:29,840
state.

3027
01:33:29,840 --> 01:33:31,280
It's also a way to promote

3028
01:33:31,280 --> 01:33:32,520
collaboration among lead

3029
01:33:32,520 --> 01:33:33,940
agencies and share best

3030
01:33:33,940 --> 01:33:36,630
practices. So if DHS is hearing

3031
01:33:36,630 --> 01:33:38,860
from one county who's really

3032
01:33:38,860 --> 01:33:40,860
doing a great job, that's an

3033
01:33:40,860 --> 01:33:41,890
opportunity for us to

3034
01:33:41,890 --> 01:33:42,760
potentially share that

3035
01:33:42,760 --> 01:33:44,100
information with other counties

3036
01:33:44,100 --> 01:33:45,410
so that they can implement

3037
01:33:45,410 --> 01:33:47,650
those practices as well.

3038
01:33:47,650 --> 01:33:49,210
So this slide is just a quick

3039
01:33:49,210 --> 01:33:50,880
overview of what the lead

3040
01:33:50,880 --> 01:33:52,450
agency review process looks

3041
01:33:52,450 --> 01:33:53,640
like.

3042
01:33:53,640 --> 01:33:55,230
So it's typically about a

3043
01:33:55,230 --> 01:33:57,660
six-month process and there's a

3044
01:33:57,660 --> 01:33:58,570
schedule. There's a whole

3045
01:33:58,570 --> 01:34:00,450
website on there and the DHS

3046
01:34:00,450 --> 01:34:01,950
Web page where you can find the

3047
01:34:01,950 --> 01:34:04,300
schedule every year which

3048
01:34:04,300 --> 01:34:06,300
counties were reviewing.

3049
01:34:06,600 --> 01:34:08,200
But it's a six-month process.

3050
01:34:08,200 --> 01:34:09,660
Counties undergo this about

3051
01:34:09,660 --> 01:34:11,820
every 3 to 4 years, depending

3052
01:34:11,820 --> 01:34:12,710
kind of what's going on with

3053
01:34:12,710 --> 01:34:13,900
that county. But it first

3054
01:34:13,900 --> 01:34:16,300
involves up revisit activities,

3055
01:34:17,840 --> 01:34:19,200
initiation or kickoff

3056
01:34:19,200 --> 01:34:20,440
teleconference. So there's the

3057
01:34:20,440 --> 01:34:22,840
supervisors lead agency lead

3058
01:34:23,620 --> 01:34:24,780
agency survey go to all

3059
01:34:24,780 --> 01:34:25,790
programs, staff and we're

3060
01:34:25,790 --> 01:34:27,510
gathering program data from DHS

3061
01:34:27,510 --> 01:34:29,200
Systems.

3062
01:34:29,200 --> 01:34:30,520
Next is really the meat of the

3063
01:34:30,520 --> 01:34:31,940
lead agency review, which is

3064
01:34:31,940 --> 01:34:33,960
the review itself. So as a part

3065
01:34:33,960 --> 01:34:34,860
of this, we're looking at the

3066
01:34:34,860 --> 01:34:36,270
case file. We take a random

3067
01:34:36,270 --> 01:34:37,960
sample of case files for each

3068
01:34:37,960 --> 01:34:39,170
program

3069
01:34:39,170 --> 01:34:40,670
and then we review those with

3070
01:34:40,670 --> 01:34:42,180
the team. I think it's about

3071
01:34:42,180 --> 01:34:44,340
10% or so of case files that we

3072
01:34:44,340 --> 01:34:46,600
sample and that differs

3073
01:34:46,600 --> 01:34:47,670
depending on the total number.

3074
01:34:47,670 --> 01:34:48,710
If there is, for example,

3075
01:34:48,710 --> 01:34:49,650
a smaller county and there's

3076
01:34:49,650 --> 01:34:51,120
only 10 files, we review all of

3077
01:34:51,120 --> 01:34:52,120
them.

3078
01:34:52,120 --> 01:34:55,200
And as I alluded to earlier,

3079
01:34:55,200 --> 01:34:56,590
all of this review includes the

3080
01:34:56,590 --> 01:34:57,810
case management conducted by

3081
01:34:57,810 --> 01:34:59,520
the lead agency itself, as well

3082
01:34:59,520 --> 01:35:02,520
as the contracted lead agency

3083
01:35:02,750 --> 01:35:03,620
through the site review.

3084
01:35:03,620 --> 01:35:04,920
We're going to Dana 5 practices

3085
01:35:04,920 --> 01:35:07,920
and tools that lead agencies

3086
01:35:08,470 --> 01:35:09,940
that contribute to, you know,

3087
01:35:09,940 --> 01:35:11,410
potentially stronger. Maybe not

3088
01:35:11,410 --> 01:35:12,920
so strong, technical compliance

3089
01:35:12,920 --> 01:35:14,350
and outcomes.

3090
01:35:14,350 --> 01:35:16,300
And the review also includes

3091
01:35:16,300 --> 01:35:17,550
focus group meetings and

3092
01:35:17,550 --> 01:35:18,730
meetings with supervisors and

3093
01:35:18,730 --> 01:35:21,190
directors at the county level.

3094
01:35:21,190 --> 01:35:23,500
And then lastly, there is a

3095
01:35:23,500 --> 01:35:25,700
post visit activity where there

3096
01:35:25,700 --> 01:35:27,330
might be potential remediation.

3097
01:35:27,330 --> 01:35:28,990
So all non compliant items that

3098
01:35:28,990 --> 01:35:30,850
were found during the review

3099
01:35:30,850 --> 01:35:32,670
need to be remediated within 60

3100
01:35:32,670 --> 01:35:34,170
days of the review.

3101
01:35:34,170 --> 01:35:35,880
And the lead agency will

3102
01:35:35,880 --> 01:35:37,360
correct each of these items and

3103
01:35:37,360 --> 01:35:39,420
then return that information

3104
01:35:39,420 --> 01:35:42,240
back to DHS for our review.

3105
01:35:42,240 --> 01:35:43,490
There's also potential for

3106
01:35:43,490 --> 01:35:45,890
corrective action so that

3107
01:35:46,100 --> 01:35:48,310
corrective actions can occur.

3108
01:35:48,310 --> 01:35:50,310
>> When there's a certain

3109
01:35:50,310 --> 01:35:52,310
number of

3110
01:35:52,700 --> 01:35:53,620
>> items that are out of

3111
01:35:53,620 --> 01:35:54,970
compliance, more than one,

3112
01:35:54,970 --> 01:35:57,410
for example, that really needs

3113
01:35:57,410 --> 01:35:58,600
warrants a little bit more

3114
01:35:58,600 --> 01:36:01,900
deeper attention. So we we will

3115
01:36:01,900 --> 01:36:03,840
issue that corrective action.

3116
01:36:03,840 --> 01:36:05,320
The lead agency has 10 business

3117
01:36:05,320 --> 01:36:06,590
days to develop and submit

3118
01:36:06,590 --> 01:36:08,340
their plan to DHS. And that

3119
01:36:08,340 --> 01:36:09,260
needs to outline how they're

3120
01:36:09,260 --> 01:36:10,300
going to address each of those

3121
01:36:10,300 --> 01:36:12,260
actions. And then there's

3122
01:36:12,260 --> 01:36:14,610
follow-up post visit activities

3123
01:36:14,610 --> 01:36:16,120
in the follow-up survey

3124
01:36:16,120 --> 01:36:17,920
includes the agencies reporting

3125
01:36:17,920 --> 01:36:20,310
back on there, how things are

3126
01:36:20,310 --> 01:36:21,590
going

3127
01:36:21,590 --> 01:36:22,700
with that corrective action

3128
01:36:22,700 --> 01:36:23,780
plan and whether or not they're

3129
01:36:23,780 --> 01:36:24,930
meeting the metrics and their

3130
01:36:24,930 --> 01:36:26,660
plan that they've worked on

3131
01:36:26,660 --> 01:36:29,900
with us. There is potential if

3132
01:36:29,900 --> 01:36:30,180
elite agency is still

3133
01:36:30,180 --> 01:36:32,150
struggling to comply with that

3134
01:36:32,150 --> 01:36:33,390
corrective action plan where we

3135
01:36:33,390 --> 01:36:35,100
would put them into like a

3136
01:36:35,100 --> 01:36:36,420
shorten lead agency review in

3137
01:36:36,420 --> 01:36:38,300
the next cycle.

3138
01:36:38,300 --> 01:36:40,220
So in a nutshell, that's what

3139
01:36:40,220 --> 01:36:42,860
the lead agency review is.

3140
01:36:42,860 --> 01:36:44,450
There's also a follow-up survey

3141
01:36:44,450 --> 01:36:45,960
where counties can give us

3142
01:36:45,960 --> 01:36:47,200
feedback on how it's going,

3143
01:36:47,200 --> 01:36:48,990
what we need to do to improve.

3144
01:36:48,990 --> 01:36:51,770
I will say am I mentioned this

3145
01:36:51,770 --> 01:36:53,110
earlier and it may be on a

3146
01:36:53,110 --> 01:36:55,300
subsequent slide here, but we

3147
01:36:55,300 --> 01:36:56,480
are really looking into as a

3148
01:36:56,480 --> 01:36:57,710
part of lead agency review,

3149
01:36:57,710 --> 01:36:59,380
making sure that we're asking

3150
01:36:59,380 --> 01:37:01,750
and provide or lead agencies to

3151
01:37:01,750 --> 01:37:03,510
a test whether or not they have

3152
01:37:03,510 --> 01:37:05,580
insurance policies in place and

3153
01:37:05,580 --> 01:37:07,490
their contracts with count with

3154
01:37:07,490 --> 01:37:09,490
entities, private entities.

3155
01:37:09,690 --> 01:37:11,770
If they do great, we might want

3156
01:37:11,770 --> 01:37:12,720
to take a look at some of those

3157
01:37:12,720 --> 01:37:13,880
insurance policies. If they

3158
01:37:13,880 --> 01:37:14,780
don't, we're going to work with

3159
01:37:14,780 --> 01:37:15,920
the lead agency to make sure

3160
01:37:15,920 --> 01:37:17,590
that they've got that the

3161
01:37:17,590 --> 01:37:18,820
quality assurance built into

3162
01:37:18,820 --> 01:37:20,820
their contracts.

3163
01:37:23,280 --> 01:37:24,810
And I think the last thing I

3164
01:37:24,810 --> 01:37:26,400
wanted to mention on this slide

3165
01:37:26,400 --> 01:37:27,270
just in the interest of time

3166
01:37:27,270 --> 01:37:28,870
was in the 2026 session.

3167
01:37:28,870 --> 01:37:31,150
The governor did recommend a

3168
01:37:31,150 --> 01:37:32,350
few items related to a

3169
01:37:32,350 --> 01:37:33,680
contractor to Weaver case

3170
01:37:33,680 --> 01:37:34,530
management. And one of the

3171
01:37:34,530 --> 01:37:36,530
items was 2. Look at the fees

3172
01:37:36,530 --> 01:37:37,860
out of the use of contracted

3173
01:37:37,860 --> 01:37:40,260
case management and throughout

3174
01:37:40,930 --> 01:37:42,420
a long period of time during

3175
01:37:42,420 --> 01:37:43,600
which we would be to evaluate

3176
01:37:43,600 --> 01:37:44,740
rates and the so I think the

3177
01:37:44,740 --> 01:37:46,120
governor recommended

3178
01:37:46,120 --> 01:37:47,490
potentially phasing out the use

3179
01:37:47,490 --> 01:37:48,780
of contracted case management

3180
01:37:48,780 --> 01:37:50,780
as of 2031.

3181
01:37:50,940 --> 01:37:52,410
That item did not make it

3182
01:37:52,410 --> 01:37:54,170
across the finish line. But the

3183
01:37:54,170 --> 01:37:55,300
rate evaluation that we

3184
01:37:55,300 --> 01:37:57,300
recommended and representative

3185
01:37:57,460 --> 01:37:59,460
fishers initiatives and

3186
01:37:59,690 --> 01:38:01,000
actually Representative Gilman,

3187
01:38:01,000 --> 01:38:02,140
I think we're closely on those

3188
01:38:02,140 --> 01:38:03,590
as well. Did pass a we'll talk

3189
01:38:03,590 --> 01:38:04,860
a little bit about those to

3190
01:38:04,860 --> 01:38:06,860
end.

3191
01:38:06,990 --> 01:38:08,910
So the initiatives that I just

3192
01:38:08,910 --> 01:38:10,700
alluded to that Representative

3193
01:38:10,700 --> 01:38:12,650
Fisher and they share Gilman,

3194
01:38:12,650 --> 01:38:15,330
worked on, wanted to lift up

3195
01:38:15,330 --> 01:38:16,480
the waiver case management

3196
01:38:16,480 --> 01:38:18,700
advisory working group, first

3197
01:38:18,700 --> 01:38:20,800
of all, and then we'll talk a

3198
01:38:20,800 --> 01:38:21,600
little bit about the case

3199
01:38:21,600 --> 01:38:22,470
management, great evaluation

3200
01:38:22,470 --> 01:38:24,470
and recommendations.

3201
01:38:28,240 --> 01:38:30,260
So the waiver case management

3202
01:38:30,260 --> 01:38:31,940
advisory working group is in

3203
01:38:31,940 --> 01:38:32,940
the process of being

3204
01:38:32,940 --> 01:38:34,540
implemented right now. We have

3205
01:38:34,540 --> 01:38:36,790
appointments that have went

3206
01:38:36,790 --> 01:38:37,860
through the secretary of state

3207
01:38:37,860 --> 01:38:39,410
process. I believe we got about

3208
01:38:39,410 --> 01:38:42,290
50 individuals who want to be a

3209
01:38:42,290 --> 01:38:43,320
part of this working group,

3210
01:38:43,320 --> 01:38:45,350
which is really great. And

3211
01:38:45,350 --> 01:38:47,410
initially the the interest was

3212
01:38:47,410 --> 01:38:48,790
a little bit slow to come in.

3213
01:38:48,790 --> 01:38:50,740
But now we're we're heartened

3214
01:38:50,740 --> 01:38:51,660
to know we've got a lot of

3215
01:38:51,660 --> 01:38:53,660
great broad-based support.

3216
01:38:54,280 --> 01:38:55,310
So this is a working group

3217
01:38:55,310 --> 01:38:56,400
that's going to look at the

3218
01:38:56,400 --> 01:38:57,850
quality of case management

3219
01:38:57,850 --> 01:38:59,490
Weaver, case management

3220
01:38:59,490 --> 01:39:00,870
work for sustainability.

3221
01:39:00,870 --> 01:39:02,540
Accountability like we've been

3222
01:39:02,540 --> 01:39:03,750
talking about today and just

3223
01:39:03,750 --> 01:39:05,290
long-term stability of the case

3224
01:39:05,290 --> 01:39:06,970
management system, CBS Case

3225
01:39:06,970 --> 01:39:08,970
Management system, statewide

3226
01:39:09,550 --> 01:39:10,710
recommendations are due to the

3227
01:39:10,710 --> 01:39:12,530
legislature and the beginning

3228
01:39:12,530 --> 01:39:14,530
of September 2027.

3229
01:39:15,380 --> 01:39:16,870
So we look forward to doing

3230
01:39:16,870 --> 01:39:18,410
this work. It will be open if

3231
01:39:18,410 --> 01:39:19,490
there is interest, you know,

3232
01:39:19,490 --> 01:39:21,900
from legislative staffer or

3233
01:39:21,900 --> 01:39:23,260
legislative members reach out

3234
01:39:23,260 --> 01:39:24,720
to us and we can let you know

3235
01:39:24,720 --> 01:39:26,170
how to keep keep up with those

3236
01:39:26,170 --> 01:39:28,200
discussions. We haven't quite

3237
01:39:28,200 --> 01:39:29,330
started meeting at because it

3238
01:39:29,330 --> 01:39:30,370
takes a while to get the

3239
01:39:30,370 --> 01:39:32,730
funding one session ends in our

3240
01:39:32,730 --> 01:39:34,660
accounts and then to get those

3241
01:39:34,660 --> 01:39:36,100
secretary of state appointments

3242
01:39:36,100 --> 01:39:37,670
completed. But hopefully we'll

3243
01:39:37,670 --> 01:39:38,690
be starting to me pretty

3244
01:39:38,690 --> 01:39:40,930
quickly to have a really robust

3245
01:39:40,930 --> 01:39:42,130
discussion about what's needed

3246
01:39:42,130 --> 01:39:44,130
in the system.

3247
01:39:46,380 --> 01:39:48,320
Representative Fisher.

3248
01:39:48,320 --> 01:39:49,840
>> Thank you. Chair Oppmann,

3249
01:39:49,840 --> 01:39:51,250
thank you. Ms ground for the

3250
01:39:51,250 --> 01:39:52,280
presentation. One of the

3251
01:39:52,280 --> 01:39:54,800
questions I have is I so people

3252
01:39:54,800 --> 01:39:56,150
have some people contacted me

3253
01:39:56,150 --> 01:39:57,610
that are not going to be on the

3254
01:39:57,610 --> 01:39:58,840
workgroup. They wondering what

3255
01:39:58,840 --> 01:40:00,330
is the way for them to monitors

3256
01:40:00,330 --> 01:40:01,480
and when they have to work who

3257
01:40:01,480 --> 01:40:02,680
has a meetings, how can the

3258
01:40:02,680 --> 01:40:04,560
public watch what's going on or

3259
01:40:04,560 --> 01:40:06,340
be engaged in that process?

3260
01:40:06,340 --> 01:40:07,600
Mister a.

3261
01:40:07,600 --> 01:40:08,960
>> Our Chair, Representative

3262
01:40:08,960 --> 01:40:09,730
Fischer. That's a great

3263
01:40:09,730 --> 01:40:11,400
question. I asked that myself.

3264
01:40:11,400 --> 01:40:13,200
I don't know that we have a

3265
01:40:13,200 --> 01:40:15,200
determined

3266
01:40:15,480 --> 01:40:17,220
pathway for that yet. But it is

3267
01:40:17,220 --> 01:40:18,450
this is a group that will be,

3268
01:40:18,450 --> 01:40:19,500
you know, subject to the open

3269
01:40:19,500 --> 01:40:20,600
meeting laws. So there will be

3270
01:40:20,600 --> 01:40:22,210
a way for public participation

3271
01:40:22,210 --> 01:40:23,570
and to submit comment or

3272
01:40:23,570 --> 01:40:25,360
feedback as well. But I can

3273
01:40:25,360 --> 01:40:26,370
follow up with the committee

3274
01:40:26,370 --> 01:40:27,180
and make sure that you have

3275
01:40:27,180 --> 01:40:28,440
that information before we get

3276
01:40:28,440 --> 01:40:30,440
going with it.

3277
01:40:30,800 --> 01:40:31,690
>> Thank you very much.

3278
01:40:31,690 --> 01:40:32,930
Appreciate that. I've got some

3279
01:40:32,930 --> 01:40:34,140
folks that like to share with.

3280
01:40:34,140 --> 01:40:36,140
So thank you.

3281
01:40:39,780 --> 01:40:41,120
>> All right, Mister Chair, so

3282
01:40:41,120 --> 01:40:42,470
I'm going to wrap up here so

3283
01:40:42,470 --> 01:40:44,340
you can

3284
01:40:44,340 --> 01:40:45,820
stop listening to me, talk and

3285
01:40:45,820 --> 01:40:46,840
get to they can get to the

3286
01:40:46,840 --> 01:40:48,200
county presentation here.

3287
01:40:48,200 --> 01:40:50,430
But I did just want to mention

3288
01:40:50,430 --> 01:40:53,410
really a core part of that.

3289
01:40:53,410 --> 01:40:55,210
This discussion is making sure

3290
01:40:55,210 --> 01:40:56,660
that we have sustainable Weaver

3291
01:40:56,660 --> 01:40:59,600
case management rates system.

3292
01:40:59,740 --> 01:41:01,200
Our rates for Weaver case

3293
01:41:01,200 --> 01:41:02,700
management have not been

3294
01:41:02,700 --> 01:41:04,400
changed in quite some time.

3295
01:41:04,400 --> 01:41:06,350
They are flat rates, 15 minute

3296
01:41:06,350 --> 01:41:08,370
units and they are not

3297
01:41:08,370 --> 01:41:09,630
sustainable.

3298
01:41:09,630 --> 01:41:11,580
We've had growing numbers of

3299
01:41:11,580 --> 01:41:13,490
programs we have now counties

3300
01:41:13,490 --> 01:41:15,390
are just trying to manage

3301
01:41:15,390 --> 01:41:17,390
overwhelming case loads.

3302
01:41:17,430 --> 01:41:18,580
So it really shouldn't be a

3303
01:41:18,580 --> 01:41:19,910
surprise that we're struggling

3304
01:41:19,910 --> 01:41:22,230
as a system and to sustain

3305
01:41:22,230 --> 01:41:23,890
these services at the level and

3306
01:41:23,890 --> 01:41:25,780
the quality that we want to.

3307
01:41:25,780 --> 01:41:27,410
So last session, the

3308
01:41:27,410 --> 01:41:28,680
legislature didn't act a

3309
01:41:28,680 --> 01:41:30,910
provision that tells DHS that

3310
01:41:30,910 --> 01:41:32,300
we need to go out there and

3311
01:41:32,300 --> 01:41:33,970
study and at what the rate

3312
01:41:33,970 --> 01:41:35,290
should be, what the costs are

3313
01:41:35,290 --> 01:41:37,170
to provide case management

3314
01:41:37,170 --> 01:41:38,100
water, some workforce

3315
01:41:38,100 --> 01:41:40,000
pressures. What should a case

3316
01:41:40,000 --> 01:41:41,360
loads look like? If we want a

3317
01:41:41,360 --> 01:41:43,330
caseload of 30 people per case

3318
01:41:43,330 --> 01:41:45,340
manager than then what is what

3319
01:41:45,340 --> 01:41:47,260
is the cost of that

3320
01:41:47,260 --> 01:41:48,640
as well as qualifications and

3321
01:41:48,640 --> 01:41:50,580
training that we want in that

3322
01:41:50,580 --> 01:41:52,980
particular workforce? So this

3323
01:41:53,140 --> 01:41:55,700
is work that will be informed

3324
01:41:55,700 --> 01:41:56,690
by the advisory workgroup and

3325
01:41:56,690 --> 01:41:58,840
must be by law. So that was

3326
01:41:58,840 --> 01:42:01,000
smart to kind of make these to

3327
01:42:01,000 --> 01:42:02,510
dovetail those 2 requirements

3328
01:42:02,510 --> 01:42:04,930
together and we will be

3329
01:42:04,930 --> 01:42:06,210
submitting recommendations.

3330
01:42:06,210 --> 01:42:08,150
The legislature in 2028, the

3331
01:42:08,150 --> 01:42:09,710
end of 2028 with the

3332
01:42:09,710 --> 01:42:11,340
recommended updated payment

3333
01:42:11,340 --> 01:42:13,600
methodology to better fund this

3334
01:42:13,600 --> 01:42:14,910
work.

3335
01:42:14,910 --> 01:42:16,820
So that is just something that

3336
01:42:16,820 --> 01:42:18,680
we've heard repeatedly from at

3337
01:42:18,680 --> 01:42:20,120
the county level in particular

3338
01:42:20,120 --> 01:42:22,200
that the system is really on

3339
01:42:22,200 --> 01:42:23,230
the verge of

3340
01:42:23,230 --> 01:42:24,610
collapse and we need to address

3341
01:42:24,610 --> 01:42:27,100
the reimbursement rates there.

3342
01:42:28,910 --> 01:42:30,910
Thank you, scrum.

3343
01:42:31,240 --> 01:42:32,410
>> Representative Fisher

3344
01:42:32,410 --> 01:42:34,690
Representative Keleman are kind

3345
01:42:34,690 --> 01:42:36,900
of like Elisa. You guys didn't

3346
01:42:36,900 --> 01:42:38,230
put up this work. That's on

3347
01:42:38,230 --> 01:42:39,790
that 50 people wanting to be on

3348
01:42:39,790 --> 01:42:41,650
it to you and and put yourself

3349
01:42:41,650 --> 01:42:43,520
in their position is, you know,

3350
01:42:43,520 --> 01:42:45,520
let the system.

3351
01:42:46,800 --> 01:42:47,880
>> Thank you, Kara Hoffman.

3352
01:42:47,880 --> 01:42:50,400
I let the represent Cuban speak

3353
01:42:50,400 --> 01:42:52,160
for herself. I know that as I

3354
01:42:52,160 --> 01:42:53,630
was looking at, it was letting

3355
01:42:53,630 --> 01:42:55,300
the folks to the work at hand

3356
01:42:55,300 --> 01:42:56,540
that was asking when they make

3357
01:42:56,540 --> 01:42:58,600
someone that smart, I want to

3358
01:42:58,600 --> 01:42:59,140
serve. I want to hear from the

3359
01:42:59,140 --> 01:42:59,800
people that are in the

3360
01:42:59,800 --> 01:43:00,880
trenches, want to see what

3361
01:43:00,880 --> 01:43:02,880
they're doing, be involved, let

3362
01:43:02,880 --> 01:43:04,520
them let them do it. Making

3363
01:43:04,520 --> 01:43:05,660
sure that we've got the voices

3364
01:43:05,660 --> 01:43:07,220
of people who are

3365
01:43:07,220 --> 01:43:08,270
>> receiving the services.

3366
01:43:08,270 --> 01:43:09,410
That's the big thing is making

3367
01:43:09,410 --> 01:43:10,450
sure that their centered in

3368
01:43:10,450 --> 01:43:12,260
this conversation. Okay.

3369
01:43:12,260 --> 01:43:14,620
Did I understand that it may be

3370
01:43:14,620 --> 01:43:15,490
something as we're going

3371
01:43:15,490 --> 01:43:16,490
forward? It may not be

3372
01:43:16,490 --> 01:43:18,890
one-size-fits-all is when you

3373
01:43:19,600 --> 01:43:19,960
take a look at the different

3374
01:43:19,960 --> 01:43:21,270
services that may have to be

3375
01:43:21,270 --> 01:43:22,570
something establishing

3376
01:43:22,570 --> 01:43:23,520
depending on the type of

3377
01:43:23,520 --> 01:43:25,150
service may be what the case

3378
01:43:25,150 --> 01:43:26,910
but racial might be in that

3379
01:43:26,910 --> 01:43:28,510
particular service. I

3380
01:43:28,510 --> 01:43:29,920
appreciate the work that the

3381
01:43:29,920 --> 01:43:31,110
county's take a look at.

3382
01:43:31,110 --> 01:43:33,900
I do understand the need for

3383
01:43:33,900 --> 01:43:34,510
adjusting the rates and I

3384
01:43:34,510 --> 01:43:35,560
appreciate I think we've got a

3385
01:43:35,560 --> 01:43:37,450
good process set up and looking

3386
01:43:37,450 --> 01:43:38,250
forward to the work getting

3387
01:43:38,250 --> 01:43:39,560
underway. I like where you're

3388
01:43:39,560 --> 01:43:40,960
going. He said one size fits

3389
01:43:40,960 --> 01:43:41,810
all. It's not.

3390
01:43:41,810 --> 01:43:42,690
>> Because I think about like

3391
01:43:42,690 --> 01:43:44,900
Beltrami County operates

3392
01:43:44,900 --> 01:43:45,830
completely different than that.

3393
01:43:45,830 --> 01:43:47,300
Hennepin County.

3394
01:43:47,300 --> 01:43:48,940
We're talking lots of

3395
01:43:48,940 --> 01:43:50,630
difference, right? Its capacity

3396
01:43:50,630 --> 01:43:52,120
size stuff like that.

3397
01:43:52,120 --> 01:43:54,100
>> And I'd like to you and on

3398
01:43:54,100 --> 01:43:54,940
the work that you guys, you

3399
01:43:54,940 --> 01:43:55,870
guys were the ones who are

3400
01:43:55,870 --> 01:43:57,410
really having this conversation

3401
01:43:57,410 --> 01:43:59,250
last session. So hats off to

3402
01:43:59,250 --> 01:44:00,390
you represent going for that.

3403
01:44:00,390 --> 01:44:02,610
So having said, thank you.

3404
01:44:02,610 --> 01:44:04,210
>> Ms crowd for that. This is

3405
01:44:04,210 --> 01:44:05,440
this is where I wanted to go

3406
01:44:05,440 --> 01:44:06,800
with this.

3407
01:44:06,800 --> 01:44:08,710
>> Stuber at you get that

3408
01:44:08,710 --> 01:44:09,960
Meacham.

3409
01:44:09,960 --> 01:44:11,800
>> And the well, a cough are

3410
01:44:11,800 --> 01:44:12,560
welcome for everybody. Knows

3411
01:44:12,560 --> 01:44:14,600
the Hennepin County Eye on

3412
01:44:14,600 --> 01:44:15,640
their forget.

3413
01:44:15,640 --> 01:44:17,550
>> Get this with the newer.

3414
01:44:17,550 --> 01:44:19,100
And I did a town hall in time

3415
01:44:19,100 --> 01:44:20,750
and it was on this golf with

3416
01:44:20,750 --> 01:44:22,720
the it wasn't all glitz.

3417
01:44:22,720 --> 01:44:24,550
New Britain know Minneapolis.

3418
01:44:24,550 --> 01:44:26,850
It was in Minneapolis in and

3419
01:44:26,850 --> 01:44:28,000
and it was so many questions.

3420
01:44:28,000 --> 01:44:29,610
The pup, Christine was there to

3421
01:44:29,610 --> 01:44:31,500
cover that Christie. And it was

3422
01:44:31,500 --> 01:44:32,910
like I should use. That was

3423
01:44:32,910 --> 01:44:34,330
like Phil Donahue. I could just

3424
01:44:34,330 --> 01:44:35,580
give him the microphone to.

3425
01:44:35,580 --> 01:44:36,630
Well, I mean, you just

3426
01:44:36,630 --> 01:44:37,660
absolutely a wealth of

3427
01:44:37,660 --> 01:44:38,900
information that night. I'll

3428
01:44:38,900 --> 01:44:40,710
never forget it. It's great.

3429
01:44:40,710 --> 01:44:42,200
And I know I have to be kind to

3430
01:44:42,200 --> 01:44:43,950
Pat Meacham because my needs

3431
01:44:43,950 --> 01:44:45,570
texted me

3432
01:44:45,570 --> 01:44:48,500
prior to this committee, Paul

3433
01:44:48,500 --> 01:44:50,930
and said, you know what,

3434
01:44:50,930 --> 01:44:52,360
they'll have me gyms comments.

3435
01:44:52,360 --> 01:44:53,500
He better be nice to him.

3436
01:44:53,500 --> 01:44:55,990
So I got well, I don't want to

3437
01:44:55,990 --> 01:44:57,280
I don't want to be in trouble

3438
01:44:57,280 --> 01:44:59,710
with my knees. So we're good on

3439
01:44:59,710 --> 01:45:00,750
that.

3440
01:45:00,750 --> 01:45:02,100
So thank you for being here.

3441
01:45:02,100 --> 01:45:03,510
Kind of talk about I mean,

3442
01:45:03,510 --> 01:45:05,300
this this issue.

3443
01:45:05,300 --> 01:45:06,800
I can't believe how frustrated

3444
01:45:06,800 --> 01:45:09,110
I am when I read the emails of

3445
01:45:09,110 --> 01:45:11,900
up contacted case manager from

3446
01:45:11,900 --> 01:45:13,400
a certain organization say that

3447
01:45:13,400 --> 01:45:14,600
organization out loud if you

3448
01:45:14,600 --> 01:45:16,230
want, but I won't because you

3449
01:45:16,230 --> 01:45:17,900
guys all know who it is.

3450
01:45:17,900 --> 01:45:20,210
That was so inappropriate.

3451
01:45:20,210 --> 01:45:22,110
I'm giving you a question.

3452
01:45:22,110 --> 01:45:24,100
I'm having fun it regardless.

3453
01:45:24,100 --> 01:45:25,780
Don't personalize my question,

3454
01:45:25,780 --> 01:45:27,570
right? I mean, how many times

3455
01:45:27,570 --> 01:45:28,730
we've had this conversation

3456
01:45:28,730 --> 01:45:30,690
throughout the years? You know,

3457
01:45:30,690 --> 01:45:33,110
I I personalize some a lot of

3458
01:45:33,110 --> 01:45:35,240
times, you know, and it's good.

3459
01:45:35,240 --> 01:45:37,140
You call me out on that, right?

3460
01:45:37,140 --> 01:45:38,160
But in this case, don't

3461
01:45:38,160 --> 01:45:39,570
personalize it in an email to

3462
01:45:39,570 --> 01:45:41,510
somebody. It's not about you.

3463
01:45:41,510 --> 01:45:42,830
It's about the individual.

3464
01:45:42,830 --> 01:45:44,200
That's why it breaks my heart.

3465
01:45:44,200 --> 01:45:45,460
When AJ Klug, you did that

3466
01:45:45,460 --> 01:45:46,960
story of an individual that was

3467
01:45:46,960 --> 01:45:48,460
and housing support

3468
01:45:48,460 --> 01:45:49,920
and she now is homeless.

3469
01:45:49,920 --> 01:45:52,700
She's couch jumping. And I ask

3470
01:45:52,700 --> 01:45:53,860
that certainly I get one person

3471
01:45:53,860 --> 01:45:55,380
to just come forward and say I

3472
01:45:55,380 --> 01:45:56,370
care, I want to get this

3473
01:45:56,370 --> 01:45:58,700
person, the services they need.

3474
01:45:58,700 --> 01:45:59,270
That person shouldn't be caught

3475
01:45:59,270 --> 01:46:01,330
jumping, right. I think we all

3476
01:46:01,330 --> 01:46:03,370
agree with that. Like where did

3477
01:46:03,370 --> 01:46:04,670
the breakdown happened within

3478
01:46:04,670 --> 01:46:05,830
the structured system of

3479
01:46:05,830 --> 01:46:07,500
communicating to somebody to

3480
01:46:07,500 --> 01:46:09,690
say there it is. And maybe I

3481
01:46:09,690 --> 01:46:10,980
need to form some work groups

3482
01:46:10,980 --> 01:46:13,380
to understand communication and

3483
01:46:13,550 --> 01:46:14,910
I'm getting on the workgroup

3484
01:46:14,910 --> 01:46:16,200
step. But that is really

3485
01:46:16,200 --> 01:46:17,800
frustrating for me, Paul and

3486
01:46:17,800 --> 01:46:20,200
in. So we had

3487
01:46:20,820 --> 01:46:22,770
the governor saying this is

3488
01:46:22,770 --> 01:46:24,130
what you know he wanted to do

3489
01:46:24,130 --> 01:46:25,690
with

3490
01:46:25,690 --> 01:46:26,190
contracted case management.

3491
01:46:26,190 --> 01:46:28,190
We have folks

3492
01:46:28,470 --> 01:46:30,860
that said, you know, no, you

3493
01:46:30,860 --> 01:46:31,990
got to rethink this. You know,

3494
01:46:31,990 --> 01:46:32,980
I'll never forget having the

3495
01:46:32,980 --> 01:46:34,250
conversation. Michelle say car

3496
01:46:34,250 --> 01:46:35,840
to year who said, you know,

3497
01:46:35,840 --> 01:46:37,510
wait, you got a look at it this

3498
01:46:37,510 --> 01:46:39,420
way to get people that are in

3499
01:46:39,420 --> 01:46:40,950
this envelope have the

3500
01:46:40,950 --> 01:46:43,620
conversation. And so thank you

3501
01:46:43,620 --> 01:46:45,680
for being a 3 and commissioner,

3502
01:46:45,680 --> 01:46:47,600
thank you for staying here with

3503
01:46:47,600 --> 01:46:48,230
this in Christie. Thank you for

3504
01:46:48,230 --> 01:46:49,180
being part of this, too.

3505
01:46:49,180 --> 01:46:51,250
So all the mice,

3506
01:46:51,250 --> 01:46:53,650
thank you chair often.

3507
01:46:53,800 --> 01:46:55,250
>> First, FISA as chair off and

3508
01:46:55,250 --> 01:46:56,970
ICE have our presentation ready

3509
01:46:56,970 --> 01:46:58,830
to start with a brief review.

3510
01:46:58,830 --> 01:47:00,960
I the county role in the

3511
01:47:00,960 --> 01:47:01,780
validation.

3512
01:47:01,780 --> 01:47:02,610
>> And that's what we wanted to

3513
01:47:02,610 --> 01:47:03,600
know what you want to be valid

3514
01:47:03,600 --> 01:47:04,900
issue, housing going. What is

3515
01:47:04,900 --> 01:47:06,260
the county? Because it seems to

3516
01:47:06,260 --> 01:47:07,570
me I keep asking this and you

3517
01:47:07,570 --> 01:47:08,800
can as chair Newel who never

3518
01:47:08,800 --> 01:47:10,220
forget anything. I ask him the

3519
01:47:10,220 --> 01:47:11,100
question

3520
01:47:11,100 --> 01:47:12,450
who's responsible for doing

3521
01:47:12,450 --> 01:47:13,990
the, you know, exception on

3522
01:47:13,990 --> 01:47:15,630
this is a person which clearly

3523
01:47:15,630 --> 01:47:16,650
needs some

3524
01:47:16,650 --> 01:47:17,750
some exceptions on this.

3525
01:47:17,750 --> 01:47:19,490
It's like I just Im confused.

3526
01:47:19,490 --> 01:47:21,610
So thank you for doing that.

3527
01:47:21,610 --> 01:47:23,100
>> So very quickly on the

3528
01:47:23,100 --> 01:47:24,130
county experienced Henry

3529
01:47:24,130 --> 01:47:27,130
validation, the first thing is

3530
01:47:27,230 --> 01:47:28,930
a reminder and for some of you

3531
01:47:28,930 --> 01:47:30,130
may be an explanation.

3532
01:47:30,130 --> 01:47:32,530
Something new that counties

3533
01:47:32,700 --> 01:47:35,110
have a dual role. One is

3534
01:47:35,110 --> 01:47:36,640
concentrating on continuity of

3535
01:47:36,640 --> 01:47:38,740
care, both supporting our

3536
01:47:38,740 --> 01:47:40,430
providers and responding to the

3537
01:47:40,430 --> 01:47:41,920
needs of our residents and

3538
01:47:41,920 --> 01:47:43,750
communicating with DHS on

3539
01:47:43,750 --> 01:47:45,200
providing the continuity of

3540
01:47:45,200 --> 01:47:46,300
care.

3541
01:47:46,300 --> 01:47:47,380
The second one is the counties

3542
01:47:47,380 --> 01:47:49,330
themselves are providers.

3543
01:47:49,330 --> 01:47:51,600
So on that first issue, which I

3544
01:47:51,600 --> 01:47:52,270
know is very important to this

3545
01:47:52,270 --> 01:47:53,920
hearing on the continuity of

3546
01:47:53,920 --> 01:47:55,750
care, one of our biggest

3547
01:47:55,750 --> 01:47:57,740
challenges is related to the

3548
01:47:57,740 --> 01:47:59,500
lack of providers, particularly

3549
01:47:59,500 --> 01:48:01,900
in rural areas and

3550
01:48:02,960 --> 01:48:04,640
in the rural areas. When we

3551
01:48:04,640 --> 01:48:07,200
lose a large provider, the

3552
01:48:07,200 --> 01:48:08,900
continuity of care is very

3553
01:48:08,900 --> 01:48:10,700
limited. This may sound

3554
01:48:10,700 --> 01:48:12,800
simplistic, but it's important

3555
01:48:12,800 --> 01:48:13,330
to say out loud that we can

3556
01:48:13,330 --> 01:48:15,570
only provide care as well as we

3557
01:48:15,570 --> 01:48:17,500
have providers available to

3558
01:48:17,500 --> 01:48:19,500
provide it.

3559
01:48:19,500 --> 01:48:20,730
That is one of our biggest

3560
01:48:20,730 --> 01:48:22,730
problems. And

3561
01:48:23,750 --> 01:48:25,640
as far as the notification

3562
01:48:25,640 --> 01:48:27,810
from, I'm from DHS U.S. a

3563
01:48:27,810 --> 01:48:28,770
little bit more about that

3564
01:48:28,770 --> 01:48:30,520
later. We do get a lot of

3565
01:48:30,520 --> 01:48:31,830
coordination. A lot of

3566
01:48:31,830 --> 01:48:33,700
notification from DHS will talk

3567
01:48:33,700 --> 01:48:36,100
about on the next slide

3568
01:48:36,100 --> 01:48:38,290
as a provider. We still have

3569
01:48:38,290 --> 01:48:39,410
some counties waiting and

3570
01:48:39,410 --> 01:48:41,200
appeals.

3571
01:48:41,200 --> 01:48:42,820
We've had some of the same

3572
01:48:42,820 --> 01:48:44,560
experience that other providers

3573
01:48:44,560 --> 01:48:46,230
have had where we thought we

3574
01:48:46,230 --> 01:48:47,150
were done. But then there are

3575
01:48:47,150 --> 01:48:48,660
more requirements, more

3576
01:48:48,660 --> 01:48:50,500
paperwork,

3577
01:48:50,500 --> 01:48:52,130
counties taken clients really

3578
01:48:52,130 --> 01:48:53,520
seriously. And so part of the

3579
01:48:53,520 --> 01:48:55,410
reason why it is complicated

3580
01:48:55,410 --> 01:48:56,650
for us is that we're trying to

3581
01:48:56,650 --> 01:48:59,640
do as well as we possibly can.

3582
01:48:59,640 --> 01:49:01,290
So we're trying to be very good

3583
01:49:01,290 --> 01:49:03,770
students on and good providers

3584
01:49:03,770 --> 01:49:05,720
there.

3585
01:49:05,720 --> 01:49:06,750
And we're frustrated that

3586
01:49:06,750 --> 01:49:08,130
process. But again, we

3587
01:49:08,130 --> 01:49:09,980
understand this was initiated

3588
01:49:09,980 --> 01:49:12,380
from outside the state

3589
01:49:12,610 --> 01:49:14,640
and we understand that purpose

3590
01:49:14,640 --> 01:49:15,960
of it. We also understand there

3591
01:49:15,960 --> 01:49:17,790
are no, there's not a lot of

3592
01:49:17,790 --> 01:49:20,560
new capacity added to DHS to do

3593
01:49:20,560 --> 01:49:22,560
this. So

3594
01:49:23,360 --> 01:49:26,270
go on into next slide.

3595
01:49:26,270 --> 01:49:27,860
The court nation.

3596
01:49:27,860 --> 01:49:28,880
I'm just covering this at a

3597
01:49:28,880 --> 01:49:32,200
very high level. We have people

3598
01:49:32,200 --> 01:49:33,170
that have been available to the

3599
01:49:33,170 --> 01:49:35,570
counties to ensure continuity

3600
01:49:35,570 --> 01:49:38,120
of care. So there are people we

3601
01:49:38,120 --> 01:49:41,400
can call if we learned that

3602
01:49:41,400 --> 01:49:42,330
county has an important

3603
01:49:42,330 --> 01:49:44,910
provider that is getting close

3604
01:49:44,910 --> 01:49:46,200
to shutting down because of a

3605
01:49:46,200 --> 01:49:48,820
lack of payment, for example.

3606
01:49:48,820 --> 01:49:51,840
And we've been able to and use

3607
01:49:51,840 --> 01:49:55,230
that to try to push for the try

3608
01:49:55,230 --> 01:49:57,120
to help agencies with appeals

3609
01:49:57,120 --> 01:49:59,590
so that building can be

3610
01:49:59,590 --> 01:50:01,990
restarted during those appeals.

3611
01:50:02,370 --> 01:50:03,160
And then we've also been

3612
01:50:03,160 --> 01:50:04,300
helping each other with our own

3613
01:50:04,300 --> 01:50:06,290
Reid allegations. We have

3614
01:50:06,290 --> 01:50:08,600
counties doing the usual county

3615
01:50:08,600 --> 01:50:10,230
sharing thing, helping each

3616
01:50:10,230 --> 01:50:11,710
other with documents. I'm

3617
01:50:11,710 --> 01:50:13,270
helping each other with the

3618
01:50:13,270 --> 01:50:14,140
trainings and other

3619
01:50:14,140 --> 01:50:15,440
certifications that we need to

3620
01:50:15,440 --> 01:50:17,390
provide to the state.

3621
01:50:17,390 --> 01:50:18,780
One thing I don't have an here

3622
01:50:18,780 --> 01:50:19,920
for coordination that I should

3623
01:50:19,920 --> 01:50:21,570
have added is

3624
01:50:21,570 --> 01:50:22,880
and I mentioned this in the

3625
01:50:22,880 --> 01:50:24,400
hearing earlier this summer,

3626
01:50:24,400 --> 01:50:27,170
we do get weekly lists

3627
01:50:27,170 --> 01:50:28,840
providers and where they are in

3628
01:50:28,840 --> 01:50:30,440
the revaluation process.

3629
01:50:30,440 --> 01:50:31,690
And in the beginning, they were

3630
01:50:31,690 --> 01:50:35,180
unwieldy and the state has DHS

3631
01:50:35,180 --> 01:50:36,790
has really listen to provide or

3632
01:50:36,790 --> 01:50:38,460
input on that. And also with

3633
01:50:38,460 --> 01:50:39,800
the weekly,

3634
01:50:39,800 --> 01:50:40,860
the weekly meetings and

3635
01:50:40,860 --> 01:50:43,400
updates, the webinars they've

3636
01:50:43,400 --> 01:50:45,300
listened to lead agency needs

3637
01:50:45,300 --> 01:50:46,710
and that information has gotten

3638
01:50:46,710 --> 01:50:49,290
a lot easier for us to use and

3639
01:50:49,290 --> 01:50:50,510
which makes it easier for us to

3640
01:50:50,510 --> 01:50:51,900
monitor providers and how

3641
01:50:51,900 --> 01:50:52,960
they're doing is very valid

3642
01:50:52,960 --> 01:50:54,450
ation.

3643
01:50:54,450 --> 01:50:56,490
So to sum up, Rob, our role is

3644
01:50:56,490 --> 01:50:57,490
free of allegation. Our

3645
01:50:57,490 --> 01:51:00,160
experience with the right now.

3646
01:51:00,160 --> 01:51:02,400
We are like everyone else

3647
01:51:02,400 --> 01:51:03,410
popping up will be able to

3648
01:51:03,410 --> 01:51:05,900
finish soon. I don't think

3649
01:51:05,900 --> 01:51:06,400
there is a party involved that

3650
01:51:06,400 --> 01:51:09,200
does not wish for that. You

3651
01:51:09,200 --> 01:51:09,970
have any other questions about

3652
01:51:09,970 --> 01:51:11,130
every validation before we go

3653
01:51:11,130 --> 01:51:12,530
on to.

3654
01:51:12,530 --> 01:51:12,660
>> And now I'm still trying to,

3655
01:51:12,660 --> 01:51:13,870
you know, I know I think this

3656
01:51:13,870 --> 01:51:14,830
is good because I'm still

3657
01:51:14,830 --> 01:51:17,370
trying to figure out just,

3658
01:51:17,370 --> 01:51:18,460
you know, the ideal charred

3659
01:51:18,460 --> 01:51:20,410
about okay, you're doing this

3660
01:51:20,410 --> 01:51:23,620
in in the process. How was this

3661
01:51:23,620 --> 01:51:25,570
in effect? Who's the go to, you

3662
01:51:25,570 --> 01:51:26,820
know, providers getting all

3663
01:51:26,820 --> 01:51:28,370
that me say? I don't know to

3664
01:51:28,370 --> 01:51:30,310
talk to us on hold with this

3665
01:51:30,310 --> 01:51:31,520
group for 2 and a half hours

3666
01:51:31,520 --> 01:51:32,340
and serious that there was

3667
01:51:32,340 --> 01:51:33,290
somebody on hold for 2 and a

3668
01:51:33,290 --> 01:51:34,920
half hours and luella knows

3669
01:51:34,920 --> 01:51:36,200
what I'm talking about. It's a

3670
01:51:36,200 --> 01:51:38,800
book, right? Why did that

3671
01:51:38,800 --> 01:51:39,550
happen? You know, and then what

3672
01:51:39,550 --> 01:51:40,560
can we do to fix it? So I'm

3673
01:51:40,560 --> 01:51:42,120
just trying to your part of the

3674
01:51:42,120 --> 01:51:43,630
counties in the retaliation

3675
01:51:43,630 --> 01:51:44,720
process. I'm still trying to

3676
01:51:44,720 --> 01:51:46,340
wrap my head around

3677
01:51:46,340 --> 01:51:48,480
that system. Did we set it up?

3678
01:51:48,480 --> 01:51:51,160
So it's working and I think

3679
01:51:51,160 --> 01:51:52,200
you're answering that by the

3680
01:51:52,200 --> 01:51:53,340
fact he would back. It said the

3681
01:51:53,340 --> 01:51:54,880
department is now.

3682
01:51:54,880 --> 01:51:56,920
>> Pretty nice, right is been

3683
01:51:56,920 --> 01:51:59,920
listening to our concerns and

3684
01:52:00,500 --> 01:52:02,190
making it easier for us to keep

3685
01:52:02,190 --> 01:52:03,580
track of our providers and see

3686
01:52:03,580 --> 01:52:05,980
how they're doing. And,

3687
01:52:07,390 --> 01:52:08,280
you know, I'd say about the

3688
01:52:08,280 --> 01:52:09,900
communication with that.

3689
01:52:09,900 --> 01:52:11,560
We share the same concerns

3690
01:52:11,560 --> 01:52:13,600
about communication and wanting

3691
01:52:13,600 --> 01:52:14,510
to communicate with our

3692
01:52:14,510 --> 01:52:15,750
residents.

3693
01:52:15,750 --> 01:52:17,370
And just as a reminder,

3694
01:52:17,370 --> 01:52:18,320
something to remember

3695
01:52:18,320 --> 01:52:19,230
throughout this whole

3696
01:52:19,230 --> 01:52:22,230
presentation, the when I talk

3697
01:52:22,980 --> 01:52:24,440
about our residents and our and

3698
01:52:24,440 --> 01:52:26,700
our clients for summer, smaller

3699
01:52:26,700 --> 01:52:27,720
counties, we're literally

3700
01:52:27,720 --> 01:52:29,900
talking about their neighbors

3701
01:52:29,900 --> 01:52:30,890
that they know very well.

3702
01:52:30,890 --> 01:52:32,720
So it's a very one-on-one sort

3703
01:52:32,720 --> 01:52:34,460
of situation and a lot of

3704
01:52:34,460 --> 01:52:37,890
counties and which is to say

3705
01:52:37,890 --> 01:52:39,230
sometimes the accountability

3706
01:52:39,230 --> 01:52:40,320
takes place in the grocery

3707
01:52:40,320 --> 01:52:41,830
store.

3708
01:52:41,830 --> 01:52:44,200
And so very, very important for

3709
01:52:44,200 --> 01:52:45,840
us. That, of course, is not the

3710
01:52:45,840 --> 01:52:48,770
same, as you know, the systems

3711
01:52:48,770 --> 01:52:50,500
of communication that we're

3712
01:52:50,500 --> 01:52:51,690
accountable for to the

3713
01:52:51,690 --> 01:52:54,900
legislature and all taxpayers.

3714
01:52:54,390 --> 01:52:55,670
And we recognize that there are

3715
01:52:55,670 --> 01:52:56,760
some places for that could

3716
01:52:56,760 --> 01:52:58,580
improve. And we have continual

3717
01:52:58,580 --> 01:53:00,600
processes for working on that

3718
01:53:00,600 --> 01:53:01,680
with the state and others.

3719
01:53:01,680 --> 01:53:02,850
I think well, as some doubt on

3720
01:53:02,850 --> 01:53:04,850
that

3721
01:53:05,250 --> 01:53:07,250
it's called for.

3722
01:53:07,580 --> 01:53:09,620
>> Hello, I chair members of

3723
01:53:09,620 --> 01:53:11,150
the committee luck for a night

3724
01:53:11,150 --> 01:53:12,370
senior department administrator

3725
01:53:12,370 --> 01:53:14,750
with Hennepin County and also

3726
01:53:14,750 --> 01:53:15,880
work with Max and the adult

3727
01:53:15,880 --> 01:53:17,530
services.

3728
01:53:17,530 --> 01:53:18,750
As you were talking chair.

3729
01:53:18,750 --> 01:53:20,250
Kind of one of the things as

3730
01:53:20,250 --> 01:53:21,360
Paul was answering that

3731
01:53:21,360 --> 01:53:23,520
question is I think it's

3732
01:53:23,520 --> 01:53:25,270
important for all of us to also

3733
01:53:25,270 --> 01:53:26,770
remember, we work in a very

3734
01:53:26,770 --> 01:53:28,380
complicated system. We talk

3735
01:53:28,380 --> 01:53:29,840
about even the term continuity

3736
01:53:29,840 --> 01:53:31,230
of care. I hear you talking

3737
01:53:31,230 --> 01:53:32,520
about something and I don't

3738
01:53:32,520 --> 01:53:33,370
think we're always even

3739
01:53:33,370 --> 01:53:35,280
answering the same question

3740
01:53:35,280 --> 01:53:36,420
because there are many

3741
01:53:36,420 --> 01:53:37,930
complicated things that people

3742
01:53:37,930 --> 01:53:39,300
who receive our services and

3743
01:53:39,300 --> 01:53:40,630
the providers who are delivery

3744
01:53:40,630 --> 01:53:42,300
services are trying to operate

3745
01:53:42,300 --> 01:53:44,390
within our complicated system.

3746
01:53:44,390 --> 01:53:47,380
And so I do think there are

3747
01:53:47,380 --> 01:53:49,150
there are opportunities for us

3748
01:53:49,150 --> 01:53:51,300
to improve. But I think as far

3749
01:53:51,300 --> 01:53:53,150
as communication, one thing

3750
01:53:53,150 --> 01:53:54,670
that's important for all of us

3751
01:53:54,670 --> 01:53:57,410
is to like what I've been doing

3752
01:53:57,410 --> 01:53:58,740
is really listening to what

3753
01:53:58,740 --> 01:54:00,800
people are talking about and

3754
01:54:00,800 --> 01:54:02,360
take a complicated part of our

3755
01:54:02,360 --> 01:54:04,440
system and tease that apart and

3756
01:54:04,440 --> 01:54:06,260
resolve the the barriers

3757
01:54:06,260 --> 01:54:08,600
because sometimes I think we

3758
01:54:08,600 --> 01:54:10,460
shortcut what we're thinking.

3759
01:54:10,730 --> 01:54:13,680
We're trying to resolve and we

3760
01:54:13,680 --> 01:54:15,260
all of our jobs is really to

3761
01:54:15,260 --> 01:54:16,550
think about the cop, the system

3762
01:54:16,550 --> 01:54:17,940
and the complexities of it that

3763
01:54:17,940 --> 01:54:19,290
people are trying to navigate

3764
01:54:19,290 --> 01:54:21,270
cell. That's one thing that I

3765
01:54:21,270 --> 01:54:22,390
think I would just add in the

3766
01:54:22,390 --> 01:54:24,390
continuity of care,

3767
01:54:25,260 --> 01:54:26,350
their spurt certain things

3768
01:54:26,350 --> 01:54:27,970
around provider Ravelo the sun.

3769
01:54:27,970 --> 01:54:29,120
But sometimes that's not

3770
01:54:29,120 --> 01:54:30,600
actually provide a re

3771
01:54:30,600 --> 01:54:31,640
validation that the issue is

3772
01:54:31,640 --> 01:54:32,950
about their couple of other

3773
01:54:32,950 --> 01:54:35,300
things going on in our system.

3774
01:54:35,300 --> 01:54:38,300
They're our continent of care.

3775
01:54:38,630 --> 01:54:40,260
>> Thank you all for that that

3776
01:54:40,260 --> 01:54:42,600
you Mr. Attack and indoors.

3777
01:54:42,600 --> 01:54:44,600
Thank you.

3778
01:54:44,990 --> 01:54:46,750
>> Thank you. Chair up and it's

3779
01:54:46,750 --> 01:54:48,170
another questions about the

3780
01:54:48,170 --> 01:54:50,400
validation that all moved to

3781
01:54:50,400 --> 01:54:51,270
the county rolls contracted

3782
01:54:51,270 --> 01:54:53,270
case management.

3783
01:54:58,170 --> 01:54:59,500
>> Again, nobody. I think we're

3784
01:54:59,500 --> 01:55:01,500
good.

3785
01:55:02,710 --> 01:55:04,710
Representative Fish. Yeah.

3786
01:55:05,840 --> 01:55:07,510
One of the things that comes I

3787
01:55:07,510 --> 01:55:08,530
don't know if it's an easy

3788
01:55:08,530 --> 01:55:09,520
number to come up with this.

3789
01:55:09,520 --> 01:55:10,340
We hear about the number of

3790
01:55:10,340 --> 01:55:11,970
providers out there.

3791
01:55:11,970 --> 01:55:13,750
What I'm curious is how many

3792
01:55:13,750 --> 01:55:14,840
people are being affected by

3793
01:55:14,840 --> 01:55:16,500
that? What are the clients that

3794
01:55:16,500 --> 01:55:17,360
are at risks that are losing

3795
01:55:17,360 --> 01:55:18,740
their services? You know, we

3796
01:55:18,740 --> 01:55:19,620
always hear the number the

3797
01:55:19,620 --> 01:55:20,970
providers, but we don't hear

3798
01:55:20,970 --> 01:55:22,730
about the clients themselves.

3799
01:55:22,730 --> 01:55:23,930
And I think this is one of the

3800
01:55:23,930 --> 01:55:25,190
things that is part at least

3801
01:55:25,190 --> 01:55:26,400
for me to know when I talked to

3802
01:55:26,400 --> 01:55:28,370
people because it well prior,

3803
01:55:28,370 --> 01:55:30,000
let's just provided. You don't

3804
01:55:30,000 --> 01:55:30,950
realize how many people are

3805
01:55:30,950 --> 01:55:32,360
connected that are risking

3806
01:55:32,360 --> 01:55:33,390
losing the service. And so

3807
01:55:33,390 --> 01:55:34,680
having some kind of information

3808
01:55:34,680 --> 01:55:36,330
on that line, I think would be

3809
01:55:36,330 --> 01:55:37,970
helpful because when people

3810
01:55:37,970 --> 01:55:39,460
start tossed out numbers back

3811
01:55:39,460 --> 01:55:40,440
and forth, they forget about

3812
01:55:40,440 --> 01:55:42,500
the individuals who need it and

3813
01:55:42,500 --> 01:55:43,740
they don't realize how many

3814
01:55:43,740 --> 01:55:45,470
people are being impacted by.

3815
01:55:45,470 --> 01:55:46,820
You know, we hear overall

3816
01:55:46,820 --> 01:55:48,300
Medicaid system that 1.2

3817
01:55:48,300 --> 01:55:49,660
million. But when we're talking

3818
01:55:49,660 --> 01:55:52,300
about this, the personnel that

3819
01:55:52,300 --> 01:55:53,830
we are looking at, our clients

3820
01:55:53,830 --> 01:55:56,610
are our citizens who are in the

3821
01:55:56,610 --> 01:55:58,120
services are being Ravelo data

3822
01:55:58,120 --> 01:55:59,920
right now. We lose that in the

3823
01:55:59,920 --> 01:56:01,100
process and I think it's

3824
01:56:01,100 --> 01:56:02,430
something that could help in

3825
01:56:02,430 --> 01:56:05,290
like people of don't understand

3826
01:56:05,290 --> 01:56:06,650
how much more serious it is,

3827
01:56:06,650 --> 01:56:08,500
what we're talking about,

3828
01:56:08,500 --> 01:56:09,700
how many people might be at

3829
01:56:09,700 --> 01:56:10,470
risk losing service to some

3830
01:56:10,470 --> 01:56:11,390
people. I think ultimately a

3831
01:56:11,390 --> 01:56:12,330
couple of people, it's

3832
01:56:12,330 --> 01:56:13,980
substantially more than that.

3833
01:56:13,980 --> 01:56:14,880
But I don't have a number I'm

3834
01:56:14,880 --> 01:56:16,880
ever give.

3835
01:56:18,910 --> 01:56:20,300
>> I can start with an answer

3836
01:56:20,300 --> 01:56:22,300
and then we'll see if the

3837
01:56:22,300 --> 01:56:23,580
college have something to tear

3838
01:56:23,580 --> 01:56:25,470
out. They'll go ahead at the

3839
01:56:25,470 --> 01:56:26,540
time.

3840
01:56:26,540 --> 01:56:28,660
This has been difficult for us

3841
01:56:28,660 --> 01:56:31,100
to to gauge in some ways.

3842
01:56:31,100 --> 01:56:32,640
One of the reasons is that the

3843
01:56:32,640 --> 01:56:34,920
effect and the risk is delayed.

3844
01:56:34,920 --> 01:56:36,810
So if and the agent, if a

3845
01:56:36,810 --> 01:56:38,990
provider was to actually go

3846
01:56:38,990 --> 01:56:40,460
under

3847
01:56:40,460 --> 01:56:41,920
the speed of which that happens

3848
01:56:41,920 --> 01:56:43,880
has to do with what they have

3849
01:56:43,880 --> 01:56:45,100
for reserves. But their

3850
01:56:45,100 --> 01:56:47,410
tolerance for risk is

3851
01:56:47,670 --> 01:56:50,670
some of them. Smaller providers

3852
01:56:50,910 --> 01:56:52,910
could go faster.

3853
01:56:53,740 --> 01:56:56,130
And so it has there is for a

3854
01:56:56,130 --> 01:56:58,100
long time. We still weren't

3855
01:56:58,100 --> 01:56:59,170
hearing of anyone losing

3856
01:56:59,170 --> 01:57:01,700
services directly.

3857
01:57:01,700 --> 01:57:03,150
But the risk of that was high

3858
01:57:03,150 --> 01:57:04,680
enough that it, you know,

3859
01:57:04,680 --> 01:57:07,400
is the same level of alarm that

3860
01:57:07,400 --> 01:57:10,350
we felt regardless of that.

3861
01:57:10,350 --> 01:57:12,590
But it is it is hard to measure

3862
01:57:12,590 --> 01:57:14,290
just because of that delay to

3863
01:57:14,290 --> 01:57:16,770
fact a lot of providers for use

3864
01:57:16,770 --> 01:57:19,170
2 different kinds delays and

3865
01:57:19,350 --> 01:57:20,340
what they see as delays in

3866
01:57:20,340 --> 01:57:21,580
payments, which sometimes our

3867
01:57:21,580 --> 01:57:23,460
normal process and times and

3868
01:57:23,460 --> 01:57:25,000
sometimes our normal processing

3869
01:57:25,000 --> 01:57:27,130
times are behind. Also.

3870
01:57:27,130 --> 01:57:29,260
So as the low point that it is

3871
01:57:29,260 --> 01:57:31,600
complicated, which is a long

3872
01:57:31,600 --> 01:57:32,190
way of not giving you a number,

3873
01:57:32,190 --> 01:57:33,160
but

3874
01:57:33,160 --> 01:57:34,240
we can work towards that.

3875
01:57:34,240 --> 01:57:36,240
Thank you,

3876
01:57:38,990 --> 01:57:40,990
commissioner.

3877
01:57:41,970 --> 01:57:43,500
>> So we can certainly, I think

3878
01:57:43,500 --> 01:57:44,270
to a little bit of homework

3879
01:57:44,270 --> 01:57:45,230
here to see if we can offer

3880
01:57:45,230 --> 01:57:47,390
numbers. It's more difficult

3881
01:57:47,390 --> 01:57:49,300
when we're talking about ouch.

3882
01:57:49,300 --> 01:57:50,250
A patient providers, for

3883
01:57:50,250 --> 01:57:51,480
example, of behavioral health

3884
01:57:51,480 --> 01:57:52,520
services relative to a

3885
01:57:52,520 --> 01:57:53,770
residential service provider

3886
01:57:53,770 --> 01:57:55,920
words. It's more apparent to

3887
01:57:55,920 --> 01:57:56,720
the number of folks that

3888
01:57:56,720 --> 01:57:58,690
they're serving any one time.

3889
01:57:58,690 --> 01:57:59,940
Sometimes it's retrospective

3890
01:57:59,940 --> 01:58:01,140
looking at claims data. So it's

3891
01:58:01,140 --> 01:58:02,870
complicated, but we we can

3892
01:58:02,870 --> 01:58:04,300
certainly engage with you about

3893
01:58:04,300 --> 01:58:05,540
how to estimate what that might

3894
01:58:05,540 --> 01:58:07,980
be. And certainly I think we're

3895
01:58:07,980 --> 01:58:09,110
doing our level best to the

3896
01:58:09,110 --> 01:58:10,360
appeals process to maintain

3897
01:58:10,360 --> 01:58:12,400
payment, responding to some of

3898
01:58:12,400 --> 01:58:13,500
the concerns from Dr Larson and

3899
01:58:13,500 --> 01:58:14,350
others with respect to

3900
01:58:14,350 --> 01:58:15,650
authorizations and issues with

3901
01:58:15,650 --> 01:58:17,100
the Sentra, putting them on a

3902
01:58:17,100 --> 01:58:18,260
corrective action plan using

3903
01:58:18,260 --> 01:58:19,720
the levers of that contract.

3904
01:58:19,720 --> 01:58:22,200
So trying to avoid that outcome

3905
01:58:22,200 --> 01:58:24,200
whenever possible. But

3906
01:58:24,120 --> 01:58:25,000
appreciate the question.

3907
01:58:25,000 --> 01:58:27,580
And we can certainly call.

3908
01:58:27,580 --> 01:58:29,310
>> Mr. Chairman, add one thing.

3909
01:58:29,310 --> 01:58:31,800
Absolutely.

3910
01:58:31,800 --> 01:58:32,230
Thank you. And Representative

3911
01:58:32,230 --> 01:58:34,580
Fisher broader than just the

3912
01:58:34,580 --> 01:58:36,140
validation. I guess there.

3913
01:58:36,140 --> 01:58:38,300
I wanted to just remind members

3914
01:58:38,300 --> 01:58:39,580
there is a requirement around

3915
01:58:39,580 --> 01:58:41,910
DHS posting a dashboard and

3916
01:58:41,910 --> 01:58:43,540
outcomes related to continuity

3917
01:58:43,540 --> 01:58:45,300
of care. So that is work that

3918
01:58:45,300 --> 01:58:46,400
we are actively doing at the

3919
01:58:46,400 --> 01:58:49,400
department. And and we have

3920
01:58:49,660 --> 01:58:51,100
some

3921
01:58:51,100 --> 01:58:52,390
kind of a patchwork of

3922
01:58:52,390 --> 01:58:53,890
antiquated systems that we're

3923
01:58:53,890 --> 01:58:55,440
using to track information

3924
01:58:55,440 --> 01:58:57,260
related to continuity of care.

3925
01:58:57,260 --> 01:58:58,800
So we are also actively working

3926
01:58:58,800 --> 01:59:00,300
to have a more streamlined

3927
01:59:00,300 --> 01:59:02,700
process so that we can identify

3928
01:59:02,700 --> 01:59:03,990
where that each individual

3929
01:59:03,990 --> 01:59:06,400
individuals impacted and work

3930
01:59:06,400 --> 01:59:07,250
more closely and efficiently

3931
01:59:07,250 --> 01:59:09,250
with lead agencies.

3932
01:59:09,730 --> 01:59:10,870
Thank you, Chris. That is

3933
01:59:10,870 --> 01:59:12,620
correct

3934
01:59:12,620 --> 01:59:14,620
to Brett.

3935
01:59:14,680 --> 01:59:16,750
>> Thank you. Chair now respond

3936
01:59:16,750 --> 01:59:18,210
to speak at the county rolling

3937
01:59:18,210 --> 01:59:20,530
contract. Its case management

3938
01:59:20,530 --> 01:59:21,660
specifically waiver case

3939
01:59:21,660 --> 01:59:23,660
management.

3940
01:59:23,820 --> 01:59:25,100
The first thing I'd like to say

3941
01:59:25,100 --> 01:59:27,510
is I really like the way I

3942
01:59:27,510 --> 01:59:29,740
describe how late highlighted

3943
01:59:29,740 --> 01:59:31,280
case management

3944
01:59:31,280 --> 01:59:32,560
case management press is

3945
01:59:32,560 --> 01:59:34,560
absolutely foundational.

3946
01:59:35,130 --> 01:59:37,180
It is the be the case. Managers

3947
01:59:37,180 --> 01:59:38,260
are the people who have the

3948
01:59:38,260 --> 01:59:40,620
most contact us with the people

3949
01:59:40,620 --> 01:59:43,180
we serve during very difficult

3950
01:59:43,180 --> 01:59:45,480
times in their life. So as much

3951
01:59:45,480 --> 01:59:47,300
as possible, even more than

3952
01:59:47,300 --> 01:59:49,100
possible, if we can, we try to

3953
01:59:49,100 --> 01:59:50,780
do it as well as effectively

3954
01:59:50,780 --> 01:59:52,430
and caring with parents and as

3955
01:59:52,430 --> 01:59:54,250
we can.

3956
01:59:54,250 --> 01:59:56,170
So some of the needs of the

3957
01:59:56,170 --> 01:59:57,930
reasons why we use contracted

3958
01:59:57,930 --> 02:00:00,230
waiver case management. One of

3959
02:00:00,230 --> 02:00:02,100
them is actually budget

3960
02:00:02,100 --> 02:00:04,100
flexibility.

3961
02:00:04,190 --> 02:00:06,840
Case management lows can rise

3962
02:00:06,840 --> 02:00:09,910
and fall. It can be difficult

3963
02:00:09,910 --> 02:00:11,490
for counties, particularly

3964
02:00:11,490 --> 02:00:13,290
right now under financial

3965
02:00:13,290 --> 02:00:15,300
stress to be able to add

3966
02:00:15,300 --> 02:00:17,700
full-time employees very easily

3967
02:00:17,830 --> 02:00:19,650
or quickly.

3968
02:00:19,650 --> 02:00:21,220
And

3969
02:00:21,220 --> 02:00:23,490
because property taxes operate

3970
02:00:23,490 --> 02:00:24,970
at a different speed. And

3971
02:00:24,970 --> 02:00:27,970
they're not quite as responsive

3972
02:00:28,400 --> 02:00:30,930
is it gives us the flexibility

3973
02:00:30,930 --> 02:00:33,150
to ensure that we meet our

3974
02:00:33,150 --> 02:00:35,740
mandated needs, but also just

3975
02:00:35,740 --> 02:00:37,440
the needs we have to serve.

3976
02:00:37,440 --> 02:00:39,600
Our residents gives us the

3977
02:00:39,600 --> 02:00:40,890
flexibility to be able to do

3978
02:00:40,890 --> 02:00:42,530
that. And

3979
02:00:42,530 --> 02:00:44,160
it's very important that we

3980
02:00:44,160 --> 02:00:45,890
have that

3981
02:00:45,890 --> 02:00:47,460
the second one is the need for

3982
02:00:47,460 --> 02:00:49,310
culturally specific and

3983
02:00:49,310 --> 02:00:51,310
specialty expertise.

3984
02:00:52,720 --> 02:00:53,950
Second, the brain injury

3985
02:00:53,950 --> 02:00:55,660
examples that, sir, one that

3986
02:00:55,660 --> 02:00:58,130
we've seen a number of times

3987
02:00:58,130 --> 02:01:02,100
also we have clients who may be

3988
02:01:02,100 --> 02:01:04,560
a part of a culture that is not

3989
02:01:04,560 --> 02:01:05,870
as well represented where they

3990
02:01:05,870 --> 02:01:07,600
live. And so being able to get

3991
02:01:07,600 --> 02:01:10,000
case management from agencies

3992
02:01:10,990 --> 02:01:13,470
that are staffed and have

3993
02:01:13,470 --> 02:01:14,930
boards of people from that

3994
02:01:14,930 --> 02:01:16,980
community, I can be very

3995
02:01:16,980 --> 02:01:18,540
effective and very helpful

3996
02:01:18,540 --> 02:01:20,520
support for them.

3997
02:01:20,520 --> 02:01:23,300
And then lastly, we already

3998
02:01:23,300 --> 02:01:24,700
talked about the county of

3999
02:01:24,700 --> 02:01:26,700
financial responsibility.

4000
02:01:26,520 --> 02:01:28,000
It's a quick way that some of

4001
02:01:28,000 --> 02:01:29,820
the maximum, but this is we are

4002
02:01:29,820 --> 02:01:32,600
not pay for wind chill time.

4003
02:01:32,600 --> 02:01:34,620
And also the other thing they

4004
02:01:34,620 --> 02:01:35,910
remind us is that for some

4005
02:01:35,910 --> 02:01:38,460
counties and rural areas to

4006
02:01:38,460 --> 02:01:40,520
come to to come to say the Twin

4007
02:01:40,520 --> 02:01:42,180
cities and no, the providers is

4008
02:01:42,180 --> 02:01:44,110
something that

4009
02:01:44,110 --> 02:01:46,100
is very difficult for them to

4010
02:01:46,100 --> 02:01:47,970
do. So those are the the main,

4011
02:01:47,970 --> 02:01:50,300
the 3 largest region reasons

4012
02:01:50,300 --> 02:01:52,240
that we use waiver contracted

4013
02:01:52,240 --> 02:01:53,750
case management. You know, I

4014
02:01:53,750 --> 02:01:54,170
hear.

4015
02:01:54,170 --> 02:01:56,380
>> I just leaned over to chair

4016
02:01:56,380 --> 02:01:58,330
during an aching its that

4017
02:01:58,330 --> 02:02:01,200
the ability to, you know,

4018
02:02:01,200 --> 02:02:03,000
could somebody up to speed on

4019
02:02:03,000 --> 02:02:05,000
this complicated system.

4020
02:02:06,180 --> 02:02:07,670
Krista, technical assistance on

4021
02:02:07,670 --> 02:02:09,000
that. And then there's this

4022
02:02:09,000 --> 02:02:10,900
complete

4023
02:02:10,900 --> 02:02:12,920
turn around. There's, you know,

4024
02:02:12,920 --> 02:02:15,600
you see it for I could lose my

4025
02:02:15,600 --> 02:02:16,660
case manager now was my case

4026
02:02:16,660 --> 02:02:17,740
manager. And I was like a

4027
02:02:17,740 --> 02:02:19,620
strategy now and it all goes

4028
02:02:19,620 --> 02:02:20,980
down to deny. The other thing

4029
02:02:20,980 --> 02:02:24,240
that lead over in line was

4030
02:02:24,240 --> 02:02:26,630
it makes it difficult when, you

4031
02:02:26,630 --> 02:02:27,890
know,

4032
02:02:27,890 --> 02:02:29,340
leadership goes into a corner

4033
02:02:29,340 --> 02:02:30,930
office

4034
02:02:30,930 --> 02:02:33,190
and that decides to turn around

4035
02:02:33,190 --> 02:02:34,670
and tell us to cut 300 million

4036
02:02:34,670 --> 02:02:36,260
dollars without going through

4037
02:02:36,260 --> 02:02:37,740
the process that we ensure the

4038
02:02:37,740 --> 02:02:39,740
original thing

4039
02:02:39,750 --> 02:02:42,150
last year was terrible

4040
02:02:42,380 --> 02:02:43,970
because there are so many fixes

4041
02:02:43,970 --> 02:02:46,970
that we wanted to do

4042
02:02:47,630 --> 02:02:49,700
that. We could do

4043
02:02:49,700 --> 02:02:51,310
great, not only fix fix fix,

4044
02:02:51,310 --> 02:02:52,660
but I mean, you know, help the

4045
02:02:52,660 --> 02:02:54,940
system be smooth or 2

4046
02:02:54,940 --> 02:02:56,640
because we are hindered by the

4047
02:02:56,640 --> 02:02:58,590
fact that we had, by the way,

4048
02:02:58,590 --> 02:02:59,780
let's just look at health and

4049
02:02:59,780 --> 02:03:00,750
human services. The human

4050
02:03:00,750 --> 02:03:02,410
services is a bucket of cash

4051
02:03:02,410 --> 02:03:04,160
for everything else we pay for.

4052
02:03:04,160 --> 02:03:05,950
I'm tired of that.

4053
02:03:05,950 --> 02:03:08,680
Tired of the the the narrative

4054
02:03:08,680 --> 02:03:11,800
about Minnesota fraud, waste

4055
02:03:11,320 --> 02:03:12,840
and abuse. Yes, it became

4056
02:03:12,840 --> 02:03:13,900
political and it should have

4057
02:03:13,900 --> 02:03:14,900
been because of the fact that

4058
02:03:14,900 --> 02:03:16,200
people with disabilities are

4059
02:03:16,200 --> 02:03:16,830
the ones who are already the

4060
02:03:16,830 --> 02:03:18,100
most on it.

4061
02:03:18,100 --> 02:03:19,730
And we can't pay our contracted

4062
02:03:19,730 --> 02:03:21,580
case managers or case managers,

4063
02:03:21,580 --> 02:03:24,580
the money that they do

4064
02:03:24,890 --> 02:03:26,430
keeps me up at night, Paul.

4065
02:03:26,430 --> 02:03:27,590
It really does say it's because

4066
02:03:27,590 --> 02:03:28,440
it's like, alright, who's

4067
02:03:28,440 --> 02:03:30,150
there. And in the meantime,

4068
02:03:30,150 --> 02:03:31,880
I just keep seeing this woman

4069
02:03:31,880 --> 02:03:32,910
who was part of the housing

4070
02:03:32,910 --> 02:03:35,310
stabilization program and he's

4071
02:03:35,480 --> 02:03:37,160
received was receiving services

4072
02:03:37,160 --> 02:03:39,600
is now couch jumping in

4073
02:03:39,600 --> 02:03:40,470
Minneapolis.

4074
02:03:40,470 --> 02:03:42,160
I can't give them that

4075
02:03:42,160 --> 02:03:43,230
because that baby shouldn't

4076
02:03:43,230 --> 02:03:45,230
become a champion.

4077
02:03:46,900 --> 02:03:48,430
This just what you hear is

4078
02:03:48,430 --> 02:03:50,160
exactly what we want and what

4079
02:03:50,160 --> 02:03:51,190
we need the culturally

4080
02:03:51,190 --> 02:03:53,200
specific, you know, specific,

4081
02:03:53,200 --> 02:03:53,930
culturally specific and

4082
02:03:53,930 --> 02:03:55,500
special, the expertise got to

4083
02:03:55,500 --> 02:03:57,500
be there, right?

4084
02:03:57,690 --> 02:03:59,780
I just wish, you know,

4085
02:03:59,780 --> 02:04:02,110
representative newer, you know,

4086
02:04:02,110 --> 02:04:04,330
you hear from people, you know,

4087
02:04:04,330 --> 02:04:05,230
that's a whole we're gonna

4088
02:04:05,230 --> 02:04:06,750
structural deficit that we're

4089
02:04:06,750 --> 02:04:08,450
going to have to kind of get

4090
02:04:08,450 --> 02:04:10,450
next year.

4091
02:04:10,560 --> 02:04:11,990
Whoever is the chair of this

4092
02:04:11,990 --> 02:04:13,180
committee next year will have

4093
02:04:13,180 --> 02:04:14,840
that same piece. But that

4094
02:04:14,840 --> 02:04:16,580
shouldn't stop us from

4095
02:04:16,580 --> 02:04:17,860
there's a need, but school

4096
02:04:17,860 --> 02:04:18,850
fulfill it.

4097
02:04:18,850 --> 02:04:20,370
>> If we truly care about if we

4098
02:04:20,370 --> 02:04:21,620
truly believe in the Olmsted

4099
02:04:21,620 --> 02:04:22,780
provision, if we truly believe

4100
02:04:22,780 --> 02:04:24,600
that ultimately the services,

4101
02:04:24,600 --> 02:04:25,640
what if we truly believe the

4102
02:04:25,640 --> 02:04:26,800
counties are the ones or if we

4103
02:04:26,800 --> 02:04:28,520
truly believe that, then let's

4104
02:04:28,520 --> 02:04:30,380
start advocating for that

4105
02:04:30,380 --> 02:04:32,380
Representative Door.

4106
02:04:32,470 --> 02:04:33,370
>> Thank you, Mister Chair and

4107
02:04:33,370 --> 02:04:34,920
thank you for this

4108
02:04:34,920 --> 02:04:37,500
presentation. I do want to jump

4109
02:04:37,500 --> 02:04:38,940
into this conversation but

4110
02:04:38,940 --> 02:04:40,510
looking to the offense, the

4111
02:04:40,510 --> 02:04:42,220
statement, the budget

4112
02:04:42,220 --> 02:04:44,220
constraints

4113
02:04:44,580 --> 02:04:46,890
given that was shifting

4114
02:04:46,890 --> 02:04:48,260
the responsibility from the

4115
02:04:48,260 --> 02:04:49,970
county too

4116
02:04:49,970 --> 02:04:51,970
contracted case management

4117
02:04:52,790 --> 02:04:54,550
and knowing that you will be

4118
02:04:54,550 --> 02:04:56,430
having

4119
02:04:56,430 --> 02:04:58,100
different case loads because

4120
02:04:58,100 --> 02:04:59,390
one of the biggest that issue

4121
02:04:59,390 --> 02:05:02,000
that we've been seeing is

4122
02:05:02,000 --> 02:05:03,660
contract and case management or

4123
02:05:03,660 --> 02:05:05,440
even if it's the county,

4124
02:05:05,440 --> 02:05:07,780
the caseload for we but case

4125
02:05:07,780 --> 02:05:09,700
management is higher compared

4126
02:05:09,700 --> 02:05:10,770
to

4127
02:05:10,770 --> 02:05:12,830
anything else. So do you know

4128
02:05:12,830 --> 02:05:15,350
on average a month how many

4129
02:05:15,350 --> 02:05:17,970
hours do case images provide

4130
02:05:17,970 --> 02:05:20,230
services to the recipient so

4131
02:05:20,230 --> 02:05:22,230
participants?

4132
02:05:24,130 --> 02:05:26,400
>> Thank you, chair in Art.

4133
02:05:26,400 --> 02:05:27,560
I'm minding checked in here.

4134
02:05:27,560 --> 02:05:29,440
Really quickly. Might him

4135
02:05:29,440 --> 02:05:30,580
first? Can you answer that for

4136
02:05:30,580 --> 02:05:32,580
your county here?

4137
02:05:34,550 --> 02:05:36,790
>> Break that there is you get

4138
02:05:36,790 --> 02:05:37,850
to this. It makes sense.

4139
02:05:37,850 --> 02:05:40,550
You want the how many hours to

4140
02:05:40,550 --> 02:05:42,550
$0.70 to? Well, well.

4141
02:05:43,940 --> 02:05:46,740
>> Chair law. So my first

4142
02:05:46,740 --> 02:05:48,800
thought is we need to look at

4143
02:05:48,800 --> 02:05:49,390
the numbers to see kind of like

4144
02:05:49,390 --> 02:05:50,920
because DHS have the Billings.

4145
02:05:50,920 --> 02:05:52,510
We can see the number of units,

4146
02:05:52,510 --> 02:05:53,580
for instance, like Christine

4147
02:05:53,580 --> 02:05:56,420
talked about the the it's

4148
02:05:56,420 --> 02:05:57,980
billed like number of units.

4149
02:05:57,980 --> 02:05:59,000
So we could take a look at

4150
02:05:59,000 --> 02:06:00,460
that. They tie, you know,

4151
02:06:00,460 --> 02:06:01,620
they report their time. I would

4152
02:06:01,620 --> 02:06:02,840
say

4153
02:06:02,840 --> 02:06:04,270
in part like when you think

4154
02:06:04,270 --> 02:06:05,820
about the standards for waiver

4155
02:06:05,820 --> 02:06:07,150
case management, there's a

4156
02:06:07,150 --> 02:06:08,500
certain number of requirements

4157
02:06:08,500 --> 02:06:09,820
of time that we need to spend

4158
02:06:09,820 --> 02:06:11,220
with the person so like there's

4159
02:06:11,220 --> 02:06:12,520
meeting the requirements and

4160
02:06:12,520 --> 02:06:13,590
the time that might go into

4161
02:06:13,590 --> 02:06:15,500
that. But of course,

4162
02:06:15,500 --> 02:06:16,560
representative nor part of the

4163
02:06:16,560 --> 02:06:18,400
answer that question is I don't

4164
02:06:18,400 --> 02:06:18,870
know if there's an average

4165
02:06:18,870 --> 02:06:20,870
because each person's

4166
02:06:20,950 --> 02:06:23,230
individual needs are different.

4167
02:06:23,230 --> 02:06:24,530
And so I will say, you know,

4168
02:06:24,530 --> 02:06:27,900
last week I was watching case

4169
02:06:27,900 --> 02:06:29,600
managers like help people move

4170
02:06:29,600 --> 02:06:31,980
to a new it all residential

4171
02:06:31,980 --> 02:06:33,890
setting. And it was like they

4172
02:06:33,890 --> 02:06:35,880
probably were putting in 40

4173
02:06:35,880 --> 02:06:37,220
hours, you know, working with

4174
02:06:37,220 --> 02:06:39,120
one or 2 people. That's not

4175
02:06:39,120 --> 02:06:40,760
that's not the norm, you know,

4176
02:06:40,760 --> 02:06:42,360
probably for the average.

4177
02:06:42,360 --> 02:06:44,610
And so I would I think we'd

4178
02:06:44,610 --> 02:06:46,630
have to get a sense of, you

4179
02:06:46,630 --> 02:06:47,830
know, what is the typical to

4180
02:06:47,830 --> 02:06:50,200
meet the basic requirements of

4181
02:06:50,200 --> 02:06:51,420
case management and what what

4182
02:06:51,420 --> 02:06:52,820
Keibert waiver case managers

4183
02:06:52,820 --> 02:06:54,490
must do. But then it's really

4184
02:06:54,490 --> 02:06:56,130
driven by the individual

4185
02:06:56,130 --> 02:06:57,420
situation and what's kind of a

4186
02:06:57,420 --> 02:06:59,810
priority this week and how you

4187
02:06:59,810 --> 02:07:01,570
know how many other people

4188
02:07:01,570 --> 02:07:03,110
they're trying to help. So we

4189
02:07:03,110 --> 02:07:04,600
have to look for the data to

4190
02:07:04,600 --> 02:07:07,600
give you an actual answer.

4191
02:07:10,740 --> 02:07:12,430
>> You could go ahead. Pat.

4192
02:07:12,430 --> 02:07:13,730
Thank you. I think that

4193
02:07:13,730 --> 02:07:15,690
Champaign County tap each image

4194
02:07:15,690 --> 02:07:17,140
and disability services manager

4195
02:07:17,140 --> 02:07:18,220
Pine County.

4196
02:07:18,220 --> 02:07:20,620
I think the question

4197
02:07:21,420 --> 02:07:22,790
not to just say it gets more

4198
02:07:22,790 --> 02:07:24,360
complicated by thinking example

4199
02:07:24,360 --> 02:07:26,330
to is for waiver case managers,

4200
02:07:26,330 --> 02:07:28,170
one of mine this year had 8

4201
02:07:28,170 --> 02:07:29,280
individuals in and out of the

4202
02:07:29,280 --> 02:07:30,640
hospital.

4203
02:07:30,640 --> 02:07:32,750
This is the summer.

4204
02:07:32,750 --> 02:07:34,730
I don't we don't stop providing

4205
02:07:34,730 --> 02:07:36,500
care at that time, but that's

4206
02:07:36,500 --> 02:07:37,900
not waiver. Billable time.

4207
02:07:37,900 --> 02:07:39,850
So to just expand on, well,

4208
02:07:39,850 --> 02:07:41,740
as point like we could run that

4209
02:07:41,740 --> 02:07:43,310
data, we can look at the

4210
02:07:43,310 --> 02:07:44,470
department could pull the

4211
02:07:44,470 --> 02:07:46,280
waiver bill in time. But

4212
02:07:46,280 --> 02:07:47,120
there's so many other things

4213
02:07:47,120 --> 02:07:48,300
that we do that are not being

4214
02:07:48,300 --> 02:07:49,650
reimbursable to the counties.

4215
02:07:49,650 --> 02:07:52,150
Also care doesn't stop just

4216
02:07:52,150 --> 02:07:53,500
based on where they are that

4217
02:07:53,500 --> 02:07:55,500
day.

4218
02:07:58,850 --> 02:08:00,100
>> Hearing that the kid doesn't

4219
02:08:00,100 --> 02:08:02,700
stop and knowing that we are

4220
02:08:02,700 --> 02:08:03,990
waiting for their weight

4221
02:08:03,990 --> 02:08:05,990
evaluation until December 2028.

4222
02:08:07,940 --> 02:08:10,100
And given that if you compare

4223
02:08:10,100 --> 02:08:12,230
that to the TCM, which is based

4224
02:08:12,230 --> 02:08:13,830
on the monthly compared to the

4225
02:08:13,830 --> 02:08:16,830
15 minute unit full, you know,

4226
02:08:17,200 --> 02:08:18,930
wave a case management,

4227
02:08:18,930 --> 02:08:20,300
how are we going to fix this

4228
02:08:20,300 --> 02:08:21,350
issue? Because I see the

4229
02:08:21,350 --> 02:08:22,810
biggest gap that we have is the

4230
02:08:22,810 --> 02:08:25,180
constraints of the budget that

4231
02:08:25,180 --> 02:08:26,720
we have a kid full. We have a

4232
02:08:26,720 --> 02:08:28,240
case pending. That's number one

4233
02:08:28,240 --> 02:08:29,920
issue. How do we solve that

4234
02:08:29,920 --> 02:08:30,880
issue to make sure that we're

4235
02:08:30,880 --> 02:08:33,400
providing an effective fission,

4236
02:08:33,400 --> 02:08:34,370
more compassionate care for

4237
02:08:34,370 --> 02:08:35,630
those individuals were getting

4238
02:08:35,630 --> 02:08:36,500
with the case. Managment

4239
02:08:36,500 --> 02:08:38,500
substance.

4240
02:08:39,250 --> 02:08:40,300
>> Thank you. Chair Chair

4241
02:08:40,300 --> 02:08:41,380
Hoffman. Thank you. Chair are

4242
02:08:41,380 --> 02:08:43,380
for your question.

4243
02:08:44,480 --> 02:08:45,910
I would say one of that.

4244
02:08:45,910 --> 02:08:47,770
It's difficult because

4245
02:08:47,770 --> 02:08:50,240
we absolutely cannot wait and

4246
02:08:50,240 --> 02:08:51,830
get the perfect long-term fix.

4247
02:08:51,830 --> 02:08:53,480
So like a lot of problems with

4248
02:08:53,480 --> 02:08:54,860
human services were trying to

4249
02:08:54,860 --> 02:08:57,260
find short-term games gains.

4250
02:08:58,300 --> 02:08:59,950
Well, not giving up on our

4251
02:08:59,950 --> 02:09:01,940
long-term goals.

4252
02:09:01,940 --> 02:09:03,230
I would say something happened

4253
02:09:03,230 --> 02:09:06,370
between that is the the waiver

4254
02:09:06,370 --> 02:09:08,580
case management working group.

4255
02:09:08,580 --> 02:09:09,910
I think because of all the

4256
02:09:09,910 --> 02:09:11,340
parties that will be involved

4257
02:09:11,340 --> 02:09:12,650
in that we can come up with

4258
02:09:12,650 --> 02:09:14,570
some recommendations.

4259
02:09:14,570 --> 02:09:16,140
And I believe that finishes its

4260
02:09:16,140 --> 02:09:18,540
September 2027. Is the report

4261
02:09:18,650 --> 02:09:19,550
so

4262
02:09:19,550 --> 02:09:22,600
that actually some of that work

4263
02:09:22,600 --> 02:09:24,440
we'll be coming up

4264
02:09:24,440 --> 02:09:25,820
will help us informed the

4265
02:09:25,820 --> 02:09:28,220
process. And because those are

4266
02:09:28,220 --> 02:09:30,500
public meetings, maybe there

4267
02:09:30,500 --> 02:09:32,240
will even be preliminary

4268
02:09:32,240 --> 02:09:33,590
results are findings that we

4269
02:09:33,590 --> 02:09:35,450
could work with to try and

4270
02:09:35,450 --> 02:09:37,450
improve the process.

4271
02:09:38,430 --> 02:09:40,360
As far as

4272
02:09:40,360 --> 02:09:41,860
you know, one of the difficult

4273
02:09:41,860 --> 02:09:44,300
questions is, of course,

4274
02:09:44,300 --> 02:09:45,390
the payment.

4275
02:09:45,390 --> 02:09:48,390
The volatility to the workforce

4276
02:09:48,550 --> 02:09:49,920
is no surprise when you

4277
02:09:49,920 --> 02:09:52,170
consider that our case

4278
02:09:52,170 --> 02:09:54,170
managers, whether contractor

4279
02:09:54,190 --> 02:09:56,800
working for the county that are

4280
02:09:56,800 --> 02:09:58,800
case managers are

4281
02:09:59,320 --> 02:10:01,110
underpaid for very difficult

4282
02:10:01,110 --> 02:10:03,800
work.

4283
02:10:03,800 --> 02:10:04,800
And that is one of the things

4284
02:10:04,800 --> 02:10:06,250
that leads to people moving

4285
02:10:06,250 --> 02:10:08,540
from agency to agency. Also,

4286
02:10:08,540 --> 02:10:10,800
when people are very good case

4287
02:10:10,800 --> 02:10:11,430
managers,

4288
02:10:11,430 --> 02:10:13,300
I can tell you that our

4289
02:10:13,300 --> 02:10:15,430
counties compete for them

4290
02:10:16,100 --> 02:10:17,340
and it's because we all want to

4291
02:10:17,340 --> 02:10:18,760
provide the best care for our

4292
02:10:18,760 --> 02:10:20,310
counties. But it does not

4293
02:10:20,310 --> 02:10:21,680
contribute to the says the

4294
02:10:21,680 --> 02:10:23,310
situation. I wish I had a very

4295
02:10:23,310 --> 02:10:25,500
easy for you to answer for you

4296
02:10:25,500 --> 02:10:26,650
chair in our, but I'm very

4297
02:10:26,650 --> 02:10:27,780
happy to work with you on the

4298
02:10:27,780 --> 02:10:29,700
answer. We do have some other

4299
02:10:29,700 --> 02:10:31,700
ideas coming

4300
02:10:31,130 --> 02:10:33,140
from our committees and max

4301
02:10:33,140 --> 02:10:36,140
that will share with you.

4302
02:10:41,900 --> 02:10:42,610
One thing I want to talk about

4303
02:10:42,610 --> 02:10:45,100
is monitoring and support

4304
02:10:46,860 --> 02:10:48,420
contracted Baver case

4305
02:10:48,420 --> 02:10:51,900
management is not just the same

4306
02:10:51,900 --> 02:10:53,750
as hiring say attempt to come

4307
02:10:53,750 --> 02:10:56,820
in to an agency to do some sort

4308
02:10:56,820 --> 02:10:58,900
of work that is repetitive and

4309
02:10:58,900 --> 02:11:00,690
less skilled.

4310
02:11:00,690 --> 02:11:02,400
We have to do a lot of work to

4311
02:11:02,400 --> 02:11:04,250
make sure that our waiver case

4312
02:11:04,250 --> 02:11:06,650
management is not isolated

4313
02:11:07,700 --> 02:11:09,610
and that the work they're doing

4314
02:11:09,610 --> 02:11:12,940
fits our demands and our our

4315
02:11:12,940 --> 02:11:14,600
principles and what we want to

4316
02:11:14,600 --> 02:11:16,580
see from our own case managers.

4317
02:11:16,580 --> 02:11:19,290
I'll talk a little bit more

4318
02:11:19,290 --> 02:11:20,350
about that in a second in

4319
02:11:20,350 --> 02:11:22,900
detail. But I would say that

4320
02:11:22,900 --> 02:11:24,100
the through line of what ice

4321
02:11:24,100 --> 02:11:25,800
side and checking in with our

4322
02:11:25,800 --> 02:11:27,430
counties about this and

4323
02:11:27,430 --> 02:11:28,540
everything that we talked about

4324
02:11:28,540 --> 02:11:31,830
last year is that the more that

4325
02:11:31,830 --> 02:11:33,520
contracted waiver case

4326
02:11:33,520 --> 02:11:35,520
management providers are

4327
02:11:35,690 --> 02:11:37,390
integrated into the normal

4328
02:11:37,390 --> 02:11:38,900
county

4329
02:11:38,900 --> 02:11:40,970
case management teams, the

4330
02:11:40,970 --> 02:11:43,100
better the communication is and

4331
02:11:43,100 --> 02:11:45,640
the better the results are for

4332
02:11:45,640 --> 02:11:48,220
our residents. So one of the

4333
02:11:48,220 --> 02:11:49,850
foundational believes we have

4334
02:11:49,850 --> 02:11:51,220
is that the same? We have the

4335
02:11:51,220 --> 02:11:52,420
same response will be a

4336
02:11:52,420 --> 02:11:54,680
responsibility of care to

4337
02:11:54,680 --> 02:11:57,600
clients. Whether the person is

4338
02:11:57,600 --> 02:11:59,260
being served by waive are case

4339
02:11:59,260 --> 02:12:01,180
managed or contract case

4340
02:12:01,180 --> 02:12:02,710
manager or one of the county

4341
02:12:02,710 --> 02:12:03,990
case managers. There is no

4342
02:12:03,990 --> 02:12:05,880
difference for us.

4343
02:12:05,880 --> 02:12:07,320
We know of some counties that

4344
02:12:07,320 --> 02:12:09,300
and dedicate more than 20

4345
02:12:09,300 --> 02:12:11,480
full-time equivalent simply to

4346
02:12:11,480 --> 02:12:13,780
manage and support contracted

4347
02:12:13,780 --> 02:12:16,130
waiver case managers, many

4348
02:12:16,130 --> 02:12:18,490
counties are providing training

4349
02:12:18,490 --> 02:12:20,270
that's tailored to make sure

4350
02:12:20,270 --> 02:12:23,120
that the case managers are able

4351
02:12:23,120 --> 02:12:24,560
to meet the same standard of

4352
02:12:24,560 --> 02:12:26,360
care.

4353
02:12:26,360 --> 02:12:27,400
And here are some of the

4354
02:12:27,400 --> 02:12:28,960
examples of things that some of

4355
02:12:28,960 --> 02:12:31,360
the counties are doing.

4356
02:12:31,630 --> 02:12:33,300
There are monthly forms for all

4357
02:12:33,300 --> 02:12:35,430
the supervisors where they work

4358
02:12:35,430 --> 02:12:37,670
with the contract that in case

4359
02:12:37,670 --> 02:12:38,930
meant and I county case

4360
02:12:38,930 --> 02:12:40,300
managers together in the same

4361
02:12:40,300 --> 02:12:42,940
place annual August. Of course,

4362
02:12:42,940 --> 02:12:46,250
we have a lot of support during

4363
02:12:46,250 --> 02:12:48,500
really important and difficult

4364
02:12:48,500 --> 02:12:50,100
times like transfers for

4365
02:12:50,100 --> 02:12:52,600
services.

4366
02:12:52,600 --> 02:12:53,480
We also have lots of subject

4367
02:12:53,480 --> 02:12:55,220
matter experts that are

4368
02:12:55,220 --> 02:12:57,620
actually assigned to individual

4369
02:12:58,100 --> 02:13:00,410
contracted agencies. And then

4370
02:13:00,560 --> 02:13:02,910
we have updates that basically

4371
02:13:02,910 --> 02:13:04,440
are the same whether or not

4372
02:13:04,440 --> 02:13:05,540
your contracted or case

4373
02:13:05,540 --> 02:13:07,940
management contract that our

4374
02:13:07,990 --> 02:13:09,800
county case management, we also

4375
02:13:09,800 --> 02:13:12,400
provide training to get them up

4376
02:13:12,400 --> 02:13:14,890
to speed on county and DHS

4377
02:13:14,890 --> 02:13:16,270
policies

4378
02:13:16,270 --> 02:13:17,730
and all the county procedures

4379
02:13:17,730 --> 02:13:20,730
are based on ditches policies.

4380
02:13:26,780 --> 02:13:28,650
>> I was asking new are the

4381
02:13:28,650 --> 02:13:30,900
questions. Sorry, Paul, that

4382
02:13:30,900 --> 02:13:32,600
you keep going? I think where

4383
02:13:32,600 --> 02:13:34,500
people think you are. We're at

4384
02:13:34,500 --> 02:13:36,510
2.44, we're still having this

4385
02:13:36,510 --> 02:13:37,830
conversation. If the answer,

4386
02:13:37,830 --> 02:13:39,250
OK, we'll just keep going for

4387
02:13:39,250 --> 02:13:41,380
the next 5 minutes. You know?

4388
02:13:41,380 --> 02:13:43,250
Yes, so if you mean friends for

4389
02:13:43,250 --> 02:13:44,130
the slides?

4390
02:13:44,130 --> 02:13:46,450
>> Yes, a very quickly on that.

4391
02:13:46,450 --> 02:13:47,600
Again. I was back in touch with

4392
02:13:47,600 --> 02:13:48,430
the slightest. Want to

4393
02:13:48,430 --> 02:13:49,790
reiterate that we have found

4394
02:13:49,790 --> 02:13:51,820
the more that the county and

4395
02:13:51,820 --> 02:13:53,190
the contractor case managers

4396
02:13:53,190 --> 02:13:54,310
are integrated together in

4397
02:13:54,310 --> 02:13:57,310
teams, the better the workouts.

4398
02:13:59,850 --> 02:14:01,530
The last thing we'd also been

4399
02:14:01,530 --> 02:14:04,110
asked to say a few things about

4400
02:14:04,110 --> 02:14:06,110
the rate setting process our

4401
02:14:06,110 --> 02:14:07,400
own role in perspective in

4402
02:14:07,400 --> 02:14:08,980
that.

4403
02:14:08,980 --> 02:14:10,360
I'm glad that Patrick is here

4404
02:14:10,360 --> 02:14:11,550
today might be able to answer

4405
02:14:11,550 --> 02:14:12,790
questions more specifically

4406
02:14:12,790 --> 02:14:13,640
about this. It's a very

4407
02:14:13,640 --> 02:14:15,640
complicated process.

4408
02:14:18,290 --> 02:14:20,450
The process itself was laid out

4409
02:14:20,450 --> 02:14:22,310
well and that the DHS

4410
02:14:22,310 --> 02:14:25,280
presentation. But just from our

4411
02:14:25,280 --> 02:14:26,650
perspective, what we see is

4412
02:14:26,650 --> 02:14:29,600
very simply a service provider

4413
02:14:29,600 --> 02:14:31,840
request a re ticks requests

4414
02:14:31,840 --> 02:14:34,770
rate exception on behalf of a

4415
02:14:34,770 --> 02:14:37,560
client. Then the case manager

4416
02:14:37,560 --> 02:14:39,350
reviews that then it's the

4417
02:14:39,350 --> 02:14:41,810
county submitted to DHS and

4418
02:14:41,810 --> 02:14:44,360
then DHS approves or denies

4419
02:14:44,360 --> 02:14:45,220
that. And then we have a

4420
02:14:45,220 --> 02:14:47,250
responsibility to go back to

4421
02:14:47,250 --> 02:14:49,630
the provider and the client.

4422
02:14:49,630 --> 02:14:51,900
It is a complicated,

4423
02:14:51,900 --> 02:14:54,700
complicated process and we all

4424
02:14:54,700 --> 02:14:55,510
know the complicated processes

4425
02:14:55,510 --> 02:14:57,500
can sometime processes can slow

4426
02:14:57,500 --> 02:14:59,500
down.

4427
02:14:59,650 --> 02:15:01,360
One of the things that would

4428
02:15:01,360 --> 02:15:02,450
like to remain to remind

4429
02:15:02,450 --> 02:15:04,450
everyone is that the more we

4430
02:15:04,450 --> 02:15:06,110
use rate exceptions, the more

4431
02:15:06,110 --> 02:15:07,930
it can raise the cost of care

4432
02:15:07,930 --> 02:15:09,530
in Minnesota and the cost of

4433
02:15:09,530 --> 02:15:11,690
these services is one of the

4434
02:15:11,690 --> 02:15:12,920
reasons why we have to have a

4435
02:15:12,920 --> 02:15:15,320
lot of difficult conversations

4436
02:15:15,790 --> 02:15:16,950
last session, the one before

4437
02:15:16,950 --> 02:15:19,470
that and this coming session.

4438
02:15:19,470 --> 02:15:20,940
We do know that there are

4439
02:15:20,940 --> 02:15:22,540
delays in processing of both

4440
02:15:22,540 --> 02:15:25,540
the county and state level.

4441
02:15:25,830 --> 02:15:26,770
And

4442
02:15:26,770 --> 02:15:28,290
we also know that there are

4443
02:15:28,290 --> 02:15:30,190
some I learned that there are

4444
02:15:30,190 --> 02:15:31,680
some differing interpretations

4445
02:15:31,680 --> 02:15:32,990
of the statute between

4446
02:15:32,990 --> 02:15:35,500
providers, counties in the

4447
02:15:35,500 --> 02:15:37,450
state, specifically over who

4448
02:15:38,400 --> 02:15:39,860
not to say U.S., final say, but

4449
02:15:39,860 --> 02:15:41,250
the nature of the decision,

4450
02:15:41,250 --> 02:15:44,170
a step in the process

4451
02:15:44,170 --> 02:15:46,360
and counties we do. We do feel

4452
02:15:46,360 --> 02:15:48,200
pressure to support the rate

4453
02:15:48,200 --> 02:15:49,780
expectations

4454
02:15:49,780 --> 02:15:52,420
and that that pressure to serve

4455
02:15:52,420 --> 02:15:53,820
think that our residents as

4456
02:15:53,820 --> 02:15:55,940
well as we can

4457
02:15:55,940 --> 02:15:57,390
can make it difficult to go

4458
02:15:57,390 --> 02:15:58,550
through these because if we see

4459
02:15:58,550 --> 02:16:00,810
a lot of rain, exceptions being

4460
02:16:00,810 --> 02:16:02,310
requested,

4461
02:16:02,310 --> 02:16:04,290
then you know me that we worry

4462
02:16:04,290 --> 02:16:06,500
about the rate or the service

4463
02:16:06,500 --> 02:16:07,590
itself. And that is something

4464
02:16:07,590 --> 02:16:09,270
that's hard for us to

4465
02:16:09,270 --> 02:16:10,780
and the long term of working on

4466
02:16:10,780 --> 02:16:13,160
it legislatively. But we have

4467
02:16:13,160 --> 02:16:14,820
clients sitting in front of us.

4468
02:16:14,820 --> 02:16:16,500
And so we're hoping to get the

4469
02:16:16,500 --> 02:16:17,120
right

4470
02:16:17,120 --> 02:16:18,620
the right information to them

4471
02:16:18,620 --> 02:16:21,580
and make the right decision

4472
02:16:21,580 --> 02:16:22,980
and we cannot go into questions

4473
02:16:22,980 --> 02:16:23,760
or C.

4474
02:16:23,760 --> 02:16:24,980
>> Yeah, I think the discussion

4475
02:16:24,980 --> 02:16:26,830
I city they're in Christie had

4476
02:16:26,830 --> 02:16:28,370
mentioned it earlier and I just

4477
02:16:28,370 --> 02:16:29,320
brought it up and that's what I

4478
02:16:29,320 --> 02:16:30,200
was leaning over to it.

4479
02:16:30,200 --> 02:16:31,900
>> To represent new around is

4480
02:16:31,900 --> 02:16:32,760
that, you know, is there a way

4481
02:16:32,760 --> 02:16:33,720
we could do that? What would

4482
02:16:33,720 --> 02:16:35,500
that look like receiver to do

4483
02:16:35,500 --> 02:16:36,470
an interim rate increase or is

4484
02:16:36,470 --> 02:16:37,580
there could you provide some

4485
02:16:37,580 --> 02:16:39,580
technical assistance for

4486
02:16:39,600 --> 02:16:42,600
all of us? You would.

4487
02:16:42,720 --> 02:16:44,460
What? What? What would that?

4488
02:16:44,460 --> 02:16:45,910
Look, the shaking is somewhat

4489
02:16:45,910 --> 02:16:48,310
you answer my question.

4490
02:16:48,610 --> 02:16:50,260
>> Mister Chair. Yes, we could

4491
02:16:50,260 --> 02:16:51,750
provide technical assistance.

4492
02:16:51,750 --> 02:16:53,900
I think oftentimes when we

4493
02:16:53,900 --> 02:16:55,190
identify any rate in the

4494
02:16:55,190 --> 02:16:56,630
Medicaid system that's in need

4495
02:16:56,630 --> 02:16:58,380
of, you know, an increase or

4496
02:16:58,380 --> 02:16:59,250
modification to the

4497
02:16:59,250 --> 02:17:00,890
methodology. We oftentimes see

4498
02:17:00,890 --> 02:17:02,370
the legislature

4499
02:17:02,370 --> 02:17:03,940
investing some at the front end

4500
02:17:03,940 --> 02:17:05,400
while we wait for that long

4501
02:17:05,400 --> 02:17:06,470
term solution that Mr. Bret

4502
02:17:06,470 --> 02:17:08,860
mentioned so if the legislature

4503
02:17:08,860 --> 02:17:10,980
say wanted to maybe get some

4504
02:17:10,980 --> 02:17:12,890
fiscal technical assistance,

4505
02:17:12,890 --> 02:17:14,790
we could we could provide you

4506
02:17:14,790 --> 02:17:16,480
that information. These are

4507
02:17:16,480 --> 02:17:17,950
historic flat rates and I don't

4508
02:17:17,950 --> 02:17:19,160
believe they have inflationary

4509
02:17:19,160 --> 02:17:20,340
update. So I think I'd be

4510
02:17:20,340 --> 02:17:22,210
pretty simple to draft that.

4511
02:17:22,210 --> 02:17:23,410
And it would just be a matter

4512
02:17:23,410 --> 02:17:24,760
of serve what the state can

4513
02:17:24,760 --> 02:17:26,760
afford

4514
02:17:28,200 --> 02:17:30,220
words. Yeah, like that.

4515
02:17:30,220 --> 02:17:31,620
>> What options? What options

4516
02:17:31,620 --> 02:17:33,910
exist for us this crime?

4517
02:17:33,910 --> 02:17:35,910
So

4518
02:17:36,120 --> 02:17:38,120
Mister Chair.

4519
02:17:38,120 --> 02:17:39,100
>> Thank you, Mr. Chen just

4520
02:17:39,100 --> 02:17:41,170
wanted to inquire full TCM.

4521
02:17:41,170 --> 02:17:43,840
We may have exceptions based on

4522
02:17:43,840 --> 02:17:45,160
the need to find individual.

4523
02:17:45,160 --> 02:17:47,140
Do we have exceptions in wave a

4524
02:17:47,140 --> 02:17:48,640
case management,

4525
02:17:48,640 --> 02:17:50,190
the rates that we've thing to

4526
02:17:50,190 --> 02:17:52,530
the case manages if it's a

4527
02:17:52,530 --> 02:17:54,210
complex case that they're

4528
02:17:54,210 --> 02:17:56,210
doing.

4529
02:17:57,450 --> 02:17:58,680
>> The answer. No. Mister Chair

4530
02:17:58,680 --> 02:18:00,410
chair in or not. To my

4531
02:18:00,410 --> 02:18:01,900
knowledge, I double checked the

4532
02:18:01,900 --> 02:18:03,300
fee schedule this morning and

4533
02:18:03,300 --> 02:18:05,940
we've got a 15 minute unit for

4534
02:18:05,940 --> 02:18:07,210
regular case management.

4535
02:18:07,210 --> 02:18:08,470
I think there's another 15

4536
02:18:08,470 --> 02:18:09,150
minute unit for a

4537
02:18:09,150 --> 02:18:11,150
paraprofessional level. Right?

4538
02:18:11,420 --> 02:18:12,610
But beyond that, there's no

4539
02:18:12,610 --> 02:18:14,610
customization.

4540
02:18:14,740 --> 02:18:15,860
>> We want to do. Are you

4541
02:18:15,860 --> 02:18:17,400
going? What are you thinking of

4542
02:18:17,400 --> 02:18:19,000
the affected? Sometimes they're

4543
02:18:19,000 --> 02:18:20,680
working outside of the round,

4544
02:18:20,680 --> 02:18:22,500
not billable hours. They're

4545
02:18:22,500 --> 02:18:23,610
doing something that's really

4546
02:18:23,610 --> 02:18:24,850
unique to the individual's

4547
02:18:24,850 --> 02:18:27,960
needs to be headed with that.

4548
02:18:27,960 --> 02:18:29,940
>> Yes, such and I think we I

4549
02:18:29,940 --> 02:18:31,290
don't like knuckle assistance

4550
02:18:31,290 --> 02:18:32,910
is to add all those factors

4551
02:18:32,910 --> 02:18:34,910
into consideration.

4552
02:18:36,250 --> 02:18:38,250
Thank you, everybody.

4553
02:18:38,750 --> 02:18:40,360
I want to thank everybody for

4554
02:18:40,360 --> 02:18:42,300
being here this. I want to see

4555
02:18:42,300 --> 02:18:44,230
this conversation happened

4556
02:18:44,230 --> 02:18:47,400
a lot and I'm still I'm still

4557
02:18:47,400 --> 02:18:48,890
upset about last year or this

4558
02:18:48,890 --> 02:18:50,640
past year, 300 million dollars

4559
02:18:50,640 --> 02:18:52,450
all said he got a tattoo

4560
02:18:52,450 --> 02:18:54,800
million. Doesn't help us do

4561
02:18:54,800 --> 02:18:55,930
what you need. A commissioner

4562
02:18:55,930 --> 02:18:58,560
Cali that's addressed for the

4563
02:18:58,560 --> 02:19:01,250
system doesn't help us really

4564
02:19:01,250 --> 02:19:03,760
do it. But really our citizens

4565
02:19:03,760 --> 02:19:04,860
need

4566
02:19:04,860 --> 02:19:06,560
it doesn't surprise me that one

4567
02:19:06,560 --> 02:19:07,800
of the organizations that was

4568
02:19:07,800 --> 02:19:10,220
mentioned today is of has a big

4569
02:19:10,220 --> 02:19:11,270
investor. That's a private

4570
02:19:11,270 --> 02:19:12,940
equity firm. The county kind of

4571
02:19:12,940 --> 02:19:14,580
scares me. I would

4572
02:19:14,580 --> 02:19:16,470
that why are they start to dip

4573
02:19:16,470 --> 02:19:19,630
into the the round of our

4574
02:19:19,630 --> 02:19:21,420
systems work? Is that become a

4575
02:19:21,420 --> 02:19:22,550
hindrance to the system?

4576
02:19:22,550 --> 02:19:23,530
Worked in the city? That's a

4577
02:19:23,530 --> 02:19:24,340
question. That's not a

4578
02:19:24,340 --> 02:19:26,340
statement.

4579
02:19:26,350 --> 02:19:27,960
Knowing that the on the federal

4580
02:19:27,960 --> 02:19:30,110
level the CMS is Stratton.

4581
02:19:30,110 --> 02:19:32,320
Something's Minnesota's got a

4582
02:19:32,320 --> 02:19:34,100
bunch of myths out there.

4583
02:19:34,100 --> 02:19:36,150
Even Kcp 5 does it didn't

4584
02:19:36,150 --> 02:19:37,510
article on, you know,

4585
02:19:37,510 --> 02:19:39,360
dispelling the myth of of

4586
02:19:39,360 --> 02:19:41,160
Minnesota. This fraud, waste

4587
02:19:41,160 --> 02:19:42,950
and abuse. Right

4588
02:19:42,950 --> 02:19:44,360
fries Fried is for the very

4589
02:19:44,360 --> 02:19:46,160
first hearing. I did as chair

4590
02:19:46,160 --> 02:19:48,150
knew or was here 4 years ago

4591
02:19:48,150 --> 02:19:50,150
was on Friday.

4592
02:19:50,200 --> 02:19:51,660
It's something that we've dealt

4593
02:19:51,660 --> 02:19:53,430
with every year. This sessions,

4594
02:19:53,430 --> 02:19:54,670
the sessions that we've had.

4595
02:19:54,670 --> 02:19:56,770
We've always dealt with that

4596
02:19:56,770 --> 02:19:58,770
Minnesota is a

4597
02:19:59,400 --> 02:20:00,180
and you look at what other

4598
02:20:00,180 --> 02:20:02,180
states compare ability

4599
02:20:03,690 --> 02:20:05,130
Freitas Freitas pride that

4600
02:20:05,130 --> 02:20:06,510
that. But when you compare us

4601
02:20:06,510 --> 02:20:07,900
to New York,

4602
02:20:07,900 --> 02:20:09,900
Florida, Texas,

4603
02:20:12,380 --> 02:20:14,290
like Ball goes out there to the

4604
02:20:14,290 --> 02:20:15,970
Rose Revolution. They're ready

4605
02:20:15,970 --> 02:20:18,510
to rev up revelation of what we

4606
02:20:18,510 --> 02:20:20,510
are doing. Great.

4607
02:20:21,410 --> 02:20:23,390
We can do better. And I I think

4608
02:20:23,390 --> 02:20:24,810
it's really contingent upon the

4609
02:20:24,810 --> 02:20:26,670
counties and the and the state

4610
02:20:26,670 --> 02:20:28,760
to and what they're doing.

4611
02:20:28,760 --> 02:20:31,400
That work group that Gilman and

4612
02:20:31,400 --> 02:20:32,670
Fisher, you know, put together

4613
02:20:32,670 --> 02:20:34,720
in statute, I think will be

4614
02:20:34,720 --> 02:20:35,660
good to see what happened.

4615
02:20:35,660 --> 02:20:37,530
So I appreciate you all being

4616
02:20:37,530 --> 02:20:39,210
here and thank you for allowing

4617
02:20:39,210 --> 02:20:40,840
that flexibility and Sen

4618
02:20:40,840 --> 02:20:43,240
Representative Moore Tu Gilman

4619
02:20:43,860 --> 02:20:45,900
and Fisher and the rest of your

4620
02:20:45,900 --> 02:20:46,990
team. So once the car was here

4621
02:20:46,990 --> 02:20:48,400
to I appreciate you guys come

4622
02:20:48,400 --> 02:20:50,400
inside

4623
02:20:50,470 --> 02:20:51,920
a final statement, commissioner

4624
02:20:51,920 --> 02:20:53,300
for

4625
02:20:53,300 --> 02:20:55,300
call that the commissioner.

4626
02:20:55,300 --> 02:20:56,400
Go ahead.

4627
02:20:56,400 --> 02:20:56,950
>> Sheriff Man, just thanks

4628
02:20:56,950 --> 02:20:57,910
again for the opportunity.

4629
02:20:57,910 --> 02:20:59,350
Thanks from 2 members of the

4630
02:20:59,350 --> 02:21:00,980
committee. And again, I just

4631
02:21:00,980 --> 02:21:02,200
want to know we heard a great

4632
02:21:02,200 --> 02:21:03,630
deal of feedback today.

4633
02:21:03,630 --> 02:21:04,660
Government is continuous

4634
02:21:04,660 --> 02:21:05,970
improvement. We will continue

4635
02:21:05,970 --> 02:21:08,620
to engage, try to do better and

4636
02:21:08,620 --> 02:21:10,850
I'll share a mole statement.

4637
02:21:10,850 --> 02:21:12,230
We do want to work through this

4638
02:21:12,230 --> 02:21:13,580
is expeditiously as possible

4639
02:21:13,580 --> 02:21:15,450
and will continue to to engage

4640
02:21:15,450 --> 02:21:17,130
in a problem solving fashion.

4641
02:21:17,130 --> 02:21:18,620
2 imperatives of continuity of

4642
02:21:18,620 --> 02:21:20,300
care and the highest possible

4643
02:21:20,300 --> 02:21:21,480
program integrity. Thank you

4644
02:21:21,480 --> 02:21:22,990
all very much. Appreciate that.

4645
02:21:22,990 --> 02:21:24,990
We are adjourned