[0:04] >> And operationally
[0:05] sustainable for qualified
[0:07] providers, serve individuals
[0:08] with the most complex
[0:10] disabilities, Wafa serving the
[0:12] safe, dignified community base
[0:16] choices.
[0:17] What I hope we get and I
[0:19] invited the house, our House
[0:23] counterpart. Is that how you
[0:24] say that, Peter?
[0:26] And it's about improving
[0:28] access, not creating disputes
[0:31] between the department, the
[0:33] lead agencies or providers.
[0:36] The school is collaboration
[0:37] amongst them as well as
[0:39] legislators, families and
[0:40] advocates to ensure that the
[0:42] individuals receiving those
[0:43] services remain at the center
[0:45] of the discussion. We talk all
[0:47] session long about continuity
[0:49] of care.
[0:50] And it's the focus on the
[0:51] individual disabilities to
[0:53] focus on the individual needing
[0:54] the services that we
[0:56] I have to remind us of this is
[0:58] what it's about.
[1:00] We have I lived on Gilman who
[1:03] was co-chair of the House
[1:05] committee is there. Peter
[1:07] Fisher is in here. My new is on
[1:09] his way.
[1:11] I
[1:14] Natalie Zone that she's there.
[1:18] Nice welcome. And as other
[1:21] members come on, I'll make sure
[1:22] introduce them as well. And I
[1:24] also wanted to mix things up a
[1:26] little bit.
[1:28] Last time we did a a hearing.
[1:31] I felt rushed at the end with
[1:33] him,
[1:34] the folks that receive the
[1:36] services. And so talking with
[1:38] the commissioner talking with
[1:40] the county's just I want to
[1:42] start
[1:44] this hearing hearing from
[1:46] people that are the ones
[1:49] are affected by what's
[1:50] happening right now within the
[1:51] system of change. So we haven't
[1:55] zoom
[1:57] folks in the end that are going
[1:59] to be doing it. Helen, you're
[2:01] going to be the first person
[2:02] live from Beaver Frontiers.
[2:04] Thank you for coming in to talk
[2:05] to that. And then Trisha,
[2:07] far tune and then we'll and
[2:09] with a video,
[2:12] Peter or Don, you guys want to
[2:15] say they have behalf of the
[2:16] guests of the House
[2:22] dons coming on. Can you top
[2:24] Don?
[2:26] >> Yes, care. All right.
[2:28] Welcome, thanks. All right.
[2:30] Thanks so much. Promise chair
[2:31] and again, thanks to that
[2:34] Minnesotans that are showing it
[2:35] today, too, share their
[2:36] experience. And I again, we are
[2:40] here open ears to hear what the
[2:42] solutions are going to be.
[2:44] Thank you for having us.
[2:46] >> Thank you, John. Peter
[2:47] Fisher,
[2:49] thank you. Chair Poppe and once
[2:50] again else like that. So thank
[2:52] you, everyone for taking the
[2:52] time to be here today. It is
[2:54] critical that we continue to
[2:55] remain focused on making sure
[2:56] that our people who need the
[2:58] services are continuing to get
[2:59] it and trying to fit. What is
[3:00] the best way to do that is we
[3:02] have our continuing evolving
[3:03] environment. Things that have
[3:04] worked in the past may not work
[3:06] now on things that did work in
[3:07] the past may not work. So these
[3:09] are the things that we want to
[3:09] get together and buy everyone
[3:11] coming together. Hopefully
[3:12] we'll find a better way to
[3:13] deliver services that meet
[3:14] everybody's needs. Thank you,
[3:16] Peter.
[3:18] I thought at least chair.
[3:22] >> Thank you, Mister Chair and
[3:24] I appreciate the content your
[3:26] content
[3:27] continuation.
[3:29] >> Of censoring the voices of
[3:31] the folks that are receiving
[3:33] the services, the folks that
[3:34] have been impacted the most.
[3:35] I think that
[3:38] the impact on them is is what
[3:40] has been the most devastating.
[3:42] And the stories that we've
[3:44] heard throughout the session
[3:47] has been heartbreaking at
[3:48] times. And so looking forward
[3:49] to hearing from then from that
[3:51] from the agency and seeing what
[3:53] we can do to ensure that
[3:55] continue to share as we've been
[3:56] talking about all that session.
[3:57] So thank you so much.
[3:59] >> Thank you for the reminder.
[4:00] I appreciate you. That is
[4:01] something that we do talk about
[4:03] Sanam Ahmed Senator mom is with
[4:05] this. You want to say some
[4:06] things and every on a waiting
[4:08] to do. You're good. Thank you.
[4:10] So with that, I'm Eric, the
[4:12] first folks that will be
[4:14] talking to us or Erica Larson,
[4:16] who's the chair of the Autism
[4:17] Treatment Association. If
[4:19] anything, it is in the state of
[4:20] Minnesota. Eric, you've kind of
[4:22] been the
[4:23] focal point. I remember years
[4:24] back. So it's nice to see you
[4:26] and zoom and then we'll go to
[4:28] Arlen Christensen and then
[4:31] Addison Carpenter and then
[4:33] sure, all bocken, so Mr.
[4:36] Dr Larson.
[4:38] >> Thank you. I assume you can
[4:40] hear me right now. We can.
[4:43] Yes. So chair Hoffman and
[4:45] members of the committee I'm
[4:48] presenting on the sequel to the
[4:52] revaluation challenges which
[4:54] Joel Bach and we'll cover it in
[4:56] detail.
[4:58] But at this point, pick up with
[5:01] ever since
[5:03] the December's sudden border
[5:05] from the U.S. EMS produce a
[5:07] corrective action plan for
[5:09] combating fraud. The families
[5:12] and providers of had to work
[5:13] diligently to restore the
[5:15] interrupted coverage and
[5:17] staffing that's been severely
[5:20] disrupted by a series of poorly
[5:23] implemented strategies to
[5:27] address the need for
[5:28] rehabilitation. After 8 months
[5:31] of work, we now still only have
[5:34] 2 thirds of the autism provider
[5:36] locations being re-evaluated
[5:39] for authorized coverage of
[5:41] medically necessary. The IDB I
[5:43] treatment.
[5:45] But once that hard work was
[5:47] completed, the families and
[5:49] providers have now been
[5:51] surprised and frustrated to
[5:53] discover that the state's
[5:55] authorization contractor picks
[5:57] Sentra
[5:59] was now failing to authorize
[6:01] the treatment of 1000 children,
[6:04] which is one-third of the
[6:06] entire group of children who
[6:08] receive tough road. The first
[6:10] service coverage of the eye,
[6:12] the eye in the state of
[6:13] Minnesota
[6:15] as a result of eccentrics
[6:16] failure. The providers estimate
[6:19] that they will have the income
[6:21] to continue providing services
[6:23] to the children for about 3
[6:25] months, leaving all of the
[6:27] families to worry that their
[6:29] treatment will collapse.
[6:31] All of this is despite the fact
[6:33] that the state's treatment
[6:35] manual calls for eccentric to
[6:37] process authorization request
[6:40] within 7 days because of the
[6:42] children in serious need for
[6:44] treatment.
[6:45] So it's frustrating that at
[6:47] least 800 of these children are
[6:50] only seeking authorization to
[6:52] continue the care that was
[6:54] already authorized in the prior
[6:56] 6 months.
[6:58] It's also frustrating that each
[7:00] child's licensed professional
[7:02] had spent many hours directly
[7:05] value each child and developing
[7:08] a highly individualized
[7:09] treatment plan that runs to 40
[7:12] pages detail.
[7:15] It's further frustrating,
[7:16] learned the eccentric is owned
[7:18] by the global investment for
[7:20] Carlisle. And yet they only
[7:22] spare the money to pay for to
[7:25] professionals to review and
[7:27] approve these detailed
[7:28] evaluations and treatment plans
[7:32] and to further compound the
[7:33] frustration. We learned that
[7:35] both the state of Maine and
[7:37] North Carolina when faced with
[7:39] similar eccentric delays, we're
[7:42] able to immediately clear up
[7:44] backlogs by authorizing media
[7:47] coverage for continuity of
[7:49] care.
[7:50] We ask that our children be
[7:52] able to immediately access the
[7:54] treatment as determined by
[7:56] licensed professionals of
[7:58] Minnesota who stand on their
[8:00] assessments and prescriptions
[8:02] as regulated by the state of
[8:04] Minnesota.
[8:05] These Minnesota professionals
[8:07] are highly regarded license
[8:10] behavior. Analysts love Long
[8:11] served the needy children.
[8:14] Adam Record represents 24 these
[8:18] autism treatment organizations
[8:20] serving more than 2,500
[8:23] children with autism across
[8:25] Minnesota.
[8:27] Our members provide medically
[8:29] necessary autism therapy that
[8:32] depends on regular predictable
[8:34] Medicaid reimbursement to
[8:36] remain operational.
[8:38] All of the services in question
[8:41] have already been delivered and
[8:43] the clinicians hate before the
[8:45] members submit their bills to
[8:47] the state of Minnesota.
[8:49] Yes, the ongoing interruption
[8:51] of authorization of coverage is
[8:54] not survivable for many autism
[8:56] providers, most of which are
[8:59] small businesses or nonprofit
[9:01] organizations.
[9:03] They operate on narrow margins
[9:05] and rely on the state of
[9:07] Minnesota to meet legal
[9:08] Medicaid of locations.
[9:11] When the providers will be
[9:13] forced to lay off staff and
[9:15] suspend services to the
[9:17] families, they will not be able
[9:19] to quickly resume. Once the
[9:21] determination is successfully
[9:23] appealed, it will only be then
[9:26] that they can renew their
[9:27] request for authorization,
[9:29] which is a lengthy process
[9:31] itself. An attempt to recruit
[9:34] the employees could not be
[9:35] fired.
[9:38] There is an immediate and
[9:40] appropriate solution that can
[9:42] be implemented this very day at
[9:45] no costs.
[9:46] We request that the DHS
[9:49] immediately authorize
[9:51] continuity of care to enable
[9:53] the providers to continue to
[9:55] serve the children that have
[9:57] already been authorized for
[9:59] coverage in prior intervals and
[10:02] continue to provide evidence of
[10:04] medical necessity for whatever
[10:06] time in the future, That IX
[10:08] center is able to regain its
[10:10] composure to meet its
[10:12] obligations.
[10:14] We also request that eccentric
[10:16] be required to meet its
[10:18] contractual obligations.
[10:20] And Ron, the estimable bankroll
[10:23] of Carlisle to do so.
[10:25] Minnesota can address fraud
[10:27] without dismantling these
[10:29] essential autism services.
[10:32] But this current failure will
[10:34] result in provider closures
[10:36] longer. Waitlists and children
[10:38] are losing services through no
[10:40] fault of their own.
[10:42] The I D D I for a fee for
[10:45] service program is a heavily
[10:47] regulated program that was
[10:49] developed with extensive public
[10:52] and professional input over the
[10:54] course of 30 years in
[10:55] Minnesota.
[10:57] The program was intentionally
[10:58] designed to include direct
[11:00] oversight, both within and
[11:03] external to the providers,
[11:05] as well as to purposefully
[11:07] include extensive parent
[11:09] participation.
[11:11] These features are designed to
[11:13] prevent waste, fraud and abuse.
[11:16] And the providers only seek to
[11:19] receive the authorization for
[11:21] payment for these highly
[11:23] regulated services in order to
[11:26] face this incredible backlog.
[11:28] That is frustrating all of us.
[11:32] Thank you for your attention.
[11:35] >> Thank you, doctor and images
[11:37] you may members there in your
[11:38] packet are.
[11:39] >> All the letters that we got
[11:41] as well from people. So.
[11:44] >> It's it there in the packet
[11:46] for you, Mr. Christensen,
[11:48] Arlen Christensen, Welcome to
[11:50] the committee.
[11:52] >> Thank you very much.
[11:54] Thank you for allowing me to
[11:55] speak today. Speaking on the
[11:57] topic,
[11:59] but my life and I are
[12:00] caregivers of her. 39 year-old
[12:02] son live with us.
[12:04] He is honored Cdcs under that
[12:06] the waiver
[12:08] in the past. I was an executive
[12:10] director for Arc. Can you
[12:12] county?
[12:13] I think it for over 35 years.
[12:16] My goal is to advocate for our
[12:18] son.
[12:19] True and correct assessment.
[12:23] There are many topics of
[12:24] concerns addressed today,
[12:26] but I want to touch on one
[12:27] issue that does not make sense
[12:30] in the assessment for the TD
[12:32] waiver.
[12:33] He's a variable call medical
[12:36] for 25 years. Our son is always
[12:38] ban or 3 on call next.
[12:42] Since the revision that has
[12:44] changed office visits only
[12:48] I'm not sure since our sons
[12:50] needs are hired with his
[12:53] declining health,
[12:55] the on call medical the did
[12:57] because of the need for I'm
[12:59] Cole train personnel to assist
[13:01] with the seizure disorder that
[13:03] he asks.
[13:05] The letter was given from our
[13:06] sons are all just stating he is
[13:09] a very high grass status injury
[13:13] or death.
[13:14] That's that the on call trained
[13:16] carriers,
[13:18] our son and had a history of
[13:20] status seizures.
[13:22] In the letter he stated that
[13:24] EMS its second year, the fur on
[13:28] call medical the is ASAP.
[13:32] Delaying medical treatment may
[13:34] have bad outcomes.
[13:37] Person, seizures are 8 to 12
[13:39] week.
[13:40] He is angry surgery. The NSA
[13:43] implant
[13:44] I every and I see you're met
[13:46] out there with limited success.
[13:49] Her seizure protocol is making
[13:51] sure he is safe
[13:53] time. The seizure and using our
[13:55] maintenance that we have for
[13:56] are being asked to try to stop
[13:59] the seizure if possible.
[14:01] After 2 minutes were advised to
[14:04] administer rescue medications
[14:06] that we have
[14:07] and then call EMS.
[14:09] The problem is that his
[14:10] seizures have not reach the 2
[14:13] minute to give him the rescue
[14:15] mats
[14:16] and that's per the criteria
[14:18] policy of the revision.
[14:20] The on call treats services are
[14:22] not be,
[14:24] but I think they could be any
[14:26] time.
[14:27] His seizure of a lasting 60 to
[14:29] 90 seconds
[14:31] that are all just stated.
[14:33] There are some will always have
[14:34] seizures
[14:35] because is the progression of
[14:37] the disease and our son's
[14:39] health condition
[14:41] in 2023. Her son was diagnosed
[14:44] with stage 3 colon cancer.
[14:47] 12 people treatments
[14:50] at the present. The oncology if
[14:51] he's watching some suspicious
[14:53] spots and slots.
[14:56] >> The assessor and appeal
[14:57] judge stated that since he did
[15:00] not have standing seizures in
[15:01] the past year and you cannot be
[15:04] given the code 3 on call
[15:05] medical.
[15:07] This is what is very troubling
[15:09] and wrong.
[15:11] Caregivers have to be ready in
[15:14] case a seizure call Kurz and
[15:16] fall of protocol at any time.
[15:20] Dhs is rewarding a medical
[15:23] crisis rather than prevention
[15:25] in this case.
[15:28] In closing, I will reiterate
[15:30] what was sent by my state
[15:32] representative and senator 20
[15:35] years ago in my office,
[15:37] Minnesota does short-term fix.
[15:40] But for long-term consequence,
[15:44] this is still true today.
[15:47] Please step back from any plan
[15:50] actions and think about the
[15:52] future costs instead of a
[15:55] short-term fix.
[15:57] Not to mention all of you here
[16:00] for our most vulnerable to
[16:01] this.
[16:03] Don't balance the budgets.
[16:04] Our DC
[16:06] thank you very much for many
[16:08] come and testify.
[16:09] >> Thank you. Our love. Good to
[16:10] see you. And thanks for your
[16:12] years of work.
[16:14] Addison Carpenter,
[16:15] welcome to the committee.
[16:19] >> The CEO and chairman and
[16:22] members of the committee,
[16:23] my name is Edison her.
[16:25] >> And I'm a Minnesotan who
[16:26] depends on disability and home
[16:28] and community-based services
[16:30] and putting it back for
[16:31] hospital care and other
[16:33] long-term services and supports
[16:34] creamy safely in my home and my
[16:36] community and my family.
[16:38] I am here specifically to speak
[16:40] about American University
[16:41] offers a Chanel ace because
[16:43] these are not simply
[16:44] administrative problems and
[16:46] others should delay honestly,
[16:47] almost human-like this year.
[16:49] I was just sitting in a proof
[16:51] for private gain. Your son
[16:52] services back in November of
[16:54] 2024, the services were not
[16:56] optional. They were determined
[16:57] necessary because I have
[16:59] significant medical needs
[17:00] require ongoing management
[17:02] within my home and the
[17:04] community. But they have CNN
[17:06] actually receiving most nursing
[17:08] services have been 2 very
[17:09] different stories. While the
[17:11] authorization process drags on
[17:13] it without the care I had been
[17:14] assessed as needed. There was
[17:16] no backup system of people
[17:17] working between agencies and
[17:19] government entities. I think we
[17:21] want without estate after
[17:23] meeting with us are happen.
[17:25] Are you during the 2026
[17:27] legislative session? I was
[17:28] hospitalized in the ICU with a
[17:29] severe infection. Just hours
[17:31] before disability advocacy day
[17:33] at the Capitol began, I was
[17:34] intubated a fellow disability
[17:36] advocate
[17:39] back in the 5 people I work
[17:41] alongside with Ncba then sell
[17:43] and elsewhere that I was
[17:44] frankly, my friends and family
[17:46] were called to say goodbye
[17:47] because I was not expected to
[17:48] survive that weekend. I went
[17:50] and the complete kidney and
[17:51] liver failure, developed acute
[17:53] respiratory distress and then
[17:54] and have regime islands.
[17:55] I was eventually traced.
[17:57] And when I finally woke up, I
[17:58] had to re-learn how to use my
[17:59] body, including rollover
[18:01] walking, talking and eating had
[18:03] I had the nursing services I
[18:04] desperately needed. There's a
[18:05] good chance that none of that
[18:07] would have happened.
[18:08] It can mean a difference.
[18:09] We can recognize a problem at
[18:11] home.
[18:12] I'm treating it after it
[18:14] becomes a crisis and sometimes
[18:15] it can mean the difference
[18:16] between life and death.
[18:17] Unfortunately, my story did not
[18:19] end what I survived and I am so
[18:20] without the nursing services it
[18:23] because I'm so that you're
[18:24] seeing it not truly get to live
[18:25] the life that home and
[18:26] community-based services are
[18:27] supposed to make possible.
[18:29] My life is still sent one back
[18:31] and forth the clinics,
[18:31] emergency departments and
[18:33] hospitals since June. That
[18:35] since I think that this charge
[18:36] from the long term acute care
[18:38] hospital, I had former hospital
[18:39] admissions, probably our visits
[18:41] and too many plant appointments
[18:42] account.
[18:43] I was nervous. We have the
[18:44] capital for the first time and
[18:45] Hans today to testify, but
[18:47] instead was stuck in the clinic
[18:49] in addition all morning and
[18:51] literally like just walked in
[18:52] the door
[18:53] being without using affects my
[18:54] ability to be a parent to work,
[18:56] to spend time with my family.
[18:57] For a statement, The Advocate
[18:59] for the things I'm passionate
[19:00] about and even make ordinary
[19:01] plant
[19:02] home and community-based
[19:03] services are supposed to help
[19:05] people with disabilities live
[19:06] in their communities rather
[19:07] than spend their lives and
[19:08] institutions and hospitals.
[19:10] A probe into service keeper
[19:12] does not accomplish that.
[19:13] If someone is is that the
[19:14] sitting there saying and then
[19:15] weeks, months or years for that
[19:17] authorization to actually
[19:18] result in care, this is the has
[19:20] not provided this service
[19:22] patients and families afford
[19:24] the consequences. We said
[19:25] number didn't see departments
[19:26] were hospitalized for families
[19:27] to come and pick up your rates.
[19:29] We've used pieces of our lives
[19:31] while different parts of the
[19:31] system to determine who is
[19:33] responsible.
[19:34] Hackers also observers
[19:36] consequences because emergency
[19:37] departments, hospital
[19:38] admissions, intensive care and
[19:40] repeated claims that are not
[19:42] substitutes for stable public
[19:43] nursing care
[19:45] and asking in establishing the
[19:47] full, established, meaningful
[19:49] accountability and timelines
[19:50] for nursing authorizations.
[19:52] There must be a point at which
[19:53] an authorization cannot simply
[19:54] remain pending. And there must
[19:56] be some point clearly
[19:57] responsible for resolving these
[19:58] delays.
[19:59] Please do not measure success
[20:00] by how many people have
[20:01] Anderson written for service
[20:03] plan or how many offered
[20:04] stations eventually get
[20:05] approved, measured by whether
[20:07] the person actually has unders
[20:08] walking through their door
[20:10] because an authorization is not
[20:11] access, approve mercy services
[20:13] without a nurse is not fair.
[20:15] I may have survived what
[20:16] happened
[20:17] while waiting for the charity
[20:18] that but I should not have to
[20:20] nearly die for an
[20:20] administrative process to
[20:21] demonstrate how important that
[20:23] care was and I should not.
[20:24] So we wait for the opportunity
[20:26] to live my life instead of
[20:27] continuing to manage the
[20:29] consequences of going without
[20:30] it. Thank you.
[20:32] >> Thank you, Madison and next,
[20:34] Joel Bach. Enjoy all if if use
[20:37] also sent a letter. So if you
[20:39] could, you know, give us the
[20:40] essence of the debt you're
[20:42] Larson mentioned, you would go
[20:43] into detail on something.
[20:44] I just, you know, give us the
[20:45] essence of really what
[20:47] that letters about and what
[20:49] what we're doing today. And
[20:50] then while you get up on the
[20:53] screen and Helen mater animator
[20:55] and Trisha Bridge, why don't
[20:57] you work your way to the table?
[20:58] Thank you.
[21:08] Yeah, I think you get a click
[21:09] that thingy that says turn your
[21:11] Mike a
[21:14] there you go. You're right.
[21:16] >> Good to see a show. Thank
[21:18] you.
[21:19] >> Mr. Chairman members, thank
[21:20] you for the opportunity to
[21:21] speak. To give the guard in.
[21:22] The test is providing
[21:23] validation. I'm Joe Buck and
[21:25] chief executive officer of
[21:27] Solutions. We are a community
[21:29] that the House Justin's serving
[21:31] life in a so one of our
[21:32] services is the idea of
[21:34] research to get through 6
[21:36] locations stretching from Saint
[21:38] Cloud to East Grand Forks
[21:40] Solutions is nationally
[21:42] accredited as a behavioral
[21:44] health center of excellence.
[21:46] Throughout the history
[21:47] validation process solutions
[21:49] has done everything DHS have
[21:51] asked of us. We had that every
[21:54] deadline communicated by DHS
[21:56] responded properly to requests
[21:58] for additional information.
[22:01] Yet today, only one of our 60 I
[22:04] ddi sites has been we've
[22:06] allocated and that approval
[22:08] approve within the last week.
[22:10] The consequences are
[22:11] significant
[22:13] because of locations, not
[22:14] re-evaluated. We are unable to
[22:16] Bill for services provided for
[22:17] nearly 50 staff members were
[22:20] unable to Kate to obtain
[22:22] service authorizations for 30
[22:24] on the book children with
[22:25] Autism.
[22:27] The state is grossly thing like
[22:29] with Pierre of claims for
[22:30] services provided to our
[22:32] children
[22:33] if Minnesota where it is and
[22:35] instead of a government it we
[22:37] face a massive downgrade of its
[22:39] credit rating, reputation and
[22:41] borrowing ability the amount
[22:43] just to our organization
[22:45] exceeds $800,000.
[22:49] This is not simply a ministry
[22:51] to the inconvenience. The
[22:52] services have already been
[22:54] delivered to Minnesota
[22:55] families. I qualified
[22:57] professionals. We pay salary
[22:58] benefits, rent operating
[23:00] expenses while waiting months
[23:02] for approval and payment.
[23:04] Just yesterday during an thsi
[23:07] to visit, the reviewer writes
[23:09] with information that was
[23:10] substantially in at it. For
[23:12] example, DHS records did not
[23:15] identify me to see has an
[23:18] authorized agent.
[23:20] Records show Solutions
[23:22] Solutions operating from a
[23:23] location that we close more
[23:25] than 3 years ago
[23:28] when I directed asked where the
[23:29] information came from, the
[23:30] reviewer explain that DHS staff
[23:33] use a different system than the
[23:34] one providers is to submit to
[23:36] maintain information. We're
[23:38] told the reviewer would need to
[23:40] check with minutes to verify
[23:42] what we have reported. This
[23:44] experience reflects what has
[23:45] occurred throughout the
[23:47] retaliation process. We have
[23:49] repeatedly been asked to submit
[23:51] the same information
[23:53] comes down. It contained within
[23:54] the DHS system does not appear
[23:57] to match the information
[23:58] providers Inter and maintain.
[24:01] We have 9.90, days without
[24:03] payment for many clients that
[24:05] affected locations, even with
[24:07] one site approved. We do not
[24:09] anticipate anticipate payments
[24:11] until October. Even if the
[24:13] remaining site for does it
[24:16] improve tomorrow, additional
[24:17] processing timelines make
[24:19] payment before November on
[24:21] likely we are facing
[24:22] extraordinary financial
[24:24] pressure pressure on providers
[24:26] and it will limit access to
[24:27] cheap care for children and
[24:29] families who need services.
[24:31] Since April, we have lost more
[24:33] than 30 staff members. If the
[24:35] goal is to reduce access to the
[24:37] gym, it high quality autism
[24:39] services in Minnesota. The
[24:41] current retaliation system is
[24:43] accomplishing exactly that.
[24:46] We needed just to prove the
[24:48] accuracy of provider data
[24:49] systems streamlined that we've
[24:51] allocation process, reduce
[24:53] duplicative documentation,
[24:55] request and establish
[24:56] safeguards to prevent providers
[24:59] so suffering significant
[25:00] financial harm. Well,
[25:02] applications are coming.
[25:04] I respectfully ask that this
[25:06] committee meeting established
[25:08] clear measurable benchmarks for
[25:10] us DHS to achieve in the next
[25:13] 30 to 60 days and to hold the
[25:15] leadership accountable for
[25:17] those benchmarks.
[25:18] Thank you for your time
[25:20] situation. Be happy to answer
[25:22] any questions.
[25:23] >> Thanks. So we're going to
[25:24] wait till the end and that
[25:25] stuff we know
[25:26] Senator, make Weight is joining
[25:28] this online as well. Good to
[25:30] see you, Aaron. Helen mater.
[25:34] I get that right? Yes, yes,
[25:37] Helen and Trisha Helen, Helen
[25:39] mater year, the firm Behavioral
[25:41] French airs. You came here
[25:44] to China. So welcome to the
[25:46] committee.
[25:47] >> Thank you, Sir. Thank you so
[25:48] much. Chair Hoffman and members
[25:50] of the committee for your TIME
[25:51] today. I'm Helen mater. I'm a
[25:54] board certified behavior
[25:55] analysts since 2004. I'm also
[25:58] the CEO and co-founder of
[26:00] Behavior, Frontiers and
[26:02] organization providing applied
[26:04] behavior, analysis services to
[26:06] individuals with autism.
[26:07] For 22 years,
[26:09] we've been serving children
[26:10] with autism before the IDB.
[26:12] I even became a covered benefit
[26:13] in Minnesota
[26:15] and we have been accredited
[26:16] like Juul as a behavioral
[26:18] health center of excellence for
[26:19] a decade.
[26:20] We are one of many for here,
[26:22] many experience, ethical and
[26:24] high-quality ei dbi providers
[26:27] who are serving Minnesota's
[26:28] autism community.
[26:30] And a couple of our sites are
[26:31] in the community served by
[26:33] Chair Rogers and can wrap it, I
[26:35] believe
[26:37] and our organization stands
[26:38] firmly with DHS against fraud,
[26:40] waste and abuse
[26:42] providers should be held
[26:43] accountable to standards that
[26:44] promote quality and safety.
[26:47] However, the delays caused by
[26:48] the current DHS validation and
[26:50] re validation process have had
[26:52] serious negative consequences
[26:54] for the children that we serve.
[26:56] Specifically service
[26:58] authorizations have been denied
[27:00] or postponed background checks
[27:02] stalled Q S P credentialing
[27:04] applications backlog
[27:06] and behavior technician
[27:07] approvals frozen.
[27:09] All of this has resulted in
[27:10] children not getting their
[27:11] services,
[27:13] for example, since May during
[27:15] our rehabilitation process.
[27:17] We have had 34 total staff
[27:18] leave 3 of which are Q S P's
[27:21] and we have not been able to
[27:23] replace them because of the
[27:24] pending approval process.
[27:26] And that has resulted in over
[27:27] 24 children not being able to
[27:29] start or continue their
[27:30] services with us.
[27:32] Additionally, providers have
[27:34] been waiting in some cases
[27:35] almost 2 years for their
[27:37] original site validation to be
[27:39] processed. These original
[27:41] allegations need to be
[27:42] processed and should not be
[27:44] overlooked. While the re
[27:45] validation czar being
[27:46] processed.
[27:48] I urge the committee and each s
[27:49] to improve the validation and
[27:51] the validation process to be
[27:52] efficient, consistent and
[27:55] clinically relevant while still
[27:57] focused on requirements that
[27:58] maintain high quality standards
[28:00] of care.
[28:01] Dhs could take several
[28:03] practical steps to reduce
[28:04] unnecessary delays.
[28:06] Some examples include hiring
[28:08] and training additional staff
[28:10] to process of allegations
[28:12] rebound shuns credentialing
[28:14] background checks and
[28:15] technician approvals.
[28:17] Assigning a point person for
[28:19] providers who can set forth
[28:21] clear process is for
[28:22] communication status, updates
[28:24] and escalation pathways
[28:26] and continuing to backdate
[28:28] approvals to the date of
[28:29] application so that children to
[28:31] not lose access to care due to
[28:32] administrative delays.
[28:35] We understand the importance of
[28:36] ensuring that there's a proper
[28:38] vetting process in place.
[28:40] But the unnecessary paperwork
[28:42] and red tape has only delayed
[28:43] the process and delayed
[28:45] critical services to our most
[28:46] vulnerable populations.
[28:48] Thank you so much for allowing
[28:49] me to bring this to your
[28:50] attention today.
[28:51] >> Thank you. And I got to at
[28:54] C*** Rapids to get a place in
[28:55] clear ethics as well. Yes,
[28:58] Tricia brings by welcome to the
[29:02] committee and then we get far
[29:05] tune. Looks like the the
[29:06] Patricia era, Richard Anthony
[29:08] and then we get will end with
[29:10] the Mary Turner is
[29:13] video. So this bridge by
[29:15] welcome the committee.
[29:17] >> Thank you, chair half of the
[29:18] members of the committee.
[29:19] And I want to recognize the
[29:22] efforts to put that people
[29:24] first today and allow us to
[29:26] speak that action. And for
[29:29] anyone who wants to know how to
[29:30] start
[29:32] doing, you know, partnership
[29:34] and collaborating with
[29:35] families, people, disabilities.
[29:37] That's what Senator Hofmann
[29:38] just it today is put us first
[29:40] to thank you for that.
[29:42] And as you most most of you
[29:44] know, I'm Charlie's mom and I
[29:47] am a disability advocate.
[29:48] I've been doing this for a very
[29:51] long time now.
[29:53] I want to share 3 examples of
[29:55] what happens when our Human
[29:57] Service system fails to provide
[29:59] accountability and continuity
[30:01] of care.
[30:02] Let's start with our story with
[30:03] Charlie. In November of 2025,
[30:06] I learned that Charlie
[30:08] qualified for a 30% waiver
[30:11] budget enhancement.
[30:13] That would be because of his
[30:14] high level of need. I
[30:16] immediately asked his
[30:17] contracted case manager to
[30:19] submit that
[30:21] for months I emailed and I call
[30:24] the case manager her supervisor
[30:26] and eventually the Directorate
[30:29] of the contracted agency.
[30:30] I kept hearing some version of
[30:33] we are looking into it
[30:36] after nearly 9 months and only
[30:38] after I demand that they cease
[30:39] simply resubmit the request it
[30:42] was finally submitted in July.
[30:46] I got an e-mail back with 15
[30:48] minutes later. It went through.
[30:50] It just had never been
[30:51] submitted.
[30:52] But as of today, we're still
[30:54] waiting for DHS to clarify when
[30:56] it can be implemented
[30:59] those months matter. I need
[31:01] those funds to provide care for
[31:02] Charlie over the summer.
[31:04] And when Charlie does not have
[31:05] care, I don't work.
[31:08] Second, there's Brian. Brian
[31:09] uses a wheelchair after having
[31:11] his right leg amputated and has
[31:13] a spinal injury. He was relying
[31:15] on housing stabilization
[31:17] services to move from
[31:18] homelessness into housing,
[31:20] his services and it has housing
[31:22] felt through. And police
[31:24] eventually encountered been
[31:26] sleeping outside
[31:28] near a Brooklyn, a park in
[31:30] Brooklyn Park which happens to
[31:31] be in my backyard.
[31:34] The last I knew he was wheeling
[31:36] himself down as they navigate
[31:37] with everything he owned
[31:39] hanging in the target bags from
[31:40] the back of his wheelchair.
[31:42] That is what a failure of our
[31:44] human services system can look
[31:46] like.
[31:47] Then there's a fun, a 19
[31:49] year-old with autism and
[31:50] developmental disabilities.
[31:52] His family has spent more than
[31:53] a year trying to get him
[31:55] medical assistance and waiver
[31:56] services. He has had 4
[32:00] contracted case managers in one
[32:02] year
[32:04] after reviewing a years worth
[32:05] of emails. I discovered that
[32:07] his newest case manager
[32:09] appeared this was the problem.
[32:11] She kept telling them to get a
[32:13] medical assessment. So mom went
[32:15] all the doctors got
[32:16] assessments, sent them on
[32:20] the case manager didn't know
[32:22] the difference between
[32:24] obtain a medical up sent
[32:25] assessment and apply for
[32:27] medical assistance.
[32:32] Even still does not have
[32:34] service S
[32:36] these stories illustrate
[32:37] another problem. We don't talk
[32:38] nearly enough about continuity
[32:40] of care. When case managers
[32:42] change providers disappear,
[32:43] authorizations are delayed or
[32:45] we validate Jean interrupt
[32:47] services. People don't simply
[32:49] experience an administrative
[32:51] inconvenience. They lose care
[32:54] and families become the count
[32:56] continuity of care system.
[32:58] We keep the records. We
[33:00] remember what was approved.
[33:01] We explain the history to the
[33:03] next case manager. We notice
[33:05] when paperwork disappears, we
[33:07] make the calls we fix what
[33:09] falls through the cracks.
[33:12] These are not isolated
[33:13] paperwork problems. When the
[33:15] same failures happened
[33:16] repeatedly across programs,
[33:18] providers, counties and family
[33:20] families, we have a systems
[33:21] problem.
[33:23] And when the responsibility
[33:25] continually moves between the
[33:27] HS counties, contractors of
[33:29] providers, we have an
[33:30] accountability problem
[33:32] as a member of the Waiver
[33:33] Imagine Advisory Task Force.
[33:35] I am deeply concerned that we
[33:38] are preparing to build a brand
[33:39] new waiver system on top of
[33:41] processes that are already
[33:43] already feeling the people,
[33:46] please repeal waiver, imagine
[33:48] and work with people with
[33:49] disabilities and families to
[33:51] build something better.
[33:52] Minnesotans with disabilities.
[33:54] Don't need another system
[33:55] designed around them. They need
[33:57] a system designed with them and
[33:59] system accountable to them.
[34:01] Thank you,
[34:03] Representative Fisher.
[34:05] >> Thank you. Chair Poppe in
[34:06] this Press Bay. Thank you.
[34:08] Missed this spring was told
[34:09] that I should profile and say
[34:11] thank you a time to be here
[34:12] today and highlight the issues
[34:14] wrong contract case management
[34:16] die. I understand that contract
[34:19] case mantra is usually done by
[34:20] the counties of size first 500,
[34:22] which county where you was the
[34:24] contract case management
[34:25] through.
[34:26] >> Ours is through Hennepin
[34:28] County. And what I understand
[34:30] is rather than having a case
[34:33] manager at the county,
[34:36] they contract like subcontract
[34:39] with an agency
[34:41] and these agencies are not
[34:43] supporting their staff very
[34:45] well. And I don't think they're
[34:47] getting much support from the
[34:48] county or DHS either because
[34:50] this we're looking into it is
[34:52] usually dependent on someone
[34:54] getting back to that.
[34:56] >> And Mister chair, if I could
[34:58] and if thank you, thank you,
[34:59] Mrs Brain. One of the questions
[35:02] I have is do what you went
[35:04] through. The county kind of got
[35:05] a county contract, a case
[35:07] manager to the county provided
[35:08] any information. Some things
[35:09] aren't right. You have a
[35:10] contact in the county are a way
[35:12] to appeal to the county kind of
[35:13] process that will help protect
[35:15] your right.
[35:16] It's because my.
[35:18] >> Especially in at thank you
[35:21] Chair Hofmann and I especially
[35:23] in Hennepin County
[35:25] what we get
[35:27] a letter that explains we're
[35:29] going to his contract case
[35:30] management. And if we have
[35:32] questions, we can call the H s
[35:35] team
[35:36] and it's a phone number that
[35:38] has several problems
[35:41] often doesn't work very well.
[35:43] You rarely get to speak to a
[35:44] person.
[35:47] >> Theres an official. Thank
[35:48] you. I I appreciate you sharing
[35:50] the information that you went
[35:52] through. I do know that this is
[35:53] an issue that we been trying to
[35:55] address. We had some
[35:55] legislation last session to
[35:58] take very close look and
[36:00] establish standards what's
[36:01] going on. But you're
[36:02] highlighting is a problem that
[36:05] is not only happening at a
[36:06] county us into the Ramsey
[36:07] County. I appreciate your
[36:08] coming forward. Let us know
[36:09] what you're seeing. And I do
[36:10] see that we're going to have
[36:11] the opportunity to talk about
[36:12] the slow March and we will.
[36:14] >> Thank you, Mister. Thank
[36:15] you, Representative. Thank you
[36:16] to we can make room for for to
[36:18] Wile E and Patricia Richard and
[36:21] then very Turner. So one of the
[36:22] things that Representative
[36:23] Fisher, this brings up
[36:25] specifically when when Tricia
[36:27] was talking about, I believe
[36:28] Bryan was the individual.
[36:31] There was an article that was
[36:32] done Jayla go once again did a
[36:36] a story about an individual
[36:38] that she lost her services
[36:41] because of the system that
[36:42] broke down.
[36:43] She the woman is a vulnerable
[36:45] adult who happens to have a
[36:46] baby she homeless. She's couch
[36:49] jumping the whole time. This
[36:50] last year and a half we've been
[36:52] talking. It was always about
[36:53] continuity of care. Continuity
[36:55] should who's going to assure
[36:57] that this person is receiving
[36:58] services? It broke my heart to
[37:00] see that that individual was
[37:01] part of that housing
[37:02] stabilization program. No fault
[37:05] of her own.
[37:07] It's now couch jumping with a
[37:09] little baby.
[37:10] And so we need to start to
[37:11] raise those points that we know
[37:13] exist. But what do we do about
[37:15] that? Right? But it so thank
[37:17] you with that. And that's what
[37:18] Lee welcome and who do you have
[37:21] with you?
[37:22] >> Could it have to do it?
[37:24] I kept my colleague Ryan.
[37:25] We lose 10 or so tickets are
[37:27] clients of the Senate.
[37:29] >> Thank you. Welcome to nurses
[37:31] at the table at the same time,
[37:34] public health. Sorry and I get
[37:36] there on so welcome. And if you
[37:38] could,
[37:39] let us know what's going on.
[37:41] And then you have Mary Turner
[37:43] who is also a nurse. She's
[37:45] going to be on the 2 after this
[37:47] Ole Miss. Well, go ahead.
[37:49] >> Good afternoon, chair Hopman
[37:51] member of the community.
[37:53] My name is for us to where the
[37:55] owner of Peace of Mind Care
[37:57] Center
[37:58] and that is where I provide to
[38:00] 45 dever. Also days per service
[38:02] where I could climb student
[38:04] today.
[38:05] Thank you for hearing from
[38:06] providers is the assist
[38:08] discussions. We validation of
[38:09] service agreement changes
[38:12] piece of my service. People who
[38:14] many programs are not equipped
[38:16] to serve, to serve support.
[38:19] Some are nonverbal. Kind of put
[38:21] pain on the occasion needs
[38:24] others have significant
[38:26] physical disabilities, mental
[38:28] health conditions. Mobility
[38:30] needs
[38:31] this can and will concerns
[38:33] they require are in care most
[38:36] the time exemption to train
[38:39] staff for professional care,
[38:41] behavioral support and
[38:43] emergencies.
[38:44] I'm very proud of my focus is
[38:47] that of created I employees may
[38:49] discover possible
[38:51] approximately 90% of our
[38:53] immigrant women, 70% are women
[38:56] of color. They bring language
[38:59] to cultural understanding and
[39:01] patients and trusted relation
[39:04] with people who have complex
[39:06] needs as many of you know,
[39:08] where it came from and some out
[39:09] American on the problem.
[39:11] We don't have institutions to
[39:13] put our people with
[39:14] disabilities so we take care no
[39:16] matter what and keep them in
[39:17] the community.
[39:19] These individuals have work.
[39:21] They have our staff to have
[39:24] difficulty with compact.
[39:26] They do have difficulty with
[39:28] compassion and professional
[39:30] professionalism. They support
[39:32] too
[39:34] people who are really not for
[39:35] one very fiscal most of the
[39:37] time violence.
[39:38] One example, you saw the
[39:40] pictures I give you. I cannot
[39:42] provide that in public. 2 of
[39:44] the crimes that I want to talk
[39:46] up. I had a severe that the
[39:48] rush, I cannot show the public
[39:50] what the pictures look like
[39:52] that client, a young gentleman
[39:55] needed acute support foreigners
[39:58] because of his severe diaper
[40:00] Russian burnout that he had
[40:03] when we tried to charge nurse
[40:04] and as partners we were told it
[40:06] was not a meat Royce. Therefore
[40:08] we cannot support you and
[40:10] provide on the service was
[40:11] denied.
[40:14] Yeah. Also decision that's in
[40:15] effect on the level of any we
[40:17] support. So the nurse was
[40:18] refused. Another cried a little
[40:20] bit of some severe. You also
[40:22] saw
[40:23] she was had a severe abuse and
[40:26] beaten up, but she's acting and
[40:28] nonverbal. Her parents today,
[40:31] Putin com moms have initial do
[40:32] surgery and that is taking care
[40:34] of our time. Patty, what I want
[40:36] to be here today, they send
[40:37] their apologies. But I mean,
[40:39] you have for them. I'm not just
[40:40] a business owner. I think it as
[40:42] well.
[40:44] Also that individual we weren't
[40:45] paid their sense of giving did
[40:47] not come soon as of route.
[40:49] 22 6, I keep sued by step and I
[40:52] pay them to bank loans and 2
[40:54] other support needs
[40:56] peace of mind to continue
[40:57] serving these clients without
[40:59] pay. I've to probe the kind of
[41:01] continue to support. The kind
[41:03] to lose is they're talking to
[41:05] the health and safety needs to
[41:07] not optional for staff and
[41:08] preferences. Minnesota waiver
[41:11] wait long to recognize
[41:13] individuals, staff any direct
[41:16] nurse hours and establish
[41:18] euros. The S P is up, sir,
[41:21] that coming some following the
[41:23] communications. I was told when
[41:25] I so we need to knows who Luke
[41:27] Raley Michael. We'll talk about
[41:29] psychiatric medications, people
[41:31] who are on chemotherapy that
[41:33] needs support. I was told we'll
[41:35] train. You do see some of them
[41:37] administer the medication,
[41:38] which of course I would not do
[41:40] that
[41:41] without proper support, pain
[41:43] and medication problems.
[41:45] It does sometimes come become
[41:46] crisis. You didn't its creation
[41:49] injuries, hospitalization this
[41:52] chart and his 2 shutout
[41:53] placement disabilities. So it
[41:56] does not cause violence.
[41:58] Risk increases when needed care
[42:00] is missing.
[42:01] Do you support services exist
[42:03] to keep people engaged safe,
[42:05] including in the community to
[42:07] live?
[42:08] I respect the hospital
[42:11] to reserve to issues with my
[42:13] other cars with just voted,
[42:15] talked about many issues.
[42:17] So save the time, exception
[42:19] rates. Very important to
[42:22] support people. It needs nurse
[42:25] units, nerves providing
[42:26] services are very, very
[42:28] critical. And I hope that these
[42:31] needs are met. I would give my
[42:33] friend and colleague to speak a
[42:34] few minutes. Thank you.
[42:36] >> Thank you so much. And
[42:37] that's the nursing peace.
[42:40] And I did see the it's the
[42:43] parents shared the photos that
[42:47] again, it's just as
[42:49] it's us
[42:52] hurting has seen that photo as
[42:55] the person who is now homeless
[42:57] because of
[42:58] somethings. Something just
[43:00] wasn't working right now.
[43:01] And and the who who needs to
[43:04] make sure that something is
[43:05] happening, maybe we'll get an
[43:07] answer later on. It looks like
[43:10] a rally. A U.S.
[43:12] you are a nurse. Yes, I am.
[43:14] Welcome to the committee.
[43:15] Thank you so much. Good
[43:17] afternoon and community
[43:18] members.
[43:19] >> My name is family and I'm
[43:21] right to 7 access peace of mind
[43:24] center.
[43:25] >> I wanted just to give you a
[43:27] small picture of all of these
[43:29] services and our client, us
[43:32] news
[43:38] and I my heroes to us here
[43:41] today to speak,
[43:42] seeking that data to the
[43:44] effect. This is the safety,
[43:46] the committee quality of care
[43:49] that we provide for our clients
[43:52] that need for Medicaid, nursing
[43:54] staffing at the U.S.
[43:57] off. My sent a Manila folder
[43:59] kind to stuff company. Expedia
[44:02] and emotional needs and some
[44:04] are able to verbalize that what
[44:08] they experience on what they
[44:10] need
[44:12] the behavior and maybe only
[44:15] wait that the committee key
[44:17] because
[44:18] they can be on shows like 10
[44:20] well of uncomfortable of
[44:25] in distress.
[44:27] That is the way they
[44:28] communicate and tell us what
[44:30] they experienced. It is
[44:33] experiences and patient fix it
[44:37] and we shun and that's us.
[44:39] And that host episodes of
[44:41] violence and dispensing
[44:43] behavior.
[44:45] This situation is contained to
[44:47] bank. We can I think wide-scale
[44:49] nursing assistant assessment
[44:51] coast upset of patients
[44:53] candy in the nation to do next
[44:56] in a special dances. And the
[44:59] explanation
[45:01] next, the staff must be
[45:02] constantly says changes in
[45:05] behavior. Nice but to shoot 2
[45:08] cubs.
[45:10] The tenement, what in the
[45:12] nation is a puppy
[45:15] money to the client service
[45:17] Ponce and communicate different
[45:19] chains
[45:20] to the into DC discipline.
[45:23] Any team
[45:24] without coup with information
[45:26] can allow a patient to escalate
[45:29] into a completion of a violent
[45:32] increase in the risk of
[45:34] entrapment to the client, to
[45:36] our other client. This also
[45:38] staff
[45:39] and it could mess and stopping
[45:41] a Lowe's asked to intervene
[45:43] every the fun of the situation
[45:46] becomes
[45:47] us to be in crisis gauges as
[45:50] ability ability to recognize
[45:53] warning signs of it to be 12
[45:56] last part, the escalate
[45:59] behavior to safety protected
[46:01] the thinking that of our
[46:02] clients.
[46:04] Some nurses makes us from 7
[46:06] that it's not only the response
[46:08] when the crisis have been.
[46:09] It's my responsibility is to
[46:12] prevent crisis what ever this
[46:14] possible. I want to kind to the
[46:17] center. Can that safe timely?
[46:21] We'll come back to me. And the
[46:23] defeat was I strongly believe
[46:27] that ethic and their son,
[46:28] the staffing is and central.
[46:31] It is not not right. And it's
[46:33] not an option
[46:35] to make think the safety and
[46:37] quality of our clients. I spoke
[46:41] to me asking the community to
[46:42] recognize the combo sits at the
[46:45] of our client us needs but only
[46:48] messes to provide the safe and
[46:50] effective cap.
[46:52] So I wonder why this is so
[46:55] NASA's train to respond.
[46:58] Sonar of entities collation
[47:01] that kind of stuff, provide
[47:04] better care and nes U.S. and
[47:06] its investment in safety and
[47:09] dignity and quality of care.
[47:11] Thank you so much.
[47:13] Thank you, too.
[47:14] >> And with that will end with
[47:17] the
[47:18] Mary Turner.
[47:24] >> Back in in my name is Mary
[47:26] Turner.
[47:27] >> And I would love to bend
[47:29] there today, but I had a arts
[47:31] telling where my brother was a
[47:34] veteran is being very today.
[47:36] Anyway, I wear many hats, one
[47:39] national nurses, United
[47:40] president and the region at the
[47:42] university and chair of the
[47:44] board of this year. However,
[47:46] today I'm here in the most
[47:47] important role and that is as a
[47:49] registered nurse in the great
[47:51] state of Minnesota.
[47:53] >> Minnesota has one of the
[47:54] best nurse practice acts in the
[47:56] country. And under that
[47:58] document, all registered nurses
[48:00] in Minnesota.
[48:01] >> We have the right and duty
[48:03] to assess delegate and a value.
[48:07] >> In our mission to care for
[48:08] the health of all, Minnesota,
[48:09] us
[48:10] our main focus no matter where
[48:12] we practice our profession is
[48:14] patients safety and prevents
[48:18] nowhere. Is this more or in our
[48:21] in our establishments that are
[48:23] designed to help her patients
[48:25] stay out of corporate
[48:26] facilities and in the
[48:28] community.
[48:30] >> I refer to our day care and
[48:32] our group homes
[48:34] to fail to keep our clients in
[48:36] the community where they can
[48:38] have happier fuller lives.
[48:40] It is imperative that they have
[48:41] supervision
[48:43] over there. Help from a
[48:45] registered nurse whose job
[48:48] under the terms packets act
[48:49] remember is to once again
[48:51] assess delegate and a value
[48:53] that
[48:55] the registered nurses trained
[48:56] to look at the whole picture
[48:58] from diagnosis and medication
[49:01] lists.
[49:01] >> Disabilities and not go
[49:03] health issues. Most
[49:05] importantly.
[49:06] >> We catch issues before they
[49:08] become acute and
[49:09] hospitalization is required.
[49:12] Which brings me to the point of
[49:14] cost
[49:15] basically the cost of a few
[49:17] hours a week for a services of
[49:19] a registered nurse. It is
[49:21] nothing compared to the cost of
[49:23] an ice. You stay in the
[49:25] hospital.
[49:26] Did you know that the average
[49:28] stay just for the bad in ICU
[49:31] right now in the Twin Cities is
[49:33] $12,000 to gay and that is just
[49:36] for the bat.
[49:38] So this is a no-brainer, folks.
[49:40] >> Not only do we get to keep
[49:41] our people in the community.
[49:44] >> But we also do a much lower
[49:47] cost to the taxpayer. So I urge
[49:50] you I urge you to allow
[49:53] registered nurses to be able to
[49:55] do the job that they are that
[49:57] they are educated to do.
[49:58] And that is to look out for our
[50:00] people in the community so they
[50:02] can stay in the community.
[50:04] Thank you.
[50:07] >> So with that members, let's
[50:11] move on. Thank you, everybody
[50:13] for letting me to this. First.
[50:16] I again, the last time we had a
[50:18] hearing, I just felt rushed at
[50:20] the end. And so I think it's
[50:24] good for us to understand
[50:25] what's happening, the impact of
[50:27] what is happening to the people
[50:29] that
[50:32] any comments from members
[50:33] before we go to the
[50:34] commissioner.
[50:38] I don't see anybody. Enlai were
[50:41] good. John Connolly and Chris
[50:44] Teague wrong.
[50:48] Thank you for allowing me to
[50:50] the
[50:56] to where it is flexible.
[50:59] Did you did that? Give you time
[51:00] to increase to to get your
[51:02] thing too
[51:04] set up to the system? Does it
[51:06] will see TBD.
[51:09] So before we do that,
[51:11] Commissioner Connelly hearing
[51:13] from people before
[51:15] the key to that, really
[51:17] that move me and it did proud
[51:20] of, you know, the conversation
[51:22] in my mind about, you know,
[51:24] what I've seen happen to
[51:25] individuals right in that the
[51:27] amount of phone calls that just
[51:30] my office alone, our staff are
[51:33] doing. They're doing casework.
[51:36] As I look down at other
[51:38] offices. I don't see anybody
[51:40] else doing casework rate.
[51:41] And so, but that's because
[51:43] there are so many people
[51:44] relying on us to get it right.
[51:46] And so, you know,
[51:49] that's why we've had these
[51:50] conversations on going to get
[51:51] it right. So
[51:54] thank you for being here and
[51:55] thank you for giving us is an
[51:57] update of where you're at and
[52:00] and really focused. My essence
[52:02] of ways is this continuity of
[52:04] care. So thank you,
[52:06] commissioner, for being here.
[52:07] Thank you as crown for being
[52:09] here
[52:10] 2 years.
[52:12] >> Thank you, Chair Hoffman and
[52:13] thank you to everyone who
[52:15] testified already today,
[52:17] community members, providers,
[52:18] nurses, those who are doing the
[52:21] essential work in the
[52:22] community. I want to start a
[52:24] little off script and just say,
[52:25] I think building upon what the
[52:27] chair just said,
[52:29] DHS is it in a very difficult
[52:31] moment as we've heard that you
[52:33] are so please know that we
[52:35] heard you
[52:36] and that
[52:38] our mission and this is on my
[52:41] my badge right now is to help
[52:43] people live their healthiest,
[52:44] enforce lives and community.
[52:46] And I heard that from you all
[52:47] today. We are here. We exist to
[52:49] do that in partnership with
[52:51] you. And we've heard the
[52:52] feedback about the difficulties
[52:54] and the challenges and know
[52:56] that
[52:58] we serve the community and in
[53:02] support of that mission and
[53:03] that we never seek to harm
[53:06] people in our programs or
[53:08] legitimate providers.
[53:09] And I understand those words
[53:13] are words at this point.
[53:14] We'll have a lot more to say
[53:15] here in the presentation about
[53:17] what we are doing with respect
[53:18] to the different program,
[53:20] integrity and interventions
[53:23] that we are implementing and
[53:26] certainly directed to implement
[53:27] and just know that this has
[53:30] been a very difficult year and
[53:32] a half to 2 years at this
[53:33] point, particularly since the
[53:36] engagement of the federal
[53:37] government at the end of last
[53:38] year in December. And we have
[53:40] undertaken a number of
[53:41] processes in ways that
[53:43] we would not have chosen
[53:45] processes that were broader and
[53:47] more expensive than any
[53:48] Medicaid program has ever
[53:49] undertaken in terms of provider
[53:51] a validation to, of course,
[53:53] respond to to fraud and program
[53:56] integrity, concerns that are
[53:58] real. But at the same time
[54:01] being under extraordinary
[54:02] pressure to do this in a way
[54:03] that it's been never been done
[54:05] before. So with that said, we
[54:08] appeared here earlier this
[54:10] summer. We were appearing, of
[54:11] course, during session and are
[54:13] appearing again today to
[54:15] receive the feedback to provide
[54:16] updates. We will continue to be
[54:18] here with you all and the
[54:19] community too, to to engage
[54:22] again except the feedback and
[54:24] we will enter to flee adjust
[54:25] how we are doing this work in
[54:27] the ways that we can
[54:29] recognizing that we are under
[54:31] some requirements and direction
[54:33] from the federal government.
[54:34] That is extraordinary. So just
[54:37] know that we are we are
[54:38] grappling with those 2
[54:39] imperatives. It is always true
[54:41] that our imperative this to
[54:42] provide continuity of and
[54:44] access to care that people
[54:45] need, but also ensure that we
[54:47] have the highest possible
[54:48] program, integrity as we are
[54:50] accountable to the people in
[54:51] our programs, but also the
[54:52] taxpayers of the state of
[54:54] Minnesota.
[54:55] That said on the slide here
[54:58] that we start with this Israel,
[54:59] the statement of the broad
[55:00] impact of the Medicaid program,
[55:03] 20.9 billion dollars in 2024,
[55:06] roughly one-third of the state
[55:08] budget overall, 40,000
[55:09] providers involved in the
[55:11] Medicaid program. Overall,
[55:12] that's organizations that
[55:13] individuals over 300,000
[55:15] individual providers and 1.2
[55:17] million program members.
[55:19] So the Medicaid program really
[55:21] serves as the foundation of the
[55:23] healthcare system in Minnesota.
[55:26] And we know that it's essential
[55:27] for people, with disabilities,
[55:28] for children, for families,
[55:30] for older adults, for those
[55:32] during pregnancy at the
[55:34] beginning at the end of life,
[55:35] all of the above. And if you
[55:36] aren't in Medicaid right now at
[55:39] some point in your life,
[55:40] you may be and chances are
[55:41] great that, you know, someone
[55:42] who is this is really in a
[55:44] central program for so many.
[55:45] It's a lifeline for Minnesota,
[55:47] both for the individuals,
[55:48] but also for our health care
[55:50] delivery system. And as we root
[55:51] out fraud, waste and abuse, we
[55:53] know that we have an imperative
[55:55] to maintain continuity of care
[55:57] and access to service.
[56:00] That said, as I mentioned in my
[56:01] opening comments, we are under
[56:03] some extraordinary and in fact
[56:05] unprecedented circumstances.
[56:07] I know we are all tired of that
[56:08] word in Minnesota,
[56:09] unprecedented. But
[56:10] unfortunately, that is where we
[56:11] are.
[56:12] We are still dealing with
[56:13] potentially 2 billion dollars
[56:14] in cuts and another 550 million
[56:17] dollars and freezes. And of
[56:19] course, the 2 billion dollars
[56:20] in potential cuts is is what it
[56:22] is this associated with are
[56:25] tied to this review allegation
[56:26] effort that has been
[56:27] extraordinary faster and more
[56:29] expensive or fix expansive
[56:31] rather than any state has ever
[56:33] undertaken. And we should note
[56:35] that this 550 million dollars
[56:37] that is frozen that could
[56:39] eventually be clawed back.
[56:41] And the federal government has
[56:42] indicated the Centers for
[56:43] Medicare, Medicaid Services
[56:44] have indicated that it is
[56:46] possible they could claw back a
[56:47] number that is greater than the
[56:49] 550 million dollars that has
[56:51] been frozen. So just to
[56:52] underscore the great threat and
[56:55] the risk that we are grappling
[56:56] with in the reason for doing
[56:59] some of the work that we've
[56:59] been doing.
[57:02] So with respect to Minnesota,
[57:03] to validate all a review,
[57:05] some of what we talked about
[57:06] earlier in the summer in this
[57:07] forum, the federal Centers for
[57:09] Medicare and Medicaid Services
[57:11] required this effort to be done
[57:13] by May 31st as a part of our
[57:15] corrective action plan. And
[57:16] they directed us to undertake
[57:18] both in in a letter from the
[57:20] Administrator, Dr Oz in
[57:22] December and again in January,
[57:25] under great pressure to do it
[57:26] as quickly as we could. And
[57:27] with great public criticism for
[57:29] the time that we that we we
[57:31] requested to complete this
[57:33] effort. And again, this this
[57:35] 2 billion dollars that's a
[57:36] threat associated with this
[57:38] effort. And the broader
[57:39] corrective action plan is about
[57:40] one 3rd of annual disability
[57:41] waiver spending. I just want to
[57:43] know that the bottom of this
[57:44] slide, other states have now
[57:45] been given 2 years to do what
[57:47] we have done in 5 months,
[57:49] though, we continue to process
[57:50] the appeals as a result of that
[57:52] effort. And again, I'll just
[57:55] say that we've heard the
[57:57] feedback it or did lead
[57:58] throughout this process through
[57:59] a number of forums,
[58:01] communications engagement with
[58:02] providers and of a number of
[58:03] different ways and will
[58:05] continue to to revise and to
[58:08] adjust the way that we are
[58:09] doing the work to be responsive
[58:11] to what's being experienced in
[58:12] the community,
[58:15] moving on to what we've done to
[58:17] meet this moment. So given the
[58:19] extraordinary circumstances
[58:20] presented to us in the
[58:21] direction presented by the
[58:22] federal government, we set up
[58:24] an incident command within the
[58:26] department, bringing in 100
[58:27] staff from across the state
[58:29] enterprise and other
[58:30] departments to help us,
[58:31] particularly with the site.
[58:32] Visit portion of this work made
[58:35] nearly 10,000 calls to
[58:36] providers, including 4,000
[58:39] through the provider, a call
[58:39] center and of course, doing
[58:41] weekly, provide around tables,
[58:43] producing a number of
[58:44] resources, whether it be
[58:45] webinars paper.
[58:48] >> In addition to additional
[58:49] meetings, office hours and
[58:51] in-person meetings and
[58:53] different meetings with
[58:54] provider associations to again
[58:55] hear feedback and to adjust as
[58:57] we went, given the
[58:58] extraordinary direction from
[59:00] the federal government. It
[59:02] feels important for me to say
[59:03] what I said it on July 1st at
[59:05] this hearing, which is we
[59:07] understand this is not been
[59:08] perfect. We are not perfect at
[59:10] the departments. And again,
[59:11] we've sought to engage and will
[59:13] continue to seek feedback.
[59:15] It just communicate
[59:16] proactively. And of course,
[59:18] we'll do that with advocates
[59:19] and legislators, lead agencies,
[59:21] including tribal nations,
[59:22] counties and managed care
[59:24] organizations. And today we're
[59:25] here to continue that effort
[59:27] knowing there's no finish line
[59:28] here that program, integrity
[59:30] and Medicaid, the work of
[59:32] government is continuous
[59:33] improvement. That is the
[59:34] essence of what we do
[59:36] with respect to a quick update
[59:37] here on the numbers. The total
[59:39] number of providers out of the
[59:42] roughly 5800 that were read
[59:43] elevated total read audited
[59:45] providers to date is about
[59:47] almost 3600. So we're we have a
[59:49] majority who are retaliated
[59:52] a little over 1500 are still an
[59:54] appeal.
[59:55] Excuse me. Those appeals are
[59:56] completed. So of the 30 to the
[59:59] 35 87, 1500 have had their
[1:00:03] appeals completed. They are we
[1:00:04] validated remaining incue in
[1:00:06] the process are a little under
[1:00:08] 1200 providers and we are
[1:00:10] continuing to work through the
[1:00:11] through those the major
[1:00:13] challenge that we haven't.
[1:00:14] We heard the feedback from
[1:00:16] those that testified at the
[1:00:17] beginning of the hearing here
[1:00:19] about the paperwork, the
[1:00:21] difficulties they've
[1:00:21] experienced, the delays.
[1:00:23] We understand that we are aware
[1:00:25] of that and we're doing our
[1:00:26] best to minimize those issues.
[1:00:28] I will note we are we are doing
[1:00:31] our best to it or Dudley work
[1:00:33] with providers to address the
[1:00:35] gaps in the documentation
[1:00:37] they're submitting to make this
[1:00:39] more streamlined. But again, if
[1:00:41] we're continuing to grapple
[1:00:43] with issues with the
[1:00:43] documentation, we cannot
[1:00:45] approve 3 validation. That is,
[1:00:47] of course, our charge as the
[1:00:49] Medicaid agency. We owe these
[1:00:51] these certain requirements to
[1:00:53] be in place with respect to
[1:00:54] qualified staff insurance,
[1:00:57] background checks, checks, et
[1:00:58] cetera, for the people that we
[1:01:00] serve. In addition to, I think
[1:01:02] the public that expects these
[1:01:03] things to be upheld and
[1:01:05] reviewed. So we will do our
[1:01:06] best to do that in a way that
[1:01:08] that supports providers.
[1:01:09] I will note it's just incumbent
[1:01:11] on me to say that CMS has been
[1:01:14] as question to the number of
[1:01:15] times that we have worked with
[1:01:17] providers to get this right.
[1:01:18] So we are definitely under
[1:01:20] examination scrutiny for how we
[1:01:21] are handling this. But again,
[1:01:23] our aim is to to help put an
[1:01:25] end to providers, get re
[1:01:26] validated, to provide service,
[1:01:28] to maintain access to service
[1:01:30] in the program. Again, hearing
[1:01:31] what's been what's been stated
[1:01:33] here today from community
[1:01:34] members and providers.
[1:01:36] I'm a little bit more about the
[1:01:39] I think the points that were
[1:01:40] made from some that testified
[1:01:41] about the balance between the
[1:01:43] re validation Worth's
[1:01:44] extraordinary effort that we
[1:01:46] did in 5 months and the regular
[1:01:48] provider enrollment work that
[1:01:49] is backlogged. We did set aside
[1:01:52] the bulk of the work with
[1:01:53] respect to provider enrollment
[1:01:55] compliance work streams to
[1:01:57] prioritize the validation were
[1:01:59] given the tremendous figures
[1:02:00] that you saw in the earlier
[1:02:01] slides with respect to federal
[1:02:03] dollars that are at risk.
[1:02:04] That said, we have heard from
[1:02:06] community and from legislators,
[1:02:08] some of them are present here
[1:02:09] today that we need to rebalance
[1:02:11] that work. So we have begun to
[1:02:12] do that. We have expanded the
[1:02:15] number of staff that are
[1:02:16] working on regular provider
[1:02:17] enrollment work and reduced to
[1:02:19] a degree of allegation capacity
[1:02:23] to have a better balance
[1:02:25] between some of the the regular
[1:02:27] enrollment work hearing.
[1:02:28] The pressures that providers
[1:02:30] are under and that people are
[1:02:31] under with respect to enrolling
[1:02:33] new providers and updating
[1:02:35] records that providers have
[1:02:36] with us.
[1:02:38] In addition, we are trying to
[1:02:40] make the overall size of the
[1:02:41] provider enrollment in
[1:02:42] compliance team larger. We are
[1:02:44] hiring. We anticipate in the
[1:02:47] coming days and weeks hiring up
[1:02:49] to roughly the little under 30
[1:02:50] new people for that team to
[1:02:52] provide new capacity for both
[1:02:54] the rehabilitation work and the
[1:02:56] regular provider and Roman
[1:02:58] work. So that is and in the
[1:03:01] name of being responsive to
[1:03:02] some of the feedback we heard
[1:03:03] earlier also say again, that
[1:03:06] should help us process some of
[1:03:08] the remaining revalidation work
[1:03:10] faster.
[1:03:12] So I think with that I can
[1:03:15] pause on the rehabilitation
[1:03:16] after we have continuity of
[1:03:17] care slides here to come.
[1:03:19] I don't know, chair if you want
[1:03:20] to take questions at this point
[1:03:22] or are keeping the questions
[1:03:24] for commissioner
[1:03:28] because there's a
[1:03:30] three-second delay to anybody
[1:03:32] online.
[1:03:35] No. All right. Thank you.
[1:03:38] Go ahead, Jeff Commissioner,
[1:03:40] thank you chair often.
[1:03:42] So we'll we'll start this
[1:03:43] portion of the presentation.
[1:03:46] I think we lost the slides on
[1:03:48] the screen and the folks can
[1:03:49] see there we go. Okay.
[1:03:51] We know the continuity of care
[1:03:53] is paramount and it is
[1:03:54] essential to the way that folks
[1:03:56] experience the Medicaid program
[1:03:58] have continuity of care and
[1:03:59] also coordination among the
[1:04:01] array of services that they
[1:04:02] need again to help them live
[1:04:04] their healthiest and Phyllis
[1:04:05] lives and community and have
[1:04:07] integrated rational services
[1:04:09] that that makes sense relative
[1:04:11] to one another that they're
[1:04:12] coordinated. And as we know,
[1:04:13] and as many of stated here
[1:04:14] today, very, very articulate
[1:04:17] Lee and very well, this
[1:04:19] prevents on this unnecessary
[1:04:21] hospitalization and
[1:04:22] institutionalization and helps
[1:04:23] people live in the most
[1:04:25] community-based setting in
[1:04:26] accordance with Olmstead and of
[1:04:28] course, honors personal choice
[1:04:30] and direction of the services
[1:04:31] that people that people need
[1:04:33] and and also integrates their
[1:04:35] goals for their treatment and
[1:04:36] for their their overall lives
[1:04:38] and well-being.
[1:04:40] So the vision for continuity of
[1:04:41] care speaks to those those
[1:04:43] elements. First of all,
[1:04:44] seamless transitions between
[1:04:46] providers or different types of
[1:04:47] care, particularly from an
[1:04:48] institution into community,
[1:04:50] again, in alignment with
[1:04:52] Olmstead. That is our goal for
[1:04:53] folks to move whenever
[1:04:54] possible. And when it is with a
[1:04:57] within people's choice and
[1:04:58] goals to move into
[1:05:00] community-based settings
[1:05:01] whenever possible
[1:05:02] that we have consistent support
[1:05:04] teams, even if there's
[1:05:05] transition from one provider to
[1:05:07] another within a service that
[1:05:08] other providers, our constant,
[1:05:10] that they are coordinated,
[1:05:12] of course, coordinated plan,
[1:05:13] support plans, making sure that
[1:05:15] all of these things are
[1:05:16] aligned, whether it's housing,
[1:05:18] health services, personal care,
[1:05:20] and also integration and
[1:05:22] community so that all of those
[1:05:23] needs are accounted for and
[1:05:24] again, make sense together,
[1:05:29] most of the course.
[1:05:31] All right. So a little bit
[1:05:32] more. We want to be responsive
[1:05:34] to the request for an outline
[1:05:35] of the reimbursement or payment
[1:05:36] mechanisms for it for the
[1:05:39] services. And there are 3 major
[1:05:41] frameworks for this. Of course,
[1:05:43] the first is the disability
[1:05:45] waiver rates system framework
[1:05:46] or D WRs as it's known for
[1:05:49] those who are initiated and of
[1:05:51] course market rates. The second
[1:05:54] that all know here on the slide
[1:05:55] is community for services and
[1:05:56] supports or CFS S and that is a
[1:05:59] separate raid framework.
[1:06:01] And then 3rd, there are state
[1:06:03] plan services that have flat
[1:06:04] rates and in some cases
[1:06:05] depending on the benefit or
[1:06:06] service, there are inflationary
[1:06:08] updates so they could could be
[1:06:09] indexed in that fashion.
[1:06:11] A couple of examples or home
[1:06:12] care, nursing. And of course,
[1:06:13] the IDB I which is our benefit
[1:06:16] for youth, autism services
[1:06:20] a little bit more here on
[1:06:21] waiver rates and exceptions.
[1:06:23] So current reimbursement models
[1:06:25] are, as you see here on the
[1:06:26] slide configurable. So they are
[1:06:28] individualized rates depending
[1:06:30] on what individuals support
[1:06:32] plan includes and what their
[1:06:34] needs are. So the rates will
[1:06:37] vary from person to person
[1:06:38] depending on what their needs
[1:06:39] are and what services they
[1:06:40] require. Staffing levels are a
[1:06:42] key piece of what rates might
[1:06:44] be and again, depend on what
[1:06:46] the individual's needs are.
[1:06:47] And I think we heard a lot
[1:06:48] about this in the opening
[1:06:49] testimony about how different
[1:06:51] types of professionals
[1:06:52] clinicians are engaged,
[1:06:54] depending on what individuals
[1:06:55] needs might be.
[1:06:56] That said there is a process
[1:06:58] for providers to request an
[1:06:59] exception. If the the
[1:07:01] frameworks that we have to not
[1:07:03] yield the rate that they feel
[1:07:05] fully accounts for the needs
[1:07:07] that individual has in the
[1:07:08] services are professionals.
[1:07:09] They require so lead agencies
[1:07:12] may receive a request for an
[1:07:13] exception or exception. Excuse
[1:07:15] me. And DHS and lead agencies
[1:07:17] have 30 days to review that and
[1:07:19] then respond to the request.
[1:07:22] Providers may appeal, of
[1:07:24] course, if that rate exception
[1:07:25] is denied. So there is a
[1:07:26] process for that as well.
[1:07:28] Subsequent to that
[1:07:29] DHS, of course, we're always
[1:07:31] continuing to improve the
[1:07:32] processes by which we do the
[1:07:33] work to do it as efficiently
[1:07:35] and timely as possible, having
[1:07:37] consistency across the agencies
[1:07:39] across counties in the state
[1:07:42] and of course, want want the
[1:07:43] process to be clear and
[1:07:45] transparent to providers and to
[1:07:47] the people receiving services
[1:07:48] of the members of our programs,
[1:07:50] particularly when the approved
[1:07:52] rate is not what the providers
[1:07:53] sought.
[1:07:55] We're also implementing reforms
[1:07:56] to WRs that rate framework.
[1:08:00] Pursuant to, of course, the
[1:08:01] acts of the legislature signed
[1:08:03] by the governor, of course,
[1:08:04] after the during the last 2
[1:08:06] sessions and those include
[1:08:07] changes to approve the waiver.
[1:08:09] 8 exceptions if they are
[1:08:12] supported by documentation of
[1:08:14] the staffing need for the tool
[1:08:16] that served
[1:08:18] commissioner. Yes, I'm just a
[1:08:21] couple of things said.
[1:08:22] >> Thank you. You're going to
[1:08:23] go into what we did to 2026
[1:08:25] legislature, which led, which
[1:08:26] is leading to this
[1:08:27] conversation, Cathy Care, which
[1:08:29] is also, but on the radar
[1:08:30] exception,
[1:08:31] if I understand it right, is
[1:08:33] that
[1:08:36] need to nursing services are in
[1:08:37] need. That's basically what
[1:08:39] we're getting is the
[1:08:39] understanding of these needs
[1:08:41] nurses who says is it the
[1:08:42] contracted case manager that
[1:08:44] makes that first decision or
[1:08:46] what I feel it is to go to
[1:08:47] Kristie.
[1:08:49] I mean, think you think it
[1:08:50] that, Christine, by the way,
[1:08:51] I forward everything to her
[1:08:53] that comes to us. You do.
[1:08:54] You have no idea what what you
[1:08:56] have. So especially with the
[1:08:57] knowledge base when you study
[1:08:59] WRs,
[1:09:00] do you realize 12 years ago and
[1:09:02] we first had the dws
[1:09:03] conversation. He was Heidi
[1:09:05] Hamilton, Alec part live in.
[1:09:09] So
[1:09:10] that was something to to help
[1:09:12] me understand that piece
[1:09:14] because I can't wrap my hands
[1:09:15] around it if our
[1:09:16] responsibilities to make sure
[1:09:18] the most of our own people are
[1:09:20] getting the services they need.
[1:09:23] And here's one where an RN or a
[1:09:25] doctor has said this child or
[1:09:27] this. This adult needs this.
[1:09:30] And somebody saying no
[1:09:34] common sense would say, well,
[1:09:35] why is this any different than
[1:09:37] it was 6 months ago? So help me
[1:09:39] understand that. So give us a
[1:09:41] first pass. And then I refer to
[1:09:42] Christine because as you
[1:09:43] suggested,
[1:09:44] >> she is one of the original
[1:09:46] designers of this and knows
[1:09:48] more than I do about it.
[1:09:49] I say that freely and with
[1:09:51] great humility. So I think the
[1:09:53] answer to your question,
[1:09:54] chair Hoffman is yes. So the
[1:09:56] first pass is with the the case
[1:09:59] manager and that could be with
[1:10:00] a contracted agency. It could
[1:10:02] also be a county employee if
[1:10:05] the county is directly
[1:10:06] providing that service but they
[1:10:07] would develop the
[1:10:08] individualized support plan and
[1:10:10] the the the rate. But
[1:10:12] Christine, feel for the at what
[1:10:13] I said. That's correct.
[1:10:17] >> Our chair and committee
[1:10:18] Kristin Graham with the
[1:10:19] Department of Human Services
[1:10:21] Commissioner Kelly described it
[1:10:23] accurately. I think one of the
[1:10:24] complications here and
[1:10:25] complexities with nursing
[1:10:27] services is that fundamentally
[1:10:29] nursing services is paid for
[1:10:31] under our state plan.
[1:10:33] There are some unique
[1:10:34] situations and or waivers where
[1:10:36] the rate can be modified to
[1:10:38] account for RN or lpn duties.
[1:10:42] But under the state plan, those
[1:10:44] services can be authorized a
[1:10:46] little bit differently. Those
[1:10:47] usually happen. They they're
[1:10:48] author is typically through the
[1:10:49] Home Care nursing agency
[1:10:52] and then they go through the
[1:10:53] prior authorization process and
[1:10:55] get delivered by either home
[1:10:57] care, nursing Service or a
[1:10:59] skilled nurse, is it?
[1:11:01] >> Thank you for that. It did
[1:11:02] then answer the question that
[1:11:04] first process. So there's
[1:11:06] clearly a communications issue
[1:11:09] between the that contracted
[1:11:12] case manager to lead agency and
[1:11:14] the department on the unique
[1:11:15] needs of an individual. Not
[1:11:17] only that, but then I shared a
[1:11:18] letter that I had teen in the
[1:11:20] email where one of the contract
[1:11:22] and case managers was really
[1:11:26] basically when you say
[1:11:27] somebody, what is it? You still
[1:11:29] an ESL? You know it just it
[1:11:32] blows me away. It really gives
[1:11:33] that
[1:11:36] system of rule bad name.
[1:11:39] When I shared. I think you have
[1:11:40] a copy of that.
[1:11:42] So that would
[1:11:43] hens me to ask the question,
[1:11:45] are we doing everything we can
[1:11:46] to ensure that somebody knows
[1:11:48] the system or in the statutory
[1:11:51] system that we play step in
[1:11:52] there? And so maybe that's a
[1:11:54] conversation with Paul gets
[1:11:55] after. We could have that,
[1:11:57] you know, counties, the lead
[1:11:59] agency, the department have a
[1:12:01] consumer. Maybe we'll wait on
[1:12:02] that one. Commissioner, let you
[1:12:04] go into what we did in 2026,
[1:12:06] thank you for.
[1:12:09] >> Thank you, chair of and
[1:12:10] thank you. Christie for the
[1:12:11] assist there. And I agree she's
[1:12:14] a tremendous asset to us.
[1:12:16] All. Just all know that as
[1:12:17] well. And certainly if there
[1:12:19] are issues, we are all years to
[1:12:21] all partners about how to solve
[1:12:23] those issues and whether its
[1:12:25] legislators, yourself, the
[1:12:26] counties as well as agencies
[1:12:30] moving on to the continuity of
[1:12:31] care reforms that were passed
[1:12:33] during the last session and
[1:12:34] signed by the governor. Of
[1:12:36] course, these reforms create
[1:12:38] new requirements for the state,
[1:12:40] the lead agencies and providers
[1:12:41] themselves to ensure continuity
[1:12:43] of service. When there is an
[1:12:44] interruption in care, it could
[1:12:46] be for program integrity reason
[1:12:47] or for other reasons. But for
[1:12:50] all of the above their new
[1:12:51] requirements in place and for
[1:12:53] providers specifically, there
[1:12:55] must be a notification to the
[1:12:57] program members. So they know
[1:12:58] that there is going to be in an
[1:13:00] interruption and care for the
[1:13:01] current serving provider and
[1:13:03] they need notification needs to
[1:13:05] go to the program member before
[1:13:07] services are terminated.
[1:13:08] Lead agencies also have a few
[1:13:10] requirements here that are new.
[1:13:12] They have to inform the Butts
[1:13:13] persons office. They have to
[1:13:15] notify recipients or program
[1:13:17] members as well as they also
[1:13:19] have to assist providers in
[1:13:20] developing a continuity of care
[1:13:21] plan. If they stopped stopped,
[1:13:23] providing services are planned
[1:13:25] to rather. And then if there is
[1:13:27] an identification of a person's
[1:13:29] need to be complex, they must
[1:13:31] have a complex transition plan
[1:13:33] in place and work with the just
[1:13:35] to oversee that to ensure
[1:13:37] continuity of care.
[1:13:38] Dhs has responsibilities as
[1:13:40] well. Must make efforts to
[1:13:43] notify lead agencies if we are
[1:13:44] going to take an administrative
[1:13:45] action relative to program
[1:13:47] integrity in advance of taking
[1:13:49] that action, identify
[1:13:51] potentially impacted
[1:13:52] recipients. So we're sharing
[1:13:53] that information with the lead
[1:13:55] agency. So they know
[1:13:56] individuals that may have an
[1:13:57] interruption in service because
[1:13:58] of an administrative action and
[1:14:01] also ensure that lead agencies
[1:14:03] are taking the steps needed to
[1:14:04] ensure provision of of
[1:14:06] necessary services to
[1:14:08] coordinate care and provide
[1:14:09] continuity and ensure that
[1:14:11] there's yes, chair of it.
[1:14:12] No, I was going to tell you
[1:14:13] finish your sentence or the
[1:14:15] representative that was Liz
[1:14:17] cannot. She's a has a she's got
[1:14:19] her hand up. So when you when
[1:14:21] you get to your end of that
[1:14:22] point and will cut Natalie,
[1:14:24] sure, and I think a couple of
[1:14:25] key considerations are, of
[1:14:27] course, that individual's
[1:14:28] choice of providers respected
[1:14:30] and they have housing. Of
[1:14:31] course, that's a key
[1:14:32] consideration when providers
[1:14:35] stop providing services and of
[1:14:37] course, we have a requirement
[1:14:39] to establish a continuity of
[1:14:40] care team with resources.
[1:14:42] So thanks to the legislature
[1:14:43] for that so that we can support
[1:14:46] lead agencies in executing
[1:14:47] these transition of care plans.
[1:14:50] Thank you, Representative
[1:14:51] Tillis, the car.
[1:14:53] >> Thank you. Chair happen and
[1:14:56] thank you, Commissioner calmly
[1:14:58] and I really do appreciate how
[1:15:00] responsive even I had many
[1:15:02] questions and also too
[1:15:04] to Christiane, thank you both
[1:15:06] from how as we work through
[1:15:08] these issues. Question is on
[1:15:10] the graph that you showed on
[1:15:12] the number 3 validated
[1:15:13] providers. I know when we
[1:15:15] started, I think when we met in
[1:15:16] July, there was 5,600,
[1:15:19] something total providers.
[1:15:21] I'm going by and I don't know
[1:15:22] what the total exact was.
[1:15:24] I don't have that for me back.
[1:15:25] My question is that of the
[1:15:28] society have today? There's
[1:15:30] 1542 appeals that are
[1:15:32] completed. My question is,
[1:15:34] is there a dashboard that shows
[1:15:36] you know what, where who are
[1:15:38] the providers? What 5 into the
[1:15:40] state are they and who are they
[1:15:42] serving? Is it is it the I D D
[1:15:44] I is it. You know, assisted
[1:15:47] living is a non emergency
[1:15:49] transportation. I'm curious if
[1:15:51] we have any data, I'm you know,
[1:15:54] how are their 10 providers in
[1:15:56] each category that had been
[1:15:57] completed for the Metro,
[1:15:59] the suburbs, the central part
[1:16:00] of the state, northeast
[1:16:01] northwest and the same question
[1:16:03] for the appeals and progress.
[1:16:05] And the reason I ask this is
[1:16:07] that it appears I'm wondering,
[1:16:09] you know, when we have one or 2
[1:16:12] providers for non emergency,
[1:16:13] transportation are known to
[1:16:15] providers. You know what the
[1:16:16] plan is because it's a
[1:16:17] federally required
[1:16:19] program. And from what I can
[1:16:21] see in the part in the
[1:16:23] northeastern part of the state,
[1:16:25] I'm very concerned. I in in a
[1:16:27] specific category non-emergency
[1:16:29] transportation specifically in.
[1:16:32] So if yes, we have limited
[1:16:35] provider, says it is in
[1:16:36] nobody's re-evaluated. Then at
[1:16:39] explains to me why the nursing
[1:16:40] homes are paying $5,000 a
[1:16:42] month.
[1:16:43] And they're not gonna get that
[1:16:44] money back because we already
[1:16:45] made changes to that. They're
[1:16:47] transporting, too. I dialysis
[1:16:50] and these things. And there's
[1:16:51] no there's actually getting
[1:16:52] reimbursement for. So we're
[1:16:54] we're creating and other issues
[1:16:56] right now. And I'd love to know
[1:16:57] what that dashboard looks like.
[1:16:59] >> For for, you know.
[1:17:02] >> The ones that are still in
[1:17:03] process are the ones that are
[1:17:04] completed where they are the
[1:17:06] findings of the state and who
[1:17:08] they are. What category the
[1:17:10] falling of the 13 14 programs
[1:17:12] that were high risk.
[1:17:13] >> Thank you. Thank you.
[1:17:14] Representative was the car
[1:17:15] Commissioner
[1:17:17] Chair Hoffman representatives
[1:17:18] lets the car we share your
[1:17:19] concern about access to care,
[1:17:21] certainly in northeast
[1:17:22] Minnesota, but everywhere in
[1:17:23] Minnesota. And the answer to
[1:17:25] your question is, yes, we do
[1:17:26] have that dashboard and we will
[1:17:28] send updated numbers by region
[1:17:30] by service across the different
[1:17:32] 13 high-risk services that are
[1:17:34] going through a validation with
[1:17:36] you very shortly. So we have
[1:17:37] those data and we will share
[1:17:38] them with all of you. Thank
[1:17:40] you. Thank you, Jen follow-up,
[1:17:41] Natalie. Good
[1:17:42] and it. All right,
[1:17:44] commissioner,
[1:17:51] excuse me, chair up and just
[1:17:52] leaving back to the current
[1:17:54] slide.
[1:17:58] I think that's good. All right.
[1:17:59] So a few more things here with
[1:18:02] respect to continuity of care,
[1:18:03] implementation. So pursuant to
[1:18:05] the 2026 legislation, we're
[1:18:07] starting by looking at our own
[1:18:10] staff, our own capacity, our
[1:18:12] own infrastructure, to do this
[1:18:13] work looking inward to make
[1:18:15] sure that we have a plan for
[1:18:16] how to approach this. And of
[1:18:17] course, we want to talk to
[1:18:19] different folks, leaders within
[1:18:21] the department to do this work
[1:18:23] for the different benefits and
[1:18:24] different parts of the
[1:18:25] organization. So we need to
[1:18:26] come together, have an
[1:18:27] interdisciplinary approach
[1:18:28] that's consistent and
[1:18:30] responsive to community and
[1:18:31] providers and to to inform how
[1:18:34] we develop these functions in
[1:18:36] the spirit of the legislation
[1:18:37] that was passed and signed.
[1:18:40] The work is going to be
[1:18:41] basically the work of creating
[1:18:44] this new team to ensure that we
[1:18:46] do this in a consistent way
[1:18:47] that makes sense and is
[1:18:48] responsive, irrespective,
[1:18:49] again of the service, whether
[1:18:50] it's behavioral health, aging
[1:18:51] and disability services, health
[1:18:53] care, et cetera.
[1:18:55] And that we're also making
[1:18:57] clear what our roles are in
[1:18:58] this as an agency for specific
[1:19:00] staff doing the work and and
[1:19:02] what the expectations of the
[1:19:04] agency are for the community,
[1:19:05] that staff you empower, they
[1:19:07] know what to do. They know how
[1:19:08] to interact with external
[1:19:09] partners and that we're
[1:19:10] creating an efficient approach
[1:19:13] that's responsive and create
[1:19:14] seamless Nissen, the system for
[1:19:16] it for the people served.
[1:19:18] I also want to note, too, that
[1:19:20] housing is of particular
[1:19:22] importance here understanding,
[1:19:24] I think with the focus of the
[1:19:27] chair and others here on making
[1:19:28] sure that folks do not become
[1:19:29] unhoused as a result of, you
[1:19:32] know, interruptions in service
[1:19:33] by a provider that is funded by
[1:19:35] Medicaid. I do want to note
[1:19:37] that housing itself is not
[1:19:38] reimbursed are paid for by
[1:19:40] Medicaid, but a service
[1:19:42] components in housing settings
[1:19:44] are. And so that said DHS does
[1:19:47] have tools at its disposal with
[1:19:49] respect to housing, support the
[1:19:50] housing support program that is
[1:19:52] separate from Medicaid estate
[1:19:53] only program to support housing
[1:19:56] capacity. And so there are
[1:19:57] grants will be available coming
[1:19:59] out of the 2020 succession for
[1:20:01] a 4 counties in the agency's
[1:20:04] for this. And it expands the
[1:20:07] capacity for those grants.
[1:20:08] So a couple of updates here
[1:20:10] with respect to our
[1:20:11] implementation of those those
[1:20:12] housing capacity granted the
[1:20:14] expansion of them. We held an
[1:20:16] initial interest session with
[1:20:17] community partners in July 7th
[1:20:19] earlier this summer, soliciting
[1:20:21] feedback about the the RFP and
[1:20:23] its development. It's under
[1:20:25] review now with with DHS staff
[1:20:27] were on track. However, to to
[1:20:29] post that by the 21st of this
[1:20:31] month, we will have responders
[1:20:33] conference at the end of the
[1:20:34] month and the 30th so any
[1:20:36] interested applicants can can
[1:20:38] attend and ask questions and
[1:20:41] applications are due on
[1:20:42] November 18th. So that is the
[1:20:44] broad timeline. We expected
[1:20:46] funding decisions will be
[1:20:47] issued likely in January.
[1:20:51] So we'll have the prewar risk
[1:20:53] assessment in January decisions
[1:20:55] in December. And so funding
[1:20:57] should go out to to the Ortiz
[1:20:59] in late January, if not shortly
[1:21:01] thereafter.
[1:21:02] So I think those are my
[1:21:04] comments with respect to
[1:21:05] continuity of care. Again,
[1:21:06] sure, half. I'm not sure if
[1:21:07] your preference is to take your
[1:21:08] questions at this point or 2
[1:21:09] people.
[1:21:10] >> I think people are great.
[1:21:11] If you want to transition.
[1:21:13] I do. There's another piece.
[1:21:15] Commissioner I
[1:21:17] I sent a request out to meet
[1:21:20] with people regarding the
[1:21:21] Olmsted you'd mention on state
[1:21:23] early on in the that the
[1:21:25] proposed onsted plan. I the
[1:21:29] hearing from a lot of us.
[1:21:33] >> Feeling like they were not
[1:21:34] part of that. This is not your
[1:21:36] response to you. It's part of
[1:21:38] your responsibility. But you
[1:21:39] know that he created this
[1:21:40] Homestead
[1:21:41] Peace. And I'm concerned that
[1:21:43] this September 15th
[1:21:48] plan being adopted by the
[1:21:50] committee doesn't reflect the
[1:21:52] individuals that are receiving
[1:21:53] the services and the media and
[1:21:55] the September 11th with that,
[1:21:58] I think the housing
[1:21:58] commissioner, but it would be
[1:22:01] it would it would be nice if
[1:22:03] Christie, if somebody from your
[1:22:05] office was also able to attend.
[1:22:07] I know this year that but that
[1:22:09] just something to put out
[1:22:10] there. But somebody who
[1:22:11] understands Olmstead a
[1:22:14] it may be a decision that took
[1:22:16] Minnesota 17 years to put a
[1:22:17] plan together because of a
[1:22:19] federal judge. And Donovan
[1:22:20] Frank was amazing individual,
[1:22:22] by the way. And we're getting
[1:22:23] details on that.
[1:22:25] That is
[1:22:26] that is a concern to so.
[1:22:29] And then there was one other
[1:22:30] piece that we can talk about
[1:22:33] the the transitions. So thank
[1:22:35] you for your time members.
[1:22:37] I don't see any hands up.
[1:22:40] So thank you. Commissioner will
[1:22:41] transition to the
[1:22:44] contractor that case banishment
[1:22:46] to skate discussion. Maybe we
[1:22:48] should get Paul to come up to
[1:22:50] an end.
[1:22:51] >> Luella still with us.
[1:22:52] Thank you all the way from.
[1:22:54] >> The head of the county.
[1:22:55] And then
[1:22:58] I think Pat Meacham from Pine
[1:22:59] County is going to join us.
[1:23:01] You that you need 3 chairs up
[1:23:02] here
[1:23:03] just so we can have that this
[1:23:04] thank you for you. You can
[1:23:06] folks for letting me be
[1:23:08] flexible. I may
[1:23:10] and my in this committee today,
[1:23:28] no one wants to supply.
[1:23:30] I just, you know, Chris, Hedges
[1:23:32] that this would make sense
[1:23:33] because you and Paul have that,
[1:23:34] you know, we're having the same
[1:23:35] conversation you might as well
[1:23:37] have everybody at the table to
[1:23:38] really, you know, do that.
[1:23:40] And I and I appreciate you
[1:23:41] doing that. But Christy scrum,
[1:23:44] director of state government
[1:23:45] relations at the department,
[1:23:48] my choice because here, too.
[1:23:50] But he's going to go after you
[1:23:51] do so or during it.
[1:23:54] Thank you. Thanks for being
[1:23:55] here.
[1:23:56] >> Thank you. Mr. Chair led to
[1:23:57] participate in this discussion.
[1:24:00] So I'm going to talk briefly,
[1:24:01] but Weaver case management a
[1:24:03] little bit about quality
[1:24:04] oversight. I think we have a
[1:24:05] lot of shared goals between
[1:24:07] DHS, the legislature, counties.
[1:24:09] I'll try to move quickly.
[1:24:10] So we've got time for everyone
[1:24:11] to to give their input here.
[1:24:14] But I'm gonna go over sort of
[1:24:15] case management basics just to
[1:24:16] guide you through what I'm
[1:24:17] going to talk about and then go
[1:24:20] over some of the oversight
[1:24:21] facets of waiver case
[1:24:22] management. And then lastly,
[1:24:24] an implementation update of
[1:24:25] some of the reforms that passed
[1:24:26] last session. Thanks to all of
[1:24:27] your important work. So to
[1:24:30] start wanted to talk just about
[1:24:32] some basic some level setting
[1:24:34] on what waiver hcbs case
[1:24:36] management is. And before I get
[1:24:38] into that, I do just want to
[1:24:39] say
[1:24:41] case management is a really
[1:24:42] critical part of our waiver and
[1:24:44] ltsa system. We cannot have a
[1:24:46] fully integrated system without
[1:24:50] good case management. So this
[1:24:51] is a really important service.
[1:24:53] We are really heartened to know
[1:24:55] that the legislature standing
[1:24:56] with us and talking about
[1:24:58] reforms both here today,
[1:25:00] last session, hopefully into
[1:25:01] the future.
[1:25:02] So just to kind of give you a
[1:25:03] brief overview, hcbs case
[1:25:06] management and care
[1:25:07] coordination are supports that
[1:25:09] are provided under the
[1:25:09] disability waivers sometimes
[1:25:12] called Kat Katty, be IMDB as
[1:25:15] well as alternative care and
[1:25:16] essential community supports.
[1:25:18] So case management really helps
[1:25:20] connect people with the
[1:25:22] services that they need
[1:25:23] provides referrals for the
[1:25:24] services that they need.
[1:25:25] Authorizations chair. Half when
[1:25:28] you mentioned some of the work
[1:25:29] that occurs between when a
[1:25:30] person has a change in need,
[1:25:32] the case manager might need to
[1:25:33] authorize that service and
[1:25:35] really working with the person
[1:25:36] across the continuum to make
[1:25:38] sure they've got informed
[1:25:39] choice and that services are
[1:25:40] being delivered in a
[1:25:41] person-centered way. So this is
[1:25:44] really important, critical
[1:25:46] aspect for people to be able to
[1:25:47] navigate what is a very complex
[1:25:49] system.
[1:25:51] Informed choice is really
[1:25:53] paramount and the work that
[1:25:54] case managers do as well as due
[1:25:55] process and making sure that
[1:25:56] people know their rights, that
[1:25:57] they have a right to appeal.
[1:25:58] For example, if they don't
[1:26:00] agree with the decision,
[1:26:01] it's also important as we talk
[1:26:03] about program integrity we have
[1:26:05] found over the past couple of
[1:26:06] years as we have initiated and
[1:26:09] more program, integrity,
[1:26:10] reforms. We learn a lot about
[1:26:11] program, integrity, issues from
[1:26:13] our partners, our lead
[1:26:14] agencies, counties, tribal
[1:26:16] nations and managed care
[1:26:17] organizations. So having that
[1:26:19] person, the case manager,
[1:26:21] working closely with an
[1:26:22] individual to understand
[1:26:25] she's Christie's supposed to be
[1:26:26] getting the service, but she
[1:26:27] doesn't appear to be getting
[1:26:28] that service and having that
[1:26:30] connection is really important
[1:26:31] for people. It's really
[1:26:32] important for program integrity
[1:26:33] as well as continuity of care.
[1:26:37] So a little bit about who case
[1:26:39] managers are.
[1:26:41] We heard it stories and share
[1:26:44] half men you've shared and
[1:26:45] other members have shared
[1:26:47] negative outcomes that people
[1:26:49] are having with case
[1:26:50] management. And I think we know
[1:26:52] that those I wish Chrystia
[1:26:53] would get.
[1:26:55] >> Positive outcomes with all
[1:26:55] the e-mails I get are negative
[1:26:57] once and you knew that in the
[1:26:59] days of the committee
[1:27:00] administrative case. Yeah,
[1:27:02] that's the other thing since
[1:27:04] we're going to start it will
[1:27:05] county stuff that met Freeman
[1:27:07] is now back working with the
[1:27:08] counties. But he's not sitting
[1:27:10] in the chair that he always
[1:27:11] would sit in for years over
[1:27:13] there. I see him back there.
[1:27:14] So I just had to bring that to
[1:27:16] light. So go ahead. Well.
[1:27:18] >> March air met Mr. Freeman is
[1:27:20] welcome to come up here,
[1:27:21] too. And we can talk about, you
[1:27:23] know, assessments and
[1:27:24] reassessments in all of all of
[1:27:26] those good things.
[1:27:28] But I did just want to say that
[1:27:30] case managers that while there
[1:27:32] are issues with case
[1:27:34] management, it's not just
[1:27:35] contracted case management.
[1:27:38] It's all case management and
[1:27:40] many case managers do a great
[1:27:42] job.
[1:27:43] And I will say as a former case
[1:27:45] manager and
[1:27:48] case management can change
[1:27:49] people's lives for the better.
[1:27:50] So that's why we're talking
[1:27:51] about here today. And I just
[1:27:53] want to lift up the great work
[1:27:54] that many of our case managers
[1:27:55] are doing at the county level
[1:27:57] at the lead agency level.
[1:27:59] But really our case managers,
[1:28:00] as I mentioned, are the front
[1:28:02] face of it. Helping people
[1:28:05] navigate a incredibly complex
[1:28:07] system that we all have a hand
[1:28:09] in creating and making a
[1:28:10] complex and they have a lot of
[1:28:13] it. Expectations that are laid
[1:28:16] out in state line are Weaver
[1:28:17] plans, but effectively they're
[1:28:19] helping to translate people's
[1:28:21] assess needs and to their
[1:28:22] person center plans are
[1:28:23] authorizing services during
[1:28:25] that informed choice. They're
[1:28:26] supposed to be monitoring
[1:28:27] outcomes, adjusting plans as
[1:28:29] needed. So this is it's a lot.
[1:28:32] And we've we've been talking
[1:28:34] with the legislature with
[1:28:35] counties about making sure that
[1:28:36] we do have really clear duties
[1:28:37] for case managers. What is it
[1:28:39] that we expect as a state case
[1:28:40] managers to do and let's lift
[1:28:42] up those duties and clarify
[1:28:44] them if we need to.
[1:28:48] So when we talk about
[1:28:49] contracted case management,
[1:28:50] this is an activity that many
[1:28:52] lead agencies use increasingly
[1:28:55] to address
[1:28:56] to my slides. Go away for some
[1:28:58] reason.
[1:29:02] >> Sorry, I'm having technical
[1:29:04] issues chair to out me to just
[1:29:05] just the and you can execute.
[1:29:07] Okay. Can keep talking.
[1:29:11] I thought they were up there at
[1:29:12] the time. Accent just got
[1:29:14] questions. Ask Radio Shack just
[1:29:17] a
[1:29:26] a graduate of Saint Francis
[1:29:27] High School that I love it.
[1:29:32] >> All right. So many lead
[1:29:33] agencies use contracted case
[1:29:35] management. We've heard that
[1:29:36] here at DHS. This committee has
[1:29:37] heard it from our county
[1:29:38] partners as well over the past
[1:29:40] session or 2. And we'll hear
[1:29:42] more from the county's about
[1:29:43] why they do that. But, you
[1:29:44] know, they're always looking to
[1:29:46] create smaller case loads to
[1:29:47] supplement gaps and maybe
[1:29:48] experience or specialization.
[1:29:50] Maybe there's individuals who
[1:29:51] have a brain injury, for
[1:29:52] example, and the county's and
[1:29:55] say, you know what, this is
[1:29:56] organization and community is
[1:29:58] just better position to provide
[1:29:59] that case management for that
[1:30:00] individual.
[1:30:02] We also see quite frequently or
[1:30:04] counties more so quite see
[1:30:06] frequently where people are
[1:30:07] living in a different location
[1:30:09] in their county of financial
[1:30:11] responsibility and which case
[1:30:13] it may make sense for everyone
[1:30:15] to have a contract to case
[1:30:17] management that's closer to
[1:30:18] that individual to make sure
[1:30:19] they're fully connected.
[1:30:22] I will say that, you know,
[1:30:23] contracted case management
[1:30:24] isn't inherently a bad thing.
[1:30:27] We use subcontracted case
[1:30:28] management and targeted case
[1:30:29] management. Another kind of
[1:30:30] Medicaid case management.
[1:30:32] I think certainly at the
[1:30:33] department we do want to
[1:30:34] understand and have better
[1:30:36] sight lines into some of the
[1:30:37] quality assurances and
[1:30:39] oversight here. But it's not
[1:30:41] necessarily something that,
[1:30:43] you know, we need to fully get
[1:30:45] rid of all that. We've had some
[1:30:46] of those conversations.
[1:30:49] I just wanted to highlight that
[1:30:50] our federal federally approved
[1:30:52] a waiver plans as well as state
[1:30:54] law identifies that we do
[1:30:56] subcontracted case management
[1:30:58] that lead agencies me contract
[1:31:00] with a private entity to do
[1:31:01] that.
[1:31:04] >> Cms has to approve that.
[1:31:06] It's part of your Medicaid
[1:31:07] plan. Correct? Our Medicaid
[1:31:08] plan craft March air. That's
[1:31:10] correct. Thank you for that.
[1:31:13] >> Dhs does need to make sure
[1:31:14] that we're monitoring as those
[1:31:16] supervisors of the human
[1:31:17] services system. We do have a
[1:31:18] responsibility and
[1:31:19] accountability to monitor lead
[1:31:21] agency performance, quality
[1:31:23] compliance. And if there is a
[1:31:25] need for corrective actions, we
[1:31:26] do issue those.
[1:31:29] As we've worked with our county
[1:31:31] partners, we've seen data that
[1:31:33] indicates that the need for
[1:31:35] contact in case management has
[1:31:36] been increasing due to
[1:31:38] workforce issues and
[1:31:40] reimbursement concerns across
[1:31:43] the system.
[1:31:44] So we've heard that counties
[1:31:46] are actually expanding their
[1:31:47] use of contracted. Case
[1:31:48] management will talk more about
[1:31:50] that, I assume. And just some
[1:31:51] basic numbers I wanted to share
[1:31:53] with the committee's between
[1:31:54] May 2024 and today I have an
[1:31:57] acronym and here which I didn't
[1:31:58] fully right out. So that's my
[1:32:00] bad. La R Stands for lead
[1:32:02] agency review.
[1:32:04] Met with about 59 lead agency
[1:32:06] is and most of them are using
[1:32:08] contracted case management
[1:32:10] about 54% over that time
[1:32:11] period.
[1:32:16] All right. So let's talk a
[1:32:17] little bit more about lead
[1:32:18] agency review.
[1:32:21] So lead agency review is a
[1:32:23] process that the Department of
[1:32:24] Human Services initiated about
[1:32:26] 20 years ago.
[1:32:28] Seems like a long time ago.
[1:32:29] But we've been doing this for
[1:32:30] quite a while and continually
[1:32:31] improving. And and this is a
[1:32:34] process that is really meant to
[1:32:35] oversee
[1:32:37] and our lead agencies and how
[1:32:38] they're delivering case
[1:32:39] management services. So it
[1:32:41] applies to both regular case
[1:32:42] management and contracted case
[1:32:44] management. Increasingly,
[1:32:46] we are trying to, you know,
[1:32:47] hearing from the community
[1:32:48] hearing from this committee and
[1:32:50] members make sure that we're
[1:32:52] devoting ample attention or
[1:32:54] equal attention to contracted
[1:32:56] case management activities as
[1:32:57] well and how those are being
[1:32:58] addressed by counties.
[1:33:00] But really the main goals of
[1:33:02] lead agency review is to make
[1:33:03] sure that counties and tribal
[1:33:04] nations are compliant with all
[1:33:07] of the requirements and state
[1:33:08] and federal law. It's an
[1:33:10] opportunity to share
[1:33:11] performance on key measures and
[1:33:13] out comes to better support
[1:33:14] people. So we had dew track
[1:33:16] various Lt, assess long-term
[1:33:19] services and supports
[1:33:20] performance measures and work.
[1:33:22] Those into the discussions with
[1:33:24] lead agencies are on how
[1:33:25] they're doing and what their
[1:33:26] outcomes look like and how they
[1:33:27] compare to the rest of the
[1:33:28] state.
[1:33:29] It's also a way to promote
[1:33:31] collaboration among lead
[1:33:32] agencies and share best
[1:33:33] practices. So if DHS is hearing
[1:33:36] from one county who's really
[1:33:38] doing a great job, that's an
[1:33:40] opportunity for us to
[1:33:41] potentially share that
[1:33:42] information with other counties
[1:33:44] so that they can implement
[1:33:45] those practices as well.
[1:33:47] So this slide is just a quick
[1:33:49] overview of what the lead
[1:33:50] agency review process looks
[1:33:52] like.
[1:33:53] So it's typically about a
[1:33:55] six-month process and there's a
[1:33:57] schedule. There's a whole
[1:33:58] website on there and the DHS
[1:34:00] Web page where you can find the
[1:34:01] schedule every year which
[1:34:04] counties were reviewing.
[1:34:06] But it's a six-month process.
[1:34:08] Counties undergo this about
[1:34:09] every 3 to 4 years, depending
[1:34:11] kind of what's going on with
[1:34:12] that county. But it first
[1:34:13] involves up revisit activities,
[1:34:17] initiation or kickoff
[1:34:19] teleconference. So there's the
[1:34:20] supervisors lead agency lead
[1:34:23] agency survey go to all
[1:34:24] programs, staff and we're
[1:34:25] gathering program data from DHS
[1:34:27] Systems.
[1:34:29] Next is really the meat of the
[1:34:30] lead agency review, which is
[1:34:31] the review itself. So as a part
[1:34:33] of this, we're looking at the
[1:34:34] case file. We take a random
[1:34:36] sample of case files for each
[1:34:37] program
[1:34:39] and then we review those with
[1:34:40] the team. I think it's about
[1:34:42] 10% or so of case files that we
[1:34:44] sample and that differs
[1:34:46] depending on the total number.
[1:34:47] If there is, for example,
[1:34:48] a smaller county and there's
[1:34:49] only 10 files, we review all of
[1:34:51] them.
[1:34:52] And as I alluded to earlier,
[1:34:55] all of this review includes the
[1:34:56] case management conducted by
[1:34:57] the lead agency itself, as well
[1:34:59] as the contracted lead agency
[1:35:02] through the site review.
[1:35:03] We're going to Dana 5 practices
[1:35:04] and tools that lead agencies
[1:35:08] that contribute to, you know,
[1:35:09] potentially stronger. Maybe not
[1:35:11] so strong, technical compliance
[1:35:12] and outcomes.
[1:35:14] And the review also includes
[1:35:16] focus group meetings and
[1:35:17] meetings with supervisors and
[1:35:18] directors at the county level.
[1:35:21] And then lastly, there is a
[1:35:23] post visit activity where there
[1:35:25] might be potential remediation.
[1:35:27] So all non compliant items that
[1:35:28] were found during the review
[1:35:30] need to be remediated within 60
[1:35:32] days of the review.
[1:35:34] And the lead agency will
[1:35:35] correct each of these items and
[1:35:37] then return that information
[1:35:39] back to DHS for our review.
[1:35:42] There's also potential for
[1:35:43] corrective action so that
[1:35:46] corrective actions can occur.
[1:35:48] >> When there's a certain
[1:35:50] number of
[1:35:52] >> items that are out of
[1:35:53] compliance, more than one,
[1:35:54] for example, that really needs
[1:35:57] warrants a little bit more
[1:35:58] deeper attention. So we we will
[1:36:01] issue that corrective action.
[1:36:03] The lead agency has 10 business
[1:36:05] days to develop and submit
[1:36:06] their plan to DHS. And that
[1:36:08] needs to outline how they're
[1:36:09] going to address each of those
[1:36:10] actions. And then there's
[1:36:12] follow-up post visit activities
[1:36:14] in the follow-up survey
[1:36:16] includes the agencies reporting
[1:36:17] back on there, how things are
[1:36:20] going
[1:36:21] with that corrective action
[1:36:22] plan and whether or not they're
[1:36:23] meeting the metrics and their
[1:36:24] plan that they've worked on
[1:36:26] with us. There is potential if
[1:36:29] elite agency is still
[1:36:30] struggling to comply with that
[1:36:32] corrective action plan where we
[1:36:33] would put them into like a
[1:36:35] shorten lead agency review in
[1:36:36] the next cycle.
[1:36:38] So in a nutshell, that's what
[1:36:40] the lead agency review is.
[1:36:42] There's also a follow-up survey
[1:36:44] where counties can give us
[1:36:45] feedback on how it's going,
[1:36:47] what we need to do to improve.
[1:36:48] I will say am I mentioned this
[1:36:51] earlier and it may be on a
[1:36:53] subsequent slide here, but we
[1:36:55] are really looking into as a
[1:36:56] part of lead agency review,
[1:36:57] making sure that we're asking
[1:36:59] and provide or lead agencies to
[1:37:01] a test whether or not they have
[1:37:03] insurance policies in place and
[1:37:05] their contracts with count with
[1:37:07] entities, private entities.
[1:37:09] If they do great, we might want
[1:37:11] to take a look at some of those
[1:37:12] insurance policies. If they
[1:37:13] don't, we're going to work with
[1:37:14] the lead agency to make sure
[1:37:15] that they've got that the
[1:37:17] quality assurance built into
[1:37:18] their contracts.
[1:37:23] And I think the last thing I
[1:37:24] wanted to mention on this slide
[1:37:26] just in the interest of time
[1:37:27] was in the 2026 session.
[1:37:28] The governor did recommend a
[1:37:31] few items related to a
[1:37:32] contractor to Weaver case
[1:37:33] management. And one of the
[1:37:34] items was 2. Look at the fees
[1:37:36] out of the use of contracted
[1:37:37] case management and throughout
[1:37:40] a long period of time during
[1:37:42] which we would be to evaluate
[1:37:43] rates and the so I think the
[1:37:44] governor recommended
[1:37:46] potentially phasing out the use
[1:37:47] of contracted case management
[1:37:48] as of 2031.
[1:37:50] That item did not make it
[1:37:52] across the finish line. But the
[1:37:54] rate evaluation that we
[1:37:55] recommended and representative
[1:37:57] fishers initiatives and
[1:37:59] actually Representative Gilman,
[1:38:01] I think we're closely on those
[1:38:02] as well. Did pass a we'll talk
[1:38:03] a little bit about those to
[1:38:04] end.
[1:38:06] So the initiatives that I just
[1:38:08] alluded to that Representative
[1:38:10] Fisher and they share Gilman,
[1:38:12] worked on, wanted to lift up
[1:38:15] the waiver case management
[1:38:16] advisory working group, first
[1:38:18] of all, and then we'll talk a
[1:38:20] little bit about the case
[1:38:21] management, great evaluation
[1:38:22] and recommendations.
[1:38:28] So the waiver case management
[1:38:30] advisory working group is in
[1:38:31] the process of being
[1:38:32] implemented right now. We have
[1:38:34] appointments that have went
[1:38:36] through the secretary of state
[1:38:37] process. I believe we got about
[1:38:39] 50 individuals who want to be a
[1:38:42] part of this working group,
[1:38:43] which is really great. And
[1:38:45] initially the the interest was
[1:38:47] a little bit slow to come in.
[1:38:48] But now we're we're heartened
[1:38:50] to know we've got a lot of
[1:38:51] great broad-based support.
[1:38:54] So this is a working group
[1:38:55] that's going to look at the
[1:38:56] quality of case management
[1:38:57] Weaver, case management
[1:38:59] work for sustainability.
[1:39:00] Accountability like we've been
[1:39:02] talking about today and just
[1:39:03] long-term stability of the case
[1:39:05] management system, CBS Case
[1:39:06] Management system, statewide
[1:39:09] recommendations are due to the
[1:39:10] legislature and the beginning
[1:39:12] of September 2027.
[1:39:15] So we look forward to doing
[1:39:16] this work. It will be open if
[1:39:18] there is interest, you know,
[1:39:19] from legislative staffer or
[1:39:21] legislative members reach out
[1:39:23] to us and we can let you know
[1:39:24] how to keep keep up with those
[1:39:26] discussions. We haven't quite
[1:39:28] started meeting at because it
[1:39:29] takes a while to get the
[1:39:30] funding one session ends in our
[1:39:32] accounts and then to get those
[1:39:34] secretary of state appointments
[1:39:36] completed. But hopefully we'll
[1:39:37] be starting to me pretty
[1:39:38] quickly to have a really robust
[1:39:40] discussion about what's needed
[1:39:42] in the system.
[1:39:46] Representative Fisher.
[1:39:48] >> Thank you. Chair Oppmann,
[1:39:49] thank you. Ms ground for the
[1:39:51] presentation. One of the
[1:39:52] questions I have is I so people
[1:39:54] have some people contacted me
[1:39:56] that are not going to be on the
[1:39:57] workgroup. They wondering what
[1:39:58] is the way for them to monitors
[1:40:00] and when they have to work who
[1:40:01] has a meetings, how can the
[1:40:02] public watch what's going on or
[1:40:04] be engaged in that process?
[1:40:06] Mister a.
[1:40:07] >> Our Chair, Representative
[1:40:08] Fischer. That's a great
[1:40:09] question. I asked that myself.
[1:40:11] I don't know that we have a
[1:40:13] determined
[1:40:15] pathway for that yet. But it is
[1:40:17] this is a group that will be,
[1:40:18] you know, subject to the open
[1:40:19] meeting laws. So there will be
[1:40:20] a way for public participation
[1:40:22] and to submit comment or
[1:40:23] feedback as well. But I can
[1:40:25] follow up with the committee
[1:40:26] and make sure that you have
[1:40:27] that information before we get
[1:40:28] going with it.
[1:40:30] >> Thank you very much.
[1:40:31] Appreciate that. I've got some
[1:40:32] folks that like to share with.
[1:40:34] So thank you.
[1:40:39] >> All right, Mister Chair, so
[1:40:41] I'm going to wrap up here so
[1:40:42] you can
[1:40:44] stop listening to me, talk and
[1:40:45] get to they can get to the
[1:40:46] county presentation here.
[1:40:48] But I did just want to mention
[1:40:50] really a core part of that.
[1:40:53] This discussion is making sure
[1:40:55] that we have sustainable Weaver
[1:40:56] case management rates system.
[1:40:59] Our rates for Weaver case
[1:41:01] management have not been
[1:41:02] changed in quite some time.
[1:41:04] They are flat rates, 15 minute
[1:41:06] units and they are not
[1:41:08] sustainable.
[1:41:09] We've had growing numbers of
[1:41:11] programs we have now counties
[1:41:13] are just trying to manage
[1:41:15] overwhelming case loads.
[1:41:17] So it really shouldn't be a
[1:41:18] surprise that we're struggling
[1:41:19] as a system and to sustain
[1:41:22] these services at the level and
[1:41:23] the quality that we want to.
[1:41:25] So last session, the
[1:41:27] legislature didn't act a
[1:41:28] provision that tells DHS that
[1:41:30] we need to go out there and
[1:41:32] study and at what the rate
[1:41:33] should be, what the costs are
[1:41:35] to provide case management
[1:41:37] water, some workforce
[1:41:38] pressures. What should a case
[1:41:40] loads look like? If we want a
[1:41:41] caseload of 30 people per case
[1:41:43] manager than then what is what
[1:41:45] is the cost of that
[1:41:47] as well as qualifications and
[1:41:48] training that we want in that
[1:41:50] particular workforce? So this
[1:41:53] is work that will be informed
[1:41:55] by the advisory workgroup and
[1:41:56] must be by law. So that was
[1:41:58] smart to kind of make these to
[1:42:01] dovetail those 2 requirements
[1:42:02] together and we will be
[1:42:04] submitting recommendations.
[1:42:06] The legislature in 2028, the
[1:42:08] end of 2028 with the
[1:42:09] recommended updated payment
[1:42:11] methodology to better fund this
[1:42:13] work.
[1:42:14] So that is just something that
[1:42:16] we've heard repeatedly from at
[1:42:18] the county level in particular
[1:42:20] that the system is really on
[1:42:22] the verge of
[1:42:23] collapse and we need to address
[1:42:24] the reimbursement rates there.
[1:42:28] Thank you, scrum.
[1:42:31] >> Representative Fisher
[1:42:32] Representative Keleman are kind
[1:42:34] of like Elisa. You guys didn't
[1:42:36] put up this work. That's on
[1:42:38] that 50 people wanting to be on
[1:42:39] it to you and and put yourself
[1:42:41] in their position is, you know,
[1:42:43] let the system.
[1:42:46] >> Thank you, Kara Hoffman.
[1:42:47] I let the represent Cuban speak
[1:42:50] for herself. I know that as I
[1:42:52] was looking at, it was letting
[1:42:53] the folks to the work at hand
[1:42:55] that was asking when they make
[1:42:56] someone that smart, I want to
[1:42:58] serve. I want to hear from the
[1:42:59] people that are in the
[1:42:59] trenches, want to see what
[1:43:00] they're doing, be involved, let
[1:43:02] them let them do it. Making
[1:43:04] sure that we've got the voices
[1:43:05] of people who are
[1:43:07] >> receiving the services.
[1:43:08] That's the big thing is making
[1:43:09] sure that their centered in
[1:43:10] this conversation. Okay.
[1:43:12] Did I understand that it may be
[1:43:14] something as we're going
[1:43:15] forward? It may not be
[1:43:16] one-size-fits-all is when you
[1:43:19] take a look at the different
[1:43:19] services that may have to be
[1:43:21] something establishing
[1:43:22] depending on the type of
[1:43:23] service may be what the case
[1:43:25] but racial might be in that
[1:43:26] particular service. I
[1:43:28] appreciate the work that the
[1:43:29] county's take a look at.
[1:43:31] I do understand the need for
[1:43:33] adjusting the rates and I
[1:43:34] appreciate I think we've got a
[1:43:35] good process set up and looking
[1:43:37] forward to the work getting
[1:43:38] underway. I like where you're
[1:43:39] going. He said one size fits
[1:43:40] all. It's not.
[1:43:41] >> Because I think about like
[1:43:42] Beltrami County operates
[1:43:44] completely different than that.
[1:43:45] Hennepin County.
[1:43:47] We're talking lots of
[1:43:48] difference, right? Its capacity
[1:43:50] size stuff like that.
[1:43:52] >> And I'd like to you and on
[1:43:54] the work that you guys, you
[1:43:54] guys were the ones who are
[1:43:55] really having this conversation
[1:43:57] last session. So hats off to
[1:43:59] you represent going for that.
[1:44:00] So having said, thank you.
[1:44:02] >> Ms crowd for that. This is
[1:44:04] this is where I wanted to go
[1:44:05] with this.
[1:44:06] >> Stuber at you get that
[1:44:08] Meacham.
[1:44:09] >> And the well, a cough are
[1:44:11] welcome for everybody. Knows
[1:44:12] the Hennepin County Eye on
[1:44:14] their forget.
[1:44:15] >> Get this with the newer.
[1:44:17] And I did a town hall in time
[1:44:19] and it was on this golf with
[1:44:20] the it wasn't all glitz.
[1:44:22] New Britain know Minneapolis.
[1:44:24] It was in Minneapolis in and
[1:44:26] and it was so many questions.
[1:44:28] The pup, Christine was there to
[1:44:29] cover that Christie. And it was
[1:44:31] like I should use. That was
[1:44:32] like Phil Donahue. I could just
[1:44:34] give him the microphone to.
[1:44:35] Well, I mean, you just
[1:44:36] absolutely a wealth of
[1:44:37] information that night. I'll
[1:44:38] never forget it. It's great.
[1:44:40] And I know I have to be kind to
[1:44:42] Pat Meacham because my needs
[1:44:43] texted me
[1:44:45] prior to this committee, Paul
[1:44:48] and said, you know what,
[1:44:50] they'll have me gyms comments.
[1:44:52] He better be nice to him.
[1:44:53] So I got well, I don't want to
[1:44:55] I don't want to be in trouble
[1:44:57] with my knees. So we're good on
[1:44:59] that.
[1:45:00] So thank you for being here.
[1:45:02] Kind of talk about I mean,
[1:45:03] this this issue.
[1:45:05] I can't believe how frustrated
[1:45:06] I am when I read the emails of
[1:45:09] up contacted case manager from
[1:45:11] a certain organization say that
[1:45:13] organization out loud if you
[1:45:14] want, but I won't because you
[1:45:16] guys all know who it is.
[1:45:17] That was so inappropriate.
[1:45:20] I'm giving you a question.
[1:45:22] I'm having fun it regardless.
[1:45:24] Don't personalize my question,
[1:45:25] right? I mean, how many times
[1:45:27] we've had this conversation
[1:45:28] throughout the years? You know,
[1:45:30] I I personalize some a lot of
[1:45:33] times, you know, and it's good.
[1:45:35] You call me out on that, right?
[1:45:37] But in this case, don't
[1:45:38] personalize it in an email to
[1:45:39] somebody. It's not about you.
[1:45:41] It's about the individual.
[1:45:42] That's why it breaks my heart.
[1:45:44] When AJ Klug, you did that
[1:45:45] story of an individual that was
[1:45:46] and housing support
[1:45:48] and she now is homeless.
[1:45:49] She's couch jumping. And I ask
[1:45:52] that certainly I get one person
[1:45:53] to just come forward and say I
[1:45:55] care, I want to get this
[1:45:56] person, the services they need.
[1:45:58] That person shouldn't be caught
[1:45:59] jumping, right. I think we all
[1:46:01] agree with that. Like where did
[1:46:03] the breakdown happened within
[1:46:04] the structured system of
[1:46:05] communicating to somebody to
[1:46:07] say there it is. And maybe I
[1:46:09] need to form some work groups
[1:46:10] to understand communication and
[1:46:13] I'm getting on the workgroup
[1:46:14] step. But that is really
[1:46:16] frustrating for me, Paul and
[1:46:17] in. So we had
[1:46:20] the governor saying this is
[1:46:22] what you know he wanted to do
[1:46:24] with
[1:46:25] contracted case management.
[1:46:26] We have folks
[1:46:28] that said, you know, no, you
[1:46:30] got to rethink this. You know,
[1:46:31] I'll never forget having the
[1:46:32] conversation. Michelle say car
[1:46:34] to year who said, you know,
[1:46:35] wait, you got a look at it this
[1:46:37] way to get people that are in
[1:46:39] this envelope have the
[1:46:40] conversation. And so thank you
[1:46:43] for being a 3 and commissioner,
[1:46:45] thank you for staying here with
[1:46:47] this in Christie. Thank you for
[1:46:48] being part of this, too.
[1:46:49] So all the mice,
[1:46:51] thank you chair often.
[1:46:53] >> First, FISA as chair off and
[1:46:55] ICE have our presentation ready
[1:46:56] to start with a brief review.
[1:46:58] I the county role in the
[1:47:00] validation.
[1:47:01] >> And that's what we wanted to
[1:47:02] know what you want to be valid
[1:47:03] issue, housing going. What is
[1:47:04] the county? Because it seems to
[1:47:06] me I keep asking this and you
[1:47:07] can as chair Newel who never
[1:47:08] forget anything. I ask him the
[1:47:10] question
[1:47:11] who's responsible for doing
[1:47:12] the, you know, exception on
[1:47:13] this is a person which clearly
[1:47:15] needs some
[1:47:16] some exceptions on this.
[1:47:17] It's like I just Im confused.
[1:47:19] So thank you for doing that.
[1:47:21] >> So very quickly on the
[1:47:23] county experienced Henry
[1:47:24] validation, the first thing is
[1:47:27] a reminder and for some of you
[1:47:28] may be an explanation.
[1:47:30] Something new that counties
[1:47:32] have a dual role. One is
[1:47:35] concentrating on continuity of
[1:47:36] care, both supporting our
[1:47:38] providers and responding to the
[1:47:40] needs of our residents and
[1:47:41] communicating with DHS on
[1:47:43] providing the continuity of
[1:47:45] care.
[1:47:46] The second one is the counties
[1:47:47] themselves are providers.
[1:47:49] So on that first issue, which I
[1:47:51] know is very important to this
[1:47:52] hearing on the continuity of
[1:47:53] care, one of our biggest
[1:47:55] challenges is related to the
[1:47:57] lack of providers, particularly
[1:47:59] in rural areas and
[1:48:02] in the rural areas. When we
[1:48:04] lose a large provider, the
[1:48:07] continuity of care is very
[1:48:08] limited. This may sound
[1:48:10] simplistic, but it's important
[1:48:12] to say out loud that we can
[1:48:13] only provide care as well as we
[1:48:15] have providers available to
[1:48:17] provide it.
[1:48:19] That is one of our biggest
[1:48:20] problems. And
[1:48:23] as far as the notification
[1:48:25] from, I'm from DHS U.S. a
[1:48:27] little bit more about that
[1:48:28] later. We do get a lot of
[1:48:30] coordination. A lot of
[1:48:31] notification from DHS will talk
[1:48:33] about on the next slide
[1:48:36] as a provider. We still have
[1:48:38] some counties waiting and
[1:48:39] appeals.
[1:48:41] We've had some of the same
[1:48:42] experience that other providers
[1:48:44] have had where we thought we
[1:48:46] were done. But then there are
[1:48:47] more requirements, more
[1:48:48] paperwork,
[1:48:50] counties taken clients really
[1:48:52] seriously. And so part of the
[1:48:53] reason why it is complicated
[1:48:55] for us is that we're trying to
[1:48:56] do as well as we possibly can.
[1:48:59] So we're trying to be very good
[1:49:01] students on and good providers
[1:49:03] there.
[1:49:05] And we're frustrated that
[1:49:06] process. But again, we
[1:49:08] understand this was initiated
[1:49:09] from outside the state
[1:49:12] and we understand that purpose
[1:49:14] of it. We also understand there
[1:49:15] are no, there's not a lot of
[1:49:17] new capacity added to DHS to do
[1:49:20] this. So
[1:49:23] go on into next slide.
[1:49:26] The court nation.
[1:49:27] I'm just covering this at a
[1:49:28] very high level. We have people
[1:49:32] that have been available to the
[1:49:33] counties to ensure continuity
[1:49:35] of care. So there are people we
[1:49:38] can call if we learned that
[1:49:41] county has an important
[1:49:42] provider that is getting close
[1:49:44] to shutting down because of a
[1:49:46] lack of payment, for example.
[1:49:48] And we've been able to and use
[1:49:51] that to try to push for the try
[1:49:55] to help agencies with appeals
[1:49:57] so that building can be
[1:49:59] restarted during those appeals.
[1:50:02] And then we've also been
[1:50:03] helping each other with our own
[1:50:04] Reid allegations. We have
[1:50:06] counties doing the usual county
[1:50:08] sharing thing, helping each
[1:50:10] other with documents. I'm
[1:50:11] helping each other with the
[1:50:13] trainings and other
[1:50:14] certifications that we need to
[1:50:15] provide to the state.
[1:50:17] One thing I don't have an here
[1:50:18] for coordination that I should
[1:50:19] have added is
[1:50:21] and I mentioned this in the
[1:50:22] hearing earlier this summer,
[1:50:24] we do get weekly lists
[1:50:27] providers and where they are in
[1:50:28] the revaluation process.
[1:50:30] And in the beginning, they were
[1:50:31] unwieldy and the state has DHS
[1:50:35] has really listen to provide or
[1:50:36] input on that. And also with
[1:50:38] the weekly,
[1:50:39] the weekly meetings and
[1:50:40] updates, the webinars they've
[1:50:43] listened to lead agency needs
[1:50:45] and that information has gotten
[1:50:46] a lot easier for us to use and
[1:50:49] which makes it easier for us to
[1:50:50] monitor providers and how
[1:50:51] they're doing is very valid
[1:50:52] ation.
[1:50:54] So to sum up, Rob, our role is
[1:50:56] free of allegation. Our
[1:50:57] experience with the right now.
[1:51:00] We are like everyone else
[1:51:02] popping up will be able to
[1:51:03] finish soon. I don't think
[1:51:05] there is a party involved that
[1:51:06] does not wish for that. You
[1:51:09] have any other questions about
[1:51:09] every validation before we go
[1:51:11] on to.
[1:51:12] >> And now I'm still trying to,
[1:51:12] you know, I know I think this
[1:51:13] is good because I'm still
[1:51:14] trying to figure out just,
[1:51:17] you know, the ideal charred
[1:51:18] about okay, you're doing this
[1:51:20] in in the process. How was this
[1:51:23] in effect? Who's the go to, you
[1:51:25] know, providers getting all
[1:51:26] that me say? I don't know to
[1:51:28] talk to us on hold with this
[1:51:30] group for 2 and a half hours
[1:51:31] and serious that there was
[1:51:32] somebody on hold for 2 and a
[1:51:33] half hours and luella knows
[1:51:34] what I'm talking about. It's a
[1:51:36] book, right? Why did that
[1:51:38] happen? You know, and then what
[1:51:39] can we do to fix it? So I'm
[1:51:40] just trying to your part of the
[1:51:42] counties in the retaliation
[1:51:43] process. I'm still trying to
[1:51:44] wrap my head around
[1:51:46] that system. Did we set it up?
[1:51:48] So it's working and I think
[1:51:51] you're answering that by the
[1:51:52] fact he would back. It said the
[1:51:53] department is now.
[1:51:54] >> Pretty nice, right is been
[1:51:56] listening to our concerns and
[1:52:00] making it easier for us to keep
[1:52:02] track of our providers and see
[1:52:03] how they're doing. And,
[1:52:07] you know, I'd say about the
[1:52:08] communication with that.
[1:52:09] We share the same concerns
[1:52:11] about communication and wanting
[1:52:13] to communicate with our
[1:52:14] residents.
[1:52:15] And just as a reminder,
[1:52:17] something to remember
[1:52:18] throughout this whole
[1:52:19] presentation, the when I talk
[1:52:22] about our residents and our and
[1:52:24] our clients for summer, smaller
[1:52:26] counties, we're literally
[1:52:27] talking about their neighbors
[1:52:29] that they know very well.
[1:52:30] So it's a very one-on-one sort
[1:52:32] of situation and a lot of
[1:52:34] counties and which is to say
[1:52:37] sometimes the accountability
[1:52:39] takes place in the grocery
[1:52:40] store.
[1:52:41] And so very, very important for
[1:52:44] us. That, of course, is not the
[1:52:45] same, as you know, the systems
[1:52:48] of communication that we're
[1:52:50] accountable for to the
[1:52:51] legislature and all taxpayers.
[1:52:54] And we recognize that there are
[1:52:55] some places for that could
[1:52:56] improve. And we have continual
[1:52:58] processes for working on that
[1:53:00] with the state and others.
[1:53:01] I think well, as some doubt on
[1:53:02] that
[1:53:05] it's called for.
[1:53:07] >> Hello, I chair members of
[1:53:09] the committee luck for a night
[1:53:11] senior department administrator
[1:53:12] with Hennepin County and also
[1:53:14] work with Max and the adult
[1:53:15] services.
[1:53:17] As you were talking chair.
[1:53:18] Kind of one of the things as
[1:53:20] Paul was answering that
[1:53:21] question is I think it's
[1:53:23] important for all of us to also
[1:53:25] remember, we work in a very
[1:53:26] complicated system. We talk
[1:53:28] about even the term continuity
[1:53:29] of care. I hear you talking
[1:53:31] about something and I don't
[1:53:32] think we're always even
[1:53:33] answering the same question
[1:53:35] because there are many
[1:53:36] complicated things that people
[1:53:37] who receive our services and
[1:53:39] the providers who are delivery
[1:53:40] services are trying to operate
[1:53:42] within our complicated system.
[1:53:44] And so I do think there are
[1:53:47] there are opportunities for us
[1:53:49] to improve. But I think as far
[1:53:51] as communication, one thing
[1:53:53] that's important for all of us
[1:53:54] is to like what I've been doing
[1:53:57] is really listening to what
[1:53:58] people are talking about and
[1:54:00] take a complicated part of our
[1:54:02] system and tease that apart and
[1:54:04] resolve the the barriers
[1:54:06] because sometimes I think we
[1:54:08] shortcut what we're thinking.
[1:54:10] We're trying to resolve and we
[1:54:13] all of our jobs is really to
[1:54:15] think about the cop, the system
[1:54:16] and the complexities of it that
[1:54:17] people are trying to navigate
[1:54:19] cell. That's one thing that I
[1:54:21] think I would just add in the
[1:54:22] continuity of care,
[1:54:25] their spurt certain things
[1:54:26] around provider Ravelo the sun.
[1:54:27] But sometimes that's not
[1:54:29] actually provide a re
[1:54:30] validation that the issue is
[1:54:31] about their couple of other
[1:54:32] things going on in our system.
[1:54:35] They're our continent of care.
[1:54:38] >> Thank you all for that that
[1:54:40] you Mr. Attack and indoors.
[1:54:42] Thank you.
[1:54:44] >> Thank you. Chair up and it's
[1:54:46] another questions about the
[1:54:48] validation that all moved to
[1:54:50] the county rolls contracted
[1:54:51] case management.
[1:54:58] >> Again, nobody. I think we're
[1:54:59] good.
[1:55:02] Representative Fish. Yeah.
[1:55:05] One of the things that comes I
[1:55:07] don't know if it's an easy
[1:55:08] number to come up with this.
[1:55:09] We hear about the number of
[1:55:10] providers out there.
[1:55:11] What I'm curious is how many
[1:55:13] people are being affected by
[1:55:14] that? What are the clients that
[1:55:16] are at risks that are losing
[1:55:17] their services? You know, we
[1:55:18] always hear the number the
[1:55:19] providers, but we don't hear
[1:55:20] about the clients themselves.
[1:55:22] And I think this is one of the
[1:55:23] things that is part at least
[1:55:25] for me to know when I talked to
[1:55:26] people because it well prior,
[1:55:28] let's just provided. You don't
[1:55:30] realize how many people are
[1:55:30] connected that are risking
[1:55:32] losing the service. And so
[1:55:33] having some kind of information
[1:55:34] on that line, I think would be
[1:55:36] helpful because when people
[1:55:37] start tossed out numbers back
[1:55:39] and forth, they forget about
[1:55:40] the individuals who need it and
[1:55:42] they don't realize how many
[1:55:43] people are being impacted by.
[1:55:45] You know, we hear overall
[1:55:46] Medicaid system that 1.2
[1:55:48] million. But when we're talking
[1:55:49] about this, the personnel that
[1:55:52] we are looking at, our clients
[1:55:53] are our citizens who are in the
[1:55:56] services are being Ravelo data
[1:55:58] right now. We lose that in the
[1:55:59] process and I think it's
[1:56:01] something that could help in
[1:56:02] like people of don't understand
[1:56:05] how much more serious it is,
[1:56:06] what we're talking about,
[1:56:08] how many people might be at
[1:56:09] risk losing service to some
[1:56:10] people. I think ultimately a
[1:56:11] couple of people, it's
[1:56:12] substantially more than that.
[1:56:13] But I don't have a number I'm
[1:56:14] ever give.
[1:56:18] >> I can start with an answer
[1:56:20] and then we'll see if the
[1:56:22] college have something to tear
[1:56:23] out. They'll go ahead at the
[1:56:25] time.
[1:56:26] This has been difficult for us
[1:56:28] to to gauge in some ways.
[1:56:31] One of the reasons is that the
[1:56:32] effect and the risk is delayed.
[1:56:34] So if and the agent, if a
[1:56:36] provider was to actually go
[1:56:38] under
[1:56:40] the speed of which that happens
[1:56:41] has to do with what they have
[1:56:43] for reserves. But their
[1:56:45] tolerance for risk is
[1:56:47] some of them. Smaller providers
[1:56:50] could go faster.
[1:56:53] And so it has there is for a
[1:56:56] long time. We still weren't
[1:56:58] hearing of anyone losing
[1:56:59] services directly.
[1:57:01] But the risk of that was high
[1:57:03] enough that it, you know,
[1:57:04] is the same level of alarm that
[1:57:07] we felt regardless of that.
[1:57:10] But it is it is hard to measure
[1:57:12] just because of that delay to
[1:57:14] fact a lot of providers for use
[1:57:16] 2 different kinds delays and
[1:57:19] what they see as delays in
[1:57:20] payments, which sometimes our
[1:57:21] normal process and times and
[1:57:23] sometimes our normal processing
[1:57:25] times are behind. Also.
[1:57:27] So as the low point that it is
[1:57:29] complicated, which is a long
[1:57:31] way of not giving you a number,
[1:57:32] but
[1:57:33] we can work towards that.
[1:57:34] Thank you,
[1:57:38] commissioner.
[1:57:41] >> So we can certainly, I think
[1:57:43] to a little bit of homework
[1:57:44] here to see if we can offer
[1:57:45] numbers. It's more difficult
[1:57:47] when we're talking about ouch.
[1:57:49] A patient providers, for
[1:57:50] example, of behavioral health
[1:57:51] services relative to a
[1:57:52] residential service provider
[1:57:53] words. It's more apparent to
[1:57:55] the number of folks that
[1:57:56] they're serving any one time.
[1:57:58] Sometimes it's retrospective
[1:57:59] looking at claims data. So it's
[1:58:01] complicated, but we we can
[1:58:02] certainly engage with you about
[1:58:04] how to estimate what that might
[1:58:05] be. And certainly I think we're
[1:58:07] doing our level best to the
[1:58:09] appeals process to maintain
[1:58:10] payment, responding to some of
[1:58:12] the concerns from Dr Larson and
[1:58:13] others with respect to
[1:58:14] authorizations and issues with
[1:58:15] the Sentra, putting them on a
[1:58:17] corrective action plan using
[1:58:18] the levers of that contract.
[1:58:19] So trying to avoid that outcome
[1:58:22] whenever possible. But
[1:58:24] appreciate the question.
[1:58:25] And we can certainly call.
[1:58:27] >> Mr. Chairman, add one thing.
[1:58:29] Absolutely.
[1:58:31] Thank you. And Representative
[1:58:32] Fisher broader than just the
[1:58:34] validation. I guess there.
[1:58:36] I wanted to just remind members
[1:58:38] there is a requirement around
[1:58:39] DHS posting a dashboard and
[1:58:41] outcomes related to continuity
[1:58:43] of care. So that is work that
[1:58:45] we are actively doing at the
[1:58:46] department. And and we have
[1:58:49] some
[1:58:51] kind of a patchwork of
[1:58:52] antiquated systems that we're
[1:58:53] using to track information
[1:58:55] related to continuity of care.
[1:58:57] So we are also actively working
[1:58:58] to have a more streamlined
[1:59:00] process so that we can identify
[1:59:02] where that each individual
[1:59:03] individuals impacted and work
[1:59:06] more closely and efficiently
[1:59:07] with lead agencies.
[1:59:09] Thank you, Chris. That is
[1:59:10] correct
[1:59:12] to Brett.
[1:59:14] >> Thank you. Chair now respond
[1:59:16] to speak at the county rolling
[1:59:18] contract. Its case management
[1:59:20] specifically waiver case
[1:59:21] management.
[1:59:23] The first thing I'd like to say
[1:59:25] is I really like the way I
[1:59:27] describe how late highlighted
[1:59:29] case management
[1:59:31] case management press is
[1:59:32] absolutely foundational.
[1:59:35] It is the be the case. Managers
[1:59:37] are the people who have the
[1:59:38] most contact us with the people
[1:59:40] we serve during very difficult
[1:59:43] times in their life. So as much
[1:59:45] as possible, even more than
[1:59:47] possible, if we can, we try to
[1:59:49] do it as well as effectively
[1:59:50] and caring with parents and as
[1:59:52] we can.
[1:59:54] So some of the needs of the
[1:59:56] reasons why we use contracted
[1:59:57] waiver case management. One of
[2:00:00] them is actually budget
[2:00:02] flexibility.
[2:00:04] Case management lows can rise
[2:00:06] and fall. It can be difficult
[2:00:09] for counties, particularly
[2:00:11] right now under financial
[2:00:13] stress to be able to add
[2:00:15] full-time employees very easily
[2:00:17] or quickly.
[2:00:19] And
[2:00:21] because property taxes operate
[2:00:23] at a different speed. And
[2:00:24] they're not quite as responsive
[2:00:28] is it gives us the flexibility
[2:00:30] to ensure that we meet our
[2:00:33] mandated needs, but also just
[2:00:35] the needs we have to serve.
[2:00:37] Our residents gives us the
[2:00:39] flexibility to be able to do
[2:00:40] that. And
[2:00:42] it's very important that we
[2:00:44] have that
[2:00:45] the second one is the need for
[2:00:47] culturally specific and
[2:00:49] specialty expertise.
[2:00:52] Second, the brain injury
[2:00:53] examples that, sir, one that
[2:00:55] we've seen a number of times
[2:00:58] also we have clients who may be
[2:01:02] a part of a culture that is not
[2:01:04] as well represented where they
[2:01:05] live. And so being able to get
[2:01:07] case management from agencies
[2:01:10] that are staffed and have
[2:01:13] boards of people from that
[2:01:14] community, I can be very
[2:01:16] effective and very helpful
[2:01:18] support for them.
[2:01:20] And then lastly, we already
[2:01:23] talked about the county of
[2:01:24] financial responsibility.
[2:01:26] It's a quick way that some of
[2:01:28] the maximum, but this is we are
[2:01:29] not pay for wind chill time.
[2:01:32] And also the other thing they
[2:01:34] remind us is that for some
[2:01:35] counties and rural areas to
[2:01:38] come to to come to say the Twin
[2:01:40] cities and no, the providers is
[2:01:42] something that
[2:01:44] is very difficult for them to
[2:01:46] do. So those are the the main,
[2:01:47] the 3 largest region reasons
[2:01:50] that we use waiver contracted
[2:01:52] case management. You know, I
[2:01:53] hear.
[2:01:54] >> I just leaned over to chair
[2:01:56] during an aching its that
[2:01:58] the ability to, you know,
[2:02:01] could somebody up to speed on
[2:02:03] this complicated system.
[2:02:06] Krista, technical assistance on
[2:02:07] that. And then there's this
[2:02:09] complete
[2:02:10] turn around. There's, you know,
[2:02:12] you see it for I could lose my
[2:02:15] case manager now was my case
[2:02:16] manager. And I was like a
[2:02:17] strategy now and it all goes
[2:02:19] down to deny. The other thing
[2:02:20] that lead over in line was
[2:02:24] it makes it difficult when, you
[2:02:26] know,
[2:02:27] leadership goes into a corner
[2:02:29] office
[2:02:30] and that decides to turn around
[2:02:33] and tell us to cut 300 million
[2:02:34] dollars without going through
[2:02:36] the process that we ensure the
[2:02:37] original thing
[2:02:39] last year was terrible
[2:02:42] because there are so many fixes
[2:02:43] that we wanted to do
[2:02:47] that. We could do
[2:02:49] great, not only fix fix fix,
[2:02:51] but I mean, you know, help the
[2:02:52] system be smooth or 2
[2:02:54] because we are hindered by the
[2:02:56] fact that we had, by the way,
[2:02:58] let's just look at health and
[2:02:59] human services. The human
[2:03:00] services is a bucket of cash
[2:03:02] for everything else we pay for.
[2:03:04] I'm tired of that.
[2:03:05] Tired of the the the narrative
[2:03:08] about Minnesota fraud, waste
[2:03:11] and abuse. Yes, it became
[2:03:12] political and it should have
[2:03:13] been because of the fact that
[2:03:14] people with disabilities are
[2:03:16] the ones who are already the
[2:03:16] most on it.
[2:03:18] And we can't pay our contracted
[2:03:19] case managers or case managers,
[2:03:21] the money that they do
[2:03:24] keeps me up at night, Paul.
[2:03:26] It really does say it's because
[2:03:27] it's like, alright, who's
[2:03:28] there. And in the meantime,
[2:03:30] I just keep seeing this woman
[2:03:31] who was part of the housing
[2:03:32] stabilization program and he's
[2:03:35] received was receiving services
[2:03:37] is now couch jumping in
[2:03:39] Minneapolis.
[2:03:40] I can't give them that
[2:03:42] because that baby shouldn't
[2:03:43] become a champion.
[2:03:46] This just what you hear is
[2:03:48] exactly what we want and what
[2:03:50] we need the culturally
[2:03:51] specific, you know, specific,
[2:03:53] culturally specific and
[2:03:53] special, the expertise got to
[2:03:55] be there, right?
[2:03:57] I just wish, you know,
[2:03:59] representative newer, you know,
[2:04:02] you hear from people, you know,
[2:04:04] that's a whole we're gonna
[2:04:05] structural deficit that we're
[2:04:06] going to have to kind of get
[2:04:08] next year.
[2:04:10] Whoever is the chair of this
[2:04:11] committee next year will have
[2:04:13] that same piece. But that
[2:04:14] shouldn't stop us from
[2:04:16] there's a need, but school
[2:04:17] fulfill it.
[2:04:18] >> If we truly care about if we
[2:04:20] truly believe in the Olmsted
[2:04:21] provision, if we truly believe
[2:04:22] that ultimately the services,
[2:04:24] what if we truly believe the
[2:04:25] counties are the ones or if we
[2:04:26] truly believe that, then let's
[2:04:28] start advocating for that
[2:04:30] Representative Door.
[2:04:32] >> Thank you, Mister Chair and
[2:04:33] thank you for this
[2:04:34] presentation. I do want to jump
[2:04:37] into this conversation but
[2:04:38] looking to the offense, the
[2:04:40] statement, the budget
[2:04:42] constraints
[2:04:44] given that was shifting
[2:04:46] the responsibility from the
[2:04:48] county too
[2:04:49] contracted case management
[2:04:52] and knowing that you will be
[2:04:54] having
[2:04:56] different case loads because
[2:04:58] one of the biggest that issue
[2:04:59] that we've been seeing is
[2:05:02] contract and case management or
[2:05:03] even if it's the county,
[2:05:05] the caseload for we but case
[2:05:07] management is higher compared
[2:05:09] to
[2:05:10] anything else. So do you know
[2:05:12] on average a month how many
[2:05:15] hours do case images provide
[2:05:17] services to the recipient so
[2:05:20] participants?
[2:05:24] >> Thank you, chair in Art.
[2:05:26] I'm minding checked in here.
[2:05:27] Really quickly. Might him
[2:05:29] first? Can you answer that for
[2:05:30] your county here?
[2:05:34] >> Break that there is you get
[2:05:36] to this. It makes sense.
[2:05:37] You want the how many hours to
[2:05:40] $0.70 to? Well, well.
[2:05:43] >> Chair law. So my first
[2:05:46] thought is we need to look at
[2:05:48] the numbers to see kind of like
[2:05:49] because DHS have the Billings.
[2:05:50] We can see the number of units,
[2:05:52] for instance, like Christine
[2:05:53] talked about the the it's
[2:05:56] billed like number of units.
[2:05:57] So we could take a look at
[2:05:59] that. They tie, you know,
[2:06:00] they report their time. I would
[2:06:01] say
[2:06:02] in part like when you think
[2:06:04] about the standards for waiver
[2:06:05] case management, there's a
[2:06:07] certain number of requirements
[2:06:08] of time that we need to spend
[2:06:09] with the person so like there's
[2:06:11] meeting the requirements and
[2:06:12] the time that might go into
[2:06:13] that. But of course,
[2:06:15] representative nor part of the
[2:06:16] answer that question is I don't
[2:06:18] know if there's an average
[2:06:18] because each person's
[2:06:20] individual needs are different.
[2:06:23] And so I will say, you know,
[2:06:24] last week I was watching case
[2:06:27] managers like help people move
[2:06:29] to a new it all residential
[2:06:31] setting. And it was like they
[2:06:33] probably were putting in 40
[2:06:35] hours, you know, working with
[2:06:37] one or 2 people. That's not
[2:06:39] that's not the norm, you know,
[2:06:40] probably for the average.
[2:06:42] And so I would I think we'd
[2:06:44] have to get a sense of, you
[2:06:46] know, what is the typical to
[2:06:47] meet the basic requirements of
[2:06:50] case management and what what
[2:06:51] Keibert waiver case managers
[2:06:52] must do. But then it's really
[2:06:54] driven by the individual
[2:06:56] situation and what's kind of a
[2:06:57] priority this week and how you
[2:06:59] know how many other people
[2:07:01] they're trying to help. So we
[2:07:03] have to look for the data to
[2:07:04] give you an actual answer.
[2:07:10] >> You could go ahead. Pat.
[2:07:12] Thank you. I think that
[2:07:13] Champaign County tap each image
[2:07:15] and disability services manager
[2:07:17] Pine County.
[2:07:18] I think the question
[2:07:21] not to just say it gets more
[2:07:22] complicated by thinking example
[2:07:24] to is for waiver case managers,
[2:07:26] one of mine this year had 8
[2:07:28] individuals in and out of the
[2:07:29] hospital.
[2:07:30] This is the summer.
[2:07:32] I don't we don't stop providing
[2:07:34] care at that time, but that's
[2:07:36] not waiver. Billable time.
[2:07:37] So to just expand on, well,
[2:07:39] as point like we could run that
[2:07:41] data, we can look at the
[2:07:43] department could pull the
[2:07:44] waiver bill in time. But
[2:07:46] there's so many other things
[2:07:47] that we do that are not being
[2:07:48] reimbursable to the counties.
[2:07:49] Also care doesn't stop just
[2:07:52] based on where they are that
[2:07:53] day.
[2:07:58] >> Hearing that the kid doesn't
[2:08:00] stop and knowing that we are
[2:08:02] waiting for their weight
[2:08:03] evaluation until December 2028.
[2:08:07] And given that if you compare
[2:08:10] that to the TCM, which is based
[2:08:12] on the monthly compared to the
[2:08:13] 15 minute unit full, you know,
[2:08:17] wave a case management,
[2:08:18] how are we going to fix this
[2:08:20] issue? Because I see the
[2:08:21] biggest gap that we have is the
[2:08:22] constraints of the budget that
[2:08:25] we have a kid full. We have a
[2:08:26] case pending. That's number one
[2:08:28] issue. How do we solve that
[2:08:29] issue to make sure that we're
[2:08:30] providing an effective fission,
[2:08:33] more compassionate care for
[2:08:34] those individuals were getting
[2:08:35] with the case. Managment
[2:08:36] substance.
[2:08:39] >> Thank you. Chair Chair
[2:08:40] Hoffman. Thank you. Chair are
[2:08:41] for your question.
[2:08:44] I would say one of that.
[2:08:45] It's difficult because
[2:08:47] we absolutely cannot wait and
[2:08:50] get the perfect long-term fix.
[2:08:51] So like a lot of problems with
[2:08:53] human services were trying to
[2:08:54] find short-term games gains.
[2:08:58] Well, not giving up on our
[2:08:59] long-term goals.
[2:09:01] I would say something happened
[2:09:03] between that is the the waiver
[2:09:06] case management working group.
[2:09:08] I think because of all the
[2:09:09] parties that will be involved
[2:09:11] in that we can come up with
[2:09:12] some recommendations.
[2:09:14] And I believe that finishes its
[2:09:16] September 2027. Is the report
[2:09:18] so
[2:09:19] that actually some of that work
[2:09:22] we'll be coming up
[2:09:24] will help us informed the
[2:09:25] process. And because those are
[2:09:28] public meetings, maybe there
[2:09:30] will even be preliminary
[2:09:32] results are findings that we
[2:09:33] could work with to try and
[2:09:35] improve the process.
[2:09:38] As far as
[2:09:40] you know, one of the difficult
[2:09:41] questions is, of course,
[2:09:44] the payment.
[2:09:45] The volatility to the workforce
[2:09:48] is no surprise when you
[2:09:49] consider that our case
[2:09:52] managers, whether contractor
[2:09:54] working for the county that are
[2:09:56] case managers are
[2:09:59] underpaid for very difficult
[2:10:01] work.
[2:10:03] And that is one of the things
[2:10:04] that leads to people moving
[2:10:06] from agency to agency. Also,
[2:10:08] when people are very good case
[2:10:10] managers,
[2:10:11] I can tell you that our
[2:10:13] counties compete for them
[2:10:16] and it's because we all want to
[2:10:17] provide the best care for our
[2:10:18] counties. But it does not
[2:10:20] contribute to the says the
[2:10:21] situation. I wish I had a very
[2:10:23] easy for you to answer for you
[2:10:25] chair in our, but I'm very
[2:10:26] happy to work with you on the
[2:10:27] answer. We do have some other
[2:10:29] ideas coming
[2:10:31] from our committees and max
[2:10:33] that will share with you.
[2:10:41] One thing I want to talk about
[2:10:42] is monitoring and support
[2:10:46] contracted Baver case
[2:10:48] management is not just the same
[2:10:51] as hiring say attempt to come
[2:10:53] in to an agency to do some sort
[2:10:56] of work that is repetitive and
[2:10:58] less skilled.
[2:11:00] We have to do a lot of work to
[2:11:02] make sure that our waiver case
[2:11:04] management is not isolated
[2:11:07] and that the work they're doing
[2:11:09] fits our demands and our our
[2:11:12] principles and what we want to
[2:11:14] see from our own case managers.
[2:11:16] I'll talk a little bit more
[2:11:19] about that in a second in
[2:11:20] detail. But I would say that
[2:11:22] the through line of what ice
[2:11:24] side and checking in with our
[2:11:25] counties about this and
[2:11:27] everything that we talked about
[2:11:28] last year is that the more that
[2:11:31] contracted waiver case
[2:11:33] management providers are
[2:11:35] integrated into the normal
[2:11:37] county
[2:11:38] case management teams, the
[2:11:40] better the communication is and
[2:11:43] the better the results are for
[2:11:45] our residents. So one of the
[2:11:48] foundational believes we have
[2:11:49] is that the same? We have the
[2:11:51] same response will be a
[2:11:52] responsibility of care to
[2:11:54] clients. Whether the person is
[2:11:57] being served by waive are case
[2:11:59] managed or contract case
[2:12:01] manager or one of the county
[2:12:02] case managers. There is no
[2:12:03] difference for us.
[2:12:05] We know of some counties that
[2:12:07] and dedicate more than 20
[2:12:09] full-time equivalent simply to
[2:12:11] manage and support contracted
[2:12:13] waiver case managers, many
[2:12:16] counties are providing training
[2:12:18] that's tailored to make sure
[2:12:20] that the case managers are able
[2:12:23] to meet the same standard of
[2:12:24] care.
[2:12:26] And here are some of the
[2:12:27] examples of things that some of
[2:12:28] the counties are doing.
[2:12:31] There are monthly forms for all
[2:12:33] the supervisors where they work
[2:12:35] with the contract that in case
[2:12:37] meant and I county case
[2:12:38] managers together in the same
[2:12:40] place annual August. Of course,
[2:12:42] we have a lot of support during
[2:12:46] really important and difficult
[2:12:48] times like transfers for
[2:12:50] services.
[2:12:52] We also have lots of subject
[2:12:53] matter experts that are
[2:12:55] actually assigned to individual
[2:12:58] contracted agencies. And then
[2:13:00] we have updates that basically
[2:13:02] are the same whether or not
[2:13:04] your contracted or case
[2:13:05] management contract that our
[2:13:07] county case management, we also
[2:13:09] provide training to get them up
[2:13:12] to speed on county and DHS
[2:13:14] policies
[2:13:16] and all the county procedures
[2:13:17] are based on ditches policies.
[2:13:26] >> I was asking new are the
[2:13:28] questions. Sorry, Paul, that
[2:13:30] you keep going? I think where
[2:13:32] people think you are. We're at
[2:13:34] 2.44, we're still having this
[2:13:36] conversation. If the answer,
[2:13:37] OK, we'll just keep going for
[2:13:39] the next 5 minutes. You know?
[2:13:41] Yes, so if you mean friends for
[2:13:43] the slides?
[2:13:44] >> Yes, a very quickly on that.
[2:13:46] Again. I was back in touch with
[2:13:47] the slightest. Want to
[2:13:48] reiterate that we have found
[2:13:49] the more that the county and
[2:13:51] the contractor case managers
[2:13:53] are integrated together in
[2:13:54] teams, the better the workouts.
[2:13:59] The last thing we'd also been
[2:14:01] asked to say a few things about
[2:14:04] the rate setting process our
[2:14:06] own role in perspective in
[2:14:07] that.
[2:14:08] I'm glad that Patrick is here
[2:14:10] today might be able to answer
[2:14:11] questions more specifically
[2:14:12] about this. It's a very
[2:14:13] complicated process.
[2:14:18] The process itself was laid out
[2:14:20] well and that the DHS
[2:14:22] presentation. But just from our
[2:14:25] perspective, what we see is
[2:14:26] very simply a service provider
[2:14:29] request a re ticks requests
[2:14:31] rate exception on behalf of a
[2:14:34] client. Then the case manager
[2:14:37] reviews that then it's the
[2:14:39] county submitted to DHS and
[2:14:41] then DHS approves or denies
[2:14:44] that. And then we have a
[2:14:45] responsibility to go back to
[2:14:47] the provider and the client.
[2:14:49] It is a complicated,
[2:14:51] complicated process and we all
[2:14:54] know the complicated processes
[2:14:55] can sometime processes can slow
[2:14:57] down.
[2:14:59] One of the things that would
[2:15:01] like to remain to remind
[2:15:02] everyone is that the more we
[2:15:04] use rate exceptions, the more
[2:15:06] it can raise the cost of care
[2:15:07] in Minnesota and the cost of
[2:15:09] these services is one of the
[2:15:11] reasons why we have to have a
[2:15:12] lot of difficult conversations
[2:15:15] last session, the one before
[2:15:16] that and this coming session.
[2:15:19] We do know that there are
[2:15:20] delays in processing of both
[2:15:22] the county and state level.
[2:15:25] And
[2:15:26] we also know that there are
[2:15:28] some I learned that there are
[2:15:30] some differing interpretations
[2:15:31] of the statute between
[2:15:32] providers, counties in the
[2:15:35] state, specifically over who
[2:15:38] not to say U.S., final say, but
[2:15:39] the nature of the decision,
[2:15:41] a step in the process
[2:15:44] and counties we do. We do feel
[2:15:46] pressure to support the rate
[2:15:48] expectations
[2:15:49] and that that pressure to serve
[2:15:52] think that our residents as
[2:15:53] well as we can
[2:15:55] can make it difficult to go
[2:15:57] through these because if we see
[2:15:58] a lot of rain, exceptions being
[2:16:00] requested,
[2:16:02] then you know me that we worry
[2:16:04] about the rate or the service
[2:16:06] itself. And that is something
[2:16:07] that's hard for us to
[2:16:09] and the long term of working on
[2:16:10] it legislatively. But we have
[2:16:13] clients sitting in front of us.
[2:16:14] And so we're hoping to get the
[2:16:16] right
[2:16:17] the right information to them
[2:16:18] and make the right decision
[2:16:21] and we cannot go into questions
[2:16:22] or C.
[2:16:23] >> Yeah, I think the discussion
[2:16:24] I city they're in Christie had
[2:16:26] mentioned it earlier and I just
[2:16:28] brought it up and that's what I
[2:16:29] was leaning over to it.
[2:16:30] >> To represent new around is
[2:16:31] that, you know, is there a way
[2:16:32] we could do that? What would
[2:16:33] that look like receiver to do
[2:16:35] an interim rate increase or is
[2:16:36] there could you provide some
[2:16:37] technical assistance for
[2:16:39] all of us? You would.
[2:16:42] What? What? What would that?
[2:16:44] Look, the shaking is somewhat
[2:16:45] you answer my question.
[2:16:48] >> Mister Chair. Yes, we could
[2:16:50] provide technical assistance.
[2:16:51] I think oftentimes when we
[2:16:53] identify any rate in the
[2:16:55] Medicaid system that's in need
[2:16:56] of, you know, an increase or
[2:16:58] modification to the
[2:16:59] methodology. We oftentimes see
[2:17:00] the legislature
[2:17:02] investing some at the front end
[2:17:03] while we wait for that long
[2:17:05] term solution that Mr. Bret
[2:17:06] mentioned so if the legislature
[2:17:08] say wanted to maybe get some
[2:17:10] fiscal technical assistance,
[2:17:12] we could we could provide you
[2:17:14] that information. These are
[2:17:16] historic flat rates and I don't
[2:17:17] believe they have inflationary
[2:17:19] update. So I think I'd be
[2:17:20] pretty simple to draft that.
[2:17:22] And it would just be a matter
[2:17:23] of serve what the state can
[2:17:24] afford
[2:17:28] words. Yeah, like that.
[2:17:30] >> What options? What options
[2:17:31] exist for us this crime?
[2:17:33] So
[2:17:36] Mister Chair.
[2:17:38] >> Thank you, Mr. Chen just
[2:17:39] wanted to inquire full TCM.
[2:17:41] We may have exceptions based on
[2:17:43] the need to find individual.
[2:17:45] Do we have exceptions in wave a
[2:17:47] case management,
[2:17:48] the rates that we've thing to
[2:17:50] the case manages if it's a
[2:17:52] complex case that they're
[2:17:54] doing.
[2:17:57] >> The answer. No. Mister Chair
[2:17:58] chair in or not. To my
[2:18:00] knowledge, I double checked the
[2:18:01] fee schedule this morning and
[2:18:03] we've got a 15 minute unit for
[2:18:05] regular case management.
[2:18:07] I think there's another 15
[2:18:08] minute unit for a
[2:18:09] paraprofessional level. Right?
[2:18:11] But beyond that, there's no
[2:18:12] customization.
[2:18:14] >> We want to do. Are you
[2:18:15] going? What are you thinking of
[2:18:17] the affected? Sometimes they're
[2:18:19] working outside of the round,
[2:18:20] not billable hours. They're
[2:18:22] doing something that's really
[2:18:23] unique to the individual's
[2:18:24] needs to be headed with that.
[2:18:27] >> Yes, such and I think we I
[2:18:29] don't like knuckle assistance
[2:18:31] is to add all those factors
[2:18:32] into consideration.
[2:18:36] Thank you, everybody.
[2:18:38] I want to thank everybody for
[2:18:40] being here this. I want to see
[2:18:42] this conversation happened
[2:18:44] a lot and I'm still I'm still
[2:18:47] upset about last year or this
[2:18:48] past year, 300 million dollars
[2:18:50] all said he got a tattoo
[2:18:52] million. Doesn't help us do
[2:18:54] what you need. A commissioner
[2:18:55] Cali that's addressed for the
[2:18:58] system doesn't help us really
[2:19:01] do it. But really our citizens
[2:19:03] need
[2:19:04] it doesn't surprise me that one
[2:19:06] of the organizations that was
[2:19:07] mentioned today is of has a big
[2:19:10] investor. That's a private
[2:19:11] equity firm. The county kind of
[2:19:12] scares me. I would
[2:19:14] that why are they start to dip
[2:19:16] into the the round of our
[2:19:19] systems work? Is that become a
[2:19:21] hindrance to the system?
[2:19:22] Worked in the city? That's a
[2:19:23] question. That's not a
[2:19:24] statement.
[2:19:26] Knowing that the on the federal
[2:19:27] level the CMS is Stratton.
[2:19:30] Something's Minnesota's got a
[2:19:32] bunch of myths out there.
[2:19:34] Even Kcp 5 does it didn't
[2:19:36] article on, you know,
[2:19:37] dispelling the myth of of
[2:19:39] Minnesota. This fraud, waste
[2:19:41] and abuse. Right
[2:19:42] fries Fried is for the very
[2:19:44] first hearing. I did as chair
[2:19:46] knew or was here 4 years ago
[2:19:48] was on Friday.
[2:19:50] It's something that we've dealt
[2:19:51] with every year. This sessions,
[2:19:53] the sessions that we've had.
[2:19:54] We've always dealt with that
[2:19:56] Minnesota is a
[2:19:59] and you look at what other
[2:20:00] states compare ability
[2:20:03] Freitas Freitas pride that
[2:20:05] that. But when you compare us
[2:20:06] to New York,
[2:20:07] Florida, Texas,
[2:20:12] like Ball goes out there to the
[2:20:14] Rose Revolution. They're ready
[2:20:15] to rev up revelation of what we
[2:20:18] are doing. Great.
[2:20:21] We can do better. And I I think
[2:20:23] it's really contingent upon the
[2:20:24] counties and the and the state
[2:20:26] to and what they're doing.
[2:20:28] That work group that Gilman and
[2:20:31] Fisher, you know, put together
[2:20:32] in statute, I think will be
[2:20:34] good to see what happened.
[2:20:35] So I appreciate you all being
[2:20:37] here and thank you for allowing
[2:20:39] that flexibility and Sen
[2:20:40] Representative Moore Tu Gilman
[2:20:43] and Fisher and the rest of your
[2:20:45] team. So once the car was here
[2:20:46] to I appreciate you guys come
[2:20:48] inside
[2:20:50] a final statement, commissioner
[2:20:51] for
[2:20:53] call that the commissioner.
[2:20:55] Go ahead.
[2:20:56] >> Sheriff Man, just thanks
[2:20:56] again for the opportunity.
[2:20:57] Thanks from 2 members of the
[2:20:59] committee. And again, I just
[2:21:00] want to know we heard a great
[2:21:02] deal of feedback today.
[2:21:03] Government is continuous
[2:21:04] improvement. We will continue
[2:21:05] to engage, try to do better and
[2:21:08] I'll share a mole statement.
[2:21:10] We do want to work through this
[2:21:12] is expeditiously as possible
[2:21:13] and will continue to to engage
[2:21:15] in a problem solving fashion.
[2:21:17] 2 imperatives of continuity of
[2:21:18] care and the highest possible
[2:21:20] program integrity. Thank you
[2:21:21] all very much. Appreciate that.
[2:21:22] We are adjourned