Home and Community Based Services
Partner Panel
August 12, 2011
9:00 a.m. – 12:00 p.m.
Minnesota Department of Human Services
Elmer L. Andersen Building, 540 Cedar Street, Room 2380
St. Paul, MN
Notes
1. Welcome and Introductions, Review Agenda – Glenda Eoyang, Human Systems
Dynamics Institute
2. Permanent Supportive Housing Evidence Based Practice – Dave Schultz, Adult Mental
Health Administration
Dave gave out two handouts to explain the concept of permanent supportive housing
evidence-based practice and how it fits into the overall mental health services system in
Minnesota. Permanent supportive housing is community-based, not residential.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA) promotes
the use of practices which have, through research, demonstrated some results and show
promise of an evolving evidence base. Currently there are seven of these “evidence-based
practices” which SAMHSA promotes, five of which have been rolled out in Minnesota by DHS.
The most recent of these is Permanent Supportive Housing. To comply with the research
tested model this housing must be “permanent”, meaning tenants may live there as long as
they meet the basic obligation of tenancy, such as paying the rent; it must be “supportive”,
meaning tenants have access to the support services that they need and want to retain
housing; and it must be “housing” meaning the tenants have a private and secure place to
make their home, just like other members of the community, with the same rights and
responsibilities.
Permanent Supportive Housing is driven by a set of core values and principles (shown on
handout). One of the core principles is that the housing service and the support services be
unbundled. The tenant must have free choice whether or not to use the support services—
they must not be a condition of tenancy.
SAMSHA has developed a toolkit to help guide providers in developing housing services that
meet the elements of Evidence-based Permanent Supportive Housing. (The URL for the
handbook is given on the handout.)
Permanent Supportive Housing is not a Medical Assistance service and people do not need to
be MA-eligible to receive PSH. They do have to have low to moderate income.
Dave ran through a handout with a graphic representation of all the service elements of the
adult mental health service system.
3. Update on Managed Care for People with Disabilities – Pam Parker, Health Care
Administration
Pam described new legislation for expansion of managed care for people with disabilities. This
new program, referred to as Special Needs Basic Care (SNBC), includes Medical Assistance
basic care, including mental health services, but no long-term care services. The potential
population to be enrolled is projected at approximately 17,000 children and 95,000 adults,
and enrollment is to be phased in between January and July. Those who opt out will remain
on Medical Assistance under fee-for-service. SNBC has been in operation since 2008 and I
currently has enrollment of 6,000 through five health plans. The goal of SNBC is to increase
access to primary and preventative care.
The department will need to establish processes for enrolling people in some counties without
SNBC coverage, and fully intend to ensure people know their options for opting in or out of
the program. They are working on client involvement and stakeholder meetings to gather
input and to help clients understand the available options.
The Disability Linkage Line will be available to assist people and enrollments will be
conducted at the state. If people opt out, they will be able to opt back in at a later date,
depending on need and other regulations. Pam clearly made the point that this is a voluntary
process that gives the clients choice.
Members of the panel pointed out that while this program was apparently developed to cut
costs, the apparent savings are actually realized through delayed payments that shift costs
from one fiscal year to another.
4. Legislative Review and Next Steps – Loren Colman, Assistant Commissioner, Continuing
Care Administration and Alex Bartolic, Director, Disability Services Division
Loren gave highlights from the final HHS bill passed by the Legislature, related to services
that affect aging, disability and mental health services. A summary and related documents
have been posted on the DHS website for public use. The Administration is prioritizing
requirements and setting their agenda for the next months.
This bill calls for 3.5% administrative reduction, which translates to generally 7.5% when the
impact of losing the federal match is factored in, and the administration is currently trying to
determine the impacts of this reduction. There are provider rate decreases of 1.5% for FY1213. The decrease does not apply to nursing homes. Only 1% of the whole decrease is
permanent. There is also an additional rate cut in effect in July1, 2012 that will be triggered
based on other developments around maintenance of effort and potential waivers. DHS is
planning to make necessary requests to CMS in the next 60 days, once staff has accurate
data and projections about the impact of the legislation.
Alex talked about the impacts for people with disabilities. The Technology grant was
continued, but slightly reduced. There is a 10% reduction in some living supports for certain
settings, and the criteria are now being developed and will be released with the next bulletin.
They are carefully reviewing the impact both on current services as well as qualifications for
future services. There is a call for a statewide quality council, which will be put in place as
quickly as possible.
Loren asked why the pressure on the limits for some waivers is not as active as previously,
when it appears that that demand might be growing, in areas like brain injury waivers. The
panel had no real suggestions, except that there may be some instances of individuals being
PP Meeting Agenda
8.12.2011
screened into one waiver category rather than others, which builds stress in some places and
not in others.
The Panel members asked how quickly these negotiated decisions can be made with high
levels of stakeholder involvement in decision making around the waiver process. While the
Administration wants to respond quickly, they will have to wait for guidance from CMS, work
with the resources they have, and engage stakeholders to look at the long-term implications
and plan for the future. They want to look at options for creating the most creative responses
to clients. Alex explained that the current timelines for strategic projects will remain in effect,
and as changes are made to those, the Panel will be informed.
5. MA Waiver Reform Reform – David Godfrey, Health Care Administration, and Loren
Colman, Continuing Care Administration – This was postponed until next meeting.
6. Round Robin on Measurement – Glenda Eoyang and Panel members – This was postponed
until next meeting.
7. State Profile – Quality Chapter RFP – Rolf Hague, Aging and Adult Services
This RFP is to develop and write the chapter on quality for the State Profile this Panel helped
to develop over the past two years. The RFP will be out by August 29, with a rapid turn
around and intentions to have someone hired to do the work by October 1. The goal is to
have a preliminary report to this group before the first of the year, with data sources,
proposed measures, and work plan, with the chapter written by the first of the year.
This work relates to the Quality Commission in that it is a goal to set a baseline and help to
make data collection and presentation to be consistent across the department. As a beginning
this is an “inventory” of data and information that is currently collected. It will also move
toward aligning and coordinating available data and its collection. Panel members asked that
they be consulted and notified as this work is being done.
8. Real Choice Systems Change Grant – Cathy Jacobson, Disability Services Division
Cathy provided a quick update on a grant opportunity that has become available. It is closely
aligned with the Money Follows the Person and would provide funds for DHS and Minnesota
Housing to expand their partnership and to work together to complete the application steps
for the HUD Section 811 program, to be announced in 2012. She also invited any of the
Partners who might be interested to submit a letter of support. This is a competitive grant,
and if it is awarded to Minnesota, Cathy will come back to the Panel to share further
information and planning at that time.
9.
10. Future Topics and Close – Glenda Eoyang
Glenda invited suggestions for topics for future meetings. The Panel members made some
suggestions:

Discuss any re-work and re-write of the strategic plan due to changes in the legislature

Discuss how much has already been accomplished by strategic projects and how it can be
used to contribute to new requirements as well

Update on provider and health reform systems

Updates on the projects that are currently in process
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
Discussion of quality and report card measures

MA Waiver
The meeting was adjourned at 11:30 am.
Remaining Meeting Dates for 2011
October 14 – MSRS
December 9 – MSRS
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8.12.2011
Home and Community Based Services
Partner Panel Attendance Record
Organizational
Affiliation
NAMI Minnesota
MN Legislature, Chair House Health/Human Services Finance
MnDACA
Alzheimer's Association
Minnesota Association of Mental Health Centers
Association of Minnesota Counties/CBP
Care Providers of Minnesota
Minnesota Association of Centers for Independent Living
Local Public Health Association (LPHA)
Minnesota Legal Services Coalition
Minnesota STAR Program
Medica - representing MN Council of Health Plans
MN Network of Hospice and Pallliative Care
ElderCare Rights Alliance
MN Legislature, Chair House Health/Human Services Reform
Comm
Minnesota Board on Aging
Courage Center (rep for TBI Advisory Group)
MN Legislature, Chair Senate Health/Human Services
Committee
Lutheran Social Services
Minnesota Disability Law Center
AARP
LTC Ombudsman
Minnesota Home Care Association
State Advisory Council on Mental Health
Minnesota Area Geriatric Education Center
PACER
Advocating Change Together (ACT)
Brain Injury Association of Minnesota
Minnesota Consortium of Citizens with Disabilities
Governors Workforce Development Council
American Association of Retired Persons
Association of Residential Resources of Minnesota
MNAPSE-The Network for Employment
Minnesota Habilitation Coalition
Ombudsman for MR/MI
MACSSA - Anoka County
Minnesota Adult Day Services Association
Minnesota Council of Child-Caring Agencies
Minnesota Association of Area Agencies on Aging
Minnesota Association for Children's Mental Health
Minnesota Home Care Association
White Earth Home Health Agency
Minnesota HIV Services Planning Council
Courage Center
First
Name
Sue
Jim
John Wayne
Mary
Ron
Patricia
Patti
Victoria
Kay
Ron
Jo
Julie
Michele
Janet
Last
Name
Abderholden
Abler
Barker
Birchard
Brand
Coldwell
Cullen
Dalle Molle
Dickison
Elwood
Erbes
Faulhaber
Fedderly
Golden
Steve
Joseph
Jodi
Gottwalt
Grant
Greenstein
David
Jodi
Anne
Heidi
Deb
Neil
James
Robert
Kim
Mary Kay
Pete
Steve
Bryan
Amy
Bruce
Bob
Lynn
Roberta
Jerry
Laura
Mary
Catherine
Debora
Jennifer
Jen
Tim
John
Hann
Harpstead
Henry
Holste
Holtz
Johnson
Jordon
Kane
Kang
Kennedy
Klinkhammer
Larson
Lindsley
McDonough
Nelson
Niemiec
Noren
Opheim
Pederson
Philbrook
Regan
Sampson
Saxhaug
Sorenson
Stevens
Sullivan
Tschida
8.12.11
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
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8.12.2011
Minnesota Leadership Council on Aging
Mike
Weber
Governor's Council on Developmental Disabilities
Colleen
Wieck
Minnesota State Council on Disability
Joan
Willshire
Aging Services of Minnesota
Mary
Youle
x
Staff Present: Alex Bartolic, Kari Benson, Glynnis Edwall, Rolf Hague, Cathy Jacobson, Lori Lippert,
Pam Parker, Lorriane Pierce, Dave Schultz, Anni Simons,
Guests Present: Glenda Eoyang and Royce Holladay, Human Systems Dynamics Institute; Janice
Jones, Health Department; Susie Schatz, LSS; Chris Bell
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8.12.2011