Home and Community Based Services
Expert Panel
August 13, 2010
Minnesota State Retirement System Building
60 Empire Drive
St. Paul, MN 55103
Meeting Notes
Note: The current versions of most of the documents mentioned in these notes can be found at the
HCBS Expert Panel page on the DHS website. Otherwise please contact Lori Lippert if you have
questions or comments at Lori.Lippert@state.mn.us.
1. Welcome – Glenda Eoyang, Human Systems Dynamics Institute
Glenda started with introductions of the individuals in the room. She then reviewed the
agenda and talked about who would be addressing the group today.
2. Elder Justice Act Update – Deb Siebenaler
Deb Siebenaler provided an update on the Elder Justice Act and the Minnesota
Vulnerable Adult Act (see handout of slide presentation). It protects people 18 years of
age and older who are vulnerable to harm due to disability or dependence on health care
services. She reported the State has been collecting data in a standard format since
2008. This trend data has potential for informing policy decisions.
She reviewed the Elder Justice Act, which is a part of the Affordable Care Act. The Act
authorizes formation of an Elder Justice Coordinating Council and Advisory Board on
Elder Abuse, Neglect, and Exploitation, however there are not appropriations to
implement these authorizations. DHS plans to establish stakeholder meetings to talk
about what can come from this legislation, but is waiting for more guidance from CMS.
This program opens the path for Tribes to create structures to support/protect their
elders, and also includes state demonstration grants, forensic centers, and other
supports, which have been authorized, but not appropriated.
Deb then focused on part of the act concerning protecting residents of long-term care
facilities, explaining details of requirements for reporting and following up of serious
bodily injury, which has a specific definition. The department contacted CMS for
guidance in interpreting and implementing these requirements.
Stella French could not join today’s meting, but she did send a statement explaining the
State’s position about current definitions and projections.
3. HCBS Dashboard Project – Hal Freshley, Steve Eiken, and Sara Galantowicz
(joined by phone)
The State has completed its state profile of available services. The next step will be to
identify a short list of key indicators to include in a scorecard to track performance. Hal
reviewed the process for developing these indicators and shared the current
recommendations.
One person expressed concern about the utility of such aggregated data. Discussion
explored the complexity of designing/collecting good system-wide data. There was
concern that measures, as provided, are less useful than other information might be that
can be disaggregated by age, gender, and/or other group. Using the whole system
snapshot does not provide information that is easily actionable. Another member
suggested that length of service is critical information. Panel members asked about the
scope of county or regional breakdown, pointing out that sometimes there are
discrepancies within counties and/or regions.
What audiences will be seeing this report? The categories used in the suggested
indicators have been developed by CMS, and the measures were based on the Expert
Panel’s previous input. There is a need for more questions to help figure out how the
state leverages the resources they have, dissect the data differently, and to be clear
about the resources available.
Steve and Hal asked the group to consider what they and their constituencies want and
need, and to provide feedback to Steve (steve.eiken@thomsonreuters.com or 651-6871136) by Friday, August 20, so it can be included and/or addressed in their work. Panel
members shared the following additional feedback. General responses from Hal and
Steve are listed in parenthesis after the questions they addressed.
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How frequently will this data be updated, and can we get the information? (At
least annually, and yes you can.)
Who is this for? (Legislators, funders, providers, and general audience to show
the progress we are making.)
What is found in other states? (It varies state by state)
What is important to this Panel?
o Focus areas? – Look at the functional assessment
o How are measures biased?
o Working adults?
4. Impact of 2009 CCA Reform Initiatives – Valerie Cooke, Bob Kane
The presenters went through the criteria for nursing home use and their plan to provide
a program of evaluation concerning the impact of those criteria across two years. Their
research questions included the impact, focusing on program outcomes, including
changes in major outcomes between baseline period before the initiatives were
introduced and data collected after a period of implementation. This is a long-term
project because the first post-implementation “impact” data won’t be available until
sometime after the end of the period being studied, which will be at least a couple of
years. They are also doing a “process assessment”, looking at the ways the initiatives
are being implemented. After reviewing their sampling procedures, they outlined the
data sources they will use as primary and secondary resources. They spoke to the
difficulty of separating out the measurement artifacts from the indicators of real change.
Their handouts included both a set of PowerPoint slides and an evaluation report, and
are available on the Expert Panel website.
5. Health Care Reform Discussion – Alex Bartolic, Jean Wood
Jean started the conversation by talking about grant opportunities and awards, and
identifying the grants the Department is exploring, using two handouts. She stated they
plan to update these documents, with the help of panel members, to help interested
parties understand what is happening with funding. The updated documents will be kept
on the HCBS expert website. If anyone has any corrections or additions to suggest they
should email those comments to Lori Lippert (Lori.Lippert@state.mn.us).
Expert Panel Notes – August 13, 2010
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The group started with a discussion about Money Follows the Person (MFP). MN is
exploring this option, looking at transitioning people from long-term institutional care to
home and community based services. She invited people’s feedback/comments.
Alex explained that the purpose of this discussion is to get input about what to explore
and how to think about the opportunities that are coming up. She opened the
discussion for suggestions from panel members. They were as follows.
Goal: Move people out of Institutions.
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Can this be a system-wide pool of money to reduce funding constraints and
competitions? Like to see this provide a single source of money rather than
multiple MA funds. Are there legislative limits?
There seems to be little downside to this proposal.
We need a variety of implementation plans.
Can we eliminate barriers in state law?
Does this include IMD’s?
Document the initial schematic – What scenarios would be helped and how?
Identify and overcome barriers to home-based services. What are those
problems?
Change the limit for home modification.
Work on function, rather than diagnosis.
Support for families to plan investment and give them a pot of money to do so.
Remove housing barriers (access, find out availability).
Provide a menu of options for spending.
Support employment options.
Address shortage of transportation options for clients to get to services.
Extend sustainability beyond 5 years.
Remove infrastructure roadblocks at the federal and state levels
Expand mental health access.
Identify how this meshes with State Operated Systems; move beyond basic
continuing care options.
Identify and develop systems that don’t squash intent of the MFP and long-term
state commitment.
o Not consumer-directed care. The money goes for infrastructure changes; it
does not go to the person.
o This is a 5-year grant period. Each person has a 1-year benefit.
Identify global waiver and services.
Support housing.
Invest in infrastructure for all parts of the state.
Level the playing field for providers.
Arrange continuity of care for individual at the end of the year.
Provide transportation for all counties.
Build an overall more efficient housing system based on extant housing
Incremental, fairly small changes as it moves forward
Focus on Medicaid population
o Address labor shortage for needed support (PCA’s, etc.)
o Combine with other federal options.
o Provide education for providers about chronic, multiple diagnoses.
o Use data about people who are moving now to fund what is already
happening.
MFP is not a new program, per se. Dr. Kane clarified the purpose of the grants and what
he sees it means to services. It is a grant to enable states time and financial support to
Expert Panel Notes – August 13, 2010
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restructure the service system over the five years of the grant. It gives state the
resources to invest in system-wide changes.
The following questions were developed.
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1915 K has incredible potential. Can the spend-down policy continue?
Can this money provide help for housing transition?
If this is institutional level of care, is this for CMS Residential Treatment? Is LTCC
modified for children? How much do we already have in place?
Is it that 1915(i) waiver is not time-limited and 1915(k) is time limited?
Can the state do all this through rule-making? by capacity? Do the various
waivers fit together in sequence?
Can healthcare costs be included under a 1915(k) waiver?
The group listed what seems consistent with current practice in the new regulations:
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It is consistent with 1915(j) that the 2007 legislation put PCA funding on hold.
1915(c) waivers and these new options are consistent
All target the same, overall, populations
All require Medicaid enrollment
All seek to avoid institutional placement
Deal with PCA alternative 1915K
Transforms PCA into 1915 K
They also listed what seems inconsistent with current practice:
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It provides assistive technology.
It replaces state money that is matched.
Covers services that were cut from PCA.
Saves people and services.
Offers a big pool rather than lots of little ones.
Current PCA is on maintenance. This allows money for enhancing and prompting
skills.
Under 1915(i) counties are more responsible for day treatment.
Under 1915(k) there are supports for work.
Serves a new population – 1915(i)
New benefit set
New funding for the old benefit set
Can’t limit the population
1915(i) reduces/slows down the need for others
Help with transition
1915(k) adds health-related issues?
Compare current and future restriction for PCA
No discrimination on basis of kind of need
Panel members provided the following comments and questions for the application due
on January 7, 2011, for the Money Follows the Person.
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How different is this from consumer-directed supports? How would it interface
for the 5-year demonstration?
Is this for people who are currently in an institutional setting? Yes.
Is this ICFMRs? Yes.
We will apply for a planning grant? Yes.
How can we (Expert Panel) be involved going forward?
How will this program work with Return to the Community? Use the same
service protocol? Consistent data?
Would any of this provide single portal money?
Expert Panel Notes – August 13, 2010
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Would this support personal responsibility?
What about nursing homes and ICFMRs?
Finally the Panel members identified ways to move forward together on this information.
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Get electronic copies of the tables to the Expert Panel members
Form a subcommittee to bring in other resources for faster and more complete
responses (Rapid Response Team)
Complete a fiscal analysis of current money against the match and opportunities.
(This is available in the materials from the hearings)
Work on something positive
Work closely with Anne Berg
6. Meeting for October 15 date works for people so it will remain on the calendar.
Remaining Meeting dates for 2010
October 15
9:00 a.m. – 12:00 noon
Location TBA
December 10
9:00 a.m. – 12:00 noon
Location TBA
Expert Panel Notes – August 13, 2010
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