Advocacy

Public Policy

ARRM works on the state and federal level to ensure the public policy and regulatory environment promotes the independence, health and safety of people with disabilities and strengthens our members' ability to support them. We achieve this by identifying policies that will create positive changes to our disability services system and help achieve the goals and ideals laid out in guiding principles such as the Minnesota Olmstead Plan, working with legislators and supporting coalitions to pass these policies at the state and federal level. Several ARRM member-committees shape the organization's policy platform and revisit it on an annual basis.

For More Information

Sara Grafstrom
Director of State and Federal Policy
sgrafstrom@arrm.org
651-291-1086, ext. 8

Federal Policy - 2021 Priorities

Background Information
According to ANCOR, “roughly two-thirds of Medicaid spending is attributed to elderly and disabled beneficiaries although they make up just a quarter of all Medicaid enrollees, and Medicaid is the single largest source of coverage for nursing home and community-based long-term supports and services.”

ANCOR goes on to state that “in the current political climate where long-term debt/deficit reduction is at the forefront of conversation, Medicaid is at risk of losing federal funding.” “Because of the system of matching funds, a $1 reduction in federal funding contribution will likely result in a $2 reduction in state spending, as most states are not likely to be able to make up that shortfall.

Three different proposals that are being discussed to reduce federal Medicaid spending include:

  • Converting the program to a block grant system, wherein states would get a fixed (lower) amount of money rather than receiving matching federal funds.
  • Implementing per-capita caps, which would provide states a set amount of funding per Medicaid enrollee
  • Reducing the rate of, or eliminating, provider taxes, which states use to fill in gaps in their Medicaid programs with federal dollars.

Additional Resources

Background Information
According to ANCOR, over 730,000 people with developmental disabilities live with aging parents. Across the nation, people with disabilities are facing a crisis in the availability of safe, affordable, and accessible housing. The American with Disabilities Act (ADA), as interpreted by the U.S. Supreme Court’s Olmstead decision, requires public entities such as states to administer services, programs, and activities in the most integrated setting appropriate to the needs of individuals with disabilities.

On the Federal level, the Frank Melville Supportive Housing Investment Act of 2010 reformed the Section 811 Program, which assists the lowest income people with significant and long-term disabilities to live independently in the community. Under the Frank Melville Supportive Housing Investment Act of 2010, the new law specifies that one purpose of the Section 811 program is to expand the supply of supportive housing that “promotes and facilitates community integration for people with significant and long-term disabilities.”

In Minnesota, Governor Dayton issued an Executive Order in 2013 establishing an Olmstead Sub-Cabinet to develop and implement a comprehensive Minnesota Olmstead Plan. Minnesota’s plan, “Putting the Promise of Olmstead into Practice: Minnesota’s 2013 Olmstead Plan” was release November 1st, 2013. For more information on Minnesota’s Olmstead plan please see the third link listed below. Olmstead Sub-Cabinet meetings continue to meet and are open to the public.

Additional Resources

Background Information
DSPs are among the nation’s most vulnerable workers, typically receiving low wages and having limited access to health insurance and other benefits. According to ANCOR, “the DSP workforce has been plagued for decades by turnover rates ranging from 40-50%, a rate far exceeding most other industries.”

Medicaid is essentially the only payer for services for people with intellectual and developmental disabilities. As a result, community providers cannot simply raise prices or shift costs to meet an increased minimum wage or other labor rules. Provider rates are determined by individual states.

Minnesota recently passed a new minimum wage law during the 2014 Legislative Session, mandating that large employers pay $9.50 by August of 2016 and small employers pay $7.75 by August of 2016, and beginning in 2018, the minimum wage will be set to inflation. The law however does not adjust provider rates to reflect these changes.

Additional Resources

Background Information
Most Medical Assistance recipients with disabilities receive services on a fee-for-service basis. However, some disabled MA recipients receive Medicaid services through a managed care program. In Minnesota that program is called the Special Needs Basic Care Program. People are automatically enrolled in special needs plans, unless they choose to opt out of managed care enrollment and remain in fee-for-service.

According to the Arc of Minnesota, Special Needs Basic Care (SNBC) plans promote access to primary and preventive health care including coordination of Medicare and MA benefits. SNBC plans also provide navigators, care coordinators or care guides to assist their members with accessing benefits. SNBC plans also waive state MA copays and deductibles. In Minnesota, SNBC does not include home and community-based services provided under the MA waiver programs, personal care assistance or private duty nursing services. These services will still be provided under MA fee-for-service generally through the county.

Additional Resources

State Policy - 2021 Priorities

SF 492/ HF 976

Extending Remote Supports

The ability to provide certain Home and Community-Based Services remotely under the Peacetime Emergency has been critical in ensuring little to no service interruption during the COVID-19 pandemic. This allowance expires in June 2021.

Through Waiver Re-Imagine, the state is engaged with the federal government on how to make this option permanent for certain services. ARRM’s proposal will extend the allowance of Remote Supports under the Peacetime Emergency to June 2022.

Create a service for hospital stays

Federal changes in the summer of 2020 allow for states to authorize a service that would allow Direct Support Professionals and Personal Care Assistants to be reimbursed for time spent supporting individuals during short-term, acute hospital visits.

Minnesota must develop the language for the legislature to authorize that will give individuals with disabilities the access to direct support staff while in the hospital, allowing them to get the individual care that they need.

ARRM’s proposal would direct the Commissioner of Human Services to work with stakeholders in the development of language that would enable this services in Minnesota.

Develop a task force for service delivery in a person's own home

As service models have evolved and transitioned to options outside of provider controlled settings, in settings owned or rented by the individual receiving services, some of the rules and regulations with Minnesota Statute 245D are no longer appropriate.

ARRM’s proposal would direct the Commissioner of Human Services to develop a task force to examine Minnesota Statute 245D and make recommendations on potential changes to the statute when services are provided outside of a provider controlled setting, in an individual that is receiving service's own home.

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SF 562 / HF 740

Adjust ICF/DD rates
ICF/DD rates are determined outside of the Disability Waiver Rate System with the last rate increase for ICF services being in 2015 for 1%.

With the recent investments made in waiver rates, a growing pay gap for Direct Support Professionals in ICFs versus waiver services is occurring. ARRM’s proposal would adjust ICF rates by 5%.

A variable rate is a tool that providers can use when an individual’s needs change, due to aging or other health changes. It is the tool to request a higher reimbursement rate.

Current law restricts variable rate usage

ARRM’s proposal would remove the restriction on providers, allowing any provider to request a variable rate taking into consideration aging and changing needs as a reason to request a variable rate. It would create a process to request a variable rate similar to what is available to individuals that are served through a waiver.

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SF 3117 / HF 3206

Creates retention grants for HCBS providers using a portion of the enhanced FMAP dollars specific to HCBS services that were passed in the American Recovery Act

Retention grants would begin in July 2021 and are dispersed on a quarterly basis, based on the providers previous month’s Medicaid billing

Allowable uses include: DSP bonuses, hazard pay, benefits as well as investments in assistive technology or increased expenses due to the COVID pandemic

50% of revenue from the retention grants must be used on DSP compensation

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