Legislative Priorities
The Issues
Preserving Independence - With the budget deficit at almost $1.2 billion, the threat of cuts to programs and services is again very real. Thus, preserving programs and services that enhance independence is critically important.
Care Coordination - AXIS Healthcare is an innovative model of disability care coordination because it puts the person with a disability at the center of everything rather than the insurance provider, health care provider or equipment supplier. This model must be preserved and expanded so person-centered health care decisions are the norm.
Transportation - For people with disabilities, the lack of accessible transit is not just about cars, buses and trains, it affects people’s employment, education and even healthcare challenges. We need to solve the problems of access and quality to fix one of the greatest barriers to independence.
Courage Center’s Transitional Rehabilitation Program (TRP) - The TRP serves a complex population, most with newly acquired brain and spinal injuries. However, the reimbursement received to provide services does not come close to covering the running costs. We need better reimbursement rates to fund the TRP and continue to provide higher quality services and better outcomes for all individuals with disabilities.
Our Focus at the Legislature for 2010
We understand the 2010 legislative session will be difficult. Our goals recognize the current fiscal environment, while also preparing for the more difficult circumstances that will surround the 2011 session.
Our 12,000 clients represent some of the state’s most vulnerable citizens. More than 35 percent of them rely on Medical Assistance (MA) as their only form of health insurance. Significant changes to MA are now underway to greatly improve the system: tightening the PCA program, standardizing payment for services, state (rather than county) regulation of providers, and more consistency in assessing long-term care needs. These and other changes will save money and create greater program accountability. Unfortunately, the savings won’t be booked this biennium.
Continuing to limit access to needed health services – like rehabilitation therapies – for those with complex needs (and trimming the rates paid to providers of disability services) will not save money in the long run. It will cause high-quality organizations like Courage Center to restrict our MA book of business, and the clients we now serve will see declines in health and independence.
Priorities for 2010
Preserve rehabilitation therapy services
After unallotment decisions in 2009, physical, occupational and speech therapy rates were cut 6.5 percent. These services return people to their lives and livelihoods after an accident, injury or adverse health event (such as a stroke or hip replacement). Gov. Pawlenty has proposed they be eliminated. In 2008, 525 MA clients received these services and we were paid $1.3 million. Ironically, eliminating these services would help our bottom line. On average, we lose about $600 on every MA client due to inadequate reimbursement rates.
Measuring outcomes for long-term care services and supports
The passage of the Health Reform Act of 2008 resulted in a renewed attention on purchasing health and medical services based on their effectiveness and value. As a result, much work has been done since then to develop indicators and strategies to rate and group health providers based on their cost-effectiveness and quality. Unfortunately, very little data and few measurement strategies exist for the $4 billion the state spends on long-term care services for the elderly and disabled. We, in partnership with the Minnesota Consortium for Citizens with Disabilities (a coalition of more than 100 statewide disability organizations) are introducing a budget-neutral bill to create an outcomes framework for long-term care services.
Reward high-quality skilled nursing facilities, like Courage Center’s TRP
Effective July 1, 2006, nursing facilities may contract with DHS to earn performance-incentive Medical Assistance payments of up to five percent of the operating payment rate. These payments are competitively awarded, time-limited rate adjustments. Funding available to implement new projects under this provision for fiscal year ending June 30, 2011 is equal to approximately $2 million (state share). We’re proposing these payments be allowed to reach up to 10 percent of operating cost. This change would increase individual grant amounts, but have no impact on the state budget.