Waiver Reimagine Advisory Committee June 29, 2023, meeting summary

Committee members present: Kathryn Barton, Annie Braun, Tricia Brisbine, Jennifer Drganc, Rosalie Eisenreich, Lisa Evert, Mary Fenske, Kelly Friesen, Arbdella Hudson, Zahnia Harut, Dr. Katrina Jirik, Susan Mackert, Meredith McKinnon, Julie Morrison, Polly Owens, Rijuta Pathre, Bud Rosenfield, Saudade SammuelSon, Elizabeth Scheel-Keita, Pat Wright, Wa Xiong, Gina Winter, Lauren Thompson, Sherri Pickthorn

Committee members not present: Fartun Weli, Jeanne McGuire, Chad Wilson, Myrna Peterson, Phyllis Reller, Kathy Rogers, Lisa Harvey

DHS staff present: Meghan Lindblom, Sandy Zuhlsdorf, Elliot Rankin, Matt Knutson, Maria Trueblood, Mai-Ling Mui. Peter Beierwaltes, Amber Jepperson, Jen Olson

Meeting notes

April meeting recap

· DHS described 12 services and the WRAC asked questions, discussed and developed recommendations for which waiver each of the 12 services should be available under:

Waiver 1 (for people who live in their own home or family home).

Waiver 2 (for people who live in provider-managed residential settings).

· At the April meeting, people noted that service mix information resulted in the most confusion at the February meeting.

· Plans were to revisit that topic at the June meeting. However, due to time and the need for focus of this meeting on budget exception development, service mixes will be reviewed at another point in the future.

WRAC member and DHS meeting objectives

For WRAC members:

· Overview of rates and budgets.

· Provide feedback on future budget exception implementation.

For DHS staff:

· Provide understandable explanation of rates, budgets and budget exception development.

· Listen and note feedback responses.

· Answer questions and note follow up.

Today’s meeting will be an information-gathering session with WRAC members reviewing DHS and other stakeholder groups in creating future budget exception development work. The focus on pre-meeting survey results and further goup input on:

· Additional budget exception types proposed by members.

· Developing clarity in unclear budget exception.

· Revisiting outstanding questions or comments.

Meeting goal was for development of a solid list of budget exception types, not to finalize the budget exception process.

Rates and budget recap

Meghan Lindblom, program integrity supervisor, reviewed rates and budgets per some members expressing confusion following the February meeting. Time was allotted for members to speak to their confusion and/or ask questions.

Service rates are the cost of services and budgets are how much a person has available to spend on services.The following example was provided for further clarification:

· Rates for a service are like the cost of an item at the store.

· A budget is the amount you would have to spend on all the items you need to buy at the store.

Policy Development: Budget exceptions overview

Sandy Zuhlsdorf, fiscal policy analyst, explained an exception is a situation to which a rule does not apply and the exception process acknowledges that one rule does not meet the needs of all. Past data was used to determine roughly who may need a budget exception following the launch of individual budgets through Waiver Reimagine.

The exceptions discussed at this meeting were based on feedback from:

· National research.

· Multiple lead agency work groups.

· Broad feedback from interested parties.

· Internal development: real cases of people over budget and other policy exception staff.

Core question exceptions for developing the budget exception criteria:

· Who is eligible for an exception?

· What type of exception(s) do they need?

· How much of the exception(s) do they need?

· What is the process for request, review, approval/denial, and renewal the exceptions?

Meeting focus was on the who and the what is needed for exception development. Decisions about the last two questions will be answered following the determination of concrete reasons for future budget exceptions. Feedback received from the pre-work survey regarding the process for getting an exception was put in a parking lot to be answered later.

Policy development: Proposed budget exceptions and feedback

Meghan Lindblom discussed the eight proposed budget exceptions:

· High/above average health or behavorial needs

· Safety net

· 24-hour staffing

· High need setting

· Emergency need

· Age-based transition

· Temporary transition

· Employment use.

In addition, the following exception ideas from the pre-work survey were discussed:

· Trauma informed care requiring expertise or training for providers

· Housing transition or disruption of service causing bump in need for period of time

· Cultural/language barriers

· Transportation

· Home/vehicle modifications

· Social/community integration

· Leave dates

· Funds for unattainable state planned service allotment-unable to access due to lack of staff or providers. Requires use of waiver services to meet needs instead.

· Health and wellness

· Overtime rates for staff

· Caregiver aging needs. Age of the person getting help and age of the person providing help affect the services.

Sandy Zuhlsdorf, reviewed the following list of unclear exceptions obtained by the pre-survey from WRAC members to discuss and clarify:

· Emergency need: clarification

· Terminations automatic exception

· Temporary transition definition: how long do these last?

· 24 hour with a focus on awake and asleep staffing

· High needs setting

· Safety net

· What does stability mean?

· Examples.

Adjourn

The meeting was adjourned. The next meeting of the WRAC will be Aug. 24, 2023. Meeting details can be found on the Waiver Reimagine Advisory Committee website under the Meetings tab.