External Program Review Committee (EPRC) agenda

Date: 2-4 p.m. on April 4, 2024

DSD liaisons: Stacie Enders and Ari Dionisopoulos

Type: Whole committee

Location: Room 2222, Elmer L. Andersen Building, 540 Cedar Street, Saint Paul, MN 55101

Meeting link: https://minnesota.webex.com/minnesota/j.php?MTID=m18725c4007b15e4c653d9dc3ddd2064a

Access code: 2486 040 8341

Accommodations: If you need an accommodation for this meeting, you must notify a DSD liaison three days before the meeting. Email PositiveSupports@state.mn.us or call (651) 431-4300.

Common acronyms used by the committee

We ask committee members to avoid the use of acronyms. Here are common acronyms:

· BIRF: DHS form 5148: Behavioral Intervention Report Form

· CABC: Context, antecedent, behavior, consequence

· DEED: Minnesota Department of Employment and Economic Development

· DHS: Minnesota Department of Human Services

· DLI: Minnesota Department of Labor and Industry

· DSD: Disability Services Division

· DSP: Direct support professional

· EUMR: Emergency use of manual restraint

· FBA: Functional behavior assessment

· HCBS: Home and community-based services

· IRP: Interim Review Panel (Predecessor to the EPRC)

· MDH: Minnesota Department of Health

· PCA: Personal care assistant

· PSR: Positive Supports Rule: Minnesota Rule 9544

· PSTP: DHS form 6810: Positive Support Transition Plan

General reminders for committee members

Before speaking, please state your name. Committee members are expected to:

· Be on time.

· Read the minutes, agenda and supporting documents before each meeting.

· Participate in ideas and conversations, as well as pause to allow others to share input.

· Commit to spending the whole meeting time present and not engage in other activities during the meeting.

Technology

The first few minutes of every meeting will be dedicated to addressing any connectivity issues, to ensure everyone can hear other meeting participants.

Agenda items

Public comments

The committee encourages public participants to share their thoughts and ask questions about committee activities at the beginning of each meeting. The committee will continue on to the next agenda item when either 1) 30 minutes have passed or 2) when there are no additional comments or questions, whichever comes first.

Vote

The committee will discuss and vote on the minutes from March 2024.

Updates to share

Direct care workforce shortage

· CFSS receives federal approval. This may impact worker shortages in the following ways:

Allows people more choice and control as the employer of their support professionals.

Allows a person’s spouse or the parent of a minor to be paid as a support professional.

Gives people the opportunity to purchase technology to meet their support needs.

Provides each person a support professional training and development budget.

· Elderly Waiver (EW) amendment package receives federal approval. This may impact worker shortages in the following ways:

Increases Consumer Directed Community Supports (CDCS) budgets, which could be used to increase staff wages and benefits.

Changes the number of hours for which parents of minors and spouses can be paid to provide personal assistance.

· Bill proposals:

Would provide supplemental payments to providers who support high-acuity hospital patients, with funds directed towards “wages or equipment”: SF 2885 as introduced - 93rd Legislature (2023 - 2024) (mn.gov)

Adds to the psychiatric residential treatment facility rate “estimated additional staffing compensation costs, subject to review by the commissioner”: HF 1683 1st Engrossment - 93rd Legislature (2023 - 2024) (mn.gov)

Intends but doesn’t entirely meet the goals of permitting overtime reimbursement, overnight asleep reimbursement, and reimbursement for shifts of 24 hours or longer for PCA and CFSS workers: HF 4675 as introduced - 93rd Legislature (2023 - 2024) (mn.gov)

Proposes providing additional staff training for those providing youth care services: HF 4671 as introduced - 93rd Legislature (2023 - 2024) (mn.gov)

· A Request for proposals (RFP) to Support New Americans in the Long-Term Care Workforce is now available for application. The purpose of these grants is to provide specialized services and supports to New Americans to enter and grow within the long-term care workforce.

The application window for this RFP is Tuesday, March 19th – Monday, May 6th, 2024.

Link: RFP information_DHS is supporting new Americans in the long-term care workforce.

Please do share this grant opportunity with your networks.

If you have any questions, please contact MN.GEAR.DHS@state.mn.us.

· AmeriCorps and the Administration for Community Living (ACL) have entered into a Memorandum of Understanding (MOU) to facilitate development of collaborative activities to “significantly increase the number of volunteers, including older adults and people with disabilities, engaged in service activities.” The MOU states that the additional volunteers will “help bolster the ability of Americans of all ages to live at home with the support they need and participate fully in society while also supporting communities in need throughout the United States.” More information can be found at: Memorandum of Understanding between the Administration for Community Living and AmeriCorps. Specific areas of focus for the two agencies include:

Encouraging the utilization of AmeriCorps volunteers by the aging and disability networks to support home and community-based services for older adults and persons with disabilities.

Through training and related activities, exploring efforts to promote the use of volunteers in respite programs and other family and caregiver support services.

Promoting activities that enhance efforts to build natural supports for families.

· Federal Standard Occupational Classification code for direct support professionals:

The Recognizing the Role of Direct Support Professionals Act (S1332) passed in the Senate in March. The push now moves to the House. The House bill, H.R.2941, has been introduced by Rep. Brian Fitzpatrick (R-PA).  

You may contact your representatives in the House and tell them to vote yes on HR 2941 and recognize the role and value of direct support professionals. 

For more on why the Standard Occupational Classification is so important, read Direct Support Professionals need a ... Standard Occupational Classification. 

· Twin Cities nursing home employees walk off the job, citing worker shortages, pay (startribune.com).

· This federal bill would create a family caregiver tax credit: S.3702 - 118th Congress (2023-2024): Credit for Caring Act of 2024 | Congress.gov | Library of Congress.

Subcommittee updates

Printing the Psychotropic Medication Manual

In response to a question from the committee’s March meeting about printing the new manual as a PDF document:

· There is not a way to convert DHS manuals to PDFs. The background information on this is that DHS uses HTML-based manuals because they are easy to update and they are the most accessible way to present information.

· DHS has historically encouraged people to not print manual pages because there’s no guarantee they are working with the most up-to-date information once it is printed. However, if someone wants to print a manual, MNIT has designed the pages to be as printer-friendly as possible, so the pages won’t look too bad in printed form. The Psychotropic Medication Manual pages can be printed in this way.

· The forms within the new manual, however, are PDFs and can be filled out and printed.

Requests for approval subcommittee

This subcommittee continues to support teams with developing positive support and other strategies to phase out the use of restraint.

Emergency use of manual restraint subcommittee

This subcommittee continues to read incident reports and positive support plans, and follows up with providers as needed to offer support.

Discussion

Annual recommendations

The committee will discuss progress on the 2023 annual report. The committee’s 2023-2024 goals are, in no particular order:

2023-2024 Goal 1: Provide resources and guidance for improving communication skills

The committee recommends expanding their 2022 goal related to communication. The new goal is to share existing or create new resources or materials for teams on how to support people with developing additional communication skills. The target audiences for this goal are service providers, lead agencies, direct care professionals and families because all members of the team have a role in supporting effective communication. Additional communication skills can be helpful in giving people greater control over their services and improving health outcomes. Many people who fall within the EPRC’s purview, due to use of restraint by license holders, need support with developing additional communication skills.

· The guide on how to teach another person new communication skills and the communication resources manual page are still under review. There has been discussion about to what extent Minn. Stat. 245D providers are expected to teach skills. Under Minn. Rule 9544.0030, providers “must use positive support strategies in providing services to a person.” Positive support strategies emphasize “teaching a person productive and self-determined skills.” However, these regulations appear to conflict with an understanding by some that only licensed specialists should be teaching new skills. While that would be ideal, ongoing and frequent support from licensed specialists is not always available to people receiving 245D services. DHS is working to find a balance in the responsibilities of all parties that ensures skill development and thoughtful planning is supported by all service providers.

2023-2024 Goal 2: Simplify and organize online DHS materials and training resources related to positive supports or intervention services

There are many materials related to positive supports online, but the materials are scattered and numerous, and it can be unclear to service providers where to find information. There are also some gaps in the information. The committee recommends:

· Reviewing all DHS-owned positive support materials and related topics.

· Organizing the materials by topic and grouping related materials in fewer locations to reduce search times.

· Identifying the most helpful materials and removing less helpful materials to reduce clutter.

· Identifying gaps in resources, and developing new materials as needed to fill those gaps.

The goal of this project is to provide clear and easily accessible guidance to providers so they have the tools and knowledge they need to support people using services with living their best lives.

2023-2024 Goal 3: Explore ways to improve access to positive support services

Waitlists for positive support services continue to be long, often taking several months to start services. This can be a safety concern for people and their teams when the person is engaging in serious aggressive or self-injurious behaviors. The committee recommends DHS continue working towards increasing positive support service capacity.

2023-2024 Goal 4: Support efforts to improve the direct care workforce shortage

While many people have high quality positive support plans, it can take months or even years to find positive support specialists or other direct caregivers to implement the plans or to provide general care. Additionally, turnover in these positions is common. As noted for 2023 Goal 3, this can be a safety concern for people and their teams. The committee recommends DHS continue to support efforts to address the direct care workforce shortage, particularly efforts to improve wages and benefits for professionals who provide day-to-day care that reflects the complexity and skill needed to do the job well.

Closing

Committee members are welcome to ask questions or bring up other topics for discussion.