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External Program Review Committee (EPRC) agenda

Date: 2-4 p.m. June 6, 2024

DSD liaisons: Stacie Enders and Ari Dionisopoulos

Type: Whole committee

Location: Room 2222, Elmer L. Andersen Building, 540 Cedar St., St. 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

· The Minnesota Department of Administration shared a report: An analysis of migration trends and patterns in Minnesota April 2024. Some takeaways from the report include:

Migration now accounts for 42% of Minnesota's population growth, a share that has been growing since 1950 and is expected to continue rising.

Minnesota is experiencing a decline in births and an increase in deaths due to population aging, meaning future population growth will need to come from migration.

Minnesota has consistently gained more people through migration than it has lost, though the annual gains have slowed since the 2000s.

The state has seen a shift in migration patterns since 2020, with more people moving into rural and small-town areas and fewer moving into urban areas.

This shift in migration patterns has helped offset the negative natural population change (more deaths than births) in many rural parts of the state.

While Minnesota's overall migration numbers are lower than some other states, the state is still outperforming its Midwest neighbors in terms of population growth.

There is little evidence that high-earners are fleeing Minnesota due to taxes, as the state has high rates of retention among this group.

· Nursing Home Workforce Standards Board: At its April 29 meeting, the standards board voted to approve draft standards that include a general minimum wage, three occupation-specific minimum wages and holiday pay as follows:

General minimum wage

· $19 an hour effective Jan. 1, 2026

· $20.50 an hour effective Jan. 1, 2027

Certified nursing assistant minimum wage

· $22.50 an hour effective Jan. 1, 2026

· $24 an hour effective Jan. 1, 2027

Trained medical assistant minimum wage

· $23.50 an hour effective Jan. 1, 2026

· $25 an hour effective Jan. 1, 2027

Licensed practical nurse minimum wage

· $27 an hour effective Jan. 1, 2026

· $28.50 an hour effective Jan. 1, 2027

Holiday pay

· Effective Jan. 1, 2025, all nursing home employees required to work on any of the state-recognized holidays shall be paid a minimum of time-and-one-half for all hours worked for that 24-hour period. The exact start and stop times for the 24-hour period can be modified by a collective bargaining agreement.

State-recognized holidays include:

· New Year's Day, Jan. 1

· Martin Luther King's Birthday, the third Monday in January

· Washington's and Lincoln's Birthday, the third Monday in February

· Memorial Day, the last Monday in May

· Juneteenth, June 19

· Independence Day, July 4

· Labor Day, the first Monday in September

· Indigenous Peoples Day, the second Monday in October

· Veterans Day, Nov. 11

· Thanksgiving Day, the fourth Thursday in November

· Christmas Day, Dec. 25.

· If agreed upon by a majority of affected employees or the exclusive representative of the affected employees if one exists, and determined prior to the start of the calendar year, up to four holidays on this list can be substituted for alternate days to be paid at time-and-a-half.

History and next steps

· The initial vote came after a period of public engagement that included five public forums and a set of three questionnaires, as well as more than half a dozen full-board meetings discussing proposals.

· Staff members at the Department of Labor and Industry will draft rules to reflect the voted-upon standards. The board will review and vote on the draft rules before sending them to the Minnesota Office of the Revisor of Statutes.

· The new Access Rule will have an impact on workforce projects: Federal Register: Ensuring Access to Medicaid Services.

Subcommittee updates

Requests for approval subcommittee

· This subcommittee noted that two people they are working with are uninterested in their communication devices. It is unclear why they do not like the tools or how those specific tools were chosen. People often assume that people with disabilities want to communicate using aids, but not everyone does in the way we might expect them to.

Emergency use of manual restraint subcommittee

· This subcommittee noted that one of the people they have been working with for many years who used to have many BIRFs now has very few BIRFs thanks to successful implementation of positive support strategies developed by their support team.

Discussion

Annual report

The committee will review its 2024 goals, which are listed in no particular order:

· Provide resources and guidance for improving communication skills. The committee will work 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.

· 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 and 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 with living their best lives.

· 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.

· Support efforts to improve the direct care workforce shortage.

While many people have 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. This can be a safety concern for people and their teams. The committee recommends DHS continuing 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.

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