Waiver Reimagine Advisory Committee meeting 15 notes

Thursday, June 27, 2024

Committee attendees: Charlene Abramson, Kathryn Barton, Tricia Brisbine, Jennifer Drganc, Rosalie Eisenreich, Lisa Evert, Kelly Friesen, Abigail Gertken, Zahnia Harut, Elizabeth Iddings, Katrina Jirik, Meredith McKinnon, Sue Mackert, Julie Morrison, Polly Owens, Rijuta Pathre, Sherri Pickthorn, Phyllis Reller, Gretchen Spier, Fartun Weli, Chad Wilson, Gina Winter, Pat Wright

Not present: Jennifer Ballinger, Don Barnes, Annie Braun, Cathy Chavers, Mary Fenske, Arbdella Hudson, Ali Kofiro, Jessica McKane, Addyson Moore, Danielle Otto, Kathy Rogers, Saudade SammuelSon, Elizabeth Scheel-Keita, Wa Xiong

DHS attendees: Curtis Buhman, Heidi Hamilton, Sarah Jones, Matt Knutson, Natasha Merz

Welcome

Facilitator Lea

· Live captions: https://www.streamtext.net/player?event=WRAC

Meeting notes

· Facilitator Lea welcomed everyone to the meeting.

Meeting practices

Facilitator Lea

· When speaking, re-introduce yourself (and who you represent)

· Speak slowly so the captioner can accurately capture what you share

· Stay present giving your full attention to this discussion; let us know via chat if you need to leave the discussion and when you are back

· Please stay focused on the agenda item being discussed (Jot out note for reference later) (chat guidance)

· Share your main thoughts/key points early when speaking

· All members have the right to share their ideas and all ideas are valuable

· Be respectful of other participants - including privacy (avoid sharing private details)

· Listen to other members and DHS with an open mind

· Focus on the issue, not the person giving feedback

· Assume positive intent – embracing a mindset that will lead to something good

· Advocate for all, not individual situations - stories are shared to inform the policy

· Summarize what you heard to ensure understanding before reacting to another’s comment

· Please be mindful of the distracting nature of chat messages to both presenters and other members and use chat to add to the conversation when you are unable to directly share your thoughts

· Time has been allotted throughout the meeting for questions and discussion

Today’s meeting objectives

Facilitator Lea

· To confirm input from members in April’s meeting and to discuss next steps

· To prioritize agenda topics for future discussion

· Caveat: We are hoping to use new technology with a polling feature today. It isn’t working now; hope it will be when we get to that part of the agenda. We may have to use a manual technique.

April meeting recap

Facilitator Lea

· Brief recap before Heidi tells you what specifically was heard in April’s meeting.

Heidi Hamilton, director of Disability Services Division

· April’s meeting was a great meeting to hear about people’s concerns, and what to focus on going forward

· Some members want to discuss the two-waiver decision

· Some people want more input into setting agendas and determining the format of meetings

· Some people want collaboration and partnership with DHS to understand and inform policy decisions that impact Waiver Reimagine

Feedback and confirmation of April’s input

Heidi Hamilton, director of Disability Services Division

· New legislative language will include the requirement for the Assistant Commissioner Natasha Merz to attend meetings as of August. She may attend later today if she is available

· The connection between MnCHOICES and Waiver Reimagine was mentioned by some people, with the desire to provide some feedback

· WRAC members want to hear more about changes that are happening in the system and be consulted when those changes come up

· Members want to work from the Group’s charter and establish goals

· Some members want to meet in person periodically

· Language was also added where WRAC can collaborate in a meaningful way. We will discuss what that means during this meeting. Provide feedback on the role of assessment and the MnCHOICES 2.0 assessment tool. Additional language added related to the Commissioner of Humans Services collaborating with members. Language of collaboration was added about MnCHOICES 2.0. It was language that was not only added to the WRAC section, but also in our broader engagement with people on the Waiver Reimagine project to collaborate, consult and get input

· DHS is required to provide quarterly updates

· Updates will include how input is being developed and feedback incorporated into the development of Waiver Reimagine. WRAC is one of the groups DHS works with, and has plans to engage more with other community partners, too.

· Facilitator Lea: Can the statute language be shared with members?

Heidi Hamilton: Yes. It’s part of our normal documentation

· Member: Can WRAC be more involved in those efforts to get more community feedback? Requests update on MnCHOICES 2.0.

Heidi Hamilton: Later we will discuss further collaboration. It does make sense for WRAC to give suggestions on how to reach other community members.

MnCHOICES 2.0 upda: Over the past 1 1/2 years, DHS has been working closing with partners and sponsors group on the rollout. Rollout delayed to ensure process is ready. Did a mini-rollout with Lead agencies, counties, tribes and health plans. DHS deciding in July whether to have the full launch of MnCHOICES 2.0 on October 1. All new assessments will be done in MnCHOICES 2.0, and reassessments, except a small group on PCA, who will be exempt and able to use the legacy assessment. The partners and sponsor groups are counties, tribes, health plans, DHS staff, and our IT group, MNIT. DHS is working on identified issues and working with partners to make sure everything is accurate.

Not waiting for it to be perfect but acknowledge it’s better to roll out something and make changes along the way.

DHS will provide more information, if needed.

· Member: Some members are concerned about the implication for changes in MnCHOICES 2.0 and want DHS to hear from us.

Heidi Hamilton: DHS heard anecdotally that some CDCS budgets have decreased, and is looking into this. CDCS budgets have decreased, but needs haven’t changed. Questions were misinterpreted. Accessors have been asked to contact DHS if they see a CDCS budget has decreased. DHS asked recipients to contact DHS, too, to see what the current discrepancy is. Taking it case by case. I will give the group the way to reach out regarding MnCHOICES.

DHS contacted people receiving services directly; looking at reported issues so it doesn’t have to go through the appeal process. DHS wants to address these at the policy level before there is an appeal.

· Facilitator Lea: We will now ask two questions using the polling feature: How should WRAC agendas be developed, and how will WRAC reach consensus?

Legislative language and collaboration

Facilitator Lea

· Polling feature is not working so we are asking for members to raise their hands for their chosen option(s)

· How should WRAC meeting agendas be developed?

A. During previous meeting discussion - 11 votes

B. In separate, additional meetings (with DHS) – 6 votes

C. Members meet separately and provide recommendations to DHS – 6 votes

D. I have another suggestion _______________________

· Member: We could plan the agenda together at the end of the previous meeting. The agenda could be discussed while the community and DHS are present. It is a way to share power and work together rather than making recommendations.

Facilitator Lea: So, you’re suggesting to extend the meetings 2 ½ to 3 hours ton accommodate agenda planning.

· Member: I agree about meeting to discuss the agenda at the end of the meeting. Could also potentially meet separately. Maybe have a meeting with DHS to plan the agenda, then another short meeting for members who need time to process. Make sure we are partnering with WRAC members.

Facilitator Lea: So, take the time within our meetings to plan agendas, and have a separate meeting later to confirm content. We’d need to determine DHS timing and availability.

· Member: I don’t want to have extra meetings to talk about our next meeting. Adding to our two hour meetings is a big chunk of time. It would be hard to carve out extra meeting time on a regular basis for all members. I suggest having a living document that anyone can assess at any time to make agenda topic suggestions. I’m uncertain if DHS allows a living document. Could also send emails with agenda suggestions and have members prioritize suggestions.

Facilitator Lea: Thank you for acknowledging there are constraints for the state regarding sharing documents. This is indeed the case. The Waiver Reimagine email box could serve as the point of contact for suggestions. I hear you don’t want to add time to the current meetings.

· Member: Is all input captured?

Facilitator Lea: For WRAC, all member contributions during meetings are documented and reviewed for future agenda setting. Contributions are taken very seriously.

· Member: I like the previous suggestion for both DHS and WRAC to determine the agenda together. I think it’s crucial to have community input drive the changes because we are the end users. However, the agenda is set, it has to be collaborative. Can these polling questions be sent out ahead of meeting, then keep a running tally of the follow-ups we will address at the meeting?

Facilitator Lea: Polling questions were sent ahead of today’s meeting with meeting materials, to give members the opportunity to interact with them today. The polling is a work in progress.

· Member: Could send an email to members ahead of the meetings with polling questions and a deadline to respond to agenda suggestions? That wouldn’t require extra meeting time. Could do this one week prior to meetings.

Facilitator Lea: Agenda setting happens more than two weeks before the meeting. We freeze meeting content two weeks prior to meetings because of accessibility requirements and sending materials out to members two weeks ahead of the meeting to allow for preparation. There’s a whole team that prepares for meeting presentations. Having an agenda set three weeks prior to the meeting is bare minimum deadline.

· Member: We could remind members of the agenda setting deadline. Then send out agenda in an email, asking members to reply, and then agenda is set. It would help with time because extra meetings are a lot of work

· Member: Suggest using a meeting template for the agenda so we can anticipate how the meeting is going to flow. Voting and polling needs to be used for everything that is discussed in the meeting. All voices need to be heard. Also want to discuss the mysterious legislative report that we are all working on building together: Time to look at this document as it evolves.

Facilitator Lea: Curtis will speak to the legislative report

Curtis Buhman: Want to discuss the distinction between feedback and recommendations. As we move forward, how do we capture the shared recommendations of the committee? Lots of ways to do that. Being collaborative, polling and voting and capturing the shared perspective of members so they can be incorporated into DHS’ direction and then passed along to the legislature. There will be situations we need legislature to take action on to give DHS the ability to act on the recommendations we are hearing. We need a vehicle to capture the information, such as having meeting conversations focused on making recommendations from members. We may need to use gradients of agreement where there two streams of thought and to capture input. We need to develop a roadmap of future meeting topics, sequencing them so we talk about what needs to be discussed in what order.

Facilitator Lea: To clarify, the legislative report hasn’t been started yet. Member input to date will inform the content. The report will be brought to members who will be able to review it, provide input and confirm content.

Curtis Buhman: We intend to capture member recommendations through polling and other input strategies.

· Member: I like the idea of documenting the input, decisions and recommendations members have made.

Facilitator Lea: Our next poll is how do members reach a consensus to make a recommendation?

· What "recommendations" mean for WRAC members.

1. Must be unanimous agreement – 3 votes

2. Simple majority of attendees – 13 votes

3. I have a different suggestion__________________ - 7 votes

Facilitator Lea: Poll Results: we might need to reach out to members who haven’t been able to vote to include those members’ content. Possibly put vote in Chat.

Poll results: Technical issues. Trying new technology so people have equitable input. Results will be shared in a later meeting.

Facilitator Lea: Finally, we’d like to prioritize future meeting topics.

Curtis Buhman: This will help us establish the roadmap of future meeting topics. What are your high, medium, low priorities? Some topics, like the legislative report aren’t on here because it is mandated work and has to be done.

Road map topic priorities

Facilitator Lea

· Certain topics need to be completed at a particular time. DHS will present them as part of the road map, similar to the meeting roadmap we’ve been sharing in previous meetings. We’ll let you know when topics are coming up again, and we’ll give members plenty of time to prepare for that conversation

· We’d like members to prioritize these 12 topics. Review what high, medium and low means to you, and some considerations for you to make

· Are any of these topics urgent? Is there a timeframe they should be addressed? Are other topics dependent on it?

· Several topics go together and may need to be in particular order to make sense to members. How important is that topic? Do they represent substantial attention and concern from people with disabilities? How many people are impacted by that topic? Is this a legislative requirement or authority that is required by us, and thereby highly important? Are resources needed?

· Some topics will require substantive information and foundation setting so that members can participate effectively in discussions and decisions.

· Vote by three stars for high, two stars medium, one star is low priority.

· Member: I don’t feel like we have enough information to vote today. Propose DHS go through each of these topics and talk to us about the impact and requirements of each because DHS holds the data. Members need to understand what the barriers are. Why were decisions previously made? What’s happening within other projects, and how does that impact waiver reimagine? Have a back-and-forth dialogue. We need to have more from DHS to understand what you know as policy experts and the legislative barriers we are working within on a state level. Also, CMS standards have to be met. Hope we can get creative.

Facilitator Lea: That’s exactly the intention of this discussion. The question is, how is it going to happen? This is the start of the conversation. The proposal is to come back in August to begin the conversation. Agree on a roadmap with the members. With some topics we may need time to lay the foundation so the proposal would be to discuss these topics and agree on a road map with members.

Curtis Buhman: We are trying to get to the same place. Need feedback from members so we can prioritize the conversations. This isn’t a one-time thing; we can revisit. It’s a vehicle to frame where we start this conversation.

· Member: Three things that are more philosophical underpinning: program simplification, budget process and informed decision making and self-direction of services. Need this for all discussions and aren’t things to rank.

Facilitator Lea: Trying to figure out high, medium and low voting preferences so we know where to begin this conversation in August. Asked members if they want to vote on all topics today?

Heidi Hamilton: Foundation piece we discussed earlier: do we want one waiver or one budget? So many people wanted to have a discussion about how the two-budget structure was made and can it be revisited. Don’t want to sway any of the voting, but feel it is a foundational piece. Want everyone to understand when we say the two-waiver structure it’s not how we continue, but if that makes sense, we need to figure out the recommendation related to it due to timing restrictions.

Facilitator Lea: The majority didn’t want to vote today–called at seven votes. Some of these, like MNCHOICES, are restrictions the group needs to work with because it’s another part of DHS. Heidi is representing that connection. This is our starting point to get the top items that members want to discuss. Didn’t see a majority with seven of 23 or 24 voting. Will send topics to everyone to rank. Start discussion in August, with DHS laying out which topics are foundational and getting members’ input into the development of that topic.

· Member: Until the number of waivers is settled, it doesn’t make sense to discuss other, dependent topics. Budgets should be based on needs and not living location.

Facilitator Lea: Sending these out to members so you can make the comments you’ve been making today. Will come back in August with items to discuss and findings of that discussion as we move forward, collaborating on agenda development and where topics fall in the future, with a clear round map.

Curtis Buhman: Results of the Waiver Reimagine committee survey update:

§ Engagement work we did with focus groups. Thousands expressed desire to participate in a focus group.

§ In August, we will dive into more depth of what people said. A lot of qualitative input. Research staff working on what we heard from folks.

Facilitator Lea: Any questions about community survey?

· Member: 404 responses out of 70,000 waiver recipients?

Curtis Buhman: Scale of magnitude is accurate

· Member: Is this considered a good response in past surveys?

Curtis Buhman: This is a reasonably good survey response. There will be more outreach and engagement with people. We looked demographically. It is an anonymous survey. Who are we hearing from, or not hearing from, more importantly?

· Member: I’m interested in receiving the research methods

Curtis Buhman: DHS had a research scientist outside of DHS work on this.

Wrap-up and future meeting information

Facilitator Lea

· Future meetings:

Thursday, Aug. 22, 2024

Thursday, Oct. 24, 2024

· Meeting survey will be sent out as usual.

· We will determine a way for members to provide feedback and input around future meeting topics. In August, DHS will begin to talk about the roadmap. Some people want to see visuals. It’s more complex than just a roadmap. There are issues like two waivers and budgets that are foundational. DHS to discuss timing of internal and policy timelines. Apologize about today’s technology issue. Looking at different platforms for the future.

· Link to give feedback and ask questions after the meeting: Waiver.reimagine@state.mn.us

· Look forward to seeing you in August. Thank you again for your input today.

Key points/themes

· Members want to discuss the number of waivers and having services determined by need as opposed to where a person lives

· Members want access to information such as the statute and greater detail around efforts such as surveys; would DHS consider a SP site for the group? Can more resources be posted on the website?

· A majority of members prefer to have a roadmap of future topics and to discuss future agendas in previous meetings, rather than at separate, additional meetings

· Members accept a simple majority of participating members to reach a decision for the group

· Members need more explanation from DHS on future meeting topics – implications, dependencies, timing, etc. to determine where they might come on the roadmap

· If polling technology can work, it may be a good way to invite equitable input; need to get technology working consistently; main dependency is on DHS to agree content which has been accessibility approved prior to meeting and members having received polling content prior to meeting with enough time to plan responses or comment on content/process

· Members appreciate having Heidi and Curtis present and participating – along with other DHS folks

Full meeting chat

· Realtime Services 6/27/2024 9:47 AM • https://www.streamtext.net/player?event=MNDHS-WRAC

· Kelly Friesen 6/27/2024 10:15 AM • Could we have the statute language numbers sent to us in an email so we can read the specific language? It is very difficult to find.

· You 6/27/2024 10:16 AM • Yes. This will be sent out along with meeting documentation.

· Tricia Brisbine 6/27/2024 10:18 AM • Partners and sponsors?

· Tricia Brisbine 6/27/2024 10:20 AM • Thank you

· Polly Owens 6/27/2024 10:21 AM •

· I had my hand up but no one called on me. I have a question for Heidi

· Kelly Friesen 6/27/2024 10:21 AM • How can we confirm that MN Choice 2.0 is more accurate than 1.0? What are the markers that will be used to verify this? This is a big community concern.

· Kelly Friesen 6/27/2024 10:24 AM • Please add my comment/question about MN Choice 2.0 to the minutes for follow up.

· Tricia Brisbine 6/27/2024 10:24 AM • I have SEVERAL contacts who have reported decrease despite no change.

· Also, it appears to be VERY difficult to appeal.

· You 6/27/2024 10:25 AM • ALL questions are noted in each meeting for potential follow up.

· Meredith McKinnon 6/27/2024 10:26 AM • another issue is when needs have significantly increased and the budget does not increase

· Gina Winter 6/27/2024 10:27 AM • An offshoot to collaboration but relevant as us WRAC members are trying to include all aspects and stakeholders in making changes. Family Residential Services (FRS) providers are often overlooked as a stakeholder group, and there have not been any on the WRAC since its inception. Can DHS please make a point going forward to consider them (there are over 1,100 licensed) for inclusion in WRAC and other engagement opportunities.

· Tricia Brisbine 6/27/2024 10:28 AM • Yes, Gina! Representation of this group on the WRAC would be ideal.

· Sarah Jones (She/Her) 6/27/2024 10:29 AM
A. During previous meeting discussion
B. In separate, additional meetings (with DHS)
C. Members meet separately and provide agenda recommendations to DHS
D. I have another suggestion

· Fartun Weli 6/27/2024 10:34 AM • [Thumbs up emoji]

· Abby Gertken- ILICIL 6/27/2024 10:35 AM • sorry!

· Tricia Brisbine 6/27/2024 10:43 AM • With all due respect, Jennifer's suggestion emphasizes convenience and it doesn't account for the fact that accessibility for sharing is an issue.

· Zahnia 6/27/2024 10:44 AM • I like the idea of submitting the surveys ahead of time

· Gina Winter 6/27/2024 10:50 AM • Agreed

· Dr. Kate Jirik 6/27/2024 10:52 AM • When you default to email, it denies the opportunity for all members to hear the feedback and reach a consensus. Email keeps DHS as the ultimate decisionmaker instead of true collaboration.

· Kelly Friesen 6/27/2024 10:52 AM • In addition to Lisa's comments, we need a consistent way to follow up. The only decision I am aware of that WRAC has discussed is that we "named" the 2 waivers. We still have not heard which services will be available for which waiver, even though we voted on them.

· Jennifer Ballinger 6/27/2024 10:52 AM • Tracking action items. Many who ask DHS a question there is never an answer or follow up during the meeting. So, no conversation. It would be nice to have DHS answer topics/questions that are brought up by members.

· You 6/27/2024 10:54 AM • ALL questions are recorded and brought to DHS regularly for feedback and inclusion in future meetings.

· Tricia Brisbine 6/27/2024 10:56 AM • "collaboration" is not "confirming content". It is working together at the design level.

· Rosalie Eisenreich (SEMCIL) 6/27/2024 10:59 AM • YES LISA!!!!!

· Sarah Jones (She/Her) 6/27/2024 11:00 AM • @Kelly if you click the little chat button at the bottom of your Webex Screen it will bring the chat back up

· Kelly Friesen 6/27/2024 11:01 AM • I had a community member reach out to me who moved from corporate care to community living. He was concerned that services could no longer be bundled in the community... This is an argument for why all services should be available for each waiver. A person's needs may remain the same, whether they are in a corporate setting or community setting. The budget also needs to be based upon the person's needs, not where they live.

· Sarah Jones (She/Her) 6/27/2024 11:01 AM • A.Must be unanimous agreement
B.Simple majority of attendees
C.I have a different suggestion

· Fartun Weli 6/27/2024 11:03 AM • the poll came up

· Rosalie Eisenreich (SEMCIL) 6/27/2024 11:10 AM • If we are going to use new technology, we need to offer accessibility support to individuals BEFORE we use things. This is once again another access issue.

· Dr. Kate Jirik 6/27/2024 11:10 AM • People with disabilities MUST be those with the ultimate decision makers. There are more people that represent agencies than people with disabilities on the committee; disabled people's concerns should have priority.

· You 6/27/2024 11:11 AM • Noted. We will work on polling options and accessibility by members.

· DHS - DSD 6/27/2024 11:14 AM • https://app.sli.do/event/6Fshj62XZoqLZSN79mGNQy/embed/polls/dad59b17-b7ad-4de6-8ee4-bb7081be5dca

· Gina Winter 6/27/2024 11:14 AM • myself as well

· asking for a passcode

· Kelly Friesen 6/27/2024 11:15 AM • Me as well.

· Kayte 6/27/2024 11:15 AM • I need to log off I have to work at 11:30

· You 6/27/2024 11:15 AM • Thank you Kayte

· Polly Owens 6/27/2024 11:23 AM • Hand up with comment/question please before voting

· You 6/27/2024 11:24 AM • For those who lost track of chat, it was a "restart" of WebEx when the apps became available. It is now available again.

· Gina Winter 6/27/2024 11:24 AM • There are no options in Slido showing to vote

· Kelly Friesen 6/27/2024 11:24 AM • The most important topic is that we need to base the waiver budget off of a person's needs, not where they live. We need to solidify this foundation before we can make decisions about all the other extraneous topics.

· Julie Morrison 6/27/2024 11:24 AM • Yes Rosalie!!! I don't know the dependencies etc!

· Julie Morrison 6/27/2024 11:27 AM • I'd like to see a visual mapping of the ecosystem of who are the stakeholders, decision makers, dependencies, barriers etc, key dates...

· Lisa Evert 6/27/2024 11:29 AM • I agree with Polly. The 'program simplification' is not a ranking topic.

· Dr. Kate Jirik 6/27/2024 11:29 AM • Without knowing the background that indicates where DHS is operating from, this polling is not valid as the considerations on how the committee votes is based on accurate information and this poll does not provide this.

· Rosalie Eisenreich (SEMCIL) 6/27/2024 11:31 AM • I vote we provide our own, open input

· Tricia Brisbine 6/27/2024 11:31 AM • I won't be voting without more info regardless

· Gina Winter 6/27/2024 11:32 AM • Have we fixed the issues to vote? Restarting did not work

· Rosalie Eisenreich (SEMCIL) 6/27/2024 11:34 AM • No vote today. We need further dialogue than the confines that have been presented

· Lisa Evert 6/27/2024 11:34 AM • Thank you, Heidi. YES. WE NEED TO GO BACK TO THE BEGINNING AND ENSURE A STRONG FOUNDATION OR THIS WHOLE PROCESS IS A WASTE OF TIME.

· Gina Winter 6/27/2024 11:38 AM • FYI-Our planned dates and the website state the October meeting is 10/24. However, the slide on this today says 10/31

· Tricia Brisbine 6/27/2024 11:40 AM • Send these out to rank does not change that this method lacks validity.

· You 6/27/2024 11:41 AM • Thank you Gina!! The correct date for October's meeting is Oct 24th - always the 4th Thursday of every other month.

· Kelly Friesen 6/27/2024 11:44 AM • Last I saw was 57,000 HCBS waiver users. Updated data would be good.

· New messages

· Sue Mackert 6/27/2024 11:49 AM • Very good response, Curtis. Thank you.

· Julie Morrison 6/27/2024 11:49 AM • Did you try to survey visual learners and those who have barriers to written language, for example?

· Jennifer Ballinger 6/27/2024 11:50 AM • every waiver user has a case manager that could assist with administering the survey?

· Tricia Brisbine 6/27/2024 11:50 AM • Best practices would indicate you need to go outside to create surveys, AND you need stakeholders to collaborate on the design of that survey

· Dr. Kate Jirik 6/27/2024 11:50 AM • [Thumbs up emoji]

· Lisa Evert 6/27/2024 11:53 AM • Did WRAC collaborate in this session to set an agenda for August??

· Rijuta pathre 6/27/2024 11:55 AM • I had hard time with sliding but. Finally got it.

· Rijuta pathre 6/27/2024 11:57 AM • I meant Slido