July 18, 2017

Dear Member,

On behalf of the LeadingAge Minnesota Board of Directors, I am pleased to provide you with this comprehensive report summarizing the 2017 Legislative Session. We have designed this summary as a reference tool for you to use to better understand the new provisions in Minnesota law that affect providers of older adult services. You can also access this report on our website at www.LeadingAgeMN.org.

Along with the LeadingAge Minnesota staff, I want to thank you for your advocacy this year. As we look ahead to the 2018 legislative session, state lawmakers will return to St. Paul in February and could be tasked with making some difficult decisions due to the federal government’s anticipated restructuring of Medicaid. We will need all of you and your staff to engage your lawmakers in discussions about the important issues surrounding the field of older adult services. You don’t need to wait until February to engage. Now is the perfect opportunity to invite your lawmakers to your setting. Share with them your challenges, as well as your hopes for the future. Allow them to see the important work you and your staff do to transform and enhance the experience of aging in Minnesota each and every day.

We are grateful for the opportunity to represent you and your missions of service at the State Capitol.

Sincerely,

Gayle M. Kvenvold President and Chief Executive Officer

1 LeadingAge Minnesota 2017 Legislative Report

LeadingAge Minnesota 2550 University Avenue West Suite 350 South St. Paul, MN 55114-1900 651.645.4545 800.462.5368 www.LeadingAgeMN.og

3 Table of Contents

Overview: 2017 Session 9 Media Relations 13 General 15 Alzheimer’s Disease Work Group 17 Electronic Service Delivery Documentation System 18 Medical Assistance Eligibility Changes 19 Minnesota Choices Changes 20 OHFC Systems Improvement; Safety and Quality Improvement 21 Practices for Long-Term Care Services and Supports PCA Contract 22 Care Centers 23 Care Center Licensing Fees 25 Mental Health Targeted Case Management by Interactive Video 26 Non-Emergency Medical Transportation 27 Scholarship Program Update 28 SNSA Limits Update 29 Swing Bed Change 30 VBR Updates 31 HOUSING/HCBS 33 Adult Day Services Study 35 Adult Foster Care 36 Disability Waiver Rate (DWRS) Changes 37 Elderly Waiter Rate Reform 38 Establishment Fees 39 Group Residential Housing 40 Home Care Licensing Fees 41 Housing Support Services 42 Housing with Service – Conspicuous Notice 44 Housing with Services 45 Lodging License Exclusion for Housing with Services 47 Nurse Educational Loan Forgiveness Program Expansion 48 Return to Community Expansion 49 Self-Directed Caregiver Grants 50 Transportation Study 51 2018 Session Outlook 53 Our Process 59

5 Overview/Advocacy/Media

7 Overview: 2017 Session

Legislative leaders and the Governor began the 2017 legislative session on a hopeful and conciliatory note. They could all agree – their primary goal was to adopt an agreed-upon budget to run the state for fiscal years 2018-2019. They made plans to work together, across the partisan divide, to ensure a productive, transparent budget process with a timely end. Unfortunately, the best-laid plans often go awry. And in this case, the dynamics of power made the 2017 legislative session particularly precarious for advocates. Assessing the field Entering his penultimate legislative session, Governor Mark Dayton’s top priority was to protect his legacy of sound fiscal management by preserving the increased revenue he secured in his first term. The House of Representatives had a sizable Republican majority with veteran Speaker of the House Kurt Daudt at the helm. They had a clear agenda from day one – reduce high insurance premiums, cut taxes, and invest in transportation and infrastructure. Fellow Republicans in the Senate unexpectedly gained control of the body with a narrow, one- seat majority. Any dissent from any one majority caucus Senator had the potential to kill a bill. Senator Paul Gazelka emerged as the leader and took on the careful task of unifying his caucus. Majority Leader Gazelka also acted as the unifying presence in interactions amongst the leaders. Speaker Daudt and Governor Dayton have a complicated, often-tumultuous relationship, and Sen. Gazelka regularly acted as an intermediary. It’s worth noting that, at the beginning of session, none of the key players listed long-term care issues as their primary concern. However, for the first time ever, both bodies had dedicated committees to seniors and long-term care issues, as the Senate established a Senate Committee on Aging and Long-Term Care and the House maintained its committee on Aging and Long- Term Care. Advocating for change LeadingAge Minnesota went to the Capitol with an agenda focused on reform that resonated with many in Saint Paul. With the help of our members, the LeadingAge Minnesota developed a thoughtful agenda with short- and long-term solutions to help provide quality care for older adults in Minnesota. LeadingAge Minnesota focused on three core priorities throughout session: • Reform Elderly Waiver: Comprehensive reform of the Elderly Waiver program that provides services for low-income seniors that require a nursing-home level of care but choose to receive those services in the community.

• Address the Shortage in Professional Caregivers: Create opportunities to bolster efforts to improve recruitment and retention of caregivers in the older adult services field.

9 • Support and Maintain Value-Based Reimbursement: Continue the sustainable, predictable reimbursement system in nursing homes to ensure competitive wages and benefits as well as resources to innovate. We embraced the power of grassroots advocacy to engage lawmakers and help build champions for our agenda. Throughout session, advocates for seniors and their caregivers contacted their lawmakers in droves. Legislators received hundreds of calls and thousands of emails throughout the entirety of the session. In March, over 125 people visited their lawmakers at the Capitol to share their caregiving stories with elected officials. These interactions were essential to growing awareness about long-term care issues and promoting policies that help older adults and their caregivers. This year, the Senate stood out as a champion for seniors and their caregivers. Even before session began, the Senate established a new committee to focus on aging and long-term care. With the help of Sen. Karin Housley (R-Stillwater), the Aging and Long-term Care Committee Chair, the Senate became champions for reforms in the Elderly Waiver program and investments in home and community based services. The House Sub Committee on Aging and Long-term Care Committee, first established in 2015 and led this year by Rep. Debra Kiel (R-Crookston), also worked to advance long-term care legislation. The House had a particular interest in supporting and maintaining Value Based Reimbursement for care centers and making investments in workforce recruitment and retention. In contrast, we found ourselves frequently at odds with the Administration in this session, particularly with respect to reform and investments in Elderly Waiver. Despite our efforts to work with the state agency on this initiative, we encountered opposition and ongoing roadblocks to moving this proposal forward. The fact that Elderly Waiver reform was included in a final budget deal is a testament to our legislative champions. Beginning the end As the Legislative session ticked along, leaders in the House and Senate sped through the legislative process, with the hope of reserving ample time for budget negotiations with the Governor. The effort, however, was futile. In the last weeks of session, the Legislature and the Governor reached an impasse. The Legislature passed bills that would undoubtedly be rejected by the Governor. As promised, Governor Dayton vetoed the first round of budget bills sent to him by the Legislature. As the Legislature started to re-draft budget bills with more compromise, it became clear they needed additional time to reach a final agreement. With hours left before the constitutionally- mandated end of session, the Governor and legislative leaders announced an agreement. The Governor called the Legislature back into a Special Session to finish their work. It quickly became apparent that the “agreement” touted just hours earlier was less firm that originally depicted. It took more time that initially expected to iron out the details of each of the major budget bills. The Special Session, which was supposed to take only 36 hours, stretched into several days of negotiations. With the Memorial Day weekend lying just ahead, the Legislature raced to finish their work, sent all the budget bills to the Governor, and adjourned for the year. 10 Still, even after several days of additional negotiation, the Governor and the Legislature had only tenuous agreement on budget language. The Governor told reporters that he was “genuinely undecided” whether he would sign the bills sent to him. Complicating matters, the Legislature included a controversial provision tying funding for the state Department of Revenue to the Governor’s signature of the tax bill. If he didn’t sign the tax bill laden with tax cuts perceived to jeopardize his legacy of sound financial management, the Department of Revenue would go unfunded. Days later, after the Memorial Day weekend, the Governor signed all the bills sent to him. However, he used his line-item veto to defund the Legislature in an effort to keep them at the negotiation table. The Governor outlined several provisions that he hoped to renegotiate, and then call the Legislature back into session to make changes. Without returning for another Special Session to make the Governor’s requested changes, the Legislature – which includes partisan and nonpartisan staff – would not have funds to continue operations.

Legislative leaders were quick to call the Governor’s move unconstitutional, citing a right to separation of powers between branches of government. As promised, the Legislature sued the Governor and the suit is currently moving through the court system.

Keeping up the good fight

Considering the tumultuous legislative session, LeadingAge Minnesota accomplished our key legislative and policy objectives for 2018. We made progress on Elderly Waiver reform, laying the ground work for long- term payment reform. We successfully secured funding for several workforce initiatives, including a grant to promote older adult services careers and enhanced scholarships and loan forgiveness in long- term care settings. We strengthened the Value-Based Reimbursement structure first enacted in 2015 which ensures competitive wages and benefits in care centers.

While there is still more to do, during the 2017 legislative session, LeadingAge Minnesota helped promote policies to preserve access to quality long-term care for Minnesota’s older adults. Considering uncertain health care reforms at the federal level and a growing senior population, it is more important than ever to remain engaged with lawmakers to help shape the future of older adult services in Minnesota.

11 Media Relations During the 2017 legislative session, LeadingAge Minnesota implemented a more focused media strategy focused on the core initiatives of our legislative agenda: Reforming Elderly Waiver, Preserving Value- Based Reimbursement and Securing Workforce Solutions. We equipped members with key messages, key words and sample elevator speeches they could use with their local lawmakers and media to support the 2017 proposals:

ELDERLY WAIVER REFORM Key Message: Seniors should live independently for as long as they are able, choosing their best option for care in the communities they call home.

Key Words: Choice, Independent, Home

Sample elevator speech: The math is simple: 60,000 Minnesotans will turn 65 this year, next year, and for 15 more years. These seniors will live longer and more independent lives than ever, and they will need different kinds of services and supports as they get older. Flexible, community-based choices that help seniors stay at home are a critical part of a successful and affordable care strategy.

2017 Proposals: EW Reform, incentives to keep people in their homes rather than at care centers.

FUNDING REFORM Key Message: The State of Minnesota should continue to reform how we fund care for our seniors – our focus is on a value-based decision innovation, quality and long-term savings.

Key Words: Reform, Value, Savings

Sample elevator speech: We took the first big step in 2015 by reforming care in nursing facilities by aligning payments with the actual cost of care and providing incentives for quality improvement. Now, we need to continue to advance value by reforming Elderly Waiver and Alternative Care options. These successful and popular programs save the State money while preserving the quality of life of seniors.

Proof Point: Each month, four times as many MA recipients are choosing waivers and home care vs. care in a nursing facility. Data reported by House Research shows that the State saves money every time a senior makes this choice.

2017 Proposals: EW Reform, continued improvements to the 2015 value-based reform law

WORKFORCE SOLUTIONS Key Message: Caregivers should receive the support they need to make older adult services a successful and stable career.

Key Words: Career, Stability

Sample elevator speech: Minnesota needs a workforce development and retention plan that supports today’s caregivers in every corner of the state, and recruits caregivers for tomorrow’s needs. Wages are increasing because of the 2015 reform bill – let’s extend that strategy to home and community care, and invest in caregivers who have committed to caregiving as a career.

13 Proof Point: After the 2015 reforms, caregiver wages in nursing facilities increased, which helps retain current caregivers and reduce long-term vacancies. Minnesota will need an additional 25,000 caregivers in the next decade, with the greatest demand coming from our rapidly growing senior population.

2017 Proposals: EW Reform, innovation grant fund, scholarship and loan forgiveness

Running parallel to our Association’s media relations strategy, was Phase 3 of the Face Aging MN campaign. Face Aging MN is a public information campaign conducted in collaboration with our partner in the Long-Term Care Imperative. Since the campaign was first initiated in 2014, it has grown to serve as a valuable tool to help us raise awareness of the challenges and opportunities the state’s fast-growing aging demographics present to the state’s economy, workforce and long-term care field.

The goal for the third phase of Face Aging MN was to turn the awareness that was raised during the first two phases of the campaign into engagement. The messaging this year was balanced between general awareness of aging issues and the core agenda items that the Long- Term Care Imperative was seeking at the State Capitol.

The campaign utilized digital media, earned media and social media to target its message at the core audiences: influential lawmakers, seniors and adult children of seniors. The Face Aging MN website was revised, keeping the spirit of the campaign at its very core but adding improved functionality for information and engagement on our core priorities.

For the first time since its inception, Face Aging MN featured a focus on workforce. Utilizing data and personal stories (blog posts) from professional caregivers, Face Aging MN helped put a personal perspective on the value of caregiving, raise awareness of the workforce challenges, and generate support for our workforce solutions agenda.

14 General

15 Alzheimer’s Disease Working Group

Special Session Chapter 6, Article 3, Section 48 S.F. 2, Benson – R Dean - R Effective: July 1, 2017

Background The state is gathering information to better prepare for an increased number of individuals with Alzheimer’s disease and other dementias.

Summary By Dec. 15, 2017, The Minnesota Board on Aging will appoint a 16 member Alzheimer’s disease working group, which includes representation from consumers along with professionals in long term care, health care, research and government. The work group will revise the 2011 report, Preparing Minnesota for Alzheimer’s: The Budgetary, Social and Personal Impact, while also focusing on:  Data analysis  Public awareness  Risk reduction  Diagnosis and treatment  Professional education and training  Residential services  Cultural competence The Board on Aging must submit a report providing the findings and recommendations of the working group by January 15, 2019.

Implications Providers may be contacted by the Minnesota Board on Aging as part of a larger data gathering process.

Staff Contact Roni Falck, [email protected]

17

Electronic Service Delivery Documentation System Special Session Chapter 6, Article 3, Sections 49 S.F. 2, Benson – R Dean - R Effective: Day following final enactment.

Background The 21st Century Cures Act, Public Law 114-255, requires electronic visit verification for certain services.

Summary Within available appropriations the commissioner will take steps to comply with the electronic visit verification for PCA and Community First Services and Supports programs. The following documentation will be required when a system is developed: 1) type of service performed; (2) individual receiving the service; (3) date of the service; (4) location of the service delivery; (5) individual providing the service; and (6) time the service begins and ends

As part of the system design, consideration is to be given to ensure that the requirements: (1) are minimally administratively and financially burdensome to a provider; (2) are minimally burdensome to the service recipient and the least disruptive to the service recipient in receiving and maintaining allowed services; (3) are effective methods for preventing fraud when balanced against the requirements of clauses (1) and (2);

A report is to be provided by January 15, 2018, to the chairs and ranking minority members of the legislative committees with jurisdiction over human services with recommendations, based on the requirements to establish electronic service delivery documentation system requirements and standards.

Implications While this requirement does not directly impact most LeadingAge Minnesota members, the same type of documentation requirements have been discussed for other services in Minnesota to support fraud and abuse prevention.

Staff Contact Bobbie Guidry [email protected]

18 Medical Assistance Eligibility Changes

Special Session Chapter 6, Article 4, Sections 20-22. Amends Minnesota Statutes §§256B.056, subd. 5c and Statutes 256B.0561, subds. 2 and 4 S.F. 2, Benson – R Dean - R Effective: Various Dates

Background The Legislature often considers proposals to make changes to eligibility for Medical Assistance services. This year they considered several and adopted some that will have some impact on people served by long-term care providers.

Summary One change approved this year is an increase in the excess income standard from 80% of the federal poverty level to 81%. To be eligible for long-term care services under MA, an individual must have medical expenses that exceed their “excess income” which is their income beyond the excess income standard. To reduce the financial impact of the change, it is not effective until June 1, 2019.

The Legislature also renewed its commitment to using “periodic data matching” to find individuals on medical assistance who should not be eligible because their income is too high. A proposal to do that passed previously but was not able to be implemented, so this year the Legislature changed the dates in the statute (process to start April 1, 2018, report on impact from DHS on September 1, 2019) with the understanding that DHS will be able to meet the new timeframes.

Implications The impact of this proposal on long-term care providers will likely be limited. The data matching initiative is targeted more at younger people who find employment but remain on medical assistance, as opposed to the elders typically served by members, but it could possibly identify some elderly recipients as ineligible. The change in the excess income standard is very modest, but when it takes effect it will result in some increase in the number of people eligible for long-term care services and supports.

Staff Contact Jeff Bostic, [email protected]

19 MNChoices Changes

Special Session Chapter 6, Article 1, Sections 13-18, 51-52 Amends Minnesota Statutes §§256B.0911, subd. 1a, 2b, 4d, 5 and 6, and adds new subdivisions S.F. 2, Benson – R Dean - R Effective: July 1, 2017

Background MNChoices is the assessment tool used to establish the need for Medicid-funded long-term care services and supports, including nursing home services and both Elderly and Disability waiver programs. As the tool has begun to be used statewide in recent years, some of the agencies that use the tool for assessments have raised concerns about its length and complexity. The state pays counties to do the required assessments using the tool, and during this legislative session, several senators supported a proposal to simplify the tool and to create state savings as a result.

Summary The final legislative language is less ambitious than the version first discussed in the Senate Health and Human Services Finance committee, which would have substantially reduced the number of required assessments among other changes. It calls for the use of person-centered planning as the primary focus of the tool, calls for review and study of the policies around MnChoices to create efficiencies, allows face-to-face assessments to be conducted less often than annually “to the extent allowed by federal law” and requires the commissioner to review the timeline for a face-to-face assessment when someone under 65 years old is admitted to a care center (currently they must be assessed within 40 days). The bill also cuts funding to the counties over 15% in this biennium and an additional 2.5% in the next biennium.

Implications The impact of this proposal will largely depend on what is allowed by federal law and whether the study and reviews that DHS is required to do are able to identify efficiencies that significantly change the use or content of MnChoices assessments. In the long run, providers may see that their clients receive fewer face-to-face assessments and that the assessments are more tailored for specific client needs, but those changes will take a while to be implemented.

Staff Contact Jeff Bostic, [email protected]

20 OHFC Systems Improvement; Safety and Quality Improvement Practices for Long-Term Care Services and Supports Special Session Chapter 6, Article 10, Section 142 S.F. 2, Benson – R Dean – R Effective: August 1, 2017

Background Allegations of abuse and neglect registered with the Minnesota Department of Health (MDH), Office of Health Facility Complaints (OHFC), have been steadily increasing, drawing the attention not only of MDH personnel charged with investigation and enforcement actions but also of key legislators, who gave considerable attention this year to how OHFC conducts its work and the growing percentage of complaints and provider self-reports which OHFC is unable to investigate. In response to an OHFC request for a budget increase to fund the hiring of additional investigative staff and other resources, lawmakers engaged in a broad discussion of the adequacy of OHFC enforcement and oversight, and the workgroup described below is one outcome of that discussion.

Summary The legislation directs MDH to consult with interested stakeholders to consider:

(1) systems improvements in processes used by the Office of Health Facility Complaints to investigate reports of maltreatment of vulnerable adults received by the office and processes used to report maltreatment to the office; and

(2) options for implementing prevention strategies, alternative reporting approaches, and proven patient safety and quality improvement practices and infrastructure for long-term care services and supports.

Implications Together with an evaluation of OHFC practices by the Minnesota Office of the Legislative Auditor (currently underway), this legislation calling on MDH to convene key stakeholders means there will be on-going public discussion in the coming year about the protection of vulnerable adults in our member settings. LeadingAge Minnesota advocated for MDH to convene this discussion, and for the scope of work to include a discussion of abuse prevention strategies and ideas for broader reform of the reporting system. In parallel with this MDH-led activity, LeadingAge Minnesota will form a Maltreatment Prevention Task Force, with the goal of developing a comprehensive plan of action aimed at preventing maltreatment before it occurs.

Staff Contact Jonathan Lips [email protected]

21 PCA Contract Implementation

Special Session Chapter 6, Article 1, Section 53 S.F. 2, Benson – R Dean - R Effective: July 1, 2017

Background In the 2013 legislative session, legislation authorized the creation of a union of personal care attendants (PCAs) who work independently and not for an agency. Based on approval of representation by the Service Employees International Union (SEIU), approximately 27,000 PCAs are covered by a contract between SEIU and the state of Minnesota. The initial statewide contract took effect July 1, 2015 and expired June 30 of this year.

Summary A new contract takes effect on July 1 of this year. The final budget provided only half of the funding increase negotiated between SEIU and the administration, so after some renegotiation the final two-year contract includes the following benefits for the covered PCAs-

. A $1 an hour increase to the minimum wage for PCAs to $12 (in some cases, clients can authorize higher per hour rates for the PCAs serving them) . Time-and-a-half pay for PCAs who take care of their clients on five holidays . An increase in the amount of Paid Time Off earned . Training stipends for 5,000 workers who take voluntary trainings to build their skills in order to provide higher quality care . An online matching registry to help address the struggle clients face when trying to find quality care workers to bring into their homes . A 5% additional increase for those PCAs who work for the highest-need clients (defined as those who qualify for 12 or more hours per day of in-home care)

Implications The new PCA contact will have no direct impact on members, because any PCAs employed by members are not subject to the provisions of this contract. Given the competitive labor market in older adult services, the PCA contract is likely to have some impact on the ability of members to attract and retain direct are workers.

Staff Contact Jeff Bostic, [email protected]

22 Care Centers

23 Care Center Licensing Fees Special Session Chapter 6, Article 10, Section 59 Amends Minnesota Statutes 144.122 S.F. 2, Benson – R Dean – R Effective: July 1, 2018, and July 1, 2020

Background The Minnesota Department of Health, Office of Health Facility Complaints (OHFC), requested additional funding to hire additional staff and otherwise increase its capacity to respond to the growing number of complaints and provider self-reports relating to possible maltreatment of vulnerable adults. In order to provide this funding to OHFC, the Legislature enacted licensing fee increases for both care centers and home care agencies.

Summary The nursing home licensing fee will remain at its current level ($183 plus $91 per bed) until June 30, 2018. The fee will increase to $183 plus $100 per bed between July 1, 2018, and June 30, 2020, and will rise to $183 plus $105 per bed beginning July 1, 2020. The expense will be treated as a pass-through expense under current care center reimbursement.

Implications Care centers should factor these fee increases into their annual budgets for 2018 and beyond.

Staff Contact Jonathan Lips [email protected]

25 Mental Health Targeted Case Management by Interactive Video

Special Session Chapter 6, Article 4, Sections 25, 33-34, 44 Amends Minnesota Statutes §§256B.0621, 256B.0625, 256B.0924 S.F. 2, Benson – R Dean - R Effective: Upon Federal Approval

Background Targeted Case Management (TCM) provides resources for adults with serious and persistent mental illness to maintain and increase independence, minimize the risk of hospitalization, and improve overall functioning and well-being. By authorizing TCM to occur through interactive video in certain circumstances, the authors of this proposal hope to increase the number of contacts between case managers and service recipients, and to reduce cost and travel time, while maintaining the quality of TCM.

Summary The Minnesota Department of Human Services (DHS) is directed to seek federal approval for this change, which allows TCM providers to bill Medical Assistance for relocation TCM conducted through inter-active video, if the following requirements are met: (1) the person receiving targeted case management services is residing in: (i) a hospital; (ii) a nursing facility; or (iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging establishment or lodging establishment that provides supportive services or health supervision services according to section 157.17 that is staffed 24 hours a day, seven days a week; (2) interactive video is in the best interests of the person and is deemed appropriate by the person receiving targeted case management or the person's legal guardian, the case management provider, and the provider operating the setting where the person is residing; (3) the use of interactive video is approved as part of the person's written personal service or case plan, taking into consideration the person's vulnerability and active personal relationships; and (4) interactive video is used for up to, but not more than, 50 percent of the minimum required face-to-face contact. (5) The TCM services must actively support identification of community alternatives for the recipient and discharge planning.

Implications If federal approval is received, mental health targeted case managers who are working on relocation planning with nursing facility resident or an adult with developmental disabilities living in a residential setting may provide the service, in part, through interactive video, which may facilitate access to and delivery of the service. The law does not address the technological means by which the service would be provided.

Staff Contact Jonathan Lips, [email protected]

26 Non-Emergency Medical Transportation for MHCP Enrollees

Special Session Chapter 6, Article 4, Sections 31 Amends Minnesota Statutes section 256B.0625 S.F. 2, Benson – R Dean - R

Background Language is needed to clarify eligibility criteria for nonemergency medical transportation services for MN Healthcare Program enrollees residing in or being discharged from a licensed nursing facility.

Summary A new definition was added, stating: Nursing facility transports. A Minnesota health care program enrollee residing in, or being discharged from, a licensed nursing facility is exempt from a level of need determination and is eligible for nonemergency medical transportation services until the enrollee no longer resides in a licensed nursing facility, as provided in section 256B.04, subdivision 14a.

Implications This definition will support the availability of transportation for MHCP eligible individuals residing in or being discharged from a nursing facility.

Staff Contact Bobbie Guidry [email protected]

27 Scholarship Program Update

Special Session Chapter 6, Article 3, Section 41 Amends Minnesota Statutes §§256R.37 S.F. 2, Benson – R Dean - R Effective: October 1, 2017

Background The legislation that created Value-Based Reimbursement (VBR) for care centers in 2015, also made changes to the nursing facility scholarship program that has existed since 2001. One of the 2015 changes made in 2015 allowed student loan expenses to be covered under that program. That legislation limited coverage of student loan expenses to only “newly hired and recently graduated” employees.

Summary In reviewing the impact of the 2015 changes to the scholarship program, members felt that the restriction to only “newly hired and recently graduated” was too restrictive and limited providers’ ability to use student loan reimbursement as a tool for recruitment and retention of employees. The LTC Imperative introduced legislation this year to remove both restrictions from the law. In the process of putting together the omnibus budget bill, legislators chose to strike the “recently graduated” but to keep “newly hired” as a requirement.

Implications The change in the law to eliminate “recently graduated” means that employees can now more broadly use student loan reimbursement as a recruitment tool, even for potential employees who completed school years ago, but it can still only be offered to new employees. Care center members who want to add this to their scholarship programs can do so starting October 1, 2017. The annual cost report starting that date is the first that will include any of these costs in VBR rates, which means the first rate impact from this change will occur in the January 1, 2020 rates.

Staff Contact Jeff Bostic, [email protected]

28 Supplemental Nursing Services Agency (SNSA) Update

Special Session Chapter 6, Article 3, Sections 5,28 and Article 10, Section 72 Amends Minnesota Statutes §§144A.74, Statutes 256R.02, subdivision 4, and Statutes 144A.70, subdivision 6. S.F. 2, Benson – R Dean - R Effective: Various Dates

Background In recent years, a few issues around the laws regulating SNSAs have come to light. One has to do with an expansion of the law to include “other licensed health professionals” made a few years ago, which has unintentionally brought companies providing temporary staff such as nursing home administrators and physicians under the definition of SNSA. The other issue, which largely came to light in the process of DHS auditing cost reports to set rates under VBR, has to do with the maximum charges to nursing homes provision, which were enacted in 2001, and which were found to have some ambiguity around them as well as some clear cut cases where they were not being followed.

Summary After discussion of all the issues around SNSAs, LeadingAge MN supported legislation that did three things- (1) eliminated including other licensed health professionals under the SNSA definition; (2) sets the maximum charges to nursing homes based on wage rates in the metro area, and; (3) clarifies that care centers can pay travel and housing costs for SNSA staff who have to travel to work and puts those costs in administrative costs under current reimbursement. While stakeholders agree with these changes, there continue to be questions about the policy, both in terms of what entities should have to register and how the maximum charges provisions should be applied, so future legislation is this area is possible.

Implications These changes will have a few different impacts. Eliminating “other licensed health professionals” will reduce the number of entities that need to register, and keep care centers from being cited for using staff, such as interim administrators, that are not from a registered SNSA, even though SNSAs do not typically provide administrators.

The changes to the limits will have a modest impact, while keeping the existing limits largely intact to avoid a spike in costs for care centers needing temporary staff. The switch to the metro area for setting limits will produce a modest increase in the limits for providers in the rural areas. The clarification on paying travel and housing costs will help those providers who do that by making clear that it is not a violation of the law, but because it is an administrative cost they will get no direct rate increase on those costs.

Staff Contact Jeff Bostic, [email protected]

29 Swing Bed Change

Special Session Chapter 6, Article 3, Section 3 Amends Minnesota Statutes §§144.562, subdivision 2 S.F. 2, Benson – R Dean - R Effective: August 1, 2017

Background In the 2016 legislative session, a hospital company that operates several rural hospitals that have swing beds proposed an increase in the cap on swing bed use imposed under Minnesota state law. That legislation was not approved, but LeadingAge MNcontinued discussions with that company about the swing bed law and possible changes to it. No legislation was brought forward in the 2017 session to increase the cap, but language was introduced to correct a problem with the existing process.

Summary Under the previous swing bed law, a hospital that exceeds 2,000 swing bed days in a year can admit three additional swing bed patients. After that, the hospital can only admit additional patients with Department of Health approval and if every care center within 25 miles declines the admission. A concern was raised about whether that last requirement interferes with free choice of provider for Medicare patients, so legislation this year changed it so that the prospective swing bed patient must agree to be referred to care centers within 25 miles.

Implications This change in the swing bed law should have minimal impact. It only comes into play for swing bed hospitals who have hit the annual cap, which happens in a limited number of cases annually. In those small number of cases, the referral options for patients will be restricted to only care centers they agree to go to if accepted, which is an appropriate change that better responds to client preferences while maintaining the existing limitations on swing bed use.

Staff Contact Jeff Bostic, [email protected]

30 Value Based Reimbursement (VBR) Updates

Special Session Chapter 6, Article 3, Sections 1-2, 4, 20-25, 28-46 Amends Minnesota Statutes §§144.0724, subds. 4 and 6, Statutes 144A.071, subd. 4d, Statutes 256B.431, subds. 10, 16 and 30, Statutes 256B.434, subds. 4 and 4f, Statutes 256B.50, subdivision 1b, and Statutes 256R.02, subds. 4, 17-19, 22, 42, 52, and adds new subdivisions in 256R S.F. 2, Benson – R Dean - R Effective: Various Dates

Background During the process of implementing new care center rates, both LeadingAge MN and DHS identified issues with the lengthy new statute that created VBR in 2015. Both DHS (through the Governor’s budget process) and LeadingAge MN introduced legislation to update the VBR statute and address some of the issues that had been identified. Although there were differences between the two proposals, both produced a savings to the state while keeping in place the vast majority of the structure of the system that passed in 2015.

Summary The bill produces savings in three primary ways. The most significant one is suspending the critical access nursing facility program for another two years, since that program as it previously existed provided rates inferior to VBR. The second is phasing out the minimum wage increases that started in 2014, which makes sense under a cost-based system where that spending is reflected in the cost reports. The final savings comes from delaying the restarting of the APS inflation on property rates from October 1, 2018 to January 1, 2019, which aligns those rate adjustments with VBR rates which are issued on January 1.

Much of the rest of the provisions related to VBR are various changes intended to clarify areas of the statute that lacked detail. The Legislature ended up selecting some of the changes proposed by the Imperative, some proposed by the Governor and inserting some of their own. The most significant changes include-  Lowering the threshold for DHS to waive penalties due to late submission of MDS  Limiting the dates of rate adjustments in most cases to January 1 or July 1 (applies to all property projects, consolidations, layaways, and closure and single bed incentives)  Clarifies cost reporting of nurse consultants who work out of a corporate office  Requires providers to give notice to private pay residents of the amount of the increase in their rate (when the amount is known) and when the case mix changes  Allows DHS to assign costs to a category for rate setting in cases where the statute is not clear  Requires DHS to report to the Legislature every two years starting in 2019 on VBR and its impact of “improving quality and restraining costs”

Implications One key result of the legislative session is that the basic structure of VBR was preserved for the next two years, which means that the substantial rate increases due on January 1, 2018 will be

31 applied as scheduled. The savings in the bill were primarily due to suspending a program (critical access) that is already dormant and phasing out increases given under the old payment system. The cleanup language mostly matches with current practices but the nurse consultant change should be helpful to providers who use corporate nurse consulting. The limitation on the dates of rate increases, while a helpful simplification for consumers, will create timing challenges for property projects that providers will need to manage as much as they can. The language allowing DHS to classify costs is a concern, although the ability of providers to win appeals in ambiguous situations is untested under the current law. Finally, one piece that the LeadingAge MN supported that did not pass is to allow automatic rate adjustments in the event that a local unit of government enacted a minimum wage increase that would be higher than the state minimum wage. This means that even though Minneapolis just passed a local ordinance increasing the minimum wage for work performed in the city to $15 an hour, care centers will not receive automatic increase to help comply with the new mandates and will have to carry costs for 27 months before any recognition of the new costs. Other cities may follow the Minneapolis example and pass new minimum wage mandates and care centers will not have reimbursement to cover those new costs.

Staff Contact Jeff Bostic, [email protected]

32 Housing/HCBS

33 Adult Day Services Study

Special Session Chapter 6, Article 3, Section 47 S.F. 2, Benson – R Dean - R Effective: July 1, 2017

Background As part of LeadingAge MN’s effort to reform the Elderly Waiver (EW) rate system, we raised questions about whether the current “flat rate” payment approach for Adult Day is appropriate or whether it should be changed to a system that adjusts for the needs of those served. In addition, as both the state and consumers shift toward increased use of home and community based services, DHS is interested in gathering data on adult day services to better understand the scope of services provided, utilization patterns, and issues with oversight of state funding for those services.

Summary The bill directs the DHS Commissioner to study existing adult day models, including acuity, staffing and support levels, and quality assurance, in addition to projecting demand for adult day services into the future. DHS will report back to the legislature by January 1, 2019.

Implications Providers may be contacted by DHS as part of the data gathering process related to this study. LeadingAge Minnesota will take an active role in the study, with the specific goal of designing a new payment methodology for use in the new EW rate system.

Staff Contact Jeff Bostic, [email protected]

35 Adult Foster Care

Special Session Chapter 6, Article 2, Sections 4-8 Amends Minnesota Statutes, 245A.04, subdivision 1; section 245A.11; section 245D.04, subdivision 3 S.F. 2, Benson – R Dean - R Effective: Day following final enactment.

Background In studying Adult Foster Care settings in light of the HCBS Settings Rule, the State identified a number of items to add to Minnesota requirements to assure settings meet HCBS standards so that individuals residing in these settings experience life as it being a home rather than an institutional setting.

Summary Changes to Adult Foster Care requirements are primarily related to lease language, assurances of resident rights, and an addition of discharge notice requirements for individuals receiving financial support for services through the Elderly Waiver program. Changes include rights such as choice of roommate, right to lockable bedroom door, right to share a bedroom and bed with a spouse, right to freedom and support to access food at any time, and other rights. Criteria are detailed regarding the restriction of any of these rights for individuals where the rights may affect the person’s health or safety. Also added is that the termination policy is now required to be provided annually to those receiving support through the Elderly Waiver program. Implications Adult Foster Care providers will need to comply with the new requirements and inform their clients of the changes made to the regulations.

Staff Contact Bobbie Guidry, [email protected]

36 Disability Waiver Rate Setting (DWRS) Changes

Special Session Chapter 6, Article 1, Sections 20-22, 24-26, and 28-31 Amends Minnesota Statutes §§256B.4913, subd. 4a, and Statutes 256B.4914, subds. 2, 5–7, 9- 10, 16 and adds new subdivisions S.F. 2, Benson – R Dean - R Effective: Various Dates

Background On January 1, 2014, the implementation of a new statewide system for determining rates for community-based services for individuals with disabilities provided under the various Medical Assistance Waivers began. This new system, the Disability Waiver Rate System (DWRS), provided for a phase-in of the new rates. To accomplish this phase-in, the old rate (“Historical Rate”) moved towards the new Rate Management System rate (“RMS Rate”), over a period of years. The phase-in rate is referred to as the “Banded Rate.” The RMS rates for various services are determined through wage-based formulas with additional components included to approximate the true cost or providing services. Under current law the wage data used to set RMS rates are updated every five years.

Summary A number of changes to the DWRS were made in the recent legislative session. Below are the most significant of those changes for members, which is primarily those changes impacting Adult Day Services providers who serve disability waiver clients:  The “absence and utilization factor” for day services under RMS was increased from 3.4% to 9.4% effective January 1, 2019. Prior to that effective date, DHS is to conduct a study to determine what this factor should be based on the “underlying cost” of absence.  Banding of rates was extended by an additional year. If approved by the federal government, that will cover the year starting January 1, 2020.  Cost reports for providers covered by RMS will be required, so that DHS can study the relationship between the RMS rates and actual costs.  Updating of the RMS system based on current wage data will occur every five years starting on July 1, 2022. Under previous law, an update is scheduled to occur on July 1 of this year. That update is expected to increase RMS rates and average of 11%, as the Legislature rejected a Governor’s proposal to offset previous inflation increases which would have reduced that increase to 4%.

Implications Most of the changes made this year do not have immediate impact. The most significant impact, the RMS rate updating, was scheduled to occur this year under previous law. The cost report requirement may be burdensome for providers, and the changes to the utilization factor and additional year of banding are subject to action by future Legislatures and/or federal approval.

Staff Contact Jeff Bostic, [email protected]

37 Elderly Waiver (EW) Rate Reform

Special Session Chapter 6, Article 3, Sections 8-19. Amends Minnesota Statutes §§256B.0911, subd. 3a and 256B.0915, subds.3a, 3e, 3h, and 5, adds new subdivisions to 256B.0915 S.F. 2, Benson – R Dean - R Effective: Various Dates

Background One of LeadingAge MN’s key goals for 2017 was to enact a reform of EW rates, similar to what was approved for care centers in 2015. Throughout much of 2016, working with a group of members, as well as stakeholders representing consumers, payers and other providers, LeadingAge MN helped to develop a proposal that makes major reforms in the rates as well as important process changes designed to benefit consumers and providers.

Summary The bill begins implementation of new rates for all EW services, including community services (homemaker, chore, meals), adult day services, and residential (customized living) services. Under the new system the rate for each service is based on current wage data, with components to added on to cover additional costs like training and administration. The new rates take effect on January 1, 2019, using a blend of 10% new rate system and 90% current unadjusted rates. The caps on customized living and overall EW services are revised to adjust each January by the greater of the EW or care center increase.

The policy changes in the bill, which take effect this summer, should be helpful for providers and improve the overall functioning of the system for consumers as well. Those changes include-  Allowing adult day providers to submit information about a client’s needs in advance of an assessment (currently allowed for customized living only)  Allowing providers who submitted information to get both the service plan and the full residential services workbook  Extending to 90 days the amount of time an assessment of service need can last, which will allow more time for financial eligibility to be established  Requiring that a new assessment and service plan be completed in a case where a client has experience a significant change in condition

Implications The immediate impact of rate reform is limited, because it does not occur until 2019, and the blending of the rates means many services will see rate increases of 2% or less at that time. In the long run, creating a system for establishing EW rates that are based on the actual cost of providing services is a significant step, allowing is an opportunity to build toward full implementation in the future. The policy changes in the bill offer some more immediate benefit for providers and consumers.

Staff Contact Jeff Bostic, [email protected]

38 Establishment Fees – Food and Beverage License Fees Special Session Chapter 6, Article 10, Sections 132. Amends Minnesota Statutes 157.16, subdivision 3 S.F. 2, Benson – R Dean - R

Background Minnesota’s Food Code and accompanying policies have been under revision for several years. This change is a portion of that work.

Summary The Fees demonstrate a shift from Food and Beverage establishments being rated and charged a fee based on size to the fees being based on risk related to the food served and its preparation.

Implications There will be a shift in the title and fee structure for FBL licenses. A meeting with MDH is scheduled in July to discuss the changes and potential impact on our members.

Staff Contact Bobbie Guidry [email protected]

39 Group Residential Housing (GRH) Name Change Special Session Chapter 6, Article 2, Sections 21-36 Amends Minnesota Statutes, 256I.03-06, numerous subdivisions S.F. 2, Benson – R Dean - R Effective: July 1, 2017

Background What has been traditionally Group Residential Housing Funding has been expanded to use in additional settings so a change of name for the program has been adopted.

Summary The program, historically known as Group Residential Housing (GRH) is changing to the Housing Support Services. The change is to more accurately reflect the variety of settings where people receive the benefit – not just group settings anymore. It also highlights that it isn’t a place, but it is something people provide or receive. Implications There are no significant benefit changes for providers or recipients of Housing Support, however, what have previously been called “GRH Agreements,” will now be called “Housing Support Agreements.”

Staff Contact Bobbie Guidry [email protected]

40 Reinvestment of Home Care Fines Into Quality Improvement Projects Special Session Chapter 6, Article 10, Sections 69-70 Amends Minnesota Statutes 144.474 and 144.4799 S.F. 2, Benson – R Dean - R Effective: August 1, 2017

Background Under existing law, fines that the Minnesota Department of Health (MDH) collects from licensed home care agencies through regulatory enforcement actions are deposited into a special fund, which MDH can use to improve home care in Minnesota, as recommended by the home care advisory council. This provision aims to facilitate the application of those funds for their intended purpose.

Summary The legislation clarifies that MDH must (rather than may) use the revenue from the fines for special projects to improve home care. It provides for legislative oversight of the process, by directing that the home care advisory council shall annually review the balance of the account in the state government special revenue fund and make annual recommendations by January 15 directly to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services regarding appropriations to MDH commissioner for those purposes.

Implications The Minnesota Department of Health will formalize a process for identifying projects that would work to improve home care in Minnesota and for distributing the funds that accumulate in this special revenue account. No details are yet available, but examples might include such things as training programs, tools and templates, or grants to support provider-specific investments in certain quality improvement activities.

Staff Contact Bobbie Guidry [email protected]

41 Housing Support Services Special Session Chapter 6, Article 2, Section 10 Amends Minnesota Statutes 256B, Medical Assistance for Needy Persons by adding 256B.051 S.F. 2, Benson – R Dean - R Effective: Contingent upon Federal Approval

Background A number of individuals with disabilities have trouble obtaining or sustaining housing. This program is intended to assist these individuals to increase long-term stability in housing.

Summary A new program under Medical Assistance, is added to provide housing support services to an individual with a disability that limits the individual’s ability to obtain or maintain stable housing. The services support an individual’s transition to housing in the community and increases long-term stability in housing to avoid future periods of being at risk of homelessness or institutionalization. Those assessed to be eligible can benefit from housing transition services, and from housing and tenancy sustaining services.

Housing transition services are defined as: (1) tenant screening and housing assessment; (2) assistance with the housing search and application process; (3) identifying resources to cover one-time moving expenses; (4) ensuring a new living arrangement is safe and ready for move-in; (5) assisting in arranging for and supporting details of a move; and (6) developing a housing support crisis plan. Housing and tenancy sustaining services include: (1) prevention and early identification of behaviors that may jeopardize continued stable housing; (2) education and training on roles, rights, and responsibilities of the tenant and the property manager; (3) coaching to develop and maintain key relationships with property managers and neighbors; (4) advocacy and referral to community resources to prevent eviction when housing is at risk; (5) assistance with housing recertification process; (6) coordination with the tenant to regularly review, update, and modify housing support and crisis plan; and (7) continuing training on being a good tenant, lease compliance, and household management.

42 A housing support service may include person-centered planning for people who are not eligible to receive person-centered planning through any other service, if the person-centered planning is provided by a consultation service provider that is under contract with the department and enrolled as a Minnesota health care program. Implications This service may be available to assist some, eligible tenants, to understand and conduct themselves in ways that will support their continued tenancy.

Staff Contact Bobbie Guidry [email protected]

43 Housing with Services (HWS) Contract Act Changes – Conspicuous Notice

Special Session Chapter 6, Article 10, Section 73 Amends Minnesota Statutes 144D.04, subdivision 2 S.F. 2, Benson – R Dean - R Effective: August 1, 2017

Background Concerns have been raised that tenants may not consistently understand or be informed of a landlord’s policies regarding the impact of eligibility for public assistance on the ability to pay current rent.

Summary The law changes the 9th point of the 17 points required to be covered in a housing with services contract to require: “a conspicuous notice informing the tenant of the policy concerning the conditions under which and the process through which the contract may be modified, amended, or terminated, including whether a move to a different room or sharing a room would be required in the event that the tenant can no longer pay the current rent”

Implications Registered Housing with Services Establishments must adjust their contracts to provide a conspicuous notice related to the circumstances that may apply if a tenant can no longer pay the current rent. LeadingAge Minnesota recommends this topic is specifically discussed during the rental process and intermittently during the course of tenancy to support clear communication, understanding, and to allow for sufficient planning time should a move be required. The Minnesota Department of Health is in process of developing a bulletin to convey State expectations related to implementation of the new requirement.

Staff Contact Bobbie Guidry [email protected]

44 Housing with Services (HWS) Contract Act Changes

Special Session Chapter 6, Article 2, Sections 1-2. Amends Minnesota Statutes 144D.04, subdivision 2 S.F. 2, Benson – R Dean - R Effective: Day following final enactment.

Background As part of Minnesota’s State Transition Plan to comply with the CMS Home and Community Based (HCBS) Settings Rule several standards were identified by DHS to be added to lease requirements for HWS Establishments. Because the changes were added to 144D, they apply to all HWS establishments and tenants of those settings, not only those serving individuals receiving HCBS support through waiver programs.

Summary In addition to the seventeen points previously required in a housing with services contract, five new items were added to apply to those receiving one or more health related services from the establishment's arranged home care provider. 144D does allow the contract to be titled differently and allows for the required points to be covered in the contract or through supporting documents or attachments.

The new subdivision reads:

Subd. 2a. Additional contract requirements. (a) For a resident receiving one or more health- related services from the establishment's arranged home care provider, as defined in section 144D.01, subdivision 6, the contract must include the requirements in paragraph (b). A restriction of a resident's rights under this subdivision is allowed only if determined necessary for health and safety reasons identified by the home care provider's registered nurse in an initial assessment or reassessment, as defined under section 144A.4791, subdivision 8, and documented in the written service plan under section 144A.4791, subdivision 9. Any restrictions of those rights for people served under sections 256B.0915 and 256B.49 (MA waivers) must be documented in the resident's coordinated service and support plan (CSSP), as defined under sections 256B.0915, subdivision 6 and 256B.49, subdivision 15. (b) The contract must include a statement: (1) regarding the ability of a resident to furnish and decorate the resident's unit within the terms of the lease; (2) regarding the resident's right to access food at any time; (3) regarding a resident's right to choose the resident's visitors and times of visits; (4) regarding the resident's right to choose a roommate if sharing a unit; and (5) notifying the resident of the resident's right to have and use a lockable door to the resident's unit. The landlord shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible.

Implications Registered Housing with Services Establishments must add the required components to their leases, inform current tenants of the changes, and, as needed, adjust practices to meet the new

45 requirements. The Minnesota Department of Health is in process of developing bulletins to convey State expectations related to implementation of the new requirements.

Staff Contact Bobbie Guidry [email protected]

46 Lodging License Exclusion for Housing with Services Establishments; Study of Laws to Protect Persons with Dementia Special Session Chapter 6, Article 10, Sections 74, 146 Amends Minnesota Statutes 144D.06, S.F. 2, Benson – R Dean - R Effective: August 1, 2017

Background For many years, LeadingAge Minnesota has participated on a Lodging Work Group and MDH. It was evident that the Lodging Law no longer fits our settings and, along with our Imperative partner, advocacy has been on-going to seek exclusion from the requirement for some HWS settings to obtain a Lodging License. Summary The Law change excludes Housing with Services establishments from having to obtain a Lodging License.

To satisfy certain stakeholders that this exclusion will not lessen consumer protections, the Legislature also directs the Minnesota Department of Health (MDH) to evaluate whether existing laws, including laws governing housing with services establishments, board and lodging establishments with special services, assisted living designations, and home care providers, as well as building code requirements and landlord tenancy laws, sufficiently protect the health and safety of persons diagnosed with Alzheimer's disease or a related dementia.

Implications The change eliminates the need to obtain or renew a Lodging License for all or part of a Housing with Services registered establishment. This eliminates a licensure fee for many providers and eliminates the inconsistent interpretation of whether or not a Lodging License is required. The MDH evaluation of existing laws will be conducted in consultation with stakeholders, and LeadingAge Minnesota participate actively in that process.

Staff Contact Bobbie Guidry [email protected]

47 Nurse Educational Loan Forgiveness Program Expansion Special Session Chapter 6, Article 10, Section 60 Amends Minnesota Statutes 144.1501 S.F. 2, Benson – R Dean – R Effective: August 1, 2017

Background The purpose of Minnesota’s Loan Forgiveness program is to recruit and retain health care professionals to needed areas and facilities within Minnesota. Loan forgiveness is an important benefit for the health care professionals themselves as well as for providers and communities experiencing workforce shortages. The Minnesota Department of Health accepts applications once each year as part of a competitive process. Summary The loan forgiveness program historically has been available to nurses who agree to practice in a Minnesota nursing home; an intermediate care facility for persons with developmental disability; or a hospital if the hospital owns and operates a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse is in the nursing home. This legislation expands the program to include nurses who agree to practice in a housing with services establishment as defined in section 144D.01, subdivision 4; or for a home care provider as defined in section 144A.43, subdivision 4.

Implications Nurses who agree to work in housing with services settings or home care agencies will be eligible to apply for educational loan forgiveness, beginning with the next application cycle administered by the Minnesota Department of Health. Watch for additional information later this year.

Staff Contact Bobbie Guidry [email protected]

48 Return to Community Expansion

Special Session Chapter 6, Article 6 Amends Minnesota Statutes, 256.975, subdivision 7 S.F. 2, Benson – R Dean - R Effective: Effective July 1, 2017

Background The Senior LinkAge Line provides long-term care options counseling. The changes modify the focus and process for targeting their work.

Summary The changes modify the process for identifying individuals who will be targeted for long-term care options counseling. The changes remove former residents of nursing homes who were discharged to community settings, older adults who request service after consultation with the Senior LinkAge Line, and referrals from residents or staff of nursing homes as individuals to be contacted, replacing them with individuals who meet a profile that demonstrates that the consumer is either at risk of readmission to a nursing home or hospital, or would benefit from long-term care options counseling to age in place. Added for contact are people discharged from a hospital or for whom Medicare home care has ended that meet criteria as being appropriate for long-term care options counseling. The law also adds development of protocols for Medicare home care to identify at-risk older adults and when to refer these individuals to the Senior LinkAge Line for long-term options counseling.

Finally, an addition, guides the Senior LinkAge Line to determine when it is appropriate to refer a consumer who receives long-term care options counseling and who uses an unpaid caregiver to the self-directed caregiver service.

Implications The changes expand long-term care options counseling to individuals for whom Medicare home care is ending, with the intention of supporting individuals to remain in the community, while also providing more discretion on who receives the counseling by Senior LinkAge Line staff. For example, a resident or patient who is discharged after rehabilitation from a knee replacement, and is stable in their community setting no longer needs to be contacted.

Staff Contact Bobbie Guidry [email protected]

49 Self-Directed Caregiver Grants

Special Session Chapter 6, Article 3, Section 7 S.F. 2, Benson – R Dean - R Effective: July 1, 2019

Background An estimated 33 million individuals in the United States provide caregiving services to adult family members. Family caregivers provide necessary support and stability that enable individuals to remain in the community, but also often face higher levels of physical strain and emotional stress compared to non-family caregivers. Offering support to at-risk family caregivers who support vulnerable older adults will help those older adults remain in the community.

Summary Effective July 1, 2019, the Minnesota Board on Aging will be required to administer self- directed caregiver grants to support at-risk family caregivers of older adults to help older adults remain in their homes longer. Priority will be given to consumers referred through the nursing facility preadmission screening.

Implications Staff may encourage family caregivers to access caregiver grants to help manage the stress and strain that often accompanies family caregiving.

Staff Contact Roni Falck, [email protected]

50 Transportation Study

Special Session Chapter 6, Article 1, Sections 48. Amends Minnesota Statutes §§256B.056, subd. 5c and Statutes 256B.0561, subds. 2 and 4 S.F. 2, Benson – R Dean - R Effective: Day following final enactment.

Background Access to transportation is a consistently identified concern and barrier to services and community integration for individuals who receive home and community-based services. The legislature is interested in a study to identify opportunities to increase access to transportation for individuals who receive home and community-based services. Summary The commissioner of human services, with cooperation from lead agencies and in consultation with stakeholders, will conduct a study to identify opportunities to increase access to transportation services for an individual who receives home and community-based services. The commissioner will submit a report with recommendations to the chairs and ranking minority members of the legislative committees with jurisdiction over human services by January 15, 2019.

The report will: (1) study all aspects of the current transportation service network, including the fleet available, the different rate-setting methods currently used, methods that an individual uses to access transportation, and the diversity of available provider agencies; (2) identify current barriers for an individual accessing transportation and for a provider providing waiver services transportation in the marketplace; (3) identify efficiencies and collaboration opportunities to increase available transportation, including transportation funded by medical assistance, and available regional transportation and transit options; (4) study transportation solutions in other states for delivering home and community-based services; (5) study provider costs required to administer transportation services; (6) make recommendations for coordinating and increasing transportation accessibility across the state; and (7) make recommendations for the rate setting of waivered transportation. Implications Study results may lead to legislative action next session to increase transportation access for HCBS recipients.

Staff Contact Bobbie Guidry [email protected]

51 2018 Outlook

53 2018 Session Outlook The 2017 legislative session has concluded and even though controversy remains, it appears the issues of concern to LeadingAge are resolved. Overall, the session was successful for LeadingAge Minnesota and our members. Despite the political acrimony that defined this legislative session, there were many significant advancements around senior care: highlighted by significant investments in workforce recruitment and retention efforts, the passage of Elderly Waiver reform legislation, and continued support for Value-Based Reimbursement for care centers. Work is already underway to prepare for the next legislative session. Looking ahead, here are a few key factors that will frame next year’s work. Elections 2018 will be an election year. Every Minnesota state representative will be up for re-election in the fall; Minnesota state senators will have two more years before they face re-election. There will also be a gubernatorial election in 2018, but no incumbent as Governor Dayton and Lt. Governor Smith have both announced they will not be seeking re-election. Dozens of candidates have already emerged to campaign to be our next Governor. Given that relationships were deeply strained between lawmakers this year, it seems unlikely that another election will help inspire better cooperation next year. It will likely be very difficult to pass anything in the next legislative session due to the highly political climate that currently exists. LeadingAge MN does see an opportunity to raise the profile and relative importance of senior care issues in the next election. Through our participation in the Face Aging campaign, we will have a strong focus on educating candidates and the public on our issues. We will rely on members to be strongly engaged in this campaign to elevate awareness and support for our issues by the public and candidates. Federal Health Care Legislation As we write this report, it is difficult to predict whether Congress will have the votes to pass any sort of bill that repeals and replaces the Affordable Care Act. Every bill considered to date would dramatically restructure the Medicaid budget as we know it by establishing per capita caps that would limit on the amount of federal funding that would go to states to support Medicaid-funded programs. Limits on state spending and penalties for exceeding the limits are also in the mix. If such legislation passes, it will have a profound impact on Minnesota.

55 Assuming the federal legislation passes, there will be almost no scenario in which state legislators will have the option to leave services for the elderly and disabled unscathed. There are three key factors at work here: 1) The hole left in our s tate budget by cuts in federal dollars for those who can’t afford private insurance but make too much to qualify for Medicaid, the so-called “Medicaid Expansion”. This proposed rollback does not directly impact senior care it adds significantly to the budget challenge our state policymakers will face. 2) There would no longer be an automatic federal match for any future budgeted rate increases, such as those promised under the current nursing home reimbursement system or those anticipated under Elderly Waiver payment reform; 3) The Senate proposal includes a provision designed to take money from states currently spending above a national per capita average for Medicaid programs and redistributes it to other states who are below that average. That analysis singles out eight states for reductions in their current per capita spending – Minnesota is one of them. Taken together, these three factors will fundamentally change the Medicaid program as we know it, and in the process shift spending to Minnesota taxpayers in the face of truly untenable decisions about how and where seniors and disabled receive their care. Interim Work Because this session was so focused on budget issues, there is quite a lot of policy work that will require ongoing work and expect legislation on these issues next year: Vulnerable Adult Protection Two studies were authorized in the last legislative session regarding the state’s protection of vulnerable adults: the Vulnerable Adults Case Management System work group and the upcoming Legislative Auditor report on the Office of Health Facility Complaints. LeadingAge MN will actively participate in the work, and we expect recommendations to emerge from both groups that could be the basis for additional legislation next year. Labor Regulations One issue of strong interest to LeadingAge MN that did not pass is the uniform labor standards bill which would have prevented local workplace ordinances such as sick leave and minimum wage. This was a priority for the business community but the House and Senate leadership were unable to find a trade-off that Governor Dayton found acceptable in order to sign the bill. A pre- emption bill was passed in the special session, however the Governor vetoed it all. Along with others in the business community, this creates challenges for members of LeadingAge MN as the sick leave ordinances go into effect and cities like Minneapolis pass a $15 per hour minimum wage. these workplace ordinances. We may also need to consider legislation in 2018 to increase funding to pay for the cost increases resulting from compliance with the local ordinances.

56 SNSAs While there was legislation this year that made limited changes to the SNSA law, MDH will be convening a workgroup in the interim that will look at unresolved issues surrounding the regulation of temporary/interim health care staffing and related businesses. LeadingAge MN will be active participants in this work. Homecare Law Work is already underway to look at changes that could be made to improve the current homecare regulations. LeadingAge MN is working collaboratively with other stakeholders to generate recommendations. We anticipate additional issues to arise over the course of several months, so please stay tuned to email and Advantage for updates on our policy work. In the meantime, we encourage all members to get involved with one of our policy Committees to participate in the development of our 2018 policy agenda. The Legislature will go back into session on February 20, 2018.

57 Our Process

59 Our Process

The heart of LeadingAge Minnesota's advocacy process is our cabinet structure. Our committees are open to all LeadingAge Minnesota members. Our committees help identify legislative priorities, participate in the development of grassroots strategy, provide critical data and feedback, monitor regulatory issues, and review implementation of new laws.

Our agenda development begins with an idea exchange-we ask our committees about the top issues they would like lawmakers to address. It is a discussion with our members regarding their present-day concerns and their hopes for the future. Through these conversations, we identify both long-term goals and short-term deliverables. We then gather all the feedback provided during those discussions, and develop staff recommendations that form a proposed agenda. The agenda is presented to the LeadingAge Minnesota Board of Directors where it is further discussed and refined.

LeadingAge Minnesota also coordinates our legislative priorities with the Long-Term Care Imperative through the Long Term Care Imperative Steering Committee.

Throughout our process, we encourage our members to participate in the discussion and vocalize questions or concerns they may have.

Leadership We would like to thank the following members who have played a leadership role in our advocacy this session.

LeadingAge Minnesota Board of Directors OFFICERS: Mark R. Anderson Chair Knute Nelson Alexandria Jonathan E. Lundberg Immediate Ebenezer Minneapolis Past Chair Nancy Stratman Chair-Elect Cuyuna Regional Medical Center-Care Center Crosby Erin Hilligan Secretary- Ebenezer Minneapolis Treasurer Gayle Kvenvold President & LeadingAge Minnesota Saint Paul CEO DISTRICT DIRECTORS: Michele Halvorson District A Thief River Care Center Thief River Falls Cheri High District B St. Michael's Health and Rehabilitation Center Virginia Nathan D. Johnson District C PioneerCare Fergus Falls Lindsey Sand District D Assumption Nursing Home Cold Spring Pamela Adam District E Rice Care Center Willmar Cheryl A. Gustason District F Field Crest Care Center & Assisted Living Hayfield Melissa K. Kirchhoff District G McKenna Crossing Prior Lake ELECTED DIRECTORS: Craig Abbot Director-at- Health Dimensions Group Minneapolis Large Christine M. Bakke, Director-at- Madonna Living Community Rochester LNHA, MHA Large James E. Bettendorf Director-at- Vista Prairie Communities Hopkins Large

61 Angela Brown Director-at- Elim Care, Inc. Eden Prairie Large Donna Flaata Director-at- Brookdale Senior Living Milwaukee Large Dan Johnson Director-at- Catholic Eldercare, Inc. Minneapolis Large Shelley Kendrick Director-at- Ecumen Shoreview Large Paul R. Libbon Director-at- Ecumen Shoreview Large Michael T. Stordahl Director-at- Clara City Care Center Clara City Large APPOINTED DIRECTORS-AT-LARGE Rocklon B. Chapin, Director-at- Benedictine Health System - Twin Cities office Shoreview FACHE Large Kristi Kane Director-at- Arrowhead Area Agency on Aging - ARDC Duluth Large Barbara Klick Director-at- Sholom Saint Louis Park Large Duane W. Larson Director-at- Presbyterian Homes and Services Roseville Large Traci Larson Director-at- Presbyterian Homes and Services Roseville Large Scott R. Riddle Director-at- Walker Methodist Minneapolis Large Gail A. Skoglund Director-at- Augustana Open Circle of Heritage Park Minneapolis Large Joel Theisen Director-at- Lifesprk Edina Large EX-OFFICIO/INVITED GUESTS: Matthew L. Anderson Chair- Minnesota Hospital Association Saint Paul Appointed Director Barbara J. Blumer Ex-Officio LeadingAge Minnesota Foundation Board Chair, Eagan Barb Blumer Law, P.A. Wayne Olson Ex-Officio LeadingAge MN Savings & Solutions Board Chair, Eden Prairie Volunteers of America National Services Todd Novaczyk Ex-Officio Argentum Board Member, Eden Prairie New Perspective Senior Living Kathryn Roberts Ex-Officio LeadingAge Board Member, Shoreview Ecumen Leslie Knight Guest LeadingAge Washington Diane Damerow Guest Minnesota Association of Healthcare Volunteers Liaison Albert Lea Jennifer Parker, RN Guest MN-DONA Liaison, Bethesda Health & Housing Willmar Robert M. Dahl Guest Elim Care, Inc. Eden Prairie Daniel C. Dixon GU-POL Guardian Angels Elk River Jon Riewer GU-POL Eventide Senior Living Communities Moorhead

6260 LeadingAge Minnesota Adult Day Transitional Leadership Committee Susan M. Ryan Chair Amherst H. Wilder Foundation Adult Day Health Saint Paul Alice Tennis Vice Chair Roitenberg Family Adult Day Center Saint Paul Judy A. Andersen Member Rise, Inc. - Courage Kenny Golden Valley Alyssa Bandel Member Vital Link Adult Day Care Center Northfield Matt Beecher Member Millennium Adult Day Care Edina Michelle R. Borreson Member Gundersen Tweeten Care Center Spring Grove Jackie P. Byington Member DayBridge Adult Day Hopkins April Collman Member Adult Day Services, Inc. Bemidji Ginny Cullen Member Mount Olivet Adult Day Services Minneapolis NancyLee Dahlin Member Salvation Army Adult Day Center Maplewood Deborah Delaney Member Touching Lives Adult Day Services Savage Lisa Desnick Member Mission Today New Hope Christopher J. Member Elim Oasis Adult Day Health Center Princeton Dougherty Sarah Dvergsten Member Benedictine Health Center Adult Day Services Duluth Jennine Engen Member TenX Systems, LLC (dba ResiDex Software) Lino Lakes Kathleen Fitzgerald Member Prairie Adult Care Inc. Chanhassen Peggy S. Gaard Member Augustana Open Circle of Hopkins Hopkins Brittany Harris Member Walker Senior Club Adult Day Services Minneapolis Sarah Jones Member Boutwells Landing Adult Day Program Oak Park Heights Kristi Kane Member Arrowhead Area Agency on Aging - ARDC Duluth Donna Kavanaugh Member East Side Neighborhood Services, Friendship Center Minneapolis Kristina Kwan Member Phoenix Cove Adult Day Center Saint Paul Alyssa Leecy Member Minnesota Chippewa Tribe Adult Day Services Cass Lake Heather Liesenfeld Member Martin Luther Manor Adult Day Services Minneapolis Nanette Marsh Member Ebenezer DayBreak Adult Day Program Hastings Joyce McIntosh Member Catholic Eldercare By Day Minneapolis Carol McWalters Member Amherst H. Wilder Foundation Adult Day Health Saint Paul Ericka Meza Member Aging Well Services Saint Paul Barb Netherton Member Ebenezer Ridges Adult Day Program Burnsville Carla Nienaber Member Ecumen Bethany Community Adult Day Alexandria Deb Paulson Member Ebenezer Adult Day Program Minneapolis Mary Rodeski Member Buffalo Adult Day Center Buffalo Ann Rostratter Member Minnesota Veterans Home - Minneapolis Adult Day Program Minneapolis Maria Schugel Member Mount Olivet Rolling Acres - Adult Day Services Chanhassen Cheryl Shanks Member Camilia Club Adult Day Program Coon Rapids Gail A. Skoglund Member Augustana Open Circle of Heritage Park Minneapolis Shelley Sulier Member Bethesda Day Break Adult Day Services Willmar Anne Tabat Member Walker Methodist Minneapolis Marti Titus Member Ecumen Pathstone Day Living Mankato Pafoua Vang Xiong Member Asian Adult Day Care, LLC Saint Paul Emmanuel Varkpeh Member Senior African Services LLP Brooklyn Center Bee Vue Member Hmong Day Elders - Volunteers of America Minneapolis Paul Welch Member Breath of Life Adult Day Service Brainerd Cindy Wilkens Member Bethesda Day Break Adult Day Services Willmar Tori Wolff Member Thorne Crest Retirement Center Albert Lea Barbara Zeis Member Amherst H. Wilder Foundation Adult Day Health Saint Paul

63 LeadingAge Minnesota Awards & Recognition Committee Libby Lindberg, RN Chair Jones-Harrison Minneapolis Sara Sterling, MBA, Vice Chair Volunteers of America Maplewood Care Center Maplewood LNHA Barbara Axness Member Pelican Valley Senior Living Pelican Rapids Sue Boyd Member Elim Care, Inc. Eden Prairie Stephanie Capelle Member Nine Mile Creek Senior Living Bloomington Sarah Dvergsten Member Benedictine Health Center Adult Day Services Duluth Jena Evans Member Ecumen Lakeshore Duluth Julie Gerzin, RN Member Bigfork Valley Bigfork Leah Lindgren Member Health Dimensions Group Minneapolis Christine Link, RD, LD, Member Martin Brothers Distributing Company, Inc. Cedar Falls MBA Jennifer Melton Member Volunteers of America of Minnesota Minneapolis Kathi Payne Member Saint Therese Foundation, Inc. Saint Louis Park Jennifer Rutschke Member Ebenezer Park Apartments Minneapolis Danielle Salisbury, LSW Member Presbyterian Homes and Services Roseville Candas Schouvieller Member Oak Hills Living Center New Ulm Jodi Speicher Member Good Shepherd Community Sauk Rapids Brian Uhlenkamp, LSW Member Samaritan Bethany Home on Eighth Rochester Christopher Wright Member New Perspective Senior Living Eden Prairie

LeadingAge Minnesota Care Center Regulatory Committee Diane Vaughn Chair Volunteers of America National Services Eden Prairie Greg Wainman Vice Chair Lyngblomsten Care Center Saint Paul Barbara Axness Member Pelican Valley Senior Living Pelican Rapids Deborah Barnes Member Lakeview Methodist Health Care Center Fairmont Matthew Bedard Member Langton Place Roseville Kaleeca T. Bible Member Augustana Health Care Center of Minneapolis Minneapolis Sue Boyd Member Elim Care, Inc. Eden Prairie James D. Broich Member Cokato Manor Cokato Karen Casper-Robeson Member Waverly Gardens North Oaks Rebecca Coffin Member Voigt, Rodè & Boxeth, LLC Saint Paul Jean M. Cole Member Augustana Health Care Center of Minneapolis Minneapolis Beth Lea Deneau, RN, Member Walker Methodist Minneapolis CIC Ronald P. Donacik Member Sholom Home West Saint Louis Park Rachel Evers Member Sleepy Eye Care Center Sleepy Eye Lynn Fossen Member Advanced Health Institute Richfield Sheila Gaebel, RN Member Edgewood Sartell Sartell Bruce A. Glanzer Member Good Shepherd Community Sauk Rapids Annette C. Greely Member Park View Care Center Buffalo Randi E. Hansen Member Health Dimensions Group Minneapolis John D. Haugen, R. Ph. Member Omnicare, a CVS Health Company Brooklyn Center Pamela Hayle Member Augustana Health Care Center of Minneapolis Minneapolis Heather Heijerman, Member Johanna Shores Gables Arden Hills LNHA Tracy Hendrickx, LNHA Member Perham Living Perham

Alicia Hilk Member Auburn Homes and Services64 Chaska Ron Kaylor Member Ramsey County Care Center Maplewood Michelle Klegon Member Klegon Law Office, Ltd. Minneapolis Kelly J. Klund Member Empira Cambridge Amy Koehnen Member Meadows on Fairview Wyoming John T. Korzendorfer Member Ecumen Shoreview Rick Krant Member Auburn Manor Chaska George Kratee Member Anoka Rehabilitation and Living Center Anoka Andrea M. Krebs, Member Shaller Family Sholom East Campus Saint Paul LNHA Lisa Lauderdale Member Elim Care, Inc. Eden Prairie Marcia Lindig Member Courage Kenny Rehabilitation Institute - TRP Golden Valley Katie Lundmark Member Ecumen Detroit Lakes Detroit Lakes Krysta Mitchell Member Seaton, Peters & Revnew, P.A. Minneapolis Dawn D. Nash Member Walker Methodist Minneapolis Bryon Nelsen Member Lakeview Methodist Health Care Center Fairmont Stephanie Nelson Member Zumbrota Care Center Zumbrota Kelly O'Neill Member Stratis Health Bloomington Danielle Olson Member Sunnyside Care Center Lake Park Ryan Perhach Member Medline Lakeville Janet Perreault Member Elim Care, Inc. Eden Prairie Debbie Reitmeier, Member Annandale Care Center Annandale LNHA Frank Robinson Member Ramsey County Care Center Maplewood Robert F. Rodè Member Voigt, Rodè & Boxeth, LLC Saint Paul Lindsey Sand Member Assumption Nursing Home Cold Spring Chris C. Schulz Member Thorne Crest Retirement Center Albert Lea Laura Seleen, RN Member Essentia Health Oak Crossing Detroit Lakes Krista Siddiqui Member Zumbrota Care Center Zumbrota Michelle Solwold Member Knute Nelson Care Center Alexandria Roxanne Stelter Member Ecumen Shoreview Greg TaBelle Member CliftonLarsonAllen LLP Minneapolis Ben Van Vooren Member Norris Square Arbor and Commons Cottage Grove Susan Voigt Member Voigt, Rodè & Boxeth, LLC Saint Paul Sara Watkins, RN Member PioneerCare Center Fergus Falls Kimber Wraalstad, Member North Shore Care Center Grand Marais FACHE Mary Nell Zellner, Member Zellner Senior Health Consulting Eagan LNHA, LSW

LeadingAge Minnesota Clinical Practice Committee Carolyn Ulrich Chair Augustana Care Health & Rehabilitation of Apple Valley Apple Valley Natalie Morland, Vice Chair Presbyterian Homes and Services Roseville RN,BSN Angela Aanenson, RN Member Perham Living Home Care Perham Sophia Allwood, BSN Member Catholic Eldercare, Inc. Minneapolis Kaleeca T. Bible Member Augustana Health Care Center of Minneapolis Minneapolis Sarah Boettner Member The Alton Memory Care Saint Paul Sue Boyd Member Elim Care, Inc. Eden Prairie

Sarah Brown, LNHA, RN Member Empira 65 Cambridge Kathy Davis Member Redeemer Health & Rehab Center Minneapolis Beth Lea Deneau, RN, Member Walker Methodist Minneapolis CIC Jessica Gennow Member Great Lakes Management/Gentle Touch Health Initiatives, Golden Valley LLC Lynn Gerard Member Guardian Angels Care Center Elk River Rachel Gunderson Member Parkinson's Specialty Care Golden Valley Erin Hall, RN Member Lakeview Senior Housing Balaton Ron Kaylor Member Ramsey County Care Center Maplewood Lori Klooster, RN Member Sholom Home West Saint Louis Park Jan E. Kohout, RN Member Augustana Care Minneapolis Stacy R. Lind Member Episcopal Church Home of Minnesota Saint Paul Shelley Matthes Member Ecumen Shoreview Sheila Miller, RN Member Cuyuna Regional Medical Center-Care Center Crosby Kathie Nichols Member Stratis Health Bloomington Jesse Noska, RN Member Edgewood Blaine, LLC Blaine Kristi Petersen Member Saint Elizabeth's Health Care Center Wabasha Kristine Rogers, RN Member Lyngblomsten Care Center Saint Paul Tyra Saldana Member Edgewood Blaine, LLC Blaine Kyle Svee Member Advanced Health Institute Richfield Lores Vlaminck, RN, Member Lores Consulting, LLC Rochester BSN, MA, CHPN Stephanie Youngberg Member Senior Care Solutions, Inc. Stillwater

LeadingAge Minnesota Education Committee Cheri High Chair St. Michael's Health and Rehabilitation Center Virginia Michael Warden Vice Chair Saint Therese Foundation, Inc. Saint Louis Park Susan K. Adam Member Saint Therese of New Hope Care Center New Hope Christopher Beckman Member Ebenezer Ridges Care Center Burnsville Barb Bernstein Member Presbyterian Homes and Services Roseville Jenna Burns Member Terrace at Iris Park Saint Paul Nicki Donlon Member Baker Tilly Virchow Krause, LLP ("Baker Tilly") Minneapolis Erin Hall, RN Member Lakeview Senior Housing Balaton Olena Hanson Member Minnesota Veterans Home - Minneapolis Minneapolis Heather Johnson, RN Member Empira Cambridge Julie Juers, RN, BSN Member Walker Methodist Minneapolis David Kiel Member Elim Care, Inc. Eden Prairie Janna Kovach Member Benedictine Health System - Twin Cities office Shoreview Dorinda Krueger Member Cherrywood Pointe Senior Living of Savage Savage Adrian A. LeQue Member Samaritan Bethany Home on Eighth Rochester Jim Lindner Member Ecumen Shoreview Christine Nye Member Saint Therese of New Hope Care Center New Hope Shanna Pratt Member Aitkin Health Services Aitkin Bernadette Rasmussen Member Walker Methodist Minneapolis Cory Rutledge Member CliftonLarsonAllen LLP Minneapolis Christine Slechta Member Walker Methodist Minneapolis Jacki Smith Member Ramsey County Care Center Maplewood Lori Yaklovich Member Wipfli LLP Edina Stephanie Youngberg Member Senior Care Solutions,66 Inc. Stillwater

LeadingAge Minnesota Home Care/Assisted Living Committee Dustin Lee Chair Prairie Senior Cottages, LLC Minnetonka Victoria Wagner Vice Chair Vista Prairie Communities Hopkins Mark E. Anderson Member Eldermark Software Minnetonka Kari Armstrong Member Parkview Court Glenwood Taryn Bartz Member The Homestead at Maplewood Maplewood Josh Berg Member Accessible Space, Inc. Saint Paul Julia Biehn Member Crest View Senior Communities Columbia Heights Justin Birkeli Member Central Towers Saint Paul Barbara J. Blumer Member Barb Blumer Law, P.A. Eagan Garrett Bothun Member Haven Homes of Maple Plain Maple Plain April J. Boxeth Member Voigt, Rodè & Boxeth, LLC Saint Paul Sue Boyd Member Elim Care, Inc. Eden Prairie Suzon Braun Member Essentia Health St. Mary's Detroit Lakes David L. Brenne, CPA, Member Wipfli LLP Edina MBA James D. Broich Member Cokato Manor Cokato Allison Buersken Member Good Shepherd Community Sauk Rapids Janet M. Byrnes Member Lyngblomsten Care Center Saint Paul Tonya T. Clem, RN Member Essentia Health Lincoln Park Assisted Living Detroit Lakes Alicia C. Cline Holum Member Volunteers of America of Minnesota Minneapolis Marcia Cotter Member Parkinson's Specialty Care Golden Valley Tracy Courneya, RN Member Auburn Meadows Waconia Casey Douville, RN Member Progressive Care LLC Grand Rapids James Dravitz Member Ease Fargo Jim Dudley Member Ebenezer Loren on Park Minneapolis Victoria Edie Member Prairie Pines Community Fosston Andrea Erickson Member Engel Haus Albertville Donna Flaata Member Brookdale Senior Living Milwaukee Joe R. Flicker Member Enterprise Fleet Management Eagan Lynn Fossen Member Advanced Health Institute Richfield Jessica Gennow Member Great Lakes Management/Gentle Touch Health Initiatives, LLC Golden Valley Annette C. Greely Member Park View Care Center Buffalo Andrea Gregerson, LPN Member Shepherd of Grace Becker Rachel Gunderson Member Parkinson's Specialty Care Golden Valley Erin Hall, RN Member Lakeview Senior Housing Balaton Debbie Hjelmeland Member Thrifty White Pharmacy Minneapolis Crystal Holloway Member St. Francis Health Services of Morris Morris Sandee Horton Member Parkinson's Specialty Care Golden Valley Ryan Hoyt Member Deephaven Woods Senior Living Deephaven Jared Keeney Member The Homestead at Anoka Anoka Bonnie Kingsley Member Madonna Meadows of Rochester Rochester Michelle Klegon Member Klegon Law Office, Ltd. Minneapolis Jan E. Kohout, RN Member Augustana Care Minneapolis Dorinda Krueger Member Cherrywood Pointe Senior Living of Savage Savage Danielle Lesmeister, RN Member St. Francis Health Services of Morris Morris Laura M. Lokken, RN Member Avinity 67 Richfield Shelley Matthes Member Ecumen Shoreview Lori McGuire Member Great Lakes Management/Gentle Touch Health Initiatives, LLC Golden Valley Ashley McNally Member Ecumen Detroit Lakes Detroit Lakes Krysta Mitchell Member Seaton, Peters & Revnew, P.A. Minneapolis Natalie Morland, Member Presbyterian Homes and Services Roseville RN,BSN Chantal Nason Member Jones-Harrison Minneapolis Kim Neal Member Mary T., Incorporated Coon Rapids Jesse Noska, RN Member Edgewood Blaine, LLC Blaine Emily Nyberg Member Jones-Harrison Minneapolis Kris Odagwe, RN Member Saint Therese at Oxbow Lake Brooklyn Park Janet Perreault Member Elim Care, Inc. Eden Prairie Deborah A. Perry Member Volunteers of America National Services Eden Prairie Theresa Quast Member Ebenezer Minneapolis Debra Reynolds, RN Member Saint Therese of Woodbury Woodbury Peggy Ricci, RN Member Ecumen Lakeview Commons Assisted Living of Maplewood Maplewood Robert F. Rodè Member Voigt, Rodè & Boxeth, LLC Saint Paul Heidi J. Ryan, RN Member TenX Systems, LLC (dba ResiDex Software) Lino Lakes Tyra Saldana Member Edgewood Blaine, LLC Blaine Danielle Salisbury, LSW Member Presbyterian Homes and Services Roseville Emily A. Scheevel, CPA, Member CliftonLarsonAllen LLP Minneapolis CIA Cynthia J. Schroer Member CliftonLarsonAllen LLP Minneapolis Natalie Seehausen Member Vista Prairie Communities Hopkins Joe Signore Member Ebenezer Minneapolis Jodi Speicher Member Good Shepherd Community Sauk Rapids Joycelin Steidl Member Pelican Valley Senior Living Pelican Rapids Roxanne Stelter Member Ecumen Shoreview Bonnie Tendrup Member Bigfork Valley Villa Bigfork Mary Jo Thorne Member Augustana Care Minneapolis Vicki M. Tobroxen Member Augustana Regent at Burnsville Burnsville Corey Trembath Member Walker Methodist Plaza Anoka Tina Valerius Member Tree of Life Assisted Living New Munich Ben Van Vooren Member Norris Square Arbor and Commons Cottage Grove Diane Vaughn Member Volunteers of America National Services Eden Prairie Pennie Viggiano Member Benedictine Health System - Twin Cities office Shoreview Lores Vlaminck, RN, Member Lores Consulting, LLC Rochester BSN, MA, CHPN Kristina Waln Member Jones-Harrison Minneapolis Kim R. Webster Member StuartCo Bloomington Holly Williams Member Elim Shores Eden Prairie Stephanie Youngberg Member Senior Care Solutions, Inc. Stillwater Mary Nell Zellner, LNHA, Member Zellner Senior Health Consulting Eagan LSW

LeadingAge Minnesota Housing Committee Jodi Speicher Chair Good Shepherd Community Sauk Rapids Rochelle Langlois Vice Chair Progressive Care LLC Grand Rapids

Mark E. Anderson M Eldermark Software 68 Minnetonka Peggy Arne M Walker at Hazel Ridge Maplewood Shelli Bakken M Walker Methodist Minneapolis Brandi Barthel, LNHA M GracePointe Crossing Cambridge Taryn Bartz M The Homestead at Maplewood Maplewood Katie Bauer M Ecumen Seasons at Apple Valley Apple Valley Bob Bearson M CentraCare Health - Sauk Centre Lakeshore Estates Sauk Centre Josh Berg M Accessible Space, Inc. Saint Paul Julia Biehn M Crest View Senior Communities Columbia Heights Courtney Blomquist M Cerenity Care Center on Humboldt Saint Paul Barbara J. Blumer M Barb Blumer Law, P.A. Eagan April J. Boxeth M Voigt, Rodè & Boxeth, LLC Saint Paul Sue Boyd M Elim Care, Inc. Eden Prairie Suzon Braun M Essentia Health St. Mary's Detroit Lakes Natalie Burnell M Birchwood Cottages Owatonna Christina Cauble M Arbors at Ridges Burnsville Jed Cheney M CliftonLarsonAllen LLP Minneapolis Tonya T. Clem, RN M Essentia Health Lincoln Park Assisted Living Detroit Lakes Scott Clements M CBS Construction Services, Inc. Champlin Marcia Cotter M Parkinson's Specialty Care Golden Valley Teri Drake M Bentson Family Assisted Living Residence & Phillips Memory Saint Paul Care Center Jim Dudley M Ebenezer Loren on Park Minneapolis Victoria Edie M Prairie Pines Community Fosston Andrea Erickson M Engel Haus Albertville Erica Frey M Good Shepherd Community Sauk Rapids Christa Grubb M Wildwood Manor Mounds View Anne Marie Hansen M Gianna Homes Minnetonka Kenneth Hinz M CBS Construction Services, Inc. Champlin Michelle M. Horazdovsky M Presbyterian Homes of Bloomington - The Commons Bloomington Sandee Horton M Parkinson's Specialty Care Golden Valley Brad Johnson M Auburn Courts Chaska Sharyl Kaase M Cerenity Care Center - Marian of Saint Paul Saint Paul Jared Keeney M The Homestead at Anoka Anoka Bonnie Kingsley M Madonna Meadows of Rochester Rochester Michelle Klegon M Klegon Law Office, Ltd. Minneapolis Mary Krant, RN M Auburn Meadows Waconia Dustin Lee M Prairie Senior Cottages, LLC Minnetonka Danielle Lesmeister, RN M St. Francis Health Services of Morris Morris Carli Lindemann M Knute Nelson Care Center Alexandria Ashley McNally M Ecumen Detroit Lakes Detroit Lakes Thomas R. Melchior M CliftonLarsonAllen LLP Minneapolis Jennifer Melton M Volunteers of America of Minnesota Minneapolis Gail Miller, CPA M CliftonLarsonAllen LLP Minneapolis Kim Neal M Mary T., Incorporated Coon Rapids Kathy Olson M Millstream Commons Assisted Living Northfield Chris Palkowitsch M BKV Group Minneapolis Patrick J. Rafferty M Heartland Rural Services, LLC Lakeshore Barbara Rebischke M Good Shepherd Community Sauk Rapids 69 Robert F. Rodè M Voigt, Rodè & Boxeth, LLC Saint Paul Danielle Salisbury, LSW M Presbyterian Homes and Services Roseville Natalie Seehausen M Vista Prairie Communities Hopkins Joe Signore M Ebenezer Minneapolis Christine Soma M Pope Architects, Inc. Saint Paul Berit Spors M Ecumen Shoreview Roxanne Stelter M Ecumen Shoreview Kyle Svee M Advanced Health Institute Richfield Bonnie Tendrup M Bigfork Valley Villa Bigfork Mary Jo Thorne M Augustana Care Minneapolis Vicki M. Tobroxen M Augustana Regent at Burnsville Burnsville Corey Trembath M Walker Methodist Plaza Anoka Marie Tysdal M LB Homes Fergus Falls Pennie Viggiano M Benedictine Health System - Twin Cities office Shoreview Debra Waedt M Presbyterian Homes and Services Roseville Kim R. Webster M StuartCo Bloomington Tori Wolff M Thorne Crest Retirement Center Albert Lea

LeadingAge Minnesota Payment Committee Kevin Rymanowski Chair Benedictine Health System - Twin Cities office Shoreview Danielle Lesmeister, RN Vice Chair St. Francis Health Services of Morris Morris Craig Barness Member Ecumen Shoreview Dave Berryman Member Sholom Saint Louis Park Garrett Bothun Member Haven Homes of Maple Plain Maple Plain David L. Brenne, CPA, Member Wipfli LLP Edina MBA James D. Broich Member Cokato Manor Cokato Sarah Brown, LNHA, RN Member Empira Cambridge Allison Buersken Member Good Shepherd Community Sauk Rapids Cindy Bunting Member Volunteers of America National Services Eden Prairie Marcia Cotter Member Parkinson's Specialty Care Golden Valley NancyLee Dahlin Member Salvation Army Adult Day Center Maplewood Mark Dale, CPA Member Eide Bailly LLP Minneapolis Victoria Edie Member Prairie Pines Community Fosston Chester Fishel Member Heritage Manor Chisholm Lindsey Fouts Member Edgewood Management Group Grand Forks Cathy Gelhar Member Volunteers of America National Services Eden Prairie Andrea Gregerson, LPN Member Shepherd of Grace Becker Marnie M. Gugisberg Member Knute Nelson Alexandria Erin Hall, RN Member Lakeview Senior Housing Balaton Quintin Harris Member Lancaster Pollard Excelsior Chuck Heidbrink Member Zellner Senior Health Consulting Eagan Tracy Hendrickx, LNHA Member Perham Living Perham Tom Henry Member Episcopal Homes of Minnesota Saint Paul Shelly Jacobs Member St. Benedict's Senior Community Saint Cloud Sharon A. Johnson Member Ecumen Shoreview Jeff King Member Three Links Care Center Northfield Matthew Kinne Member Lifesprk Edina Kelly J. Klund Member Empira 70 Cambridge Christopher R. Knoll Member Minnewaska Community Health Services Starbuck Amy Koehnen Member Meadows on Fairview Wyoming John T. Korzendorfer Member Ecumen Shoreview Eric R. Lunde Member Piper Jaffray & Company Minneapolis Katie Lundmark Member Ecumen Detroit Lakes Detroit Lakes Lori McGuire Member Great Lakes Management/Gentle Touch Health Initiatives, LLC Golden Valley Mary Sue Meger Member The Lutheran Home Association Belle Plaine William J. Moncrief, MBA Member St. Francis Health Services of Morris Morris Jane Pederson Member Stratis Health Bloomington Jay Pizinger, Jr., CPA Member Augustana Care Minneapolis Patrick J. Rafferty Member Heartland Rural Services, LLC Lakeshore Debbie Reitmeier, LNHA Member Annandale Care Center Annandale Colleen Rempfer Member Jones-Harrison Minneapolis Frank Robinson Member Ramsey County Care Center Maplewood Krista Siddiqui Member Zumbrota Care Center Zumbrota Penny Solberg Member Spring Valley Living Spring Valley Kris Steiner Member Ecumen Shoreview Deb Steinke Member Vista Prairie Communities Hopkins Roxanne Stelter Member Ecumen Shoreview Michael T. Stordahl Member Clara City Care Center Clara City Wade Stubson Member Eventide Senior Living Communities Moorhead Greg TaBelle Member CliftonLarsonAllen LLP Minneapolis Ann Thole Member Sholom Saint Louis Park Jeff Thorne Member Volunteers of America National Services Eden Prairie Susan Voigt Member Voigt, Rodè & Boxeth, LLC Saint Paul Jeffery Vrieze, CPA Member CliftonLarsonAllen LLP Minneapolis Michael Warden Member Saint Therese Foundation, Inc. Saint Louis Park Matthew Wocken Member CliftonLarsonAllen LLP Minneapolis John Zwiers Member LB Homes Fergus Falls

LeadingAge Minnesota Public Policy Steering Committee Nancy Stratman Chair Cuyuna Regional Medical Center-Care Center Crosby Susan Knutson Vice Samaritan Bethany, Inc. Rochester Chair Scot Allen Member St. Francis Health Services of Morris Morris Deborah Barnes Member Lakeview Methodist Health Care Center Fairmont Marcia Cotter Member Parkinson's Specialty Care Golden Valley Alexis de Armas Member Argentum Alexandria Daniel C. Dixon Member Guardian Angels Elk River Nathan Johnson Member Eventide on Eighth Moorhead Cory Kallheim Member LeadingAge Washington Rob LaHammer Member Presbyterian Homes and Services Roseville Donna W. Loomis Member Benedictine Health System - Twin Cities office Shoreview Tim Middendorf Member Augustana Care Minneapolis Kyle R. Nordine, LNHA Member Northfield Retirement Community Northfield Anneliese Peterson Member Walker Methodist Minneapolis Michael S. Pochowski, Member Brookdale Senior Living Milwaukee MPPA Joe Signore Member Ebenezer 71 Minneapolis Ann Thole Member Sholom Saint Louis Park Jeff Thorne Member Volunteers of America National Services Eden Prairie Kimber Wraalstad, Member North Shore Care Center Grand Marais FACHE

LeadingAge Minnesota Quality & Performance Excellence Committee Sue Boyd Chair Elim Care, Inc. Eden Prairie Camilla C. Peterson- Vice Chair St. Francis Health Services of Morris Morris DeVries Angela Aanenson, RN Member Perham Living Home Care Perham Mark A. Anderson Member Three Links Care Center Northfield Christine M. Bakke, Member Madonna Living Community Rochester LNHA, MHA Jody Barney Member Martin Luther Care Center Bloomington Brandi Barthel, LNHA Member GracePointe Crossing Cambridge Josh Berg Member Accessible Space, Inc. Saint Paul Michelle R. Borreson Member Gundersen Tweeten Care Center Spring Grove Garrett Bothun Member Haven Homes of Maple Plain Maple Plain Pat Boyer Member Wipfli LLP Edina Sarah Brown, LNHA, Member Empira Cambridge RN Allison Buersken Member Good Shepherd Community Sauk Rapids Mary Chapa Member Fairview Senior Services Minneapolis Valerie Cooke Member Minnesota Department of Human Services Saint Paul Jason Czycalla Member Medline Lakeville Sandra D. Member Elim Care, Inc. Eden Prairie Delgehausen, RN Rachel Evers Member Sleepy Eye Care Center Sleepy Eye Jessica Gennow Member Great Lakes Management/Gentle Touch Health Initiatives, LLC Golden Valley Deborah Graves, RN, Member Benedictine Health System - Twin Cities office Shoreview MBA Rachel Jokela Member Minnesota Department of Health Saint Paul Mara Kaplan Member Medline Lakeville Rebecca Kapsner, RN Member TenX Systems, LLC (dba ResiDex Software) Lino Lakes Ryan Keller Member The Homestead at Anoka Anoka Todd Lundeen Member Elim Care and Rehab Center Princeton Fay M. Manning, RN Member Volunteers of America National Services Eden Prairie Professor Christine A. Member University of Minnesota School of Nursing Minneapolis Mueller, Ph.D., RN, FAAN Dawn D. Nash Member Walker Methodist Minneapolis Danielle Olson Member Sunnyside Care Center Lake Park Tim Peterson Member Thrifty White Pharmacy Minneapolis Jeri Reinhardt Member Benedictine Health System - Twin Cities office Shoreview Ann Robinson Member Health Dimensions Group Minneapolis Tracey J. Robinson Member Sholom Saint Louis Park Lindsey Sand Member Assumption Nursing Home Cold Spring Chris C. Schulz Member Thorne Crest Retirement Center Albert Lea Laura Seleen, RN Member Essentia Health Oak Crossing72 Detroit Lakes Krista Siddiqui Member Zumbrota Care Center Zumbrota Cindy Siders Member Health Care Insurance Services (HCIS) Minnetonka Lali Silva Member Minnesota Hospital Association Saint Paul Tracy Singer, RN Member Lyngblomsten Care Center Saint Paul Penny Solberg Member Spring Valley Living Spring Valley Angie Urman Member Knute Nelson Alexandria Diane Vaughn Member Volunteers of America National Services Eden Prairie Kristi Wergin Member Stratis Health Bloomington Matthew Wocken Member CliftonLarsonAllen LLP Minneapolis

LeadingAge Minnesota Workforce Solutions Committee Katie Lundmark Chair Ecumen Detroit Lakes Detroit Lakes Angela Brown Vice Chair Elim Care, Inc. Eden Prairie Deborah Barnes Member Lakeview Methodist Health Care Center Fairmont Jody Bloemke Member Ecumen Pathstone Living Mankato Blake Boche Member Johanna Shores Arden Hills Andrew Brainerd Member Arthur J. Gallagher & Co. Bloomington Natalie Burnell Member Birchwood Cottages Owatonna Ryan Burt Member USI Insurance Services Plymouth Christina Cauble Member Arbors at Ridges Burnsville Cheryl Corey Member St. Mark's Lutheran Home Austin Valerie DeFor Member HealthForce Minnesota Rochester Tom Esch Member Esch Consulting, LLC Saint Paul Murray Finger Member St. Mark's Lutheran Home Austin Chester Fishel Member Heritage Manor Chisholm Donna Flaata Member Brookdale Senior Living Milwaukee Lynn Fossen Member Advanced Health Institute Richfield John Fraser Member Lifesprk Edina Paul R. Gaebe Member RiverView Care Center Crookston Carol A. Gilbertson, Member Minnesota Veterans Home - Silver Bay Silver Bay LNHA Annette C. Greely Member Park View Care Center Buffalo Paulette Hagen Member CentraCare Health - Paynesville Paynesville Trisha A. Hall Member Lyngblomsten Saint Paul Baillee Hauser Member Bethesda Health & Housing Willmar Kerri Hicks Member Zumbrota Care Center Zumbrota Cheri High Member St. Michael's Health and Rehabilitation Center Virginia Ashley Jackson Member Ebenezer Minneapolis Leah Kaiyalethe Member Cerenity Care Center on Humboldt Saint Paul Rick Krant Member Auburn Manor Chaska Andrea M. Krebs, Member Shaller Family Sholom East Campus Saint Paul LNHA JoLynn Kullhem Member Cuyuna Regional Medical Center Crosby Carol A. Kvidt Member Ecumen Shoreview Dustin Lee Member Prairie Senior Cottages, LLC Minnetonka Kathy Messerli Member Minnesota HomeCare Association Saint Paul Holly Minners, MBA Member The Waters of White Bear Lake White Bear Lake Krysta Mitchell Member Seaton, Peters & Revnew, P.A. Minneapolis Mindy Nuhring Member River Grand Senior Living73 Grand Rapids Sarah Olson Member Walker Methodist Minneapolis Rebecca A. Peitersen Member Ebenezer Minneapolis Jay Pizinger, Jr., CPA Member Augustana Care Minneapolis Patrick J. Rafferty Member Heartland Rural Services, LLC Lakeshore Barbara Rebischke Member Good Shepherd Community Sauk Rapids John Riordan Member DAYTA Marketing Waite Park Autumn Roark Member Browns Valley Health Center Browns Valley Jaclyn Samuell Member Catholic Eldercare, Inc. Minneapolis Chris C. Schulz Member Thorne Crest Retirement Center Albert Lea Denise Sheets Member Presbyterian Homes and Services Roseville Bill Shell Member LindaShell.com Lakeville Stephanie Smith Member Parkinson's Specialty Care Golden Valley Mary Jo Thorne Member Augustana Care Minneapolis Corey Trembath Member Walker Methodist Plaza Anoka Sara Watkins, RN Member PioneerCare Center Fergus Falls Barb Wessberg Member Benedictine Health Center Duluth Cindy Wilkens Member Bethesda Day Break Adult Day Services Willmar Christopher Wright Member New Perspective Senior Living Eden Prairie Estelle Wright, J.D. Member Sholom Saint Louis Park Munna Yasiri Member Minnesota Department of Human Services Saint Paul Brooke Zabel, PHR, Member Knute Nelson Alexandria SHRM-CP

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