The person being given a 60-day service termination was influenced by the individual’s legal guardian/mother deciding to not have the person return to the program after she was not comfortable with safety in the Adult Foster Care (AFC) setting during the COVID-19 pandemic and elected to provide care to the individual for a two week period. The service provider sent a letter to the individual’s mother that gave the guardian the option to provide care for two weeks to the individual in lieu of being in the AFC.  The two week timeline was based on the maximum time limit that a provider could bill for (under the guise of a “camping trip”) and continue to hold the individual’s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother’s home.  This plan included the provider having the mother become an employee to formally provide direct support to the individual.  This was influenced by the mother previously being a provider for the agency as well as what was deemed to be important to the individual.  The uncertainties of the pandemic again made timelines unclear for how long this arrangement would be appropriate.  The provider then reached out to the County to discuss the alternative plan that was currently in place.  The county couldn’t approve this alternative service delivery.  The individual’s mother was made aware of this but was still comfortable with the individual to return to an AFC setting and decided to continue to have the individual reside with her.   Based on the mother’s decision, the provider not being able to sustain the current plan and the County stance on the alternative plan the person was given a 60-day termination notice.  
The County’s inability to support the alternative plan was influenced by the plan’s language not matching service definitions for the service the provider was authorized to provide.  The provider was delivering residential Supported Living Services (SLS) which by regulations cannot be provided remotely.  Additionally parents cannot provide SLS in their own home and these rules were not flexible enough to accommodate the individual’s specific situation.
The provider’s decision to issue a service termination was additionally impacted by a  fiscal constraints.  Providers are unable to bill for long-term empty beds. The inability to bill is based on the Disability Waiver Rate System (DWRS) which already factors in absences in the daily rate but not the ability to bill for days away.  This billing constraint is impacted by CMS regulations which only allows one method of billing for absences.  This billing constraint is also impacted by the Minnesota State Legislature which chose this method of billing for absences. 
The uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor’s orders.
