{"Short_Answer__76":"DV_Rural Living Enivronment-SLC-2020-06","Date__77":"07\/10\/2020","Multiple_Choice__78":"David Vukelich","Short_Answer__80":"Rural Living Environment","Short_Answer__81":"Leanne Negley","Short_Answer__82":"lnegley@rurallivingmn.com","Multiple_Choice__84":"Termination of Services","Multiple_Choice__85":"St. Louis County","Date__86":"04\/23\/2019","Multiple_Choice__96":"1","Short_Answer__91":"Person was given a 60-day service termination","True_or_False__94":"Yes","Date__97":"08\/11\/2020","Free_Text__98":"The individual was living in a large 4000 sq. ft. adult foster care home in rural northern MN.  The individual has been served by this provider for approximately 10 years and was living in this particular home for the past 4 + years.   The individual\u2019s mother is her legal guardian.  The AFC was home to two other females at the time the termination notice was issued.  The individual is diagnosed with Prader-Willi syndrome and has some challenging behaviors associated with her diagnosis.  These behaviors kept the provider cautious about adding additional people in the home even though there was capacity to do so.  The provider stated that recently the individual was given a new medication and her behaviors had improved.  Staff indicated that the provider was discussing a more individualized living arrangement for the individual, which would have included a larger area of the home designated to the individual.  \r\n\r\nWhen concerns for COVID19 arose in March, the provider sent out letters to the guardians of the people they serve to see if the guardians wanted to provide direct care for their respective program participants.  The individual\u2019s mother responded and indicated that she wanted to provide care for her daughter.  The original plan was that this arrangement would last for two weeks.  The provider asked if the individual could return to the program and the individual\u2019s mother wasn\u2019t comfortable with her returning at that time.  The individual\u2019s mother had previously worked for the provider.  In an effort to continue to support the individual the provider did the following: retrained the mother, employed her as a direct support staff for the individual, provided groceries and medications to the mother\u2019s home, and provided an iPad so the individual could remain connected to others served by the provider as well as her mother being able to use the device for documentation.  The provider also provided remote support via Zoom meetings 2 hours a day, Monday through Friday.  County waiver case manager and supervisor were consulted about the alternative arrangement in response to the pandemic and they explained to the provider that they were not in support of this.  They had not been consulted until after the plan was in place.  The agency advised the provider to issue a termination notice if individual did not return to the program.  Mother and individual were notified of this recommendation and chose not to have the individual return to the program.  Mother and individual understood the termination was coming and agreed with it.  \r\n\r\nStaff reported that the provider\u2019s management team was involved with the termination notice and issued the termination in accordance with policy\/rules.  No previous terminations were noted.","Free_Text__100":"The person being given a 60-day service termination was influenced by the individual\u2019s 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\u2019s 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 \u201ccamping trip\u201d) and continue to hold the individual\u2019s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother\u2019s 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\u2019t approve this alternative service delivery.  The individual\u2019s 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\u2019s 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.  \r\nThe County\u2019s inability to support the alternative plan was influenced by the plan\u2019s 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\u2019s specific situation.\r\nThe provider\u2019s 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. \r\nThe uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor\u2019s orders.","Multiple_Choice__101":"1","Multiple_Choice__103":"0","Multiple_Choice__105":"0","Multiple_Choice__107":"0","Multiple_Choice__109":"1","Multiple_Choice__111":"0","Multiple_Choice__113":"0","Multiple_Choice__115":"3","Free_Text__116":"The County\u2019s inability to support the alternative plan was influenced by the plan\u2019s 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\u2019s specific situation.\r\nThe provider\u2019s 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. \r\nThe uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor\u2019s orders.","Multiple_Choice__117":"0","Multiple_Choice__119":"0","Multiple_Choice__121":"0","Multiple_Choice__123":"3","Free_Text__124":"The person being given a 60-day service termination was influenced by the individual\u2019s 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\u2019s 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 \u201ccamping trip\u201d) and continue to hold the individual\u2019s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother\u2019s 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\u2019t approve this alternative service delivery.  The individual\u2019s 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\u2019s 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.","Multiple_Choice__125":"0","Yes_or_No__432":"Yes"}