Rate Setting in Minnesota

At Dungarvin Minnesota, we are certainly no strangers to change.

Just this year, we have moved our central offices into an entirely new building in Mendota Heights. In addition, there was the acquisition and integration of CCP into the Dungarvin constellation of services; that was a giant change! Now that we are finally settling in after a very busy few months, the biggest changes of all – rate changes – will soon be arriving at our doorstep.

To explain these changes, I’ll briefly set the scene: In Minnesota, each county has been responsible for determining how much providers like Dungarvin are paid to support to each person we serve. In 2007, the federal government determined that the county-based system for determining these payment rates did not meet the requirements in federal law. Over the last six years, the Minnesota Department of Human Services (DHS) has developed – and the Minnesota legislature has authorized – a new Disability Waivers Rate System to meet the revised federal requirements. This new Rate System takes the responsibility for setting individual service rates away from each county and gives it to the state government (DHS). While developing the new Rate Setting System, DHS and the state legislature have decided that the rates paid to providers like Dungarvin, for nearly every person we serve, will be significantly reduced every year over the next five years. These rate decreases began on January 1, 2014.

To meet this new challenge, Dungarvin will need to undertake what will likely be the biggest change we have ever made to how we do business. Every aspect of Dungarvin’s business is currently being scrutinized to determine what is essential to delivering quality services, with less, without jeopardizing the health, safety and well-being of the people we serve. Anything that is not determined to be absolutely essential will need to be reconsidered, and we will ask (a) “What function does this serve?” and (b) “How can it be done differently – and for less?”

Major changes will need to be made. We know this to be inevitable. These changes will be seen and felt throughout the organization from the central office out to every house and location where Dungarvin provides services. An example of this can already be seen in most of our residential foster homes, where sharing a company van with one or more of the other houses has become the rule rather than the exception. Under the new Rate System, it is expected by the state that most of the people we serve in residential settings will use specialized medical transportation services or even public transportation (with the assistance of Dungarvin staff) to go to medical appointments. The tools and the means for “medical transportation” already exist and they are readily available. However, we will need to change our mindset, remembering that the transportation is no longer in our driveway, since the new Rate System will no longer support that. The money to support a “house van” will now be available for only a very small number of truly high-need programs. Dungarvin will continue to evaluate creative solutions in order to support the individuals we serve with accessing their community successfully.

This is merely one example of the changes to come, but it illustrates how we will need to be creative – and step outside of our usual comfort zones in order to meet our obligations and the needs of those we serve, under the new Rate System. The needs of those we serve may not change, but the way we meet those needs must. Hold on to your hats, the ride is just beginning!