Intervention and respite service redesign

The University of Minnesota, and state agencies, including DHS, the departments of Health and Education and several others have been working together to gather partner feedback and data on the following services:

The partner feedback and data will be used to develop legislative proposals to improve the design and quality of the four services.

Background
Timeline
Feedback
Study details

Background

Positive supports, crisis respite and specialist services are often collectively referred to as “intervention services.”

It is difficult for many people to access intervention and respite services because of a lack of providers or because they are ineligible for waiver services. Sometimes service quality needs improvement. There are many reasons for these issues. DHS would like to explore options for service improvements with the goal of preventing unnecessary hospitalizations, incarcerations, service terminations and other negative outcomes people have experienced when they do not have access to the services they need.

Supporting legislation

Under Minnesota Laws 2023 Chapter 61, Article 1, Section 74 the state has authority to:
- Conduct a study on ways to expand access to services for people with co-occurring behavioral health conditions and disabilities.
- Evaluate options to expand services authorized under Minnesota's federally approved home and community-based services waivers, including positive supports, crisis respite, respite and specialist services.
- Explore options to authorize services under Minnesota's Medical Assistance State Plan.
- Survey community providers about:
  - The barriers to meeting people's needs.
  - Strategies to decrease the number of people who remain in hospitals, jails and other acute care or crisis settings when they no longer meet medical or other necessity criteria.
Timeline

Intervention services
- 2024: We gathered partner feedback on what is working or not working about the services.
- 2025: We will draft new or updated service designs based on partner feedback.
- 2025: We will share drafts of proposed changes publicly with partners so they can provide more feedback.
- 2025-2026: Since it may take a couple of years to launch new service designs fully, DHS might make some necessary changes to existing intervention services in the interim.
- 2026-2027: After updating the service design drafts based on partner feedback, DHS will take steps to request approval of the service changes from the Legislature, governor and federal Centers for Medicaid & Medicare Services.
- 2027-2028: If approved, we will implement the new or updated services.
Respite services
- 2024: We gathered partner feedback on what is working or not working about the services.
- 2025-2026: The Legislature is considering and might pass a new unlicensed option for respite services.
- 2025-2028: DHS will continue working with partners to explore improvements to respite services through the Waiver Reimagine project.
Ways to give feedback

The University of Minnesota collected partner feedback on this project in 2024. That initiative has closed. The next opportunity to give feedback on the intervention services will be in later this year.
Sign up for Disability Services announcements to stay informed about intervention services. To stay informed about respite services through the Waiver Reimagine project, visit the Phase 2 tab, Public engagement section of the Waiver Reimagine webpage.
What is included

The recommendations from the study will include, but are not limited to, how potentially to structure one or more new simplified services, which might be Medical Assistance services or other types of services.

Recommendations for the new services must include:
- Ways to address the workforce shortage.
- Equity strategies.
The study will provide a detailed but plain language overview of recommendations for both preventive and reactive services. The recommendations must include:
- Assessment and person-centered support planning for a wide range of support needs. This must include basic assessment guidelines for collecting data on the following factors that influence behaviors:
  - Environmental
  - Psychological
  - Social
  - Biological
  - Quality of life.
- An option for direct care providers to implement a positive support plan for challenging behaviors.
- Opportunities for remote support options, when desired and appropriate for the person.
- Transition planning and supports, including but not limited to:
  - Transitions from jails, hospitals, nursing homes or other facilities to community-based settings.
  - Transitions from one provider to another.
  - Transitions to a new home.
- An outline of indirect support activities, when appropriate, such as writing a support plan, activity planning or collaborating with other professionals.
- Supports for family caregivers.
- Strategies for supporting informed choice.
- An outline of provider roles and responsibilities.
- An outline of provider qualifications and minimum training requirements.
- Goals of the service, such as increased community engagement, improved quality of life, etc.
- Rights of people who receive the services and limitations on restrictive procedures.
Recommendations for service eligibility criteria must not duplicate Early Intensive Developmental and Behavioral Intervention (EIDBI) services. The recommendations must clearly identify who might need the service(s) but would not be eligible. And they must include the reasons for excluding those people from the recommendation.

The feedback gathered during the study will also be used to:
- Provide recommendations for service rates (which might include an encounter rate for tribal nations), wages and benefits. The goal is to attract enough professionals to provide the service(s) to meet anticipated demand. The recommended rates should also provide people with choice of care providers. Recommendations must be designed to retain both:
  - Clinicians
  - Professionals who provide day-to-day direct care.
- Build career advancement opportunities into the recommendations. The recommendations should allow other types of direct caregivers, teachers, social workers or similar professionals have a path to advance into these jobs as they gain experience. They should also allow professionals who provide intervention services to advance their careers. This must include recommendations for career advancement for both:
  - People who have formal educational training.
  - People who have on-the-job training.
- Provide recommendations for rewarding providers when a person experiences positive outcomes after each year they receive service(s).
- Suggest service performance measures, including ways to evaluate the success of the service(s) for underrepresented communities.
- Provide an outline and recommendations on changes to the environment in which these services operate, such as:
  - Resources available to providers of these services.
  - DHS provider licensing and enrollment processes.
  - Influencing laws.