Heat. Heat. Heat. Heat. [music] [music] Heat. Heat. Heat. Heat. >> [music] >> Good afternoon everyone. And I want to thank the members of this committee, uh, um, Deputy Commissioner Connelly and your team for and providers across Minnesota, advocates and individuals and families who have taken time to be here today. I've also got our house um, I just said house, Dr. Liski, so that's not good. the other member, the other body is here. Our our partners in in the whole process and of also people that were part of uh uh Melissa Wickland's committee are also here as well. We want to thank everybody for being here and today's hearing is about one thing and that's ensuring that Minnesota has a provider enrollment and revalidation system that protects program integrity while preserving access to care for the people who depend on it every single day. Let's um we all agree on an important principle. Medicaid providers must meet federal and state requirements. Revalidation is not optional. It is an essential safeguard that helps ensure taxpayer dollars are protected and the qualified providers are serving motans. The question before us today is not whether a revalidation should occur. The question is how it was implemented. Minnesota faced an unprecedented challenge. Federal expectations require the department to complete in a matter of months that usually other states have three 2 to four years to complete. That created in and itself enormous pressure throughout the system. The department made decisions in response to those federal requirements. Providers are asked to navigate changing guidance, documentation requests, communication challenges, and compressed timelines while continuing to provide care for some of the most vulnerable residents in our state. Some providers succeeded. Many experienced delays, confusion, payment interruptions, and uncertainty about whether they could continue serving the people who rely on them. But let's be clear, behind every delayed application or suspended suspend suspended payment is not simply a provider. There's an older adult that's waiting for home care, a child receiving therapy, a person with a disability depending on daily support, an individual working through substance use recovery. Those are the people at the center of today's discussion. And so I want to make it very clear, members, this hearing is not about assigning blame or scoring political points. It's about understanding what happened, identified what worked, acknowledge what did not, and determine what changes that we need to make moving forward. I think we owe that to providers who acted in good faith. We owe it to the taxpayers who expect accountability. But most importantly, members, we owe it to motans whose health and independence depend specifically on a stable provider network. And so the purpose of oversight is not simply to identify problems. The purpose of us in this oversight is to improve government governance. And I appreciate Deputy Commissioner the department's willingness to participate today. And I appreciate the providers who have shared their experiences. Both perspectives are essential if we're going to make informed policy decisions. And members, there is in your packet copies of letters that were sent to us. So I ask everyone participating in today's hearing to approach this discussion with professionalism, respect, and a shared commitment to improving the system. Our responsibility is larger than just this hearing. Our responsibility is to ensure that Minnesota has a Medicaid pro Medicaid program that is accountable, transparent, federally compliant, and above all responsive to the needs of the people it serves. Um, with before we go to you uh deputy commissioner, I'd ask uh chair uh newer for comments. Thank you. >> Uh thank you uh Mr. Chair and members. Um it has not been an easy year to state the list. When we saw what happened uh that the requirement for the state uh from the federal government when the payment withholding of $515 million on a quarterly basis that was put under the federal law stating that the state of Minnesota is out of compliance that requiring that we produce a corrective action plan. Indeed, that is about $2 billion ongoing payment withhold that the threat from the federal government exist. Through that process, uh the state complied, sent a letter of compliance uh based on what needs to be done and that compliance u later was accepted. After that exception, I think there were so many other things that happened or transpired after that. On top of the payment withhold, which is a $2 billion, the federal government again put the state on a deferral, meaning that the the the resources that we've already spent that we're waiting for the bills to be paid effective the quarter that ended last year. The state of Minnesota was put on a $250 million on a quarterly basis going back then to be put on a deferral, meaning that the funds will be deferred. Even recently, there was an addition to that $250 additional $90 million that that is being deferred by the federal government. To me, Mr. and members that is weaponizing Medicaid for those who need the most. It's weaponizing the services that serve 1.5 million motans. It's putting people at risk. We have seen instances whereby there is a delay of care, there is a delay of services that it ends up even to death of individuals. We've got a significant challenge. As the chair noted, the revalidation process has given we were given a five-month period to do almost 5,600 revalidation of providers. It's not an easy undertaking. And that to me is why we're here today. The issue that we are facing is no longer isolated. providers have been navigating enrollment issues, MPSC, which is the portal system that they use, the background studies, site visits, appeals, billing suspension, and now there's a transition to Logan MN, which is also complicating the process. Members, I think this requires a more depth discussion and figuring out where we're heading. I talked about the federal government weaponizing Medicaid and are yet to hear the conclusion to the deferral, the conclusion to the payment withhold from the federal government and the next steps. We have to put accountability in place but we also need to be able to understand every services that is being provided there's a human being. there's a person who's elderly, disabled, a child, a family that is going to be impacted by the actions that we take or not take at the moment. Yes, there are so many issues and challenges that we would like to do in a different way given the circumstances. I think we will let Commissioner Connley who's before us uh to walk us through and we will have a thorough discussion of where we go from here. Thank you, Mr. Chair. >> Mr. Chair, Mr. Chair. >> Uh, Senator Abler, >> can you hear me? >> Uh, we can now, Senator. >> Okay. Thank you. Anyways, I'm thank you for the hearing. I appreciate the premise that you're doing here. I just want to single out again Haley Kind who I think uh thank the Red Dare coming to the rescue here. I admire her for her work and appreciate that. And just going forward, Mr. share if there's some things we can do offline that are connected to this. Um the provider credit update um how that's going. A lot of people are waiting for umpy numbers for months. Um the level of withholds and like some of the ATM providers and other legacy providers which are really burdensome and then finally if there's a somebody can share a contact with me that I can reach out to DHS. I think those can be taken offline but I think they're they're just really important too. So Mr. Mr. Chair, I mostly plan to listen today, but thank you for the hearing. I'm grateful. >> No, I appreciate that. And um uh Senator, we'll have uh Bryson David um follow up with what you have there. Um Don Gilman. >> Very nice. Thank you. >> Thank you. >> Thank you so much. And thank you, Mr. Chair, for having this meeting today. Again, uh here we are. We care about you. Uh and again I do want to just kind of pivot back to our responsibility uh and focus [clears throat] on what we did after COVID and just loosening loosening things and loosening how people could be eligible and just the expansion of providers that happened during um that time and what we can do to get back to accountability and again ensuring that we have the providers that need um to be especially especially in rural Minnesota has been impacted the most. We'll hear a lot from them. I'm glad that we're I'm glad that we're here to do this. It's I it's very hard to not go partisan and I've heard some of that partisan talk happening here, but with letters from the governor's office and also, you know, in communication with DHS and different folks, we have a shared goal, I hope. And there is some things that need to happen and I and I'm excited for some of those questions to be answered today into you know our legacy providers and why why weren't we pivoting to them first and different things like that so we can help help meet meet the needs of those most vulnerable. So thank you. >> Well said. I think um with that uh we'll go to Senator Asmmanson and then um thoughts about um uh when we get to you um Commissioner u Connelly then we can um figure out if we want to stop in the process to answer questions or wait till the end. I think what we'll do is we'll wait till the end and we'll just get a list of people that have questions for you. So, uh Senator Ashmanson um take us home. >> Thank you, Mr. chair and I appreciate the opportunity to have this important hearing today on an issue that is concerning and impacting motans across the state. Uh to me the fundamental challenge that we keep on coming back to and we've had this discussion on this committee previously is that the department of human services uh is unable or has really struggled to be able to differentiate between a good provider who's providing services that are needed by motans with disabilities and a provider who's fraudulent and stealing from Minnesota taxpayers. And motans have an expectation that the department of human services is going to pro uh have services for motans in need while also protecting their taxpayer dollars from going to criminals. And we can and we must do both. Um one of the answers that I would really like to have answered here today by the deputy commissioner as we go through the presentation is um how did we get to such a point? Um, and why wasn't the legislature notified sooner about the issues that the Department of Human Services was having on meeting the revalidation deadline that they had agreed to. They agreed to this deadline uh before we started session this year. And at least I wasn't notified that there were going to be these major issues with denials until it was days before providers and the state found out that there would be thousands of denials and in fact a majority of the providers going through this process were going to be denied and need to appeal if they wish to remain as a provider. Um so those are some of the questions I'm looking forward to having answered today and also hope that there'll be clarity on the process going forward uh to providers and their clients and the motans that rely on these services uh so that we make sure that everyone's getting uh what they uh need um from the state. Thank you, Mr. Chair. >> Thank you, Lee Rasmmerson. And and I um you and I um I'll I'll be corrected and it didn't dawn on me until you had said the same thing, Deputy Commissioner. It's actually interimm commissioner. So sorry about that. Um temporary commissioner. Is it interm or temporary? You just educate me, will you? The floor is yours, Mr. Connelly. Thank you, Chair Hoffman. Uh thank you to the members for your opening comments. I think uh we share much of what was expressed and um it is it's good to be here in this new role uh in partnership with you all on these important issues. the dual imperatives that we have with respect to both program integrity, the strongest possible program integrity for our Medicaid program in addition to making sure that people have access and continuity of care. Um those are things that are fundamental to our job. They are dual imperatives and um we know I think as many of you said the Medicaid program among others at the Department of Human Services, they they are essential to the health, stability, the well-being of folks to be able to live their their fullest, healthiest lives in their homes and communities. And we know it is essential to children, families, people with disabilities, older adults, people with mental health conditions, substance use disorders, many of the folks that that you all mentioned. So we we know that this program is a foundation for our health care system and essential to so many um in our state, over a million. And so I'm here today uh at the invitation of of Chair Hoffman to uh provide some opening comments and an update about the revalidation effort. Um, I'll be happy to answer questions at the chair's direction. Um, when we're done with the presentation here, I'll start with just some opening comments and then of course a quick briefing with a few slides. Um, and as I think folks have said here, members of the committee, the chair, that um, we have revalidated all providers in 13 service lines. And I'll I'll just state plainly the reason for that. Um the uh Centers for Medicare and Medicaid Services uh basically directed us in letters on December 5th and January 6th um you know at the end of 2025 and early 2026 that this was something that had to happen. It was um a cornerstone of what they sought in a corrective action plan from us um to address program integrity issues and concerns that they had. Of course, the $2.1 billion withholding was the the attachment to this corrective action plan. That is um a huge risk for our Medicaid program. It's 10% of the Medicaid program's budget, one-third of disability waiver spending alone per per year. Um in addition, as I think the chair and others mentioned, there were additional actions in February with the focused review um being announced by the vice president and the CMS administrator [snorts] and um over 350 million now being deferred as a part of that focused review of claims. And uh we do believe there's there's uh continuing risk for more deferrals in future quarters. Just to be forthright with the committee about that, we are um being vigilant about that and of course watching any communication from CMS. So given these uh tremendous um deferrals, withholdings, risks to our program, we did our best to submit a very um comprehensive u corrective action plan. Of course, with this off cycle full revalidation of all providers in those 13 services within 5 months. And and I'll note to the committee um part of why we we agreed to this um with CMS is that uh again not only did they state in both those letters but also the acceptance of the uh of the corrective action plan which I think chair no noted in March. Deputy administrator Kim Brandt said affirming this is the cornerstone of your corrective action plan. Confirm that you can get this done. Um again emphasizing that this was was something that was of of top importance to them in our our corrective actions. Um so we saw this again as a tremendous uh imperative and something that uh that we had to to execute. Um so that said as we did this our intention our core imperatives were again making sure that we have the strongest possible program integrity for the Medicaid program. uh the people in our program and the people of Minnesota deserve that and also making sure that people had continuity of care and access to service. Those are our dual imperatives. Those are core to our job in uh in operating a Medicaid program and providing service to people and again being uh being stewards of taxpayer funding. Um with respect to the work that we did as we did revalidation, the key parts of that were um to ensure uh that we had accurate up-to-date ownership and leadership information from the organizations to ensure that there wasn't involvement in other kind of criminal or suspicious activity or they weren't on exclusion lists. Um again, just knowing who's in leadership of an organization to make sure that there aren't uh bad actors involved with them. And then of course quality of service and qualification um requirements that are basic to being a Medicaid provider. Things such as staffing levels, staffing licensing and and qualifications, required trainings in place and proof of insurance. Very basic things that that just must be in place I think as the chair said in his opening comments. Um so those that was the work that we were engaged in and and had to had to get done. I want to acknowledge too I think as as many said in their opening comments, this was extraordinary. This was incredibly challenging for the providers. We understand that behind these provider or served by these provider organizations are people, the people of our programs that we have a responsibility to. It was extraordinary also for the people of DHS uh to execute days, nights, weekends, holidays. Um they really gave it their all and uh we tried very hard to to do the best and most effective job that we could. That said, we want to acknowledge this has not been perfect. This has not been perfect. We are not perfect as a department. Um that said, we sought to engage with providers, with legislators, with advocates proactively, creating a variety of different uh feedback forums, webinars, uh regular meetings, different types of communication through different media. Um and again, we uh we stood for I think questions in those in those different uh meetings. Of course, had different hearings with legislators. um and sought to be respons responsive um as we received feedback and certainly we've heard a lot of feedback from you all and from providers and we have tried to review each of those instances tracking down what the issues may have been seeking places where we could adjust and do better um and we will continue to do that. So I I'm here today in that spirit. I want to continue to to partner with you um the legislature as well as our provider and advocate community and those in our programs in the spirit of continuous improvement. After all, that is that is my job. My job and the work of government, the work of Medicaid, the work of human services is continuous improvement. There is no finish line to program integrity. There is no finish line for uh doing better for the people we serve and for the people of Minnesota. So, um I'm here in that sphere today and I think I'll give a brief kind of uh presentation here. I'll try to keep this short so we have plenty of time for for questions. Um to just give you an update of of where we are in the process. Um and happy of course to stand for questions afterward. So, um, some of this information I already shared. Of course, we had a five-month effort, uh, that concluded, at least in the the revalidation piece of this. Of course, appeals are ongoing. That concluded May 31st. And I think as as, uh, uh, leadership of the committees here uh, stated 5,583 providers in the 13 uh, service categories were identified for that uh, revalidation. I mentioned the $2 billion um, and what that represents in terms of a third of disability waiver funding. um and 10% roughly 15% counting the deferrals of of overall Medicaid funding for Minnesota. And as I said, uh this is a critical uh piece of of the corrective action plan at CMS's direction. And uh we seek to protect this critical funding while maintaining access to service for people. Um, in addition, it's important to note that f following what uh transpired here in Minnesota and the communications and requirements of CMS, other states, all the other states, territories and the District of Columbia were given uh 2 years to do what we have done in roughly 5 months. So, um they have taken this approach and they have uh required all states to go through this. Although I will note again with a less extraordinary timeline. Um I will also note uh that uh other states have not had the same level of risk applied to their programs financially. Um there have been other states now that have experienced deferrals but nothing on the level in terms of the percentage of the program's financing that we have uh experienced. How we did this work and how we've tried to meet this moment. Um, we started in January with an incident command structure that was designed in the state emergency operations center with Minnesota Homeland Security and Emergency Management Partners. We uh under that incident command brought in more than 100 staff from across the enterprise. I want to issue a thank you to all the staff that uh answered the call from across uh Minnesota State Government to help us get this done. Um over the past five months we made over nearly 10,000 calls to providers, 4,000 from uh from our provider call center. And again, as I said, we we sought to engage providers weekly in roundts um continuity of care coordination meetings with counties, human uh uh excuse me, tribal nations and managed care organizations um and have directly engaged now with uh with uh members themselves with resources from the legislature. So I'll thank the the committee and legislators for that as well. In terms of the results of this effort, um, uh, 2,000 roughly were revalidated successfully. That's about 38%. Um, 62% received disenrollment notices. Um, and the majority of that 3,400 are going through the appeals process now, though not all. Um, and I'll get to that data point in a second. I want to say that, uh, of those, I think there's been much said about the disenrollment notices and what it means. Um, this is not necessarily an an indication of fraud. Um I think this is uh again an indication of having the the documentation that is necessary, the credentials evidenced uh in place and accurate, current um and complete for uh Medicaid provider enrollment to be specific. In terms of the appeals, this is the phase of the process we are in now. Providers have 60 days to respond to that disenrollment uh notice and to initiate an appeal. We're encouraging them to do so within 7 days. However, 2472. These these uh data are just a couple of days old, but they're fairly current. They're the numbers are probably a bit different. Uh as of uh right now, midday on uh th or today is Wednesday, excuse me, um July 1st, there are 2,151 appeals in process. Uh the number here is 321 appeals completed. I'm aware that's actually increased some. So, they have adjusted some at this point. and a little I I'm aware that this number is now slightly under 600 uh who have not appealed. So these numbers continue to move really by the hour and 353 uh their appeal window has closed meaning they will be disenrolled. Um I I think I described these pieces uh previously here in the presentation. So we're encouraging direct uh directly providers to appeal. We're outreaching to them. Uh paying particular attention to residential providers, mindful that having folks housing uh associated with the treatment that they are providing their their uh you know their shelter uh associated with treatment is very important. Um, in addition, we're uh I'll be forthright. We are continuing to iteratively work with providers on getting the documentation right, but we continue to lean into that to try to help them understand what the issues are, the discrepancies or inaccuracies, the incompleteness, and help them uh get that right to the extent possible. Um, I'll note that if we can't get there, and again, we'll continue to work through this as as long as providers are responsive to us um within 30 days, we'll continue to work through this process. We will refer for a contested case hearing if we can't rectify uh that issue through technical assistance and and uh engagement with the providers to mitigate uh service recipient impact. You know what? I might just move to the next slide because there's more detail about this piece. Um in terms of continuity of care, we're working with lead agencies, so tribal nations, counties, and managed care organizations again if we sense there's a possibility of an interruption in service. So we are meeting weekly with these entities to help them understand which providers have appealed which haven't um you know and the members associated with those providers so there can be proactive outreach to the providers and to the people that they serve if there is a potential disruption in service if uh there's a chance again a provider doesn't make it through the appeal process. Um, we're also now, and again, I want to thank the legislature for these resources. Um, expanding our ability to work directly with enrolles. If they're not enrolled in a managed care plan, if they don't have uh a county or a tribal uh nation providing uh case management, for example, waiver case management, we're reaching out directly to indicate when folks may have a service disruption and help them find a new provider um and preserve continuity of care. Um, I think the other thing that's important here is connecting folks to uh income support where needed as well. um given uh the vulnerabilities that folks are facing and to pay for housing costs in particular. Um a little more here on the new continuity of care law. Again, thanks for this support. Um uh this is really outlining all of the different pieces that we're engaged in implementing now. Um making sure that folks again have that support. And I'll I'll uh excuse me, I'll I'll really focus on the third uh point here on this slide, which is that we want to make sure for folks again who have a housing risk that housing support is leveraged more assertively um to pre preserve housing if their treatment provider is disrupted and there's a housing provision related to their treatment so that folks um have that and providing of course grant assistance to providers um in in those impacted benefits. So with that, I think without taking more time, I will stop and I'm glad to stand for questions. No. Yeah, I can see um there's a couple of of things. Uh, Commissioner the I looked at the numbers and I was looking down the the um the table and and it's almost in the appeals numbers you almost had a thousand people and and my first thought is what's the department a thousand providers. What's the department doing to assure the continuity of care? And if you look back all season. That's all I kept talking about was continuity of care. And so, what what's in place for that? And we'll hear from providers. We have uh 11 people that have signed up to to testify. And you'll hear from providers today that that the system is not going as smooth as it should be. And so, I think it'll be good for that. Which then leads me to this next statement. leadership this year went off into the corner and they all decided to cut $300 million from human services. That's $300 million. That's program integrity. That's that's stuff that matters to people, right? And so it it it it bothers me to hear about this weight that has been you know added regarding extra work and and not that extra work but you know time that it takes and that we're hearing from uh providers that the response is not been reasonable right and I was with a provider two providers yesterday um who are experiencing the same same issue. So what to tell me before we go the the uh Zoom user is actually Senator Glenn Grunhagen and before I go to you Glenn I just want him to follow up with um what what what's in place to assure continuity of care. >> So thank you chair. Uh a couple of things I'll highlight. I think first is we understand that given the numbers I presented having all of the providers who were not revalidated you know cut off from payment would have been highly disruptive. we can't afford that level of disruption and at the same time we need to make sure that folks I I think as as you expressed have the right documentation have those basic uh requirements met in terms of compliance and program integrity uh for the Medicaid program. So, uh, the first thing of course was was, uh, outreaching to providers to let them know that upon appeal, if they appeal, and that's why we continue to reach out to those that haven't, they can resume their ability to bill. And we, uh, fairly quickly within a week or two, we're able to restore the ability of providers to bill. Um we are aware that there are still some instances of providers uh you know communicating us with difficulty with that and as they arise uh we we are I think following up as we receive that information but that was the first step to help providers continue to provide service and then in addition we had the weekly meetings with counties tribal nations MCOs's and of course direct outreach to to people at risk of uh service interruption. >> Thank you uh Senator Grunhagen. >> Well thank you Mr. Chair. Yeah, and uh thanks for having this meeting, Chair Huffman, and also Sen is it commissioner, assistant commissioner, thank you for coming and testifying. I think all of us care about ending fraud, but we don't want the the actual people that need these services, children, disabled, and a host of others that are getting caught up in it. And thanks for your efforts. Uh my question is you know uh the I've watched the house uh committee meetings on or the other body on fraud with uh chair Robbins and one of the things that that has come up several times and and through testimony I think it's over maybe it's more than this but I think it's over 30 employees of DHS who had come forward years earlier about concern concern about frauds with with some of these organizations. And instead of being listened to, they were ignored, threatened, and uh in some cases uh terminated from their job for reporting the fraud. So to me, and I I think all of us can agree, the people who did this to the whistleblowers, and these are frontline employees who are trying to be conscientious and report the fraud, which could have been caught years earlier according to their testimony. Uh, why has have the people who did this to the to these DHS employees who are trying to be conscientious and report fraud, were they have they been terminated or disciplined? I mean, it just it doesn't seem like anything happens to these people. Uh, I can name a couple names, but I won't. um who who have who did this to the DHS employees. Commissioner, if you would uh respond to that. [clears throat] >> Thank you, uh, Commissioner. That's a Senator Grunhagen. That is one thing about consistency in all of our hearings this year. He's he's always asked that question, so I don't know what what uh what else you can add to that, but nice seeing you, Glenn. >> Chair Hoffman, Senator Grunhagen, I I appreciate this question, and I'll say a few things. I think first of all our staff as well as the community are key in terms of helping us be strong on program integrity. We need them to be strong voices when they have uh you know an instance of an operational concern, a case of fraud or suspected fraud um some some sort of wrongdoing or a problem any problem in the organization we need a culture and a process that empowers staff to be able to report those problems. So, um, if any the things that you are describing, if any of that occurred is unacceptable and it is counter to Minnesota law, it's counter to DHS policy and it's counter to my expectations as temporary commissioner. So, I I want to say that um again I what I will say in addition is I am not personally familiar with the individual instances of this happening. I arrived at the department 2 and a half plus years ago. um have been in in this role just a couple of months. So uh I'm not familiar with individual instances of people uh experiencing what you have uh what you have uh outlined here, but certainly um if there are instances of that, if people are aware, they should be reported and we should review those carefully and respond appropriately. But again, we need our employees uh they are uh you know our strongest asset. We need them to be reporting problems including fraud. um they could do that to the compliance officer, to the inspector general within DHS, to the office of the legislative auditor, the Bureau of Criminal Apprehension. So, I appreciate the question. >> Thank you. Um >> Mr. Chairman, just one quick com. >> Yep. >> You know, I just hope some of these people who did this to the employees and if you it's not alleged. Listen to the testimonies in the House Fraud Committee. They were they actually came forward some of them and shared what happened to them. Some of them lost their job. They their families were threatened according to their testimony. And you know if if you put me in charge, I'll fire a bunch of people who who did this. All right. I mean this is ridiculous. Nobody loses their job for threatening these employees for trying to end this fraud which could have been done years earlier. >> All right. Thank you. Thank you, Mr. >> Thank you, Glenn. I'm going to bring us back to why the purpose of this hearing and I I you know thank you for that. Um I think I'm going to Senator Aaron Mcuade next and then to Senator Rasmmanson. So Senator Aron Mcquade. >> Thank you Mr. Chair. Um and thank you acting commissioner Connelly. I I have some questions around this fivemonth timeline and I'll [clears throat] just ask them all because you can answer in whatever uh order makes sense. My questions are like do you know why five months was chosen? Um, and if you had said because I this was the first time in like the 60-year history of Medicaid, right, that any state had been given this kind of timeline. If you all had responded, you know, we can't confirm that we can do it on this timeline, what would have happened or was there any like other options other than 5 months? Was this like negotiable? I'm just trying to understand how we got pinned down into this like literally first of its kind timeline when every other state gets two to three years. >> Thank you, Senator May Quaid. Uh, Commissioner Thank you, chair. Thank you, Senator McQuay. That's uh that's a really uh important question. So, I think the the way I would outline how we arrived at 5 months was the the fastest timeline on which we could execute this given the nature of CMS's communication to us both in December and January. So initially when we in our first draft of our corrective action plan in December outlined the requirements of Minnesota statute the initial response was that is inadequate. That was both communicated in meetings with CMS. It was communicated also via letter and XVideo from the administrator of CMS. So there was uh very clear displeasure um from CMS with what we had proposed though that ended up being the timeline that was eventually approved even after the revised uh corrective action plan was submitted in January and then approved later in March. But um that was the fastest we thought that we could execute it and and follow Minnesota law even though there was very clear displeasure um expressed from leadership of CMS about that timeline and about the restrictions of Minnesota law. So um that was how we ended up with such a compressed timeline and that was the fastest uh timeline in which we thought we could execute this. To your second question, forthrightly the answer is I don't know what would have happened. But what I can tell you is that given the communications in the letters again from the administrator to the governor and me um and the deputy administrators uh uh to me and also in the approval from one of the deputy administrators, the the director for program integrity um was that this was of utmost importance to them in the corrective action plan. Um this was the centerpiece. They pressed us to do this as aggressively as we could. Um, and of course there was a two billion dollar threat associated with it and we felt like we had to do our level best to execute this to pres preserve that that funding for the people that we serve. Um and uh given the the risk that we had when the letter came with the acceptance of the corrective action plan, what deputy administrator Brandt said was confirm that this is the date that you can meet and if you're proposing a different date, we need to agree to that and we felt at that point that we should stick with the timeline given the extraordinary risk to the funding uh for the program. Um so that's that's a description of kind of how we arrived at the five-month timeline. in conversation with CMS and then um to your question about what would have happened it's it is unclear but we continue to grapple with tremendous risk. >> Senator Mquay followup. >> Thank you uh Mr. Sharon, I you know I think there's two things that I think are true in this moment and one like we live in the real world right all of the context under which this is happening is is evident right it's been said publicly um you know like the retribution campaign like we know that that's happening and at the same time I think what would be really helpful is to to know and have the department be able to go back and say like this actually isn't a realistic timeline or we can't do it on this timeline or like send us help to accomplish it on this timeline. Um, and I and again like I know that that could have put things at risk, but I think it always felt at risk with the like literal stated retribution campaign. And so I think it from from sitting on this virtual table wanting to know that we actually tried to um have them meet us part way if we're giving other states two years to do this. Um 5 months is just it's it's just not enough. Um, and so I I want I want us to live in the real world and acknowledge what they have openly said they want to do to Minnesota, but also like we have to make sure that we're communicating back like that. We can't do it on this timeline cuz we we couldn't and that's really scary. >> Yeah, that seems like it's uh Senator McQuay like that there was that original letter it looked like there was an opportunity to be able to come back, you know, I couldn't get it done in this time. Um so uh but regardless that we know in the future what what what should we be doing? Do we need to do something legislatively to get better direction? I don't know. That's the question that's out there. We're going to go to Senator Rasmmanson then Representatives Liz innocent Gilman. That's who I have on my list. Is anybody else? Representative Fiser, you're after Gilman. Is that okay? So Senator Rasmmanson. >> Thank you, Mr. Chair. I have uh two questions for the acting commissioner and so I'll try to keep it brief. Um first question, Mr. Chair, for the acting commissioner. Um if could he provide some additional clarity especially to providers that are watching this hearing today that are in the midst of this appeals process. uh it'd be helpful to understand the timeline where if we have a provider who has appeal um and is going through that you know what happens at the end of 60 days um what can they expect to be hearing from DHS and what can they be telling the motans they serve commissioner >> thank you chair Hoffman thank you Senator Rasmusen uh that is a great question and I think the first thing to communicate uh to providers uh in this forum is that we need everybody to appeal if they intend to continue to provide service. So, we have a little under 600 providers that haven't appealed. We encourage them to do so. We continue to reach out directly to them to encourage them to do so. For those that are in the appeal process, we are working with them, I think, uh, in many cases, very iteratively, a lot of back and forth to to provide them with information to help them provide the documentation that is that is required that we must have. So, we can't we can't give on those requirements, but we'll continue to engage with providers to help them uh provide what is missing or correct what needs revision. Um, so again, 60 days to reply to us within uh they must reply within that timeline in order to uh maintain the ability to bill and to continue to be an enrolled provider. If they are engaged with us within that 60-day timeline and they are responsive to us within 30 days as we respond to their documentation as it comes to us, we'll continue to work with them to uh resolve the issues uh with their their revalidation uh documentation. >> That's helpful. Senator Asterson followup or thank you Mr. Chair and just a clarifying question on that. So if the appeal is not complete at the end of 60 days, so you have a provider who has appealed, is going through the process, you know, maybe making corrections, communicating back and forth with the agency, but the appeal is not complete by the end of 60 days. What happens to that provider? >> Commissioner, >> if they are responsive to us within the 60 days and responsive to us within uh a 30-day period of our response to them, they will we will continue to work with them. uh so continuously trying to uh support them through the correction uh in the revalidation in the in the provider record. >> Thank you. Um >> thank you, Mr. Chair. And just one more question then I'll I'll be done if that's okay with you, Mr. Chair. >> I'm fine with that. Senator Asmmanson, I think we're going to end up going beyond 2:30 if folks are okay with that because I do want to hear from the providers and the individuals that were affected by uh the system that that was occurring. So, Senator Asmmanson, to your point, >> thank you, Mr. Chair, and as a question to the commissioner, I I'm I'm trying to understand better understand um what went wrong here in this revalidation process and what lessons learned uh we should have going forward. Um if if I kind of look at uh the communication that I saw basically I wasn't aware there's going to be a major problem and that most providers were going to be denied through the revalidation process. Um it was notified I believe 2 days before the majority of these providers were denied. Um throughout the legislative session you know this timeline had been agreed to by the department of human services. We were told that the Department of Human Services was working on this timeline and at least, you know, when I go back and look at my notes, the indications were it was a lot of work, but they were on track and working towards that plan. And to me, when when you have a majority of the providers not be successfully revalidated and have to be now going through this appeals process, that's not on track. That's not what I thought the plan was. And so, Mr. Chair, my question for the commissioner is, you know, was this the plan all along? Was to kind of do what you can and then deny and roll people over into this appeals process or when did the agency realize that they were going to struggle to get providers through this revalidation process. >> Commissioner, >> thank you, Chair Hoffman. Senator Raasmus, and I appreciate the question, and I think uh I'll start by saying this this was not the plan. We had hoped that the vast majority of providers would be revalidated within the timeline. And the major challenges I think that we faced were and continue to work through in the appeals are just the the the the majority of providers that weren't able to provide the information that we we just needed. We we have to have that information from them in order to revalidate them. Um so we we were unable to get that from the providers that were not revalidated that that were responsive to us. I think that's number one. Um, number two, some providers, they didn't respond to us until um, mid or late May. And so, um, that was also another challenge that we had is that there was kind of a late wave of response in addition to us being unable to resolve issues through multiple engagements with the providers. And again, we we tried our level best to uh be clear about what what was needed and how to rectify issues and we just weren't able to get there. So, it certainly wasn't uh the plan to have that happen at the end of the five months. Um, and of course, I'll go back to my opening statement that we acknowledge this was extraordinary. Um, we we did not feel that we could uh move from I think the five-month timeline given uh the communications from CMS given the the tremendous risk to the program financially into the people we serve. Um, you know, and that's that's kind of how we we landed uh with the outcome that we have. And the last thing I'll add is that we crafted an appeals process to give providers an opportunity after get getting a notice of disenrollment to rectify the issues through the appeal um and preserve the ability for them to bill for service. >> Thank you. Um >> thank you Senator uh Representatives Elizabeth Nikar. How are you? >> Thank you Senator Hoffman. I'm well. Uh thank you for the opportunity and thank you acting commissioner Connley. Uh my first question is um when you to to um the previous question on the timeline the December correspondence the December correction plan was submitted by DHS. My question is it's been stated uh you stated that CMS stated that was not adequate. What was not specifically adequate in December? >> And was that um Representative that was the that was the corrective action plan you're talking about, right? Is that it? Yeah. M uh Commissioner Connley is raising shaking his head. Yes. So, um Commissioner, >> thank you, Chair Hoffman. Thank you, Representative Zlesnikar. There were a few different things that they requested that we speak to that we had had spoken to in our own department's program integrity playbook that they wanted us to speak to in that corrective action plan. Um those things did appear in the revised draft. things like managed care oversight, um things related to uh to uh program reviews, looking at different benefits for the possibility for policy change to enhance program integrity, um uh recovery efforts in terms of of recovering payment after an instance of fraud. So, there were a variety of things that uh that appeared in the second draft of the corrective action plan that was eventually approved, submitted at the end of January, approved in March. Um that appeared in that lengthier version. It's important for me to state too though that uh we responded uh to the initial uh direction to submit a corrective action plan in December. We responded uh within about three and a half weeks uh so on New Year's Eve um with uh a corrective action plan that was uh in that included all of the items that CMS asked for including the the offcycle revalidation of all the services or providers in of those services um and the provider enrollment moratoria. So we included those uh those two items that were basically uh requested or directed to be in the corrective action plan including others. Uh the original corrective action plan was uh something like six pages of memory serves. Um the revised was over 20 um I think if if memory serves. Um so we included much more content in the second version in January. Um and much of that of course was spoken to in our own internal program integrity playbook. >> Representative. >> Yes. [snorts] Uh if I can proceed with a few more questions, Senator Hoffman, please. >> Absolutely. I mean, >> okay. My second my second question is some of the it's my understanding uh from reviewing all the information that you know during the pandemic there were there were uh procedures that were policies that were loosened to get to get program dollars out fast to people and new providers came into the field. So, you know, we're we're the the programs. It it appears to me that the things that we've been asked to do in our state now are things we have actually done before for other programs as far as ensuring those integrity. Is that correct, >> Commissioner? >> Thank you, Chair. Thank you, Representative Zlesnik. Uh you're testing my longevity uh with the department with that question. I arrived in late 2023 uh as an assistant commissioner. So I I am not incredibly wellversed on what program integrity interventions historically have been in place for the programs. That said, I know that since I've been in the department that the majority of my time here has been working on putting in place new program integrity uh protections. Um in addition to providing access to service, new services, uh we're still at work on that and um of course at the direction of the legislature implementing new new waiver uh services and and new state benefits. So, um, but I I regret that I don't have, you know, having joined the department in late 2023, I don't know that I have, uh, you know, the personal longevity to answer that question fully right now. >> Representative. >> Yes. Um, and thank you. Um, I I appreciate that. I understand you've been there uh not in that period, but in the providers that I visited with, there's several providers that have been in business for 10 to 40 years that have had site visits and have done all the provisions that are in uh the plan of correction and in this revalidation and uh there are several that had not had those things. So I believe that that is accurate. My third question is I'm curious if um if if the department of uh human services in in your whole strategy of how you selected who was going to be uh processed first, second, third, the the triaged order to get this done. If you were using the data from the optimum report when the state spent $2 million to get a an an audit done, uh is that how you chose who you were who you were doing? Commissioner, please. >> Thank you, Chair Hoffman. Representative Zelelesnikar. So, I I just want to speak I had a a thought in in response to your prior question and then I'll get to the order and the question about the optimum report. So, what I can affirm is that we have always revalidated providers and if providers are limited or moderate risk, it's every 5 years. If they are classified as high risk, it's every three. So we we are always revalidating providers but it's it's based on their their kind of classification with respect to their risk level. Um so that's that's always been done. So that is accurate. I I wanted to be responsive to that question. With respect to the order um largely we were responding to providers as we received the revalidation um you know the revalidation uh documentation from them. And uh part of that was necessitated by the fact that many of the providers didn't respond to us until later in the 5-month window. So we were trying to be as prompt as possible with the the documentation that we were receiving and um have been very prompt, usually within 24 hours, referring providers that had complete revalidation documentation for a site visit uh from the inspector general um and his team. With respect to the OPTIM report, uh that didn't necessarily speak to the risk level of individual providers uh as we were revalidating them. There were other kind of broader uh issues spoken to in that report with respect to program integrity um issues, but um there wasn't necessarily uh extensive information about individual providers and how we would prioritize them in in a revalidation effort. >> Representative Zissa. >> Okay. Thank you. Uh my next question is um in the sense of >> providers. She said a couple. I guess the house you guys don't know how to count to two, do you? >> I I've spent so many hours on this topic with providers calling me from across the state that I feel called to ask a few things. >> No, you're good, Natalie. I'm kidding. I was You're good. I just wanted to ask you >> Great questions, by the way. I I love your knowledge in this base. Go. >> Does Does the Department of Human Service have an understanding? right now of how many providers are in the northeast quadrant of our state, the northwest quadrant of our state, southeast, southwest, central, the suburbs and metro that provide services in these 13 categories. I asked this because I have great concern in in all of them, but I have a extra concern for non-emergency transportation. and I spent two years on the ambulance task force and the aging task force and right now ambulances are you being used for non-emergency transportation because we have no ability to build and even if they can bill medical assistance it's not just the issue of billing medical assistance if you're not getting payment because they're holding the remittances for 30 60 90 days they can't make payroll so to my understanding and we'll hear testimony today to see if I'm right but to my understanding layoffs are happening right now and businesses are shutting down and we don't have services. So, I'd like to know if we have a provider database that shows who are the providers in the sections of the state so we know what the risk is to vulnerable adults. >> Commissioner, Chair Hoffman, Representative Zlesnikar, uh straightforwardly, yes, we do have that data. We do uh we do know where the providers are and and kind of where they are providing service and and what types of services they are providing. So, we do have those data and we share your concern about access to care and uh I know you and I have con uh have conferred about some of the issues that providers are experiencing that you're aware of um particularly uh up north in in the duth area and elsewhere and u we share again your concern to make sure that uh folks have access to care and if if there are specific issues again that we need to review and look into I think as we've discussed we're glad to do that. Um I know that there is some concern about continuity of payment uh for services delivered. Um and we'll again try to assess what the issues might be understanding that if a provider has appealed again our policy is that they can submit billing and receive payment um if that uh payment uh again meets requirements. I don't know if there are other issues with system edits with respect to the claims they're submitting that we we could uh work on with that provider or those providers. But again, if there are enduring issues here, we want to work on them and understand them. >> Representative is a followup. Well, my only followup is just um the piece that I've communicated um to you, Commissioner, is that I have great concern that if we don't get this uh solved soon, these providers in higher status that have been uh vetted through the state from providing services for 10 to 40 years, uh with site visits, with program integrity, and uh relationships with the Department of Human Services have found themselves in the same pool of the bad apples. And so however the insurance companies are not uh going to look at it that way. They are now high-risisk categories. And so their credit line loans uh the interest rates are 20 to 30% which is not sustainable. And their insurance providers are saying their their rates are going up quite substantially. And so that is going to compress our health care model. And my concern is that if we don't get this fixed in a reasonable way to sort through that we're going to see hospitals being stacked up uh with patients that could be served in a more efficient way and our ambulances are going to be uh in a in a real predicament. So I appreciate today and um those are my questions right now. Thank you. >> Thank you. Uh Representative Nar I somebody who's had the the knowledge base that she has in years of work in that. I appreciate you being here. Representative Gilman. >> Thank you, Chair. Uh question. I'll start with my question first and then I'm going to go into a comment as well. So, have certain provider types or service categories experienced higher denial or revalidation failure rates? And if so, um what specific factors does DHS believe are the driving um factors or differences? >> Commissioner, >> Chair No, uh Representative Gilman, thank you. Thank you for the question. Uh yes, there is some variation among the service lines that are a part of the revalidation, the offcycle revalidation. Um in terms of the causes, I think we're still trying to understand those because the the the effort is still very live. So um I think that's an excellent question. Glad to stay in conversation with you about how we understand that, but there is some some variation across the service lines in terms of the outcomes of the revalidation. >> Representative Gil, >> thank you so much, Chair. Um, again, I just I did get information from Washington that when Minnesota um DHS was questioned in this um and on the record, Minnesota DHS did state um that um the denials or the the com the issues with denials um again had to do around the majority of them were around the HCBS services like the providers those were the ones that were impacted the most is with revalidation. Is that correct, >> Commissioner? >> Chair nor representative Gilman. That's that's a good question. I don't have that information in front of me, but glad to take that back and get an answer for you. >> Represent Gilman. >> Okay. Thank you so much again. Um, as we're sitting here, I'm just doing rough math. Um, and when I looked at your slide, it said that more than 100 staff from across the state enterprise have joined your ef efforts to verify, visit, and validate providers. So you did indeed form a revalidate in like incident command. Is there 100 folks helping you with that or more than 100 helping you with that >> commission? Chair No, Representative Gilman. So at this moment the the staffing level has been fluid throughout the five months. Um we can get you data based on a certain point in time or currently um but I'd have to go and get those specific numbers for you, but it was roughly 100 at the beginning. Um it is fewer staff now and we uh because of the flow from the documentation piece of the review to the site visit piece of the revalidation um we had to uh reduce the staffing level at certain points um because we weren't able to to see the flow from the paper or the uh the documentation review to the the site visit and a lot of the staff that we sorry the staff that we brought in were dedicated to the site visit piece of the work. >> Represent Gilman. >> Thank you. Thank you chair. And so when I look at that and just do rough math, you know, 100 staff, 5,500 providers for five months. So they each would get 11 providers to take care of and figure out what's going on with them per month. And I mean, just as a business owner, I would have no troubles getting that done in a week. I mean to two weeks. cuz I know that it's staff again, this is no disrespect, but I want to know as your acting commissioner right now, the temporary commissioner, and you're coming and not having the information that we need. This again says to me there's a systematic issue from the top down from the governor's letter that I got back from them saying, you know, you know, we're bringing misinformation, but the the public can only deduce what they can deduce from the information that we're getting. So, if I had staff of a hundred and I needed to divide it up into 5,500 providers, I mean, there would be an expectation by the end of the week, there would be a a sheet, a goal list because you have $2 billion. Again, we can look at the feds all day long, but the fact of the matter is is this is happening in our administration's own backyard and people are impacted. And when we talk about greater Minnesota, folks needing to get to dialysis, too. And we've got providers that have been um just held out there saying just figure it out and we're going to have to come back. We come back every year and and human services gets the biggest cuts. So it's just personal responsibility. It's really frustrating. But when I do the math, unless my math is really bad, uh it's it's 11 providers that each person would have to touch and take care of. And that would be my goal based on what the consequences and the fallout could be. So if you want to respond to that that'd be great. >> Before I go to the commission I think correcting the mud is about 50 >> 50 providers. So if you're counting 55 and probably but I know there's a lot of process that goes into place for revalidation. So commissioner >> chair no uh representative Gilman. >> So the issue that we struggled with we were staffed to do the work. The issue was really because we weren't able to pass on the document review piece to the site visit. There wasn't that throughput and many providers they didn't respond within the first months of the effort and so they they didn't make it to that site visit portion that the 100 staff were responsible for uh or brought in to help with. So the issue um again that we struggled with was really getting through the documentation and correcting the issues with that before assigning the site visit to the staff that were brought in to help. So that was really the issue. >> Okay. >> Thank you. >> Thank you represent Gen. Um Representative Fiser then Senator Lisky and Senator Holstrom. >> Uh thank you Chair Hoffman, assistant commission uh act excuse me acting commissioner. Thank you Connley. Thank you for being here today. Um, one of the things that, uh, as I'm listening this past part of the discussion, uh, is a lot of the providers are out there, I know, are very small operations, what I would call mom pop operations. And so, they've got their hands full trying to run the daily operation and getting paperwork that they have to do to keep the business running. On top of that, you've got the reertification going on. And it feels to me from what I'm hearing on your discussion here that uh it seems a lot of people kind of did it like their taxes. You wait until the very end before you submit for your taxes. Am I accurate in that that there seemed to be a large number of them that waited until the end before starting to get some of the information in. >> Commissioner and Chair Hoffman, Representative Fischer, that that is correct. >> So what we kind of had is like what I would call when a snake swallows a pig. Everything came in at one time and as a result it overwhelmed the system at that point. Would that be an accurate statement? >> Commissioner Chair Hoffman, Representative Fiser. Uh I think that is that is certainly a a portion of what happened. >> Okay. Thank you. Um and then I've got a couple other questions. One of the things that I want to kind of hit on is I appreciate that we're focusing on fraud and we're focusing on making sure we're addressing providers, but I think there's one critical part here that I feel that as I've listened to the discussion that's been kind of missing is at least from the federal side that is now driving some of the discussions in our side as well. We're focused on the providers uh and fraud. I don't hear anything about the services as much. When I take a look at the testimony, I see a lot of people concerned about the services that they're losing, their loved ones are losing, etc. So, while we see the numbers of providers here, what are the numbers of the people of our state that are at risk? I don't see those anywhere here. >> Thank you, Representative Fischer. Uh, Commissioner, >> uh, Chair Hoffman, uh, Representative Fischer, you know, certainly we know that, uh, that thousands of people, uh, hundreds of thousands of people likely rely on these 13 services. And we could certainly quantify that for you. And I think that's a really important point. And part of this effort is, of course, to preserve the resources for the the people that are served by these benefits, but also for the entire Medicaid program. Uh, thank you, Acting Commissioner Connley. And it would be uh great to be able to know what the numbers are being served here because right now there's a false narrative out there that all these people that did not make it through were providing false services or creating fraud. Having worked in small nonprofits, having watched and talked to small nonprofits in my field, in my district, small forprofits that do this kind of work, they already overwhelmed trying to do the regular business. They are they are some of those ones that are in denials right now that are providing legitimate services, but we're missing that part of the conversation. So, I think it would be very helpful that for for us to know is that in terms of appeals, how many people are we talking each section because some people are saying, "Well, all these cases are closed. that was all fraud. That's not the case. I know businesses that close that had to transfer their people elsewhere that were legitimate services. And I think that's a part of the story that we're missing the in the process here is that vulnerable people aren't getting their services. We need to kind of bring it back and make it person centered again. I don't feel we're as person- centered. And I'm not meaning it as a fault in the department. It just is the narrative that's been created out there. And I think we needed to bring it back to that. Um the other thing that I had a question on is I was in the uh document that you provided us. I was noticing that you know some of the problems that had was failed site visits out there. Now having been in programs before that have been licensed by the department. It doesn't take much sometimes to fail a program to to fail a site visit is you know as you're taking a look at records etc. There are certain things that you have to put in when reertifying. I know that when yours are reertified, it doesn't always happen quickly because it's like, oh, we'd like you to make these corrections here or there before the license gets re renewed or the credentiing gets renewed, etc. And so when I see 916 providers that's failed site visit, I'm kind of curious what were those kind of violations, what kind of caused it, how many people were being serviced in that and how many of those were eventually create, you know, fixed the site, you know, the failures and were able to come back in to be certified again. So there's a lot of questions. I'm seeing information here, but it leads to these other questions is what is really meant by the numbers out there. So, example on the on the failed site visits. What are some examples that were uh failures out there that could have been things that were easily correctable or but slow down the process? >> Yeah, Representative Fischer, you bring up the most important part which is that continuity care, the assurance that the services are being met. But, um, Commissioner, if you could uh look at the second part of his question. Appreciate that. >> Thank you, Chair Hoffman. Thank you, Representative Fischer. So, I I want to say first before I answer your question straightforwardly that um this was a a fraud prevention exercise. It is a compliance exercise. So, I think uh it is important for us to make clear as you're stating because a a provider received a disenrollment notice does not necessarily mean that they were committing fraud. So, I think we should state that straightforwardly and appreciate you raising that point. Um so it is it is a matter of making sure that that certain requirements are met and certain documentation is in place. And then to the site visit portion of your question. Um when folks uh when providers submit a complete revalidation, you know, packet so to speak to us, we then go out to the site uh and then verify that information. So making sure that what we see there, what we hear there matches what's in in the documentation. So that's really a key part of of the site visit in addition to being able to have access. And um a site visit is just one key tool in program integrity work that if you go and you lay eyes on a provider site, you talk to people in leadership, the staff there, sometimes the people being served if you're doing an audit maybe uh at different parts in the process, whether it's pre- or post payment, um that you can verify what's in the documentation. So that's really what the site visit is meant for. >> Thank thank you. Thank you. Um Senator Lisky, this is what you and I were talking about the other day. Um asurances, you know, and so to that point, Senators, welcome to our committee. >> Thank you, Mr. Chair. Um Mr. Chair, acting commissioner, I I see some numbers and some things on these slides that I I guess I'm concerned about uh after hearing from my actual constituents who have licenses that were either suspended or disenrolled um that I don't think they fall under the high-risisk services. Um FRS wasn't listed as one of the high-risisk uh fac uh services and yet I have F FRS homes that are being disenrolled. Um CRS I don't believe was listed as a high-risisk and I have some CRS homes or facilities that have been disenrolled. are they included in these numbers that we're talking about? Um, at which point then I think your slide kind of has a weird narrative of high-risisk services where it's not all high-risisk services. So, if you can ask answer that question first and then I'll kind of keep going >> to Senator Liski's point. Commissioner >> Chair Hoffman, uh, Senator Lisky. >> Yes. >> Okay. Uh, so that is a really important question and happy to provide clarification about what what may have happened there. So, my understanding uh if I'm using my context clues well is that for many providers who had one of the 13 services on a record grouped with other services that were not part of those 13, that entire record was included in the disenrollment uh notice affected by the revalidation. So, that it depends on how the provider uh had grouped the different services they provide on their record. Um so one way that we've been able to rectify this uh for example is if a provider and this happened uh with more than 200 providers in our most revised numbers with respect to appeals. They said we're no longer providing those those services anymore. So we could then straightforwardly remove those services from from the record and then proceed with the revalidation without uh those those services on there or um they wouldn't have to go through a revalidation if if there aren't high-risisk services on that record anymore. Council Senator Liski. >> Thank you, Mr. Chair. Another concern that was uh on that same line, as you stated, there was multiple services on their record, right? So, they had a portion were high-risisk, a portion weren't uh CRS, FRS, again, not in the high-risisk realm, and some of them then were kicked off or, you know, terminated on this window. Um the the concern I have is that a lot of that paperwork should have been something that DHS had and was aware of, right? And so you could have notified them of that specific segment of their record as opposed to their whole record and terminating that. So that's that's an error I think in our in our pathway of how we terminated people. But then on top of that, some of the site visits that were supposedly done, uh they failed their site visit. Well, they went and visited them at their home address instead of at the facility address. Well, no one was home because they were at the facility doing the work and they failed their site visit. Well, how do you fail a site visit if they never actually went to the right site? And so that's concerning. And so something like that again in that 916 providers who may have failed the site visit, do we know a number? Do we have a percentage that may have failed it just simply because you you visited the wrong site? >> Senator Lisky, as you you're saying that, Representative Fischer was saying, yeah, that's the same issue that he was addressing with too. So, Commissioner, to those points, >> Chair Hoffman, Senator Liskey, appreciate that feedback and and understanding that those situations um may have occurred and I think if there are individual issues like that, we are glad to follow up on them individually, understand what happened, review and try to rectify. And of course, um if we need to go back out for a site visit, if the provider is seeking a revalidation, we will certainly do that. >> Senator Liskkey. >> Thank you, Mr. Chair. And I guess the final thought and I'll let my colleagues get to some of their points and I think they're going to ask similar questions that I would anyways. Um my last concern is that I had I think 14 providers in my district reach out to me. Uh 14 providers that had filled out the paperwork to their best of their knowledge uh adequately and accurately. All of them sitting on a pending site visit. Um many of them had actually filled out and submitted their paperwork early March. Um, so not the window of the group. Like you said, there was a bunch that came in right in the end of May. I can understand why that might be a little bit too much, but these individuals had their paperwork filled out well in advance of that pressure, never received a site visit, and then were dropped off as terminated. And so, what do we do now? I mean, that doesn't seem like a fair way to terminate. And if if that was really just the game to protect the $2 billion was to simply terminate all of them and then come back for an appeals process. >> I don't think that's a good way to handle this this process. And because that again continuity of care, they now have to notify all of their clients, all their patients that they have terminated their their agreements because of something DHS has done and not because they've failed to do the paperwork, failed to do the things that you've asked them to do. And so that's on DHS, that's on us. And it sounds to me like this agreement was made back in December with the federal level. And yet I don't remember hearing anything in any of the committees that I sit on asking for help, asking for us to give you an assistance of some sort to get this along. In fact, every time something was asked about, we've got it, it's on time, we're okay. And that's concerning. Um, we got to the point where it hit May, we were still in legislative body in parts of May and we were still being told that things were on time. And I don't I don't think that's a good thing. I think that's leading to a process issue. And that's something that Senator Hoffman and I have been talking about for the last two months. What happened? Where did the process fail? And why are we disenrolling people that likely had their paperwork done on time? And now we have a continuity of care issue because I know for a significant number of my constituents, they've now been displaced. They are now going into institutions instead of staying at the homes or the facilities that they were already at. And that ruins their continuity of care. And some of them may suffer lifealtering consequences because of that. >> And you know because of that we established in 2026 we established the statewide continuity of care. I mean it it was this legislature that you know did that governance. So, um, uh, those are, yeah, I don't know if there's a response to that, Commissioner, but those are those that gets to the really the essence of of this whole conversation is what Senator Liski was talking about, right? It's like, and we know that there was some um there was, you know, we had heard that, you know, the feds said, "Well, if they don't respond, just shut them down, right?" Well, I I'm not even going to buy into that, right? What I'm going to buy into the fact is all the debate that was going out there, it was still that that point that I just drive home, Senator Liski just drove home there too is that assurance of the continuity care piece, right? And so uh I don't know if you have a a followup with that or if we want to go to uh Senator Holstrom or did you have a follow-up you wanted to do? Senator Liski, Commissioner, >> Chair Hoffman, Senator Liskkey, appreciate that feedback and I think um anytime we've heard an instance, whether you know from you all or from the media of something happening or going ary with the operations of the effort, we have tried to follow up on that. We I to my knowledge have followed up on that, tried to get to the bottom of it and rectify what happened and of course engage with the providers to help them uh move forward in the process. So uh what generally I have been uh reported by staff again understanding that we are not perfect. I said that at the outset is that um once providers have a complete record in terms of the revalidation and all of the different things insurance credentials uh training verifications information about ownership and leadership within 24 hours we're able to refer them to a site visit. So I can't speak to the individual instances but as they've appeared to us either in communications from you all or in the media we we are following up on those and and reviewing and trying to rectify if anything uh needs rectification. And then with respect to the resources uh certainly we did you know and and are thankful to the legislature for resources to enhance our program integrity staff. over 450 folks will be joining us um in the upcoming two years um and and a share of them will be in provider enrollment and compliance. So um we do have capacity needs and the legislature responded to that and we're we're grateful for that investment in the work. >> Thank you, Commissioner. Um Senator Holmstrom. >> Thank you, Chair Hoffman. Uh we were invited to this committee and the goal was to try to keep this as nonpartisan as possible and um we started out with some partisan framing and I kind of want to reenter that that framing under the understanding that um you know we were it was said that the federal government weaponized $2 billion that this was some sort of retribution um campaign and again to recenter this the American taxpayer was defrauded not the Minnesota taxpayer not just them all American American taxpayers were defrauded. These were federal dollars. Um and CMS came to Minnesota and they said, "Hey, let's have a conversation. We're going to put some standards down. We need this to be rectified." And CMS came to the table and they said, "5 months we can do this." That was that was the number that that's that's that uh that DHS brought forward. Um so I I don't understand where this this framing comes from that the federal government is the bad guy here. Uh these failures are our own. Minnesota failed and and this is what happens when you fail. You know, we get expectations set upon us that we need to meet. And to that point, I'm wondering, I'm looking at uh the numbers and I don't see a number provided for how many providers failed revalidation or on appeal due to fraud. Do you have that number, >> Commissioner? Do you have that number? >> Chair Hoffman. Uh, Senator, so I I think it's uh it's an important question and at this point fraud is an intentional act and a crime that has to be proven. So we don't have a number of providers that uh have been proven to have committed fraud. What I can say is that 59 providers is the most recent number that I have in terms of uh different providers that were referred to the inspector general um for program integrity concerns as a result of the the revalidation effort. What I can say though is that since the beginning of 2025, we have referred over 700 cases for investigation by the US attorney and the attorney general here in Minnesota for fraud. >> Thank you for that response. Uh Senator Holstrom and then um go ahead Senator Holst, you'll follow up for that. >> One more followup. Uh so the other goal here is we want to try to get this back on track and I see that there are more in appeal right now than had actually originally been revalidated. Uh so to that point uh how much staff today uh do we have dedicated to that appeal and we you said that you crafted a new appeal process. My concern is that we might we might lose some of the fraud because we have a process that's understaffed and relatively new. Um, so is there do you know that the staffing numbers look like today and is there a plan to increase those staffing numbers so that these providers can be relieved of of some of this pressure and we can get through this while still maintaining integrity. >> Yeah, I think the the the point there you Senator Holster like our whole bill last year was all about that program integrity side of it. So it be maybe in the off take a look to see if there's anything you know that's a gap in your background in 245D you know which is basically the whole just of of human services. It would be nice to get your input on that one as well. But um in response to that and then I think we'll go Glenn. Sorry, we're running I want to get to hear from the providers. So I'm going to go to Representative Nure. Uh I'm going to forego my uh questions that I had because I really want to hear from the providers um in the amount of time that we have about what this did for people that should be getting services. That was our whole conversation. So if we could do that, I would appreciate that. Um and thank you everybody for for hanging in there with me. So uh Commissioner >> Chair Hoffman, thank you. Senator Holmstrom, thank you. So with respect to the number of staff that are working on the revalidation effort, that has been a fluid number. So we our Medicaid uh uh provider uh payments and or excuse me, Medicaid payment and provider services division um has flexed staff to uh to redirect them to the revalidation effort. So at this point um as needed as the paperwork is coming in as the documentation is coming in for the revalidation effort we have flexed and of course as um the the workload has has uh ebbed and flowed throughout the process and as the appeals work has ebbed and flowed and of course we're at a flow at this point given uh the number of appeals we're processing we have more from that division dedicated to the work but um that's been a fluid number but I can certainly try to get you an estimate as of as of today. >> Thank you. uh Chair Nure and then take us into Commissioner. Thank you for hanging out with us for the whole hour here and I just chair Nure's got a couple follow-up questions and then we'll go to um hearing from the public. So, thank you, Chair Nure. >> Uh thank you, Mr. Chair. Um Commissioner, thank you so much. I think from the corrective action there there was about uh close to 20 elements uh that we uh included in there. One of them was the off cycle revalidation which we're talking about right now and one of the other elements was the moratoria. Um the corrective action plan goes beyond just the uh off cycle. It goes up to 2028 in terms of meeting some of those uh uh guidelines that we have indicated that there specific timeline included in there. So I'm assuming that there'll be moratoria for the uh 13 program or maybe less because I've had it's going to be 12 program. I don't know which of the programs uh service area was removed. I don't if you can give us a little bit of a briefing in terms of where we are in general and also if the moratorial will be continued because that the deadline for that was June 27, 2026. >> Uh Commissioner >> Chair Hoffman, Chair No, thank you for the question. You're right. There are a variety of different uh pieces to the corrective action plan. In addition to the the revalidation effort, there is the provider enrollment moratoria. those are renewed in six-month intervals by CMS and of course part of that is um looking at continuity of care and looking at network adequacy. So that's a part of the analysis that we conduct um with CMS every time we renew that. So, we did renew it just recently for the 13 services um in focus today. And as we move forward and look at different program integrity issues, the implementation of the corrective action plan, um we know all of these services may be positioned differently in terms of their their risks and issues. Um I think to the statements we made earlier about um you know different uh trends and patterns among the providers and billing. Um those things I think will look different among the 13 as we move forward. So um when we feel like we have the right controls in place, we feel like um you know billing uh you know is being scrutinized appropriately and things of that nature, um it is possible we can remove that high-risisk designation um and the uh the the enrollment moratoria, but we'll continuously evaluate that. And of course um the moratoria uh happens in six-month intervals or is applied in six-month intervals. Um, Commissioner just following up I think I wanted to check in with you. One of the challenging piece that we have is the provider enrollment processing because that has created a significant delay uh for many providers who are not even under the 13 program because of the requirements. uh that significant delay was was already posted by DHS saying that there'll be delay but to some extent it's actually creating uh issues with continuity of care because some of the the changes individuals are making like the controlling individual or uh what do you call management officials that results into the suspension of payment the billing is suspended for some of those providers some of them since last year since starting the beginning of the January they're billing has been suspended and they've proh provided the documentation necessary to proceed with the program um enrollment uh process. Uh but unfortunately I think that there's been a significant delay. Is there any way to really put that as a priority to make sure that the provider enrollment process is resolved so that no one loses care? Because I'm hearing from providers who are saying they will shut down because they can no longer provide services whereby their billing is inhibited and they can no longer do that because those I don't know if they will be able to appeal the process just the delay because of the provided enrollment is creating the issue. Commissioner >> uh chair Hoffman uh chair no thank you for the question. I want to make sure that I understand the question. So this is an issue with respect to uh new provider or new uh service enrollment relative to revalidation because we prioritize the revalidation effort um and providers being unable to build because they're unable to enroll in in certain service lines. Is that is that the question? I want to make sure I'm responsive. >> So it's a twofold. Uh as part of the uh provider revalidation, there's so many changes needed to be implemented to make sure that they're in compliance. So we're looking for that compliance requirement. But one of the other big challenge is regular enrollment [clears throat] changes now triggers payment suspension to those uh providers and the care the contin of care now is significantly impacted. In fact, I was talking to a provider who was told that because of they submitted their documents on January 23 and they were supposed to send it January 20, they'll still wait uh in the uh process. And likewise, I think because of the rules that we have, if there's any additional requirement from the department, you go back to the lane uh for 30 days and then if and if there's something new, that cycle needs to end. Commissioner, I think there's a problem with the provider enrollment that I think needs to be prioritized in order to make sure that we do the same process continuity of care impacts everyone regardless of the 13 high-risisk program. But quite frankly, that is one of the challenging piece that we see at this point. >> Uh, Commissioner, >> Chair Hoffman, Chair North, thank you. Yes, this is something that's been brought to our attention in different meetings with providers and certainly we hope that as we work through the appeals that we are processing now that we can then revert back to more regular business so to speak that we can start working on some of those uh different uh provider enrollment uh submissions and that workload. So it is something we're aware of. We do want to pivot back to that business. We understand that providers uh seek to make changes to their service mix. um and and uh we want to engage with them and make sure that we have access to care. Um so we'll we'll continue to work through the appeals and hopefully uh be able to uh rebalance our our workforce back to that that uh workload as well. The other thing I just wanted to add to is we're aware of some other issues like service agreements um and are trying to speak to those issues as well um through different uh different uh approaches that providers can take in terms of issuing a service agreement through the the termination date or the ending date of their enrollment and then working with uh lead agencies to resubmit a service authorization if needed. And that's specifically for CFSS and PCA services. for the other high-risisk services, they can submit that or they can uh receive a new service agreement now. So, we have rectified or clarified that issue. Um, but we'll continue to work through these issues with providers and of course rebalance staff according to um the need and the workload as it comes in but but aware of the issues and certainly want to continue to work on them and and in partnership with you. >> Mr. Chair, thank you uh commission. I think one of the other followup is because those changes need to be done through the MN login. We are seeing a significant problem which I'm also concerned this is also starting to have an impact to recipients which requires also if they cannot validate themselves they have to go to the registars's office to pro to get a documentation for them to be authenticated to in order to receive services that's a different topic but it's also having a significant impact for those who are trying to access the portal to upload those documents and I'm hoping we can have a quick turnaround on the login. MN I hope we did not undertake the changes during this whole uh crisis uh timeline that we have that we ended up changing the technology. Uh one other piece that I just wanted to note through this revalidation process we've seen providers who've been providing services for actually more than 10 years who have been given the documentation to provide service under specific program. All of a sudden they're being told that you don't have the right credentials. In fact, some of them I had checked the Minnesota healthcare program. When I checked, everything looked fine and then all of a sudden, even if when they appealed, those services now completely terminated and then removed from the Minnesota healthcare program and they've got nowhere else to go because they don't know what to do next and it also impacts that continuity of care. I'm hoping we can find resolution on multitude of issues and you'll hear from the testifiers today who will be talking about that. Thank you. Um, Mr. Chair and Commissioner, >> thank you uh, Mr. Chair. I want to thank Commissioner Connelly for um, coming in and your willingness to answer really difficult questions, but the system this system is about the people that we serve and and the providers and and the fact that we're we should be fully transparent and and aware of what's going on. So, I appreciate you coming in front of this committee to have this conversation. This this kind of spells out what we need to be thinking about in the upcoming session as well. But, uh, thank you for your time. And with that, um, Commissioner, I again appreciate you being here. Um, members, we're going to transition. I had originally, there's 11 people that are testifying and we were thinking we could do 3 minutes each. I'm asking you to go to 2 minutes, but I'm also I noted that a lot of people that had testified for the record, um, you had sent letters in as well. All these letters will be part of the of, uh, the committee record and and be shared with, um, the department. Uh, again, thank you, Commissioner. Um, and so with that, I'm going to ask if you'll also send us letters, or if you did not send a letter in as well. But, uh, we're going to go to Zoom first. Members, um, Linda Fairchild, owner of Fairchild's Foster Care, and then up will be Lance Egley will be second. Trisha Brisbine, if you're in the, um, hearing room, why don't you work your way down to the table? And Fatima Mullis, you can work your way to the table as well. So, um, with that, Linda Fairchild, you're on Zoom, I believe. >> Hello, Senator. Honorable Senator Hoffman and Human Services Committees. Can you hear me? >> Yes, we can absolutely hear you. Thank you. >> Perfect. My name is Linda Fairchild and I'm a family residential service provider in Wright County. I've provided family residential services since 1988, so 37 years. On 53126, I received a termination letter, which surprised me as I had done my revalidation in 2024, but has always been pending. I was first asked to complete my revalidation January 16th of 24th. The letter told me I had 30 days to comply and finish a request to maintain my license. I submitted my information January 22nd of 24 via the online portal. On March 27th of that year, I received a request for more information. I resubmitted that information on April 6th within the 30 days time. And on April 26, 2024, the request detail report for revalidation portal stated complete. Thought I was done. My revalidation, however, kept saying pending. So, I sent notes to the portal stating, "When I print the provider report, it doesn't show what you've changed. doesn't show anything that was modified. How do I know if the documents are correct? No response. My revalidation continued to be pending via the port site until April 26 or from April 26 until May 31st 2020 or I'm sorry I'm trying to do it fast. Um, so from April 2024 till May 31st of 2026 when I was told via letter my record was terminated because I failed to revalidate or to respond to notices in the provider portal and my compliance was not complete. I had gotten no more messages. I had completed all my requested materials. DHS required bills in April billers in April to take a minute training. When I tried to upload my minutes training that was mandatory, I couldn't because my status was still pending. Due to being pending, I couldn't upload. So, I had to call the provider helpline to get this done so I wouldn't be terminated. I waited on hold for 2 hours. They then told me that they couldn't figure out what was wrong. So, I was given a ticket, told that I needed to talk to a provider and roller specialist. The provider enroller specialist said that since I was pending, I couldn't upload. So, I couldn't change what I needed to change, but she was able to help me. She then reviewed all my documents on May 20th so that I wouldn't be terminated on May 31st, but I got terminated. Now, not only has my family residential services home had a budget decrease of 43% because of the flat rate. I got terminated and I had done everything that I was asked. Yes, while this is pending, I can bill. But to the outside world, to everybody that reads the documents related to my home, I am now a fraud risk. I am now in fear that the state could close my doors and remove those I love. That's not fair. I did the right thing. This may be the straw that breaks the camel's back for many family residential service providers because with the significant reduction in reimbursement, it's tough enough to know how to deal with things. And now if I can't keep my license open, that's even more stress. This needs to get fixed. I've done everything you've requested and I'm still penalized. I'm still terminated at this point. I hope this gets fixed so I can continue to care for those in my home and not feel like I'm always in jeopardy. Thank you for the time. >> Thank you, Linda, for your testimony and I believe Senator Lisky has shared your emails that you have sent to him uh in the past uh with a lot of people. So, Lance Eggley, uh, you're on Zoom. >> Honorable Chair Hoffman and committee members, my name is Lance Egley. For four years, I've been leading the provider efforts on systems improvement and paperwork reduction. This gives me ongoing contact with SUD providers and repeated updates. Uh, it includes more than a year working with DHS, a large group of providers, and two national consulting organizations. After May 31st, DHS revealed a huge portion of the programs, I guess you know this now in this committee, were disenrolled. This is going to cause significant problems for clients and providers, which you're now aware of. And sadly, this all would not have needed to happen as severely if there were better communications between the Department of Human Services and providers. Among programs that did not apply, several thought they need not apply because they actually didn't use the risk service peer recovery support specialists and then didn't get letters that they were supposed to receive possibly because yes, Senator Representative Norwe did start a new communication system in the middle of this crisis and they either didn't see them or didn't get them at all. And so they only knew that they were supposed to apply when they were disenrolled. Oddly, this is a circumstance that I think uh Commissioner Connley just said that wasn't supposed to happen if you uh had services on your license, but you didn't use them or that you could could have stated that you don't have them. uh many other programs were disenrolled later because of missing documents and the programs were firmly convinced those documents were never missing. Uh lost documents have been a long-term problem at DHS, especially licensing and the report recommendations for minimizing regulatory paperwork and improving systems for substance use disorder programs already has recognized this as a problem that needs to be fixed and recommended a an electronic fix. It's just not in place. These patterns have been around for years. it's taken a long period for the department to get through the process. Uh another pattern that was identified uh was u building interactions uh between payer operation changes and electronic health record systems that are widely used by providers. So for instance at the end of this revalidation when uh several firms reapplied and they were approved and the turn funding was turned on they couldn't bill for over a week because the portal wouldn't accommodate what the EHR operated on and the HRs luckily solved this problem just one day before it would have been two more weeks before they could bill. >> Thank you. communication problems, underlying interaction problems between computer systems. These are basic problems that have been going on for a long time and they set us up for failure every time we want to deal with a crisis. In fact, they set us up to have more crisis. >> All right. Thank you, Mr. Egley. I appreciate your >> I want to recommend one thing and that is that we need a a recess hearing on the DHS report so that we can get enough attention back on it to do something. Thank you. >> Thank you. I believe that's the optim report and I'm waiting for somebody from a certain Senate district to send me a piece of paper to sign. So Trisha Brisbine, you're next on Zoom. >> Thank you, Chair Hoffman and members of the committee. Charlie was not having it with mom leaving the house today. So, thank you for the opportunity to talk to you via Zoom. I'm a disability advocate and mother of Charlie. Charlie has intellectual and developmental disabilities. The efforts to prevent fraud and ensure accountability among Medicaid providers are important and necessary. However, the implementation of this provider revalidation process has had serious and unintended consequences for motans with disabilities, many of whom have experienced significant disruptions in essential services. The impact on these individuals and families has been profound. I'm going to give you just a couple quick instances. friend of mine, a mother of four children who receive services, four children with disability services who rely on personal care assistance, PCA services uh for their daily support needs lost all four of those child the child's PCAs with little notice. Now remember these services include basic things like bathing, eating, toileting. The family was told that the provider was not revalidated because a required DHS site vis visit had not occurred despite the provers's efforts to schedule one. In another case, a young man living with his parents lost his PCA services and supports when his agency failed to receive that validation. family was told that the denial resulted from an administrative discrepancy because some documents listed the former business manager who had retired and other documents were updated to reflect the new business manager who had taken her place. Finally, there was one adult with significant disabilities that has been without essential inhome services for more than a month. She uh the resulting unmet care needs contributed to a medical crisis that ultimately required a week-long stay in the intensive care unit. I think we're all very happy to be able to say she's still with us today because we weren't sure that was going to happen. These are not isolated incidents and these results have been devastating. Uh just a few thoughts after hearing everything that I have today. So these providers were given DHS approval to provide uh they they submitted all the necessary documentation when they established as a a service provider and each time their cycle came up whether that was three or 5 years most of them could get get done what they needed to but in the last five months that many providers had problems coming up with it. And we keep talking about services again. Remember that these services are basic needs. So we should be asking our participants able to continue receiving services throughout the appeals process. I've heard some dancing around this issue and I think that you know there may be different times when they are able to but not always. And the more important issue is what is in place to protect the continuity of care when any necessary services are denied or terminated. Thank you chair and members of the committee for your time. >> Thank you uh Trisha and hi to Charlie for me William. Thank you Fatima. Welcome. >> Thank you. Uh good afternoon chair Hoffman and committee members. My name is Fatima Mus. I'm the co-founder and the chair of multicultural autism action network man. I'm also a mother of a son with profound autism. I'm here today not just as an advocate but as a mother carrying the pain and the fear of an entire community. I need you to understand what's happening to families right now. Our phones have not stopped ringing. Parents are calling us crying, panicked, desperate, asking, "What do I do now? Who will help me? How do I keep my child safe? I spoke with a mother caring for her adult child with complex medical needs who must return every two hours to prevent serious harm. Because of the service suspensions, she lost all of her staff overnight. She has not slept. Imagine being afraid to sleep, to close your eyes because if you fall asleep, your child could be harmed. Imagine lifting, turning, monitoring, and doing everything alone until your body gives out. That's not caregiving, that survival. And this is not one family. Parents across our community are collapsing from exhaustion. Some are quitting jobs. Some fear their ch children will end up in the emergency room, hospitalized or institutionalized. Not because they are failed. They failed as parents, but because the support holding the families together was ripped away. Summer is here and our children's needs do not disappear when school ends. Children with autism and disabilities need routine behavioral support, supervision, and consistent services to remain safe and regulated like my son Noah who was up the last 24 hours. These services are not luxurious. They are lifelines. They are the difference between stability and crisis, between safety and danger, between survival and collapse. Please do not reduce this to paperwork or policy. This is human suffering. Tonight, when you all go home to sleep, many parents in our community will remain awake, lifting, turning, monitoring, and deescalating, praying their child makes it safely throughout the night. Families are drowning. Please act now. Thank you for your time. >> Thank you for your testimony. Thank you. >> Thank you. >> Um, Dr. Larson, Amy Wyn, and Oga Shabaliva. I hope I said that right. Um, Dr. Larson. >> Thank you, Chair Nure and Chair Hoffman, members of the committee. I'm Dr. Eric Larson. I'm the chair of the Autism Treatment Association of Minnesota. I'm a licensed psychologist and I've been providing intensive early intervention services to kids with autism in Minnesota for 40 years. Um, our program, the EIDBI program, is a heavily regulated program that is not suffering disenrollment terminations because of credible allegations of fraud. Instead, it's about a rushed effort to complete a large amount of paperwork using a very antiquated uh documentation submission system. I'll skip over all the uh details. There's so many different glitches that occur for each provider, but the average provider that we're talking about uh goes through three to four cycles once a month of submitting forms, getting feedback a month later that the forms are incorrect in one way or another, uh correcting those and then getting new feedback a month later. So most of us were not able to get a site visit uh by the deadline and were then disenrolled because we hadn't completed the requirements. Uh our request is that there be a temporary waiver of the restrictions on enrollment of new providers that we hire to provide the services to our families and a waiver of the restriction on authorizations. So each one of our kids are required by DHS to submit a new treatment plan for every 180 days of services and our providers are not able to submit those treatment plans right now. uh DHS very genuinely um opened up the ability to bill for the services, but if we can't get the services authorized and we can't enroll the new staff to deliver the services, then we can't bill for the services. So, we're watching um an increasingly lower and lower number of potential billings coming in every two weeks. Uh and the conclusion of our fellow providers is that the uh on average we can last about 3 months of uh services before we run out of the uh funding we need to serve those kids. And if we use the projection from uh Commissioner Conny's report, um it's going to take DHS uh 7 months to complete all of the revalidations and uh our providers will have to conclude services within 3 months dating from uh June 1st. So, we're asking for a waiver of the current restriction on submitting authorization requests and uh enrolling new employees, >> you know. Thank you, Dr. Larson. I've known you for many years and and back when in 2000 even 2001, it goes way back to when when there was a debate over EID autism services and and ICI, you had those two different camps. your your name, your face has been part of autism services um not only just here in the state of Minnesota but you know nationwide and to hear you say the system failed you failed the people the the many many people that I've known your work is done for I'm I I hear you and I and I hope the commissioner is hearing you on the waiver side of it as well. So, thank you for your testimony. Um, and thank you for your service for many years. Amy, when Amy's not here, >> hi. Can Can you hear me? Okay. >> Oh, you're you're on Zoom. I'm sorry I didn't have you down at Zoom. I should have had you right away. So, go ahead, Amy. Um, >> yeah. So, chair and members of the committee, my name is Amy Wyn. I have served as program director for the Pineberg Group Home for the past seven years. We're a nonprofit provider located in rural northern Minnesota that has served people with disabilities for over 45 years, currently supporting 39 individuals. Our organization is one of the many providers affected by the recent revalidation process. Despite completing our revalidation requirements by March 2nd, not a late May submission, uh DHS disenrolled us and immediately suspended our payments for all of our service types on May 31st, including our programs not on the list of 13 high-risisk service types. Although payments were later temporarily reinstated, as of today, our organization still has not received all amounts owed to us, and DHS still has not completed its full review of our appeal, including our required site visit. Our situation remains unresolved, and if DHS does not complete these steps before its next deadline. It's unclear what will happen to providers like us. What does work with us really mean? And does that mean payments will continue? We completed our revalidation and appeal on time immediately as directed in consultation with a DHS representative and an outside expert. We have had no findings of fraud, wrongdoing or non-compliance. Um I also want to note that we were never uh required to revalidate until 2025 and that submission was still pending review when we got our most recent request. 2025 submission disappeared from the portal. We have never been asked to revalidate every 3 to 5 years as stated here today. DHS has publicly stated that they completed their review by the deadline. That is not what happened here, not only in our case, but for many providers. They did not complete required steps. The public messaging has been misleading and lacks transparency. Providers like us are being grouped into statistics that suggest non-compliance and fraud when in reality uh DHS didn't meet their own obligation. This has caused significant damage and trust uh between DHS and providers. We continued providing care without reimbursement for almost two weeks. And as a small nonprofit, we do not have the reserves to operate for long without payment, about 50 days to be exact. If we cannot sustain operations, the impact of this goes far beyond our organization. To the more than 60 employees who depend on these jobs, the local businesses and community that rely on our presence and patronage, and most importantly, the individuals who rely on us for their homes, care, and stability. We did our part. We followed the process. We met every expectations. And yet we are the ones that are at risk. We are left with no reasonable alternative but divert time and resources away from serving vulnerable people in order to defend our ability to continue serving them. This is not accountability. It is not a provider failure. It is a system failure and it needs to be corrected before more vulnerable people are put at risk. These are not numbers to us. These are people we know, people we deeply care about, people whose lives depend on the care we provide. We are asking for accountability, transparency, and a process that protects vulnerable motans, preserves critical services, and prevents situations like this from happening again. Thank you for the opportunity to speak today. >> Thank you, Amy. Um, I'm going to have uh Olga Chevaliva, you're you're next. And then Susan Rosette and Mark Ma, if you want to work your way down to the table, that would be great. Miss Cheviva, >> Chair Hoffman and committee members, thank you for the opportunity to testify. I'll try to be brief. Uh, my name is Olga Shaveiva and I serve as the vice president of Metropolitan Community Services. We're a nonprofit multipety essential community provider serving approximately 430 people through our inhome service programs. We're also a culturally specific provider specializing in services for Minnesota's Eastern European communities. Um the issue I came to talk about is to share our experience um about a failure of a site visit due to managing employee information that DHS determined has not been disclosed. Our agency believed that all managing employees have been disclosed multiple times in response to DHS and managed care organization requests over the years. Because of that understanding during our site visit, we fully and transparently identified all managing employees including their names and positions. when questioned by the surveyor. Following the visit, however, we received a termination notice from DHS stating that our enrollment was being terminated because we had failed to disclose management uh officials. This came as a surprise to our organization. Both my supervisor and I were under the impression that this information has been submitted through the MPSC portal. After receiving the termination notice, we reviewed our records and found that the information was no longer reflected in the portal. It's possible that the air was originated on our end. However, um while participating in various provider meetings, including DHS roundts, I heard reports from other providers describing similar experiences involving the loss of information in the MPSC portal. This suggests that the issue may warrant um a further review to determine whether there are system or process challenges contributing to these outcomes. The consequences of enrollment termination are immediate and significant. Our agency immediately lost access to minutes eligibility verification, service authorizations and billing submission functions. This created substantial uncertainty for our staff and concern for the individuals who depend on our services. The loss of access to service authorizations creates barriers for new participants who are ready to begin services as providers cannot admit them without an active service authorization. The inability to submit claims creates additional financial hardship for providers who have already faced significant financial strain due to recent DHS prepayment audit, the liquidation of UKare and delays associated with um transitioning members from UKare to other health plans. Significant delay de delays I might add. Um, we respectfully ask policymakers to review their validation process, improve communication regarding enrollment requirements and establish safeguards that prevent immediate service disruptions when administrative discrepancies are identified. Consideration should also be given to corrective action periods or temporary access protections that allow providers to resolve administrative issues before enrollment is terminated and services are disrupted. Such measures would help protect providers, preserve access to care and ensure continuity of services for the motans who rely on these programs. Thank you for your time and I'm happy to answer any questions. >> Uh thank you so much for your testimony. We'll now go to Susan Rosette. Please introduce yourself and proceed with your testimony for two minutes. And uh Mac, Ken, and Paul, please get ready uh to come to the testifier table. >> Thank you, Commissioner Chair Nor. Uh, [snorts] my name is Susan Rosette. We got um magical chairs going on here. Um, my name is Susan Rosette. I'm from Cardinal Comfort Care Cooperative and we are in Two Harbors, Minnesota uh right on the beautiful lake of Lake Superior. We provide 245D services, inhome services, and also the essential non-emergency medical transportation. We are the only uh non-emergency medical transportation in Lake County and we provide uh services from Grand Portage all the way down to the Twin Cities and there is a tremendous need there. Um I've heard so many wonderful, you know, good stories about what has happened to providers and I'm here again. I was here earlier this year and but I'm here this time with practical solutions uh to the ongoing DHS issues. Um home and community based services are critical to the safety and well-being of our communities. We all know that and the unprecedented challenges of our organization [snorts] has faced over the past eight months have significantly reduced our ability to deliver care. So we have experienced an approximate 70% reduction in client care capacity for DHS workforce stability and the overall provider operations. And the state is currently holding over $60,000 in services already rendered. So, as we have to navigate staffing in order to make sure that we make payroll, it it hasn't been pleasant at all for the past few months. A major contributing factor has been ongoing prepayment reviews required for the continuation of our services and this process has created an unpredictable unsustainable financial environment. We do not know which remittances will be paid or when the payment will occur, making it extraordinarily difficult to manage payroll, maintain staffing and ensure continuity of care. It is not reasonable to expect a professional organization to operate under these conditions. The impact is not only operational but is deeply human. These disruptions directly affect vulnerable motans who depend on consistent reliable supports to remain safely in their homes and communities. Many are currently in crisis and remain unserved and underserved throughout the state. We care about all of Motans. I respectfully urge the committee to take immediate action to stabilize providers and preserve access to care. Specifically, I asked the state one to establish a provider impact task force charged with working alongside of DHS in a true partnership model, one that values provider expertise and anticipates realworld consequences before policy implementation. require number two. I require formal stakeholder engagement through focus groups or feasibility studies on ongoing service delivery conditions before enacting additional administrative requirements or barriers that impact fair business practices. Uh, number three, provide immediate relief measures that bring predictability to the payment system and reduce administrative burdens that are currently destabilizing the workforce and limiting service access. And four, we all know that there's federal changes happening and I encourage you to prepare and I think we need to prepare and by that I mean um including the option to transition providers and workers into a state employed model to ensure workforce stability and maintain uninterrupted services for motans who rely on care. This is a very important piece to the ask because I think it's like playing chess right now and many of the providers are losing and it's important that we position ourselves so we're prepared for what comes down on a federal level. Minnesota has long been a leader in supporting home and community based services. maintaining that leadership will require urgent attention to the unintended consequences of current processes and renewed commitment to collaboration between state and providers. Thank you for your time and your leadership and your commitment to the people of Minnesota. I would welcome an opportunity to provide additional insight and discuss solutions that support both accountability and sustainability. I would like to add the only reason we are still providing and in business is because we had to pivot to private pay. Private pay is what is making us float. This is a shift from the most to serving the most vulnerable in our communities. We want to serve them, but we've been forced to serve those that have instead of those that do not. that concerns me. >> Thank you. Thank you for coming down from Two Harbors on your trip down. I appreciate that. >> I appreciate >> Mark Ma, you're the owner of Henipin Home Healthc Care, Inc. and then um followed up Ken Bents and Paul Verrett you coming, but I think I see Luella here. So, we'll wait till Mark's done and then you guys can just come on up. So, Mr. Ma, welcome. >> Senator Hoffman, so I can give credit where credit is due so I don't get another termination letter. My wife Amelia is the owner of Henipin Healthcare. By virtue of marriage, we are both owner operators. >> Thank Thank you. And as a constituent, I appreciate you telling me that. >> Thank you. The last time I was in front of a board was TIFF districts in 205. >> Thank you. Welcome. >> We are a three generation home healthcare company. We've been around since 1974. That's 52 years. We've gone through three-year validations because some of our services are high-risisk. We have 18 services we provide. Of the 18, four are in DHS's determined high-risisk services, which means a large grouping of them are not. We happen to have three provider licenses, we'll call them, provider programs. So, we were denied and terminated in all three of them. We had site visits. We turned in our documentation through the email portal. Upon the site visits, all three terminations were for technical issues that made no sense. They could have been determined in about five minutes each one site. First of all, we only have one site, but yet three different people came out doing the site visits. Why wouldn't you send one person? There's there's obviously a disconnect in who put this whole program together because there's so many inefficiencies and waste in itself. The first one came out. They talked to my HR person. He's a a managing person. They asked him about being on the board. He shows up to the board meetings. He's not a board member. We only have two. The president, me, CEO, my wife. When they went back, we got a termination letter stating that uh Brad had stated he was a member of the board. Not the case. Bad interpretation from the person did the site visit. Second one came in and asked about who's the owner. My wife and my HR person are sitting next to each other for the interview. She says she is. They went back and determination the the termination letter and that one stated Brad Wing stated he was the owner and oper owner of Hannibal Healthcare did not match the portal. Termination letter number two. The third one we got we were terminated because they said I was the designated biller on record. I'm not in the portal because nobody had mentioned we need to be in the portal and put my name as a designated biller. They asked a question. Again, we filled online all the information out stating who was your designated biller. They stated me. When they came there, they asked us. Now, in order to be a designated biller, we were grandfathered in. That's a new requirement. We've been around for a long time. I actually had to go sit through two 4-hour trainings backtoback on June 2nd and June 3rd. Let me tell you, they sent me an email, a link to a webinar on June 2nd. The moderator said there's about 200 providers in that seminar, which meant there were going to be 200 the next day on Wednesday. The third, I get to log in, go to click the blue box from the DHS portal. Cannot get through. Pay $200 to my IT tech to try to figure out how to get me through here. He says it's broken at the department at DHS's side. This is DHS. How can this be broken? We finally get on by cell phones. Other competitors of mine are texting each other back and forth. Are you on? Are you on? We decided amongst a group of people helping each other out. These are competitors. We got on through watching a webinar. Can you watch a webinar on this right here at the DHS doing statistical presentations? You cannot. They at least acknowledged. But they said if you didn't get on this presentation within a timely fashion, you had to start again in July. Thank goodness we were able to get on about 45 to an hour late. They still never acknowledged to anybody by email that that was broken. just turn around and say we're going to have this tomorrow when we can fix the webinar or the next day. So when you talk about putting loopholes and things that we can operate in, this is just kicking the teeth after kicking the teeth and that so many people have different issues. I've heard so many elegant speakers come before me. We're in this business because of compassion and we're all passionate because why? We take care of the vulnerable. We all hate fraud. Trust me, we hate it. You need somebody in charge of it who can deal with it. DHS is the wrong entity. I've watched situations over years of bad companies, bad players happening. We don't have anywhere to report it. There used to be a gentleman at the state of Minnesota named Tom Newman had a good fraud department. You call them up, you send it, you look up, that person's gone out of the program. That that staff, no more umpy number for that PCA. Now you report it. They just moved to a different company. Nobody cares. These are very hard times amongst this situation. UKare folds. UKare was a very large payer. You all know that. Just let it go. Nobody cares. That's a financial burden. Now we're getting these audits, the quarterly audits holding money back. Now you're getting the prepayment review holding money back. At what point do we just give up and make jelly beans and t-shirts? It's a it's a it's 101. These people are someone mentioned up here that the hospitals will be inundated. Not today, not tomorrow, but when they're not getting their care, they're going somewhere. And you guys already had to bill out HCMC for how much money? They're not going to handle it. Our industry takes care of people for a much cheaper cost. After our years of service, I can only say this is a betrayal. Now, I know you guys are elected and gals are elected. So, I appreciate your service. I've been elected. It's a it's it's a tough thing. Um, I've emailed people. I've tried to go to federal people. They won't answer me back. They won't come back to me and say, "Hey, what's your concern? Let me what can I help?" I've tried to talk in the federal level. This is like you put two two older brothers in a room to fight and the rest of it got thrown over the board on the ship with no life jackets. Just trying to defend what it is. I have other companies trying to call my nurses. Oh, I heard you guys aren't licensed. Come, come work for us. I got clients. What to do? We have as of July 1st started putting our mental health patients on hold. We can't service them. Not the ones with MA. Years ago, 6 months ago, I would have said, let's go to a tier system, two tiers, two-tier system, Medicaid, Medicare. I have to deal with two payers only. Now I turn around and say let's get rid of let's get rid of the Medicaid MA and let's go to all HMOs even though I hate them but let's go to the HMO system because they can manage things better. My solution for this revalidate everybody right now then go back and slowly make them good. We are not the fraud providers. Find them. They probably quit within two years because why? You have to be reertified every three. We just had our home care license come out. Three people spent a week in our office in December. A week seeing clients, seeing staff knowing we were a real company. We just had our substance use program. Three people again for a week in our office in March. They know we're real. But we get lumped inside of of being a terrible company. We might as well just be the ones that the auditor came in and said, "We went her last visit was a place with just sheetrock on the walls, poly plastic. It's still under construction. Nobody's there. We are considered the same as that that company. Senator Hoffman, I appreciate your time. Distinguished elected officials, I appreciate your time. And the ones that aren't here that are by Zoom, uh, you got a lot on your plate, but DHS is a problem and they're the wrong people to find fraud. OIG also wrong people to find fraud. You allow them to go back to DHS and overturn in decision where where somebody actually went to court and won. So that whole process there is a backwards position. I don't know what the answer is. I don't say I'm frier, but I'm sure plenty of us providers could show you where the fraud is. You just need to listen. Thank you. Graci Thanks, Mark. Um, last two. Ken Bence, uh, from ARM, and then Paul Ver, you want to you and Luella, are you both coming up? So, let's get the three. Go ahead, Ken. We'll get the two folks from the counties here. Um, thank you people for having patience. I, um, started to have a little anxiety over the clock, but this is really important stuff. So, I appreciate everybody for hanging in there. And, uh, with that, uh, Mr. Bence, >> thank you. And good afternoon, Chair Hoffman, Chair No, Vice Chair Gilman, and committee members from both parties or, excuse me, both bodies. Um, for the record, my name is Ken Ben. I'm the director of research analysis and policy at ARM. And rather than repeat what you've heard from directly from providers, um there's a few highlights that I want to make um on some general um concerns of ours. Um our providers are still have serious concerns about this process and our hardworking honest organizations feel that their ability to provide care is being threatened. I want I want to acknowledge that we have had some productive discussions with DHS, but the issue around provider communications is still one that we are concerned about. Um providers are having a hard time getting questions answered, getting through to the provider resource center um and being able to find out what is missing from the documents that they have submitted so that they can get their um appeal completed and um get their license back and going. Continuity of care of course is a major concern. Um and so we know that there are providers out there who have appealed who still have not had their billing reinstated. And uh Commissioner Connelly mentioned earlier that for those who did have um billing reinstated, there is now a fix to be able to allow them to get service authorizations approved and [snorts] um renewed. We have not seen any communications on that yet. And so I'm not sure that providers have experienced that or are aware of that. And so, um, being able to be able to bill for all the people they're supporting is crucial because right now they're providing services for many people for whom they can't get paid. Um, a couple other things also, um, our providers are concerned about the continued barriers, um, in making payroll and getting financing because as representatives mentioned earlier, um, lenders are less willing to extend uh, bridge financing or are putting um, uh, rates much higher because these are considered high-risisk providers. now um because they are seen as less stable, they're having increased turnover and you already know about all the uh workforce crisis that's happening in in this sector and this is making it worse. And then also as you know emergency departments and hospitals then become the backs stop when residential staffing collapses. That puts more burdens on counties and case managers who have then have to scramble and find placements for these individuals on the whole continuity of care issue. And we want to try to avoid that. And the last thing is as has been mentioned earlier just the perception in the public that these thousands of providers who are disenrolled and are still in an appeals process in the public's perception is they're were disenrolled because they were fraudulent and and committing fraud. And in the vast majority of cases that is not the case. We are concerned about the providers who are in the appeals process ultimately getting their records cleared because in the first month since May 31st we've only seen just over 300 um appeals completed and so we think the pace of this may take a very long time. So with that I will allow the next speaker to to uh speak and we thank you for your attention today. >> Thank you Mr. events. Paul, >> Chair Hoffman, Chair No, members of the committee, thank you so much for this opportunity to testify. My name is Paul Verrett. I'm testifying on behalf of the Minnesota Association of County Social Service Administrators. Um, and I want to be clear that we're testifying in the spirit of constant systems improvement, a value we all share. And I also want to have a particular focus on continuity of care from the county level. And then I also have with me uh Luella Coffer from Henipin County who can speak on an individual county le uh level and is a subject matter expert. Uh Maxa and the Association of Minnesota Counties. We were notified at the beginning of the revalidation process and also a few days before the 531 deadline that there would be a larger proportion of uh providers who would be disenrolled than expected. Um after those communications went out we started working with uh providers from the county and started making our own preparations for continuity of care. Um initially the resources we had available there were no new resources and as you know there there is no single comprehensive database of providers and openings that we could use to match people quickly to alternative care. um county staff might have more experience than some individuals seeking care, but we essentially depend on local experience and the ingenuity of our staff. Um after that, DHS began providing the weekly update meetings for the counties and tribes and we started receiving lists of people and providers who were potentially impacted by disenrollment and the appeals process. DHS staff were also available to county staff. Uh unfortunately during that time we were also receiving reports from providers about um not being able to get calls back about their reertification revalidation processes. Um and I want to go on to some very specific points that might be things that we need to pay attention to immediately about continuity of care. I mentioned before that we were receiving weekly lists. We receive um lists of people who are potentially impacted. Um the lists are very difficult to use. um they're Excel lists that come through a secure source with the state. Um and in the case of one medium-sized county, they had more the last week's list had more than 7,000 lines on it. And uh some of the things that are difficult result in us not being able to triage the list. So, county staff have to go through the list. Um county staff need to know more about the statuses of providers on those lists. And we also need to be able to easily see who is who should be worked with first, who which providers are in the most danger of um closing and um equally important which people are in danger of losing residential services and then anything else we can use to find high acuity people that we serve. So again, those lists we're very grateful that we're providing were provided with them, but we need help being able to triage people on the list. Um, additionally, and this a lot of this is just um anecdotal, we hear a lot of that the status of the providers when we hear directly from them, it's not always the same as what's on the list. And we understand that that might have to do with just the speed of updating information. Um, the impact of all this is that we are basically at equal risk of trying to help people who are not in as much danger of getting care as those who are in the highest danger. So, we need to be really we need ways that we can actually triage that. I just wanted to repeat that. Um, while we haven't formerly surveyed our members about this, we check in regularly with the counties to see if they're aware of clients losing care. Um, so far it sounds like it's a smaller amount, but we think u from what we've heard from providers that people are going to soon during the appeals process, if it takes too long, they'll reach the limits of what they can do with their their um cash reserves. if payment is interrupted or any other issues um carry on. Um so we're not hearing of very many losses, but we know that this could change if there's any problems. Thank you again for the opportunity to provide the testimony on this subject. And now I'll turn over to Luella Coffer from Henipin County. >> Thank you, Luella. Welcome. >> Uh good afternoon. Thank you, Chair Hoffman, Chair Nure, and members of the committee. I'm Luella Coffer. I'm the senior department administrator for access aging and disability services at Henipin County and I'm also one of the co-chairs for Max's adult services committee. I'm here to speak uh today a little bit about our county's experiences. Um it's a complicated, confusing time. The county goals the same as everyone else is here to support people well and to ensure they can receive the services um to meet their assessed needs. We're partnering with DHS and providers to ensure we have the information that we need in order to support case managers to meet the needs of the people they're serving. Right now, our leadership in our county is focusing on getting clarity where needed and planning in the most critical areas. Thankfully, we have been able to leverage some processes we've already had in place, including communication pathways with contracted and uh county case managers and a provider response team. However, the scale and magnitude of what's going on has created tremendous pressure even for a county who has those kinds of resources. As you've um heard today, currently our county receives the two weekly lists. We are very thankful for information. Operating without that information was even harder. Um but those um lists, they have some limitations as we've been hearing. The lists are intended for planning. So, we recognize a provider's status may have changed. These things are being updated by the hour. Also, as you can imagine, the list of people who could potentially be affected by a provider's uh termination is lengthy in a county of our size. So, we're balancing ensuring continuity of care for the people we're supporting with providing accurate information and direct direction to all of our case managers. We've focused our initial efforts on understanding the current situation for those people served by waiver providers who have a disenrollment termination final status and a provider not yet appealed status. That involves talking directly with the provider and getting clarity from DHS if needed on that provider status. In fact, my team was meeting this afternoon with DHS staff to get clarity on some specific provider records. We're also calling all wavered services providers. We're crossing our information that we gather from them with what we're understanding from the DHS lists, focusing first on residential providers and crisis respit providers. Related to continuity of care, when a case manager needs to support finding a new provider, it means cold calling from provider lists or utilizing their network. There aren't statewide lists, as Paul was mentioning, of providers available who um we know will accept uh new people. So this is all a huge undertaking by itself and really there's a a cumulative effect since provider revalidation as we all know isn't the only thing happening right now. Uh for when supporting an individual person to our case managers it may not be clear what could potentially be affecting their continuity of care. So we in our county and as leadership we're working to act quickly but with accurate information. Thank you for your time and the opportunity to speak today. Uh Luella, I'm so glad the counties that you came here because that's, you know, we talk about where services come, >> you know, and and ultimately the lead agency in this case is the county. So, I appreciate your feedback and thank you for being here. Thank you to everybody um for being here today. Uh, I want to thank Commissioner Collie uh again your willingness to answer some really difficult questions um because that's what we we want. We want to thank I want to thank the providers, advocates, and individuals and families who shared their experience. Um this is going to be my last statement, Jordan, but if you I I really need to get going because we've went beyond uh what we're doing. So, I was going to uh adjourn us, but if you have a couple of comments you want to make, go ahead. I see your hand is up. >> Thank you, Mr. chair and I I appreciate um this hearing today and getting the update from the Department of Human Services and also hearing from providers around the their experiences and I think we have a lot of work to do and I I hope that uh the conversation over the interim on this issue continues uh to make sure that we're protecting Minnesota taxpayers um while also ensuring that motans who need these services get these services. Um Mr. Mr. Chair, I just did I had one question before we adjourned today. Um you had mentioned that you were waiting on um something to have the optimum report released and just wanted to see if if you could clarify what uh we're waiting on for that that OPTI report to be released to members of the Senate Human Services Committee. I had thought, Jordan, that I had to sign a piece of paper requesting it. But I'll tell you this, Schumacher uh his final uh duty as a chair was to put in that request on behalf of uh the chairs here and you. And so um that that uh apparently is in the in the works. We we should I don't know when it we'll be getting that, but uh I I was given that update. I thought I was waiting on a piece of paper from uh you but um ignore that. So there you go. But I think Shoemarker took care of everybody here. Is that correct? My understanding too on that. Senator or Representative Mure. >> Uh thank you Mr. Chair. I think there was an email request that was sent to the commissioner requesting a follow-up because of the legislation that we passed in requiring that uh the information stays within the human services uh >> uh committee. So at least I think that request was sent in. >> Thank you. That's correct. So thank you to that. Um members, I just want to today's uh hearing reinforced some important realities and I was jotting these down is that program integrity and access to care are not competing priorities. They're complimentary responsibilities. Um we do motans deserve a Medicaid program that protects our taxpayer dollars but it ensures that qualified providers can deliver care without unnecessary barriers. This hearing also demonstrated the tremendous pressure that was placed both on the department and the providers as we worked to meet those aggressive um expectations that were in front of us. That context matters. Um we also heard clearly that communication, consistency, and predictability matter. Providers need clear expectations. They need timely responses. They need confidence that when they follow the rules, they can continue serving motans without unnecessary interruptions that with that um there are still um providers are still seeking answers. There are individuals and families concerned about continuity of services. Um there are still opportunities to improve the communication, streamline those administrative processes and rebuild confidence and that must that work must continue. Uh the role of this committee is not to manage the department. and our role specifically is oversight. I want to acknowledge uh everybody here for being part of that. I also want to acknowledge it's something that is easy to overlook that behind every policy discussion are real people in in every enrollment decision, every payment delay, every processing backlog has the potential to affect somebody's ability to receive care, remain in their home, and continue to live independently. those individuals must remain the center of every decision we make. Um, I appreciate the respectful and thoughtful discussions today and this is how good government works. We ask questions, we listen, we learn and then we act. But at the end of the day, success is not measured by how many applications were processed or how many requirements were met. success is measured by whether motans's most vulnerable residents continue to receive the services they need from a provider network that is strong, stable, and trusted. So, I want to thank everybody who contributed today. We are adjourned. [music] >> [music] [music] [music] >> Hello. [music] >> [music]