75th anniversary year—Continuation of thoughts from Association leaders
April 1, 2022
During the course of 2022, we have been sharing memories, photos, and pearls of wisdom from members new—and not so new. We sent a series of questions to former board members/Association leaders, and we will be sharing some of their thoughts with you over the course of this year, culminating with a summer party in August and a big dance celebration for all members in November. This is the third article in our series of questions and answers from leaders—the others can be found on the
“75th Anniversary: CEO Blog” page.
Q: Reflecting on key initiatives led by the Association during your tenure, what are you most proud of as a legacy initiative?
Loren Colman: There are two initiatives that stand out in my mind. The first is the alternative payment system that demonstrated how responsive Care Providers of Minnesota (CPM) was to a crisis and an early willingness to take risks and be treated like a business not entirely dependent upon government regulations. The second is F.A.I.R. which was a very early initiative to take control of the discussion and recognize that the status quo was not going to serve the industry short- or long-term.
(Anyone remember what the acronym stands for?)
Dennis Kamstra: I would have to say the alternative payment system was a major accomplishment. It lasted longer than any other payment methodology including both versions of rule 50. Many people worked on it including members and staff and it was enjoyable to work on something pro-actively.
Steve Chies: Top legacy initiatives would be CARE-PAC (political campaign) being expanded to facility staff; prioritization of a proactive legislative agenda as a top strategy; and strong Association leadership and resources.
Susan Voigt: In the late 1980s and through the 1990s, many federal laws and regulations passed impacting nursing homes. Care Providers of Minnesota (CPM) staff and board leaders met the challenges that members faced under OBRA ‘87 and OBRA ‘91 with grace, depth of information, and sensitivity for long-term care professionals, residents, and families. OBRA ’87 significantly affected the standard of care in long-term care with heavy regulatory requirements and new scrutiny. Discharge and transfers were no longer an informal process, immediate jeopardy meant something much less severe than a pest infestation or no air conditioning in southern states. Restraints became a thing of the past, and abuse and neglect reporting and investigating became the Congressional and state legislative focus. The new regulations imposed by OBRA ‘87 and ‘91 were shockingly severe and included large fines for violations and resident deaths.
The MN state agency response to these new federal regulations was not to work together with long-term care providers, but to issue heavy handed penalties. Restraint usage was punished with immediate jeopardy (IJ) deficiencies, and a $1000.00 fine issued on a facility when a death occurred. Media published the $1000.00 fines and obtained only the MDH version of the death. CPM worked tirelessly with both MDH and DHS to educate agencies, providers, and resident families about the new regulations. In spite of the heavy fines and overreaching IJ F-Tags issued, CPM continued to meet with MDH and DHS to help slow their enforcement zeal so the agencies and providers could understand how to best implement the new regs to provide for the better care and safety of long-term care residents. CPM convinced MDH to stop publishing the $1000.00 fines in the media, and eventually MDH stopped issuing them. CPM brought members to meet with MDH and DHS to provide context for their implementation of the new laws. The heavy-handedness of the agencies was successfully slowed, and quality of care improved as everyone collaborated regarding a shared goal of good care.
CPM took the initiative to set up an appeal process with MDH on discharge and transfers allowing for both the provider and the resident to have a say about what was the best placement for that resident. That process, as well as a new and improved appeal process for providers who were unfairly cited under OBRA, allowed providers to have inappropriately cited deficiencies removed. CPM worked with DHS tirelessly to get its Medical Assistance division pay for residents who were not at fault for nonpayment due to financial exploitation or in need of emergency Medical Assistance. CPM lobbied the legislature to ensure that Minnesota law allowed for an appeal process of deficiencies under the new regulations, and then developed that process step-by-step with the Minnesota Office of Administrative Hearings (OAH). CPM staff trained and educated the OAH Judges who hear those appeals in order to help them to understand the complex regulations.
Rick Carter: The association sponsored numerous initiatives to measure and improve quality thus becoming a nationwide leader in quality care. Early initiatives focused on voluntary reviews of a facility (peer review) and its quality as well as adherence to regulations and providing resources to help a facility which asked for it or where a facility did not meet the Association’s standards. The effort required each new member to go through this process prior to becoming a member. Although this effort seems very basic at this juncture, it was, nonetheless, very creative and innovative. This program also demonstrated clearly that the association was committed to quality in the performance of its members.
At the same time the association had a focus on quality and performance it also was committed to ensuring the business health of each and every member. In this regard the association was always deeply involved in regulations, regulatory process and, as well, the financing of long-term care which required deep involvement in the State Medicaid program.
Several decades ago, there was a focus on revamping the Association’s political agenda and developing the tools necessary to provide excellent member services from a political/legislative standpoint. The association reestablished a strong political action committee and a program designed to raise substantial sums of money to fund this committee and its activities including becoming a major player in providing contributions to candidates who were sympathetic to long term care and association initiatives. Obviously, the outcomes from all this activity took years to come to fruition but it was necessary to begin to bring the infrastructure of lobbying inside of the association rather than rely on purchasing lobbying solely from an outside source. The association became a very strong and effective representative of long-term care and has been recognized not only within the State of Minnesota for this but also from others on a national level.
Every legislative session since the mid-1970s has had major agendas impacting long-term care. I'm proud to say that both MAHCF and Care Providers of Minnesota has been a major player in each of those sessions in representing the membership of the association. One of the most difficult yet productive legislative sessions was one where, as always, finances were tight in Minnesota. It took a great deal of creativity to come through the session without major damage being done to Medicaid funded care. It was this session where the Association developed what is now known as the alternative payment system. This system which was legislated during that session was never intended to be a long-term answer to Minnesota’s budgetary problems but rather a transition to something new in the future. In spite of this, the alternative payment system was, in fact, a fantastic answer to what could have been a major legislative and financial loss to our members. This session demonstrated the creativity and focus of the association, it’s staff and members. Once members understood this new system and its benefit to facilities, most members embraced it and used it to enhance their financial situation.
Loren Colman: Currently private consultant; Provider leader with Extendicare; Board Chair for Care Providers of Minnesota 1996-1997, Assistant Commissioner at the Department of Human Services from 2003 through 2017
Dennis Kamstra: Currently CEO of Living Services Foundation; Board Chair for Care Providers of Minnesota 1993-1995
Steve Chies: Currently Program Director, LTC Administration, St. Joseph’s College and Independent Consultant; Board Chair, American Health Care Association 2003-2005; Master Examiner, AHCA/NCAL Quality Program; Board Chair for Care Providers of Minnesota 1981-1982
Rick E. Carter: Associate Director of the Minnesota Health Care Facilities (former name of Care Providers of Minnesota) 1973; became Executive Vice President (title changed to President/CEO) in 1983 until his retirement in 2007.
Susan Voigt: Dietary aid at Highland Chateau 1971-1973, Minnesota Legislative staff (House Research and Revisor of Statutes) 1980-1984, legal counsel and lobbyist Care Providers of Minnesota 1985-1989, Attorney representing long term care providers at Siegel Brill Law Firm 1989-2001 and Voigt Rode Boxeth Law Firm 2001-2021, CPM Foundation board trustee, Mn Elder Justice Center board 2014-2021; retired 2021.