[{"_1":2,"_88":-5,"_89":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6349556,"mediaKeyId","2238319-767e214fbeb3651bb6e785222eb0571b","parentId",2238319,"title","Life Skills & Transition Center reports declining census, more short-term admissions and statewide outreach","audioSeconds",4065,"startMs",5975000,"endMs",10040000,"viewUrl","/Search/View?dp=1&key=2238319-767e214fbeb3651bb6e785222eb0571b&start=5975&end=10040","thumbnailUrl","https://assets.pipeline.soar.com/2238319-767e214fbeb3651bb6e785222eb0571b/thumbnail_5975000.jpg","articleUrl","/articles/6349556/North-Dakota/Life-Skills-Transition-Center-reports-declining-census-more-short-term-admissions-and-statewide-outreach","mediaUrl","https://secure.pipeline.soar.com/6349556-49ce96c086048af1975c0799d8813458/orig.mp4?Expires=1776659727&Signature=ZGHnETbOXJlemywazc9WGcMDfI29snLfuoi9vMPqHDjqOxQ6k1sjIiS26OtP7T9uRhCGoWVmO6LMS4ql7xJH19zQZR7ycqnwOD-mH7iA1oALLZbrHHvePDp850CQFffVbXozxkX6-T~6I81WcnJHC01886de6rZntXVByqnqf0-Hy1Wl0ni0wGjZT8ylh90JSolG0N2wMnjWjKGBQURJmf9kSSiZgdBUgJsYHxwpCEQf4U8cIvKg3ietajfmY15y7j1biloOkOInGUMLghmc5ZWEoEgsZbr5ckBrhHHzlZ3G85YjW1lcIBDrkksBr7Sz7ZhugyxaK2nNE3ITeXQEdg__&Key-Pair-Id=KUT5TJCACFTXG","author","State of North Dakota","date","2025-02-03T00:00:00Z","article","Heather Jenkins, superintendent of the Life Skills and Transition Center (LSTC) in Grafton, told the Appropriations committee the center had a point-in-time census of 46 people as of Dec. 2024, comprised of 32 adults and 14 youth, and that the center has focused on shorter-term crisis admissions and transitions to community providers.

Nut graf: Jenkins and HHS staff described LSTC's shift from long-term institutional care toward a stabilization-and-transition role, provided data showing more admissions but shorter stays and explained budget pressures driven by overtime, contract staffing and increased clinical supports.

Jenkins said LSTC serves as a specialized crisis and stabilization resource for people with intellectual and developmental disabilities and offers residential crisis, short-term stabilization, transition supports, vocational services, applied behavior analysis, a statewide crisis stabilization team and adaptive-equipment services. \"We support families and private residential facilities,\" Jenkins said. \"We are not a permanent home, but rather the right service at the right time, helping individuals stabilize to build skills and prepare for future independence.\"

Census and transitions

- Jenkins reported a December 2024 census of 46 (32 adults; 14 youth). Between July 2023 and Dec. 2024 LSTC admitted 22 people, diverted 21 (referrals that did not result in admissions), completed 31 transitions out of the center and had 11 people \"on deck\" for transition. She said admissions increased while the overall point-in-time census fell, reflecting more short-term stays and successful moves to community settings.

- Jenkins noted long-term residence cases have declined; she said fewer than six residents now remain in long-term specialized care and gave a near-term example of a resident who had lived at LSTC for 71 years and was scheduled to transition to a community provider in mid-February.

Services, outreach and equipment

Jenkins described LSTC's nonresidential services: applied behavior analyst (ABA) teams that provide functional assessments and training; a statewide crisis-stabilization team that responds to community crises to prevent admission or to support transitions; specialized outpatient therapy (physical, occupational, speech and aquatic); and a robust adaptive-equipment program that fabricates and modifies mobility and assistive devices and offers short-term loans of gently used equipment.

She said the adaptive-equipment team completed 1,500 projects for about 346 people and provides mobile services across the state; the department contracts with an intermediary called Viridian for some waiver modifications (mentioned during the DD presentation).

Admissions, outcomes and readmissions

Jenkins said short-term crisis admissions (nine since July 2023; eight discharged, one current) resulted in shorter average lengths of stay and a low readmission rate of 5.5% during the period she reported. She said 66% of admissions that triggered a 30-day notice did not result in admission because the team helped identify alternatives or supports.

Budget drivers and staffing

Jenkins said staffing and personnel costs are the primary budget drivers (about 79% of LSTC operating costs). As of Dec. 1 the facility reported 276.44 position slots, 225.48 filled positions, 50.86 vacancies and 71 temporary staff. Average employee age was 49.3 and average years of service 12.2. Jenkins reported a turnover rate of 16.6% (as of Feb. 2024) and a retirement risk of 12.5%.

She told the committee the department uses contracted staff to fill shifts when needed and that overtime and contracted staffing have increased costs; the presentation requested additional general and federal funds to cover overtime and contracted-service needs and some capital repairs including Cedar Grove's roof replacement.

Policy and legislative items

- Jenkins described work to secure alternate billing mechanisms for crisis-stabilization and transition services now largely paid with state general funds.

- HHS staff and Jenkins discussed Senate Bill 2,112, legislation the department proposed to allow LSTC to serve a very small number of youth who are not DD-eligible in narrowly defined, short-term circumstances if no other safe, short-term placement exists. Jessica Thomason (HHS) said the bill is meant to provide a last-resort, time-limited option, not a permanent placement path; the fiscal note estimated a small biennial impact on the order of one youth per biennium in the modeling used for committee materials.

Committee questions and next steps

Committee members asked about regional access to adaptive-equipment services, LSTC's staffing vacancies and vacancy durations, use of contracted staff and the facility's psychiatrist coverage. Jenkins said the center is expanding outreach into western North Dakota and is collaborating with regional partners on psychiatric coverage and recruitment. She offered to provide additional vacancy-duration and contract-staffing detail to the committee.

Ending

Jenkins said the center will continue expanding mobile adaptive-equipment services, pursue billing options to reduce reliance on general funds for stabilization services, pursue dual accreditation and explore options to consolidate underused campus buildings. She provided contact information and asked the committee to follow up on staffing and facility capital needs.","mediaType","Video","parentTitle","House Appropriations - Human Resources Division Feb 3, 2025","oneSentenceSummary","The superintendent of the Life Skills and Transition Center told the committee the campus census has declined while admissions and short-term crisis stabilizations have risen; the center described transition supports, adaptive-equipment outreach and budget pressures tied to staffing and contracted services.","taxTitle","Appropriations - Human Resources Division, House of Representatives, Legislative, North Dakota","taxId",28888,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6349559,"HHS outlines DD services growth, waiver changes and budget requests including host-home pilot",5018,501000,5519000,"/Search/View?dp=1&key=2238319-767e214fbeb3651bb6e785222eb0571b&start=501&end=5519","https://assets.pipeline.soar.com/2238319-767e214fbeb3651bb6e785222eb0571b/thumbnail_501000.jpg","/articles/6349559/North-Dakota/HHS-outlines-DD-services-growth-waiver-changes-and-budget-requests-including-host-home-pilot","https://secure.pipeline.soar.com/6349559-905681f7ad933935a0f33b092c01ef02/orig.mp4?Expires=1776659727&Signature=kfJkwedsa5erMfHRPU2dKZT6kqLOzOHZ~aaaA-kcy0wyXCJOSDU20NAEW4EkVJa9FynR6KL5Y6Sv4ej8Sl4~rXz0vkD3eT-TtodESz82iFLGS-BR2FAJAhyo2tYmqwf8UwDq8eayfo0klgxFXSG~hIzMWvs07EIwervD3mZLkkq1kOnFZyJxunjCsLF-I0eSomS8fBSaraOIjrKRFDGew9HRun62XX7quZ5ZaiSAKZYKvkvDOHJWWjmbg5yeFsmNnO7denMNH44790QPxjQp0P8AbxQqILBcihoZZ889vLg7zQ8hPVExwJ2KixJNZ4GplJD9dsdni7EhM742ErpQVw__&Key-Pair-Id=KUT5TJCACFTXG","Tina Bay, director of the Developmental Disability Section at the Department of Health and Human Services, told the Appropriations committee the section serves about 8,410 people and operates a range of services including early intervention, program management, intermediate care facilities and a 1915(c) home- and community-based services (HCBS) waiver.

The department emphasized that eligibility and service delivery have shifted over time and requested funding in the executive budget for assessment-tool replacement, a host-home service for youth and planning for a cross-disability children's waiver.

Why it matters: Committee members were shown utilization trends and policy changes that affect how many people qualify for services, what services are available and how the state budgets for them. Several of the department's requests would change service access or payment arrangements and could increase ongoing costs if enacted.

Bay described the Developmental Disability (DD) Section's core functions: provider licensing and enrollment, waiver administration, service authorization, guardianship services and program-integrity work including quality reviews and provider audits. \"The developmental disability section is dedicated to ensuring that individuals with developmental and intellectual disabilities have access to comprehensive person centered services that promote independence, inclusion and quality of life,\" Bay said.

Officials told the committee the DD program currently employs 117 program managers, conducts an average of 240 new referrals and 191 new eligibility determinations monthly, and serves about 8,410 people with DD case management supports. Bay showed a 7.8% increase in eligibility determinations since 2019 and said self-directed services and family-home supports are among the fastest-growing delivery modes.

Program and policy changes highlighted

- Waiver renewal changes effective April 2024: Bay said in-home supports may now be provided by a mix of provider-managed and self-directed services; allowable equipment-and-supplies limits increased from $4,000 to $5,000 per waiver year; environmental-modification limits increased from $20,000 to $40,000 (over five years) and may be used in rented homes; and a stand-alone respite service was created with up to 600 hours per year.

- Family caregiver pilot: Bay said the pilot established by 2023 legislation (Senate Bill 2276) launched April 1, 2024, with funding of $2,200,000 for direct services and $300,000 for an FTE and an IT portal. As of Dec. 3, 2024, the department had received 444 applications and approved 50; 62% of approvals were ages 0-17. Bay gave daily rates used in state reporting: $77.45 per day for ages 0-17 and $154.89 per day for ages 18 and older (the department reported an annual average figure of $40,271 for the adult rate).

- Guardianship establishment fund: a $3,000-per-request fund to cover petitioning costs; Bay said 112 requests had been approved.

Appeals, wait list and implementation costs

Bay described implementation tasks tied to the family caregiver pilot and other changes. She noted the law requires a 30-day appeal process when applications are denied and that the department temporarily holds funds while an appeal is pending. As of December the wait list totaled 182, Bay said. The department reported $35,000 in appeal-related costs paid to the attorney general and Office of Administrative Hearings, covered by HHS funding rather than the SB 2276 allocation.

Bay listed IT costs the department incurred for the pilot's portal (about $73,000) and stated the portal supports application submission, uploads of extraordinary-care assessments and a status view for applicants.

Policy and budget requests

Bay presented several requests in the executive package:

- Replace the ICAP child assessment with the child version of the Supports Intensity Scale (SIS-C) and fund testing and allocation consulting: one-time $400,000 (split general and federal) for assessment licensing and consultant work.

- Establish and fund a DD host-home service intended to replace and expand the existing family-care option by adding therapeutic wraparound supports for youth and their families. Bay said the request funds 20 operational host homes serving roughly 20 youth and is an ongoing request totaling $3,379,000 (split general and federal). She said the current family-care option is underused and the host-home model would support family reunification via therapeutic services and vendor-managed host-family recruitment and training.

- Provider inflation: 1.5% per year for agencies and self-directed providers, an ongoing request of $16,800,000 split general and federal.

- Cross-disability children's waiver design and implementation work to modernize eligibility and service arrays, with a three-year design timeline and an ongoing request of $4,900,000 (split general and federal). Bay said the anticipated service start date would be July 2028 and the work includes designing a new level-of-care approach and testing tools.

Changes to eligibility and level of care

Bay explained the department proposes to revise North Dakota's DD eligibility assessment approach so the state uses more modern standards to assess support needs. She described the shift from assessments focused mainly on intellectual deficits to tools that also capture social functioning alongside conceptual and practical adaptive domains. \"We have to be very careful when we're implementing and looking at this level of care so that we don't have unintended consequences of people no longer qualifying for services,\" Bay said, adding the department will test tools, adjust allocation formulas and plan transitions to avoid sudden loss of services.

Licensure, accreditation and provider costs

Bay said the department expanded options for providers seeking accreditation and clarified that provider accreditation costs are the provider's responsibility. She told the committee that under previous payment methodologies accreditation had been reimbursable; after payment reforms the department's budget no longer covers accreditation costs. She cited Council on Quality and Leadership (CQL) person-centered accreditation averaging $20,000 to $30,000 for a four-year cycle, but said providers may now choose among accrediting entities.

Intermediate care facilities and bed use

Bay said North Dakota has 451 licensed ICF beds statewide, with an average monthly bed usage of 389 between July 2023 and June 2024 (86% utilization). She said the department wanted to explore whether some licensed beds could be repurposed for crisis needs while avoiding incentives to institutionalize people.

Outlier requests and assistive technology

Bay described the outlier staffing policy that allows additional Medicaid-funded staffing in extraordinary circumstances when other mitigation was pursued; she provided approval/denial counts for 2022-2024. She also summarized reimbursement pathways for assistive technology: Medicaid state plan coverage requires medical necessity and an enrolled vendor; 1915(c) waivers have caps and differing eligibility rules (for example DD waiver equipment-and-supplies $5,000 per year; environmental modifications $40,000 over five years). The department contracts with Viridian for intermediary services on environmental modifications for some waivers.

Budget and utilization overview

Bay presented DD program budget totals included in the executive request and highlighted that roughly 94% of the DD budget goes to private providers for direct services while about 4% is administration. The department reported a total DD funding figure in the presentation materials and identified the executive request changes for salaries, inflation, and program expansions.

What the committee asked and next steps

Committee members asked for more detail on several items, including cost estimates for repurposing ICF beds, the administrative share of host-home vendor contracts, and how many people might be affected by changing the level-of-care tool. Bay repeatedly said those numbers would require testing and that the cross-disability work is expected to be multi-year and to include careful testing to avoid unintended eligibility losses. She also noted appeals and administrative costs the department currently carries for denials.

Ending

Bay concluded by offering her contact information and appended consulting reports used in the department's planning. The committee did not take formal votes during the presentation; members indicated interest in follow-up details on cost estimates and on the level-of-care testing plan.","Department of Health and Human Services officials told the Appropriations committee the state's developmental-disability programs have grown in enrollment and scope, described recent waiver enhancements and pilots, and presented budget requests for assessment tools, a host-home service and cross-disability waiver work.","actionData","errors"]

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Life Skills & Transition Center reports declining census, more short-term admissions and statewide outreach

HHS outlines DD services growth, waiver changes and budget requests including host-home pilot