|
ARTICLE 1
CHILDREN AND FAMILY SERVICES
Sections 1 to 9 modify the child care chapter of law.
Section 1 (119B.011, subdivision 13) limits the time an adult family member who is not in an authorized activity may be temporarily absent from the home to 60 days. This section is effective April 16, 2012.
Section 2 (119B.035, subdivision 4) reduces the maximum rate of assistance that can be paid for the at-home infant child care program from 90 percent to 68 percent of the rate that is paid for licensed family child care assistance. This section is effective October 31, 2011.
Sections 3 and 4 (119B.09, subdivisions 9a and 10) limit child care assistance payments (CCAP) to child care centers that provide services and receive CCAP payments for children whose parent or a person who resides with the child is employed at the center. Section 3 is effective January 1, 2013, and section 4 is effective March 5, 2012.
Section 5 (119B.09, subdivision 13) prohibits CCAP payments for child care provided in the child’s home, unless certain conditions are met as specified in this section. This section is effective March 5, 2012.
Section 6 (119B.125, subdivision 1b) requires legal nonlicensed child care providers to complete CPR training, effective November 1, 2011.
Section 7 (119B.13, subdivision 1) reduces child care rates by 2.5 percent beginning October 31, 2011. Paragraph (d) eliminates increased payments for care provided during nonstandard hours, and Paragraph (e) eliminates payments for activity fees. Paragraph (d) is effective April 16, 2012. Paragraph (e) is effective September 3, 2012.
Section 8 (119B.13, subdivision 1a) establishes maximum daily and weekly rates and reduces legal nonlicensed family child care provider rates from 80 percent to 68 percent of the rate paid for licensed family child care. This section is effective April 16, 2012, except the amendment changing 80 to 68 and 0.80 to 0.68 is effective October 31, 2011.
Section 9 (119B.13, subdivision 7) eliminates absent day payments for legal nonlicensed child care providers and limits absent day payments to ten days per calendar year for licensed providers. This section is effective January 1, 2013.
Section 10 (256.987, subdivision 1) requires cash benefits for GA, MSA, and MFIP to be issued on a separate EBT card with the head of household's name printed on the card. Requires the card to include a statement that it is unlawful to use the card to purchase tobacco or alcoholic beverages. Subdivision 1 is effective June 1, 2012.
Subdivision 2 prohibits EBT cardholders from using the card to purchase tobacco products or alcoholic beverages. Unlawful use constitutes fraud and will result in disqualification from the program.
Section 11 (256D.05, subdivision 1) modifies two categories of eligibility for the general assistance program. This section is effective May 1, 2012.
Section 12 (256D.06, subdivision 2) modifies eligibility criteria for emergency assistance. This section is effective November 1, 2011.
Section 13 (256D.46, subdivision 1) modifies eligibility of SSI and MSA recipients for emergency assistance, allowing them to apply for emergency general assistance under section 12. This section is effective November 1, 2011.
Sections 14 and 15 (256E.35, subdivision 5; and 256E.35, subdivision 6) strike references to funding for the family assets for independence program.
Section 16 (256I.03, subdivision 8) defines "supplementary services" in the Group Residential Housing (GRH) chapter of law.
Section 17 (256I.05, subdivision 1a) prohibits counties from negotiating supplementary service rates with providers that do not encourage a policy of sobriety. This section is effective May 1, 2012.
Section 18 (256J.20, subdivision 3) reduces the MFIP vehicle asset limit from $15,000 to $10,000. This section is effective October 1, 2011.
Section 19 (256J.49, subdivision 13) specifies that “work activity” under the MFIP does not include activities done for political purposes.
Sections 20 to 30 (chapter 256M) The Children and Community Services Act was amended to be the Vulnerable Children and Adults Act. Funds were reduced by $22 million for the biennium. Changes to the act will allow counties to direct this funding to protecting and serving vulnerable children and adults. The service plan process was simplified and counties will only need to update plans as needed to reflect county policy and their use of the funds.
Section 31 (393.07, subdivision 10a) modifies the time in which counties have to issue food support for applicants who meet the federal criteria for expedited issuance of food support. Current law requires the immediate issuance of food support. This section allows the county to provide food support within five days. Removes obsolete language.
Section 32 (Section 518A.51) increases the child support cost recovery fee from one percent to two percent, and specifies how the fee must be distributed.
Section 33 (Requirement for liquor stores, tobacco stores, gambling establishments, and tattoo parlors) modifies distribution of nonfederal fees to counties. Requires liquor stores, tobacco stores, gambling establishments, and tattoo parlors to negotiate with their third-party processors to block EBT cash transactions at their places of business and withdrawals of cash at ATMs located in their places of business.
Section 34 (Minnesota EBT Business Task Force), Subdivision 1, establishes the membership of the Minnesota EBT Business Task Force.
Subdivision 2 establishes the duties of the task force.
Subdivision 3 requires the task force to report to the legislative committees with jurisdiction over Health and Human Services policy and finance by April 1, 2012, with recommendations related to the duties in subdivision 2.
Subdivision 4 makes the task force expire on June 30, 2012.
Section 35 provides the repealers:
Paragraph (a) Minnesota Statutes 2010, sections 256.979, subdivisions 5, 6, 7, and 10; and 256.9791, are repealed effective July 1, 2012.
Paragraph (b) repeals obsolete sections in Minnesota Statutes, chapter 256M.
Paragraph (c) Minnesota Rules, part 3400.0130, subpart 8, is repealed effective September 3, 2012.
Paragraph (d) Minnesota Rules, part 9500.1261, subparts 3, items D and E, 4, and 5, are repealed effective November 1, 2011.
ARTICLE 2
DEPARTMENT OF HEALTH
Section 1 (62J.04, subdivision 3) removes reference to section 62J.41, which is repealed in this article.
Section 2 (62J.17, subdivision 4a) removes certain annual reporting requirements related to major spending commitments for physician clinics.
Section 3 (62J.692) makes changes in the medical education and research cost fund (MERC).
Subdivision 3 eliminates language requiring a clinical medical education program that trains pediatricians to include curriculum training in case management for children suffering from mental illness to be eligible for MERC funds. Requires a clinical medical education program to provide their national provider identification number and the federal tax identification number of each training site used in the program for which funds are being sought.
Subdivision 4 makes training sites whose grant amount based on the formula is less than $1,000 ineligible for funds. Eliminates existing direct payments to University of Minnesota Medical Center – Fairview, the School of Dentistry, and the Academic Health Center.
Section 4 (62U.15) requires the Commissioner of Health to establish and collect quality measures for Alzheimer’s disease.
Subdivision 1, paragraph (a) requires the commissioner, beginning July 1, 2012, to review quality measures and make recommendations for future measurements for improving assessment and care related to Alzheimer’s and other dementia diagnoses, including cognitive screening, diagnoses and treatment plans.
Paragraph (b) permits the commissioner to contact with a private entity to collect the data under this section and permits the commissioner to use an existing contract to do so.
Subdivision 2 requires the commissioner to develop, by July 1, 2012, a health care home learning collaborative curriculum for identification and management of Alzheimer's disease and other dementia patients.
Subdivision 3 requires the Commissioners of Health and Human Services, the Minnesota Board of Aging, and other appropriate state offices to conduct a literature review in order to estimate current outcomes and costs compared with improved practices related to Alzheimer's disease and other dementias.
Subdivision 4 requires the commissioner to provide a progress report to the Legislature by January 15, 2013.
Sections 5 to 12 (chapter 103I) make changes to the wells and boring fees in this chapter.
Section 13 (144.1464, subdivision 1) requires the commissioner to award summer intern grants within available appropriations.
Section 14 (144.1501, subdivision 1) modifies the definition of “designated rural area” for purposes of the health professionals loan forgiveness program, to include small rural and isolated rural areas as described by the Rural Urban Commuting Area system.
Sections 15 to 18 create an accreditation exemption for certain environmental laboratories.
Section 15 (144.98, subdivision 2a) makes a conforming change related to environmental laboratory accreditation.
Section 16 (144.98, subdivision 7) makes a conforming change related to environmental laboratory accreditation.
Section 17 (144.98, subdivision 8) permits certain environmental laboratories to request an exemption from personnel requirements and specified quality control provisions, as of January 1, 2012. Permits the Commissioner of Health to grant exemptions provided the labatory complies with methodology and quality control requirements.
Section 18 (144.98, subdivision 9) requires laboratories requesting accreditations under the exemption in section 144.98, subdivision 8, to obtain acceptable proficiency test results and sets out requirements related to subsequent analysis of proficiency testing samples.
Section 19 (144A.102) requires the Commissioner of Health to work with certain long-term care providers to examine state and federal rules and regulations. Requires the commissioner to report to the Legislature by January 31, 2012, as to the implementation of this section.
Section 20 (144A.61, subdivision 9) requires the Commissioner of Health to accept electronic transmission of applications and supporting documents for the nursing assistant registry.
Section 21 (144E.123) removes the penalty to licensees for failing to report prehospital care data to the Emergency Medical Services (EMS) Board. Requires the EMS regulatory board to convene a working group, by October 1, 2011, to redesign policies related to data collection from licensees. Requires the working group to report its findings to the board by July 1, 2012.
Provides an immediate effective date.
Section 22 (145A.17, subdivision 3) requires local public health family home visiting programs to obtain permission from the family to share data with other family service providers in order to select a lead agency for the family and coordinate available resources.
Section 23 (157.15, subdivision 7a) defines a “limited food establishment” as a type of food and beverage establishment. Requires them to use equipment that is nontoxic and durable, and permits them to request a plumbing variance from the commissioner.
Section 24 (157.20, subdivision 5) permits a person to request a variance from all parts, Minnesota Rules, chapter 4626 (food code), with some specified exceptions.
Section 25 (297F.10, subdivision 1) reduces the amount that is to be transferred from cigarette tax revenue to the MERC account, effective July 1, 2011, from $8,550,000 to $6,244,000.
Section 26 requires the Commissioners of Health and Human Services to evaluate and recommend options for reorganizing a variety of regulatory responsibilities. Requires that recommendations be submitted to the Legislature by February 15, 2012.
Section 27 establishes a Minnesota Task Force of Prematurity to evaluate and make recommendations on methods to reduce prematurity and improve premature infant health care. Specifies membership of the task force and requires the Commissioner of Health to convene the first meeting by July 31, 2011. Requires a report on the current state of prematurity by November 30, 2011, and a final report by January 15, 2013.
Section 28 requires the Commissioner of Health to work with stakeholders to review, implement, and make recommendations related to efficiency for nursing home licensure.
Section 29, paragraph (a),repeals sections 62J.321, subdivision 5a (prescription drug price disclosure data); 62J.381 (prescription drug price disclosure); 62J.41, subds. 1 and 2 (cost containment reporting); and 144.1499 (promotion of health care and long-term care careers).
Paragraph (b) repeals certain provisions of Minnesota Rules, chapter 4651 related to health care provider reporting.
ARTICLE 3
MISCELLANEOUS
Section 1 (245A.14, subdivision 4) permits a family day care or group family day care provider to locate the program in a commercial space, rather than a residence, if the license holder is the primary provider of care and complies with specific zoning and fire code requirements. Requires the license holder to display the license issued by the commissioner, which will contain the statement, “This special family day care provider is not licensed as a child care center.”
Section 2 (245C.03, by adding subdivision 7) requires the commissioner to conduct background studies for children’s therapeutic supports and services (CTSS) providers.
Section 3 (245C.10, by adding subdivision 8) allows the commissioner to recover the cost of performing background studies for CTSS providers, and limits the charge to no more than $20 per study.
Section 4 (256B.0943, by adding subdivision 5a) allows a CTSS agency to access the commissioner’s NETStudy system for purposes of complying with the background study requirements.
Section 5 (256B.14, by adding subdivision 3a) requires spousal financial contribution for certain medical assistance recipients:
Paragraph (a) provides definitions of commissioner, community spouse, cost of care, department, disabled child, income, and long-term care spouse.
Paragraph (b) requires the spouse of the long-term care spouse who receives medical assistance for long-term care services or alternative care services to contribute to the cost of care, unless the community spouse is caring for a minor or disabled child in the home.
Paragraphs (c) to (f) provide the formula for computing the contribution amount.
Paragraph (g) requires the commissioner at the time of application for services to provide the spouse and community spouse a written explanation of the spousal contribution requirement, how to request a variance for undue hardship, review and redetermination of the contribution, and consequences for noncompliance.
Paragraph (h) provides that the contribution is to be assessed for each month the long term care spouse has a community spouse and is eligible for medical assistance or alternative care.
Paragraph (i) requires a review of the spousal contribution a minimum of once every 12 months and when there is a loss or gain of income in excess of ten percent. Sets out the requirements for requesting a review and the commissioner’s responsibilities in scheduling a redetermination.
Paragraph (j) provides that the contribution cannot exceed the amount of medical assistance expended or the cost of alternative care services provided. Sets out the method of reimbursement if the community spouse has contributed an amount in excess of costs.
Paragraph (k) allows a community spouse who has personal medical needs to request a variance for undue hardship if the spouse needs to retain the contribution amount to pay for these medical needs. Sets out the method for requesting the variance.
Paragraph (l) sets out the appeal rights.
Paragraph (m) sets out the method to enforce payments.
Provides an effective date of July 1, 2012.
Section 6 creates a nonemergency medical transportation single administrative structure proposal:
Paragraph (a) requires the commissioner to develop a proposal to create a single administrative structure to provide nonemergency medical transportation services to fee-for-service medical assistance recipients.
Paragraph (b) lists the required components of the proposal.
Paragraph (c) requires the commissioner to consult with the advisory council established in paragraph (d) when developing the proposal.
Paragraph (d) lists the entities to be represented on the council.
Paragraph (e) requires the commissioner to submit the proposal and legislation needed for implementation to the chairs and ranking minority members of the House and Senate committees with jurisdiction over health care policy by January 15, 2012.
ARTICLE 4
DEPARTMENT OF HUMAN SERVICES LICENSING
Section 1 (245A.10, subdivision 1) strikes state-operated programs from the list of programs exempt from a licensing fee.
Section 2 (245A.10, subdivision 3) allows an applicant for a license for a private agency to provide foster care or adoption services to submit a single application to provide services statewide.
Section 3 (245A.10, subdivision 4) modifies licensing fees and establishes new licensing fees.
Section 4 (245A.10, subdivision 7) provides that the commissioner shall plan to fully recover direct expenditures for licensing activities over a five-year period. The commissioner may have anticipated expenditures in excess of anticipated revenues in a biennium by using surplus revenues accumulated in a previous biennium.
Section 5 (245A.10, subdivision 8) establishes the human services licensing account in the state government special revenue fund. Fees collected must be deposited into the account and annually appropriated to the commissioner for licensing activities.
Sections 6 and 7 (245A.11, subdivision 2b; and 245A.143, subdivision 1) allow an adult foster care license holder to also provide family adult day care for adults 18 or over, instead of 55 or over.
Section 8 (245C.10, subdivision 9) requires the commissioner to recover the cost of background studies for all programs licensed by the commissioner, except child foster care and family child care.
Section 9 (256B.49, subdivision 16a) requires the commissioner to seek federal waiver approval for Medicaid reimbursement of family adult day services under all disability waivers. After the waiver is granted, the commissioner shall include family adult day services in the common services menu that is currently under development.
Section 10 repeals current law related to licensing fees, which is replaced by the new fees in this article.
ARTICLE 5
HEALTH-RELATED LICENSING
Section 1 (148.07 subdivision 1) makes technical change to require the Board of Chiropractic Examiners to set fees in statute rather than by rule.
Section 2 (148.108, subdivision 4) establishes animal chiropractic registration fees.
Sections 3 to 7 (148.191, subdivision 2; 148.212, subdivision 1; 148.231; 148.232; 148.243) modify the Nursing Board. The sections strike obsolete language related to temporary permits for graduate nurses, allow the board to accept or expend grants or gifts and accept registration fees for the purposes of board activities, eliminate the late fee applied to registration renewal applications that are submitted within 30 days of the license’s registration expiration date, codify the fee structure, and establish a new fee for nurses from bordering states who are authorized to practice nursing without a Minnesota license.
Section 8 (148B.17) makes technical changes and sets out the fee schedule in statute for the Board of Marriage and Family Therapy.
Section 9 (148B.33, subdivision 2) makes a conforming change.
Section 10 (148B.52) makes a technical change to require fees for Behavioral Health and Therapy to be established in statute.
Sections 11 to 16 make changes to the Board of Dentistry.
Section 11 (150A.091, subdivision 2) adds a fee for advanced dental therapist certification and for full faculty dentist.
Section 12 (150A.091, subdivision 3) makes a conforming change.
Section 13 (150A.91, subdivision 4) clarifies annual license fee.
Section 14 (150A.91, subdivision 5) makes a conforming change.
Section 15 (150A.091, subdivision 8) makes a conforming change.
Section 16 (150A.091, subdivision 16) provides a fee to be collected by the Board of Dentistry for a licensee who fails two consecutive professional development audits.
Sections 17 to 27 make changes to the Board of Pharmacy.
Section 17 (151.065) sets out a fee schedule in statute for the Board of Pharmacy.
Section 18 (151.07) makes a conforming change.
Section 19 (151.101) makes a conforming change and modifies a reference from licensure of interns to registration of interns.
Section 20 (151.102, subdivision 3) requires a fee for pharmacy technicians to be registered by the Board of Pharmacy.
Section 21 (151.12) makes a conforming change.
Section 22 (151.13, subdivision 1) makes conforming changes and modifies references to fee changes by cross-referencing Minnesota Statutes, section 151.065.
Section 23 (151.19) makes conforming changes and modifies references to fee changes by cross-referencing Minnesota Statutes, section 151.065.
Section 24 (151.25) makes a conforming change.
Section 25 (151.47, subdivision 1) makes a conforming change.
Section 26 (151.48) makes a conforming change.
Section 27 (152.12, subdivision 3) adds a cross-reference to fees set out in Minnesota Statutes, section 151.065.
Section 28 (214.107) establishes an administrative services unit for health-related licensing boards to perform administrative, financial, and management functions common to all the boards in a manner that streamlines services and reduces expenditures. The administrative services shall act as an agent of the boards. The funding for the administrative services unit shall be apportioned from each board.
Section 29 states that for licenses and registrations due to be renewed between July 1, 2011, and the day following final enactment of this section, no health-related licensing board shall assess a late fee or initiate disciplinary action for failure to renew a valid license or registration if the renewal application is submitted to the appropriate board by July 31, 2011.
Section 30 establishes an effective date for this article of the day following final enactment.
ARTICLE 6
HEALTH CARE
Section 1 (13.461, subdivision 24a) makes a technical change.
Section 2 (62E.14, subdivision 4g) specifies that a person who is eligible for the Healthy Minnesota Contribution Program under Minnesota Statutes, section 256L.031, may enroll in MCHA with a waiver of the preexisting condition limitation if the person has been denied coverage in the individual market.
Section 3 (62J.04, subdivision 9) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.
Sections 4 to 12 (62J.495) establish an electronic health records incentives program for eligible hospitals and providers.
Section 13 (62J.692, subdivision 9) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.
Section 14 (62Q.32) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.
Section 15 (62U.04, subdivision 3) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.
Section 16 (62U.04, subdivision 9) requires information on provider cost and quality to be used by government and the private sector as coverage is offered, sold, issued, or renewed, but not less than the current standard of within 12 months of when the information is published.
Section 17 (62U.06, subdivision 2) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.
Section 18 (256.01, subdivision 33) authorizes the commissioner to retain a portion of the recovered funds equal to the amount of the contingency fee when the commissioner enters into a contingency-based contract for purposes of recovering medical assistance and MinnesotaCare funds.
Section 19 (256.969, subdivision 2) requires the commissioner recategorize the diagnostic classifications and recalculate relative values and case-mix indices based on the two-year schedule in effect prior to January 1, 2013. When rates are not rebased, the commissioner may establish relative values and case-mix indices based on change data and may update the base year to the most recent data available.
Section 20 (256.969, subdivision 2b) repeals hospital rebasing effective January 1, 2013.
Section 21 (256.969, subdivision 3c) Paragraph (a) establishes a ten percent payment rate reduction for inpatient hospital admissions occurring on or after September 1, 2011, through June 30, 2015. Excludes long-term care hospitals as defined by Medicare, children’s hospitals, and payments under managed care.
Paragraph (b) requires the commissioner to calculate a readmission rate for admissions occurring within 30 days of a previous discharge.
Paragraph (c) states that for payments to hospitals made on or after July 1, 2013, through June 30, 2015, the rate reduction in paragraph (a) is reduced one percentage point for every percentage point reduction in overall readmissions rate between the two previous calendar years to a maximum of five percent.
Section 22 (256B.02, subdivision 16) defines “termination” and “terminate” for purposes of providers under the Medicaid, state children’s health insurance programs, and Medicare.
Section 23 (256B.03, subdivision 4) prohibits medical assistance payments for services delivered or items supplied outside of the U.S. and to providers, financial institutions, or entities located outside of the U.S.
Section 24 (256B.03, subdivision 5) requires claims for payments for supplies or services that are based on an order or referral to include the ordering or referring provider’s national provider identifier. States that claims ordered or referred by a vendor who is not enrolled in medical assistance are not covered.
Section 25 (256B.04, subdivision 18) requires the commissioner to modify the Minnesota health care programs application form to ask applicants if they have ever served in the U.S. military.
Section 26 (256B.04, subdivision 20) Paragraph (a) allows the commissioner or CMS to withhold payment upon initial enrollment for a 90-day payment if the provider is designated “high risk.”
Paragraph (b) allows the commissioner to require a provider to establish a compliance program as a condition of enrollment.
Paragraph (c) allows the commissioner to revoke the enrollment of an ordering or rendering provider for a period of not more than a year if the provider fails to maintain and upon request provide access to documentation relating to written orders or requests for payments for certain services.
Paragraph (d) allows the commissioner to terminate or deny the enrollment of any individual or entity if the individual or entity has been terminated from participation in Medicare or under the Medicaid program of the children’s health insurance program of any other state.
Paragraph (e) permits the commissioner or commissioner’s agents as a condition of enrollment of a “moderate” or “high-risk” provider as designated by CMS or DHS to conduct unannounced onsite inspections of any provider location.
Paragraph (f) requires high-risk providers as a condition of enrollment to consent to criminal background checks.
Section 27 (256B.06, subdivision 4) eliminates state-funded medical assistance coverage for legal noncitizens, and limits coverage under the emergency medical assistance program by specifying that various services, including those related to chronic conditions, are not covered.
Section 28 (256B.0625, subdivision 3g) requires the commissioner to implement a program to reduce the number of elective inductions of labor prior to 39 weeks gestation. For births covered by MA or MinnesotaCare on or after January 1, 2012, prohibits payments for professional services associated with a delivery unless certain information is submitted to the commissioner. Exempts from this requirement deliveries performed at hospitals that have policies and processes in place to prohibit elective inductions prior to 39 weeks gestation, that have been approved by the commissioner. Allows the commissioner to not implement or discontinue the program, if the commissioner determines that at least 90 percent of MA and MinnesotaCare births occur at hospitals that have approved policies.
Sections 29 to 31 (256B.0625, subdivisions 8, 8a, 8b, and 8c) eliminate coverage for specialized maintenance therapy for adults and requires authorization by the commissioner to provide medically necessary services to a recipient.
Section 32 (256B.0625, subdivision 8c) requires a case management approach for authorization of rehabilitation services. Authorization shall include approval for up to six months (a change from the current 12 months) of services without additional documentation from the provider. Requires the commissioner to implement an expedited five-day turnaround time to review requests for recipients who need emergency rehabilitation services.
Section 33 (256B.0625, subdivision 8e) increases from 12 to 24 the number of chiropractic visits allowed under MA before prior authorization is required.
Section 34 (256B.0625, subdivision 8f) provides MA coverage for acupuncture, only when provided by a licensed acupuncturist, or by a practitioner for whom acupuncture is within scope of practice and who has specific acupuncture training or credentialing.
Section 35 (256B.0625, subdivision 13e), paragraph (a) converts MA payment for drug ingredient costs from a formula based on average wholesale price (AWP) to one based on wholesale acquisition cost (WAC). Sets payments at WAC plus four percent for independently owned pharmacies located in a designated rural area within Minnesota, and at WAC plus two percent for all other pharmacies. Also strikes payment language related to antihemophilic factor drugs.
Paragraph (d) sets payment rates for drugs administered in an outpatient setting at the lower of the usual and customary cost or 106 percent of the average sales price. Payment under current law is at the lower of the usual and customary cost or the amount established by Medicare.
Paragraph (e) includes antihemophilic factor products in the list of specialty pharmacy products for which the commissioner may negotiate lower reimbursement rates and require enrollees to obtain from providers that have agreed to the lower rates.
Provides an effective date of July 1, 2011, or upon federal approval.
Section 36 (256B.0625, subdivision 13h) makes the following changes related to coverage of medication therapy management services:
- allows persons taking three or more prescriptions with one or more chronic conditions to be eligible (current law requires four or more prescriptions with two or more chronic conditions);
- allows coverage of persons with a drug therapy problem that is identified by a pharmacist and approved by the commissioner; and
- allows provision of the service in home settings, without an order from the provider-directed care coordination team, and also expands the definition of home settings to include long-term care settings, group homes, and assisted living facilities.
Section 37 (256B.0625, subdivision 17) effective September 1, 2011, reduces nonemergency transportation rates, including special transportation, taxi, and other commercial carriers, by 4.5 percent. Requires managed care and county-based purchasing plan payments to be reduced beginning January 1, 2012, to reflect this reduction.
Section 38 (256B.0625, subdivision 17a) effective September 1, 2011, reduces ambulance service rates by 4.5 percent. Requires managed care and county-based purchasing plan payments to be reduced beginning January 1, 2012, to reflect this reduction.
Section 39 (256B.0625, subdivision 18) removes language providing that MA covers the “costs” of the most appropriate and cost-effective form of transportation.
Section 40 (256B.0625, subdivision 25) requires the commissioner to implement a modernized electronic system for providers to request prior authorization. The system is required to be completed by March 1, 2012, and all authorization requests are required to be submitted electronically upon completion of the system, with some exceptions.
Section 41 (256B.0625, subdivision 25b), paragraph (a) prohibits the commissioner from considering a request for authorization of a service when the recipient has third-party coverage, unless the provider has made a good faith effort to obtain payment or authorization from the third party.
Paragraph (b) states that a provider is not required to bill Medicare before requesting authorization from the commissioner, if the provider has reason to believe the service is not eligible for Medicare payment.
Paragraph (c) provides that authorization is not required if a third party has made payment equal to or greater than 60 percent of the maximum payment allowed under MA.
Section 42 (256B.0625, subdivision 31) requires all vendors of durable medical equipment, prosthetics, orthotics, or medical supplies to enroll as Medicare providers. Allows the commissioner to exempt certain vendors if the vendors meet specified criteria. Defines durable medical equipment.
Section 43 (256B.0625, subdivision 31a) requires augmentative and alternative communication systems to be paid at the lower of: (1) the submitted charge; or (2) the manufacturer’s suggested retail price minus 20 percent for providers that are manufacturers, or the manufacturer’s invoice charge plus 20 percent for providers that are not manufacturers. (Under current law, payment is at the manufacturer’s suggested retail price.)
Section 44 (256B.0625, subdivision 55) allows a provider to seek payment from the recipient for services not eligible for payment under MA when the provider reviews and considers all available covered alternatives with the recipient, and obtains a signed acknowledgement from the recipient of the potential of the recipient’s liability.
Section 45 (256B.0625, subdivision 56), paragraph (a) provides MA coverage for in-reach community-based care coordination that is performed in a hospital emergency department as an eligible procedure under a state health care program or private insurance for a frequent user. Defines a frequent user. States that this service includes navigating services to address mental health, chemical health, social, economic, and housing needs, and any other activity targeted at reducing emergency room and other nonmedically necessary health care utilization.
Paragraph (b) requires reimbursement to be made in 15-minute increments under Medicaid social work reimbursement methodology. Requires in-reach care coordinators to hold a minimum of a bachelor’s degree in a specified field. Requires the commissioner to submit to the Centers for Medicare and Medicaid Services any waiver requests necessary to implement this subdivision.
Paragraph (c) defines “in-reach community-based care coordination” as the practice of a community-based worker meeting specified criteria working with an organization’s staff to transition an individual back into the individual’s living environment. Provides that this coordination includes working with an individual during discharge and for up to a defined amount of time in the individual’s living environment, reducing the individual’s need for readmittance.
Section 46 (256B.0625, subdivision 57) limits MA payment for Medicare crossover claims to the MA payment rate. This is effective for services provided on or after January 1, 2012. Excludes from this limitation payments for certain specified mental health services and for dialysis services provided to end-stage renal disease patients.
Section 47 (256B.0625, subdivision 58) limits MA payment amounts for EPSDT screening to the payment rate established in rule (75th percentile of charges) and in effect on October 1, 2010 (this has the effect of eliminating annual adjustments to the rate).
Section 48 (256B.0625, subdivision 59) provides MA coverage for services provided by advanced dental therapists and dental therapists, when provided within their scope of practice.
Section 49 (256B.0631, subdivision 1) makes the following changes related to MA cost-sharing:
- reinstates certain co-payments (these had been reduced or eliminated by the Legislature);
- requires a family deductible; and
- establishes tiered co-payments for nonpreventive visits.
Section 50 (256B.0631, subdivision 2) makes a conforming change related to cost-sharing changes.
Section 51 (256B.0631, subdivision 3) makes a conforming change related to cost-sharing changes.
Section 52 (256B.064, subdivision 2) modifies criteria and procedures used by the
commissioner to seek monetary recoveries from and sanction vendors of medical care.
Section 53 (256B.0641, subdivision 1) allows the commissioner, in order to collect past-due obligations, to adjust payments to a provider or vendor that has the same tax I.D. number as the provider or vendor with the past-due obligation.
Section 54 (256B.0751, subdivision 4) requires the Commissioner of Health to waive health care home certification requirements if the applicant demonstrates that compliance will create a major financial hardship or is not feasible, and establishes an alternative method of meeting the objectives of the certification requirement.
Section 55 (256B.0751, subdivision 8) requires health care homes and counties to coordinate care and services for health care home enrollees with complex medical or socio-economic needs or a disability, who need or are eligible for waivered services, mental health services, or other local services.
Sections 56 to 58 (256B.196) make changes to the intergovernmental transfers to coordinate with section 59.
Sections 59 and 60 (256B.198 and 256B.199) deal with payments for nonhospital-based governmental health centers and the use of federal matching funds for certified public expenditures.
Section 61 (256B.69, subdivision 5a) includes, as part of the performance targets required to be met by managed care plans and county-based purchasing plans, a requirement that the plan:
- reduces the plan’s emergency department utilization rate for medical assistance and MinnesotaCare enrollees by ten percent each year from the rate in the previous calendar year, until the rate is reduced by 25 percent of the rate for calendar year 2011;
- reduces the plan’s hospitalization admission rates for medical assistance and MinnesotaCare enrollees by five percent each year from the rate in the previous calendar year, until the rate is reduced by 25 percent of the rate for the calendar year 2011; and
- reduces the plan’s admission rates for subsequent hospitalizations within 30 days of a previous hospitalizations by five percent each year from the rate in the previous calendar year, until the rate is reduced by 25 percent of the rate for calendar year 2011.
Section 62 (256B.69, subdivision 5c), beginning July 1, 2011, requires the commissioner to reduce the amount transferred from the PMAP payment carve out to the medical education research fund.
Section 63 (256B.69, subdivision 9c) requires the commissioner to collect data regarding financials, provider payments, provider rate methodologies, and other data as determined by the commissioner and managed care and county-based purchasing plans.
Section 64 (256B.69 subdivision 28) requires persons with disabilities who are eligible for MA to enroll in the MA special needs basic health care plan. These individuals may opt out of this enrollment. This section requires the commissioner to mail no more than two sets of marketing materials per contract year to potential enrollees at the health plan’s request.
Section 65 (256B.69, subdivision 30) requires the commissioner to reduce payments and limit future rate increases to managed care plans and county-based purchasing plans. Authorizes the commissioner to use competitive bidding, payment reductions, or other reductions to achieve the required reductions and limits. Lists the reduction percentages to payments.
Section 66 (256B.76, subdivision 1) reduces payment rates to physician and professional services by three percent effective for services provided on or after September 1, 2011, through June 30, 2013.
Section 67 (256B.76, subdivision 2) reduces payments for dental services provided on or after September 1, 2011, through June 30, 2013, by three percent.
Section 68 (256B.76, subdivision 4) relates to critical access dental (CAD) providers to clarify that only clinics that are University of Minnesota or Minnesota State Colleges and Universities owned and operated may be designated as CAD providers.
Section 69 (256B.766) reduces the following payment rate for services provided on or after September 1, 2011, through June 30, 2013:
- outpatient hospital facility fees by five percent; and
- ambulatory surgery centers facility fees, medical supplies and durable medical supplies, prosthetics and orthotics, renal dialysis services, laboratory services, public health nursing services, physical therapy services, occupational therapy services, speech therapy services, eyeglasses, hearing aids, anesthesia services, and hospital services by three percent.
Section 70 (256B.771) requires the commissioner, in consultation with the Commissioner of Health, to contract with a Minnesota-based academic and research institution specializing in complementary and alternative medicine to implement a demonstration project to improve the care provided to MA enrollees with neck and back problems. The project must be conducted with FQHCs and FQHC look-alikes. Requires the project to be implemented beginning July 1, 2011, or upon federal approval, whichever is later.
Section 71 (256L.02, subdivision 3) makes a conforming change related to elimination of the Legislative Commission on Health Care Access.
Section 72 (256L.03, subdivision 5) requires MinnesotaCare enrollees to pay a family deductible. Effective January 1, 2012, establishes tiered copayments for nonpreventive visits.
Section 73 (256L.031) establishes the Healthy Minnesota Contribution Program.
Subdivision 1, paragraph (a), requires the commissioner, beginning July 1, 2012, to provide MinnesotaCare enrollees who are adults without children with gross family income greater than 200 percent of FPG with a monthly defined contribution in order to purchase health coverage through a health plan in the private individual market.
Paragraph (b) exempts these MinnesotaCare enrollees from MinnesotaCare premiums and the required enrollment in a managed care plan or a county-based purchasing plan.
Paragraph (c) states that the MinnesotaCare provisions related to covered services (Minnesota Statutes, section 256L.03), cost sharing (section 256L.03, subdivision 5), the effective date of coverage (section 256L.05, subdivision 3), and provider payments (section 256L.11) do not apply to these enrollees. This paragraph also states that the covered services, cost sharing, disenrollment for nonpayment of premiums, appeal rights and complaint procedures, and the effective date of coverage for enrollees are, instead, provided by the terms of the health plan purchased by the enrollee.
Paragraph (d) specifies that unless otherwise provided in this section, all MinnesotaCare requirements related to eligibility, income and asset methodology, income reporting, and program administration continue to apply.
Subdivision 2, paragraph (a) allows enrollees to use up to the monthly defined contribution as determined under subdivision 3 to pay premiums for coverage under a health plan.
Paragraph (b) requires an enrollee to select a health plan within three calendar months of approval of MinnesotaCare eligibility. If a health plan is not selected, the enrollee must reapply and meet al eligibility criteria.
Paragraph (c) requires the health plan that is purchased to cover mental health and chemical dependency treatment coverage and to meet the abortion coverage exclusion.
Subdivision 3, paragraph (a), requires the commissioner to determine the defined contribution amount using a sliding scale, under which the per-person defined contribution is a function of age and income. This paragraph specifies that the monthly per person base contribution ranges from $125 for persons age of 20 to 29 to $357.19 for persons age 60 and over. The base contribution is multiplied by a percentage inversely related to income, ranging from 110 to 80 percent, to obtain the monthly per person defined contribution amount.
Paragraph (b) requires the defined contribution amount calculated under paragraph (a) to be increased by 20 percent for enrollees who are denied coverage in the private individual market and who purchase coverage through MCHA.
Subdivision 4, paragraph (a), requires the commissioner to administer the defined contributions by calculating and processing defined contributions for enrollees and paying the defined contribution to the health plan companies or MCHA, as applicable.
Paragraph (b) states that nonpayment of a premium results in disenrollment and prohibits the enrollee from reenrolling for four months.
Subdivision 5 requires the commissioner, in consultation with the Commissioner of Commerce, to develop an efficient and cost-effective method to refer eligible enrollees to professional insurance agent associations.
Subdivision 6 states that beginning July 1, 2012, MinnesotaCare enrollees who are eligible under this section, and who are denied coverage in the individual market are eligible for coverage through MCHA and may enroll in MCHA in accordance with chapter 62E. This paragraph also states that any difference between the revenue and covered losses to MCHA related to the implementation of this section shall be paid to MCHA from the health care access fund.
Subdivision 7 requires the commissioner to seek all federal approvals of federal participation for adult enrollees.
Section 74 (256L.04, subdivision 1) eliminates an exemption from the program income limit for certain children who transition from MA to MinnesotaCare (other provisions related to this transition group are repealed in this article; federal approval for this transition has not yet been obtained). The elimination of the exemption from the income limit is effective retroactively to October 1, 2008.
Section 75 (256L.04, subdivision 10) continues MinnesotaCare eligibility for legal noncitizens who are not eligible for federal participation.
Section 76 (256L.05, subdivision 3a) clarifies that for children enrolled under section 256L.07, subdivision 8, the first period of renewal begins the month the enrollee turns 21 years of age.
Section 77 (256L.05, subdivision 6) requires the commissioner to ensure that all MinnesotaCare applicants who identify themselves as veterans, are referred to a county veterans service officer for assistance in applying to the U.S. Department of Veterans Affairs for any VA benefits for which they are eligible.
Section 78 (256L.09, subdivision 2) aligns MinnesotaCare residency requirements for adults without children with medical assistance residency requirements.
Section 79 (256L.11, subdivision 6) clarifies that inpatient services that are paid directly by the commissioner under MinnesotaCare for single adults without children do not include chemical dependency, hospital-based, and residential treatment.
Section 80 (256L.11, subdivision 7) reduces the critical access dental (CAD) add-on payment for MinnesotaCare from 50 percent to 30 percent, which is in line with the CAD add-on payment for MA.
Section 81 (256L.12, subdivision 9) includes, as part of the performance targets required to be met by managed care plans and county-based purchasing plans, a requirement that the plan:
- reduces the plan’s emergency department utilization rate for medical assistance and MinnesotaCare enrollees by ten percent each year from the rate in the previous calendar year, until the rate is reduced by 25 percent of the rate for calendar year 2011;
- reduces the plan’s hospitalization admission rates for medical assistance and MinnesotaCare enrollees by five percent each year from the rate in the previous calendar year, until the rate is reduced by 25 percent of the rate for the calendar year 2011; and
- reduces the plan’s admission rates for subsequent hospitalizations within 30 days of a previous hospitalizations by five percent each year from the rate in the previous calendar year, until the rate is reduced by 25 percent of the rate for calendar year 2011.
Section 82 (256L.15, subdivision 1) extends the elimination of premiums for members of the military and their families who are eligible for MinnesotaCare.
Section 83 (295.52, subdivision 8) Paragraph (a) requires the Commissioner of Management and Budget on December 1 of each year beginning in 2011,to determine the projected balance in the health care access fund for the biennium.
Paragraph (b) states if the commissioner determines that projected balance for the biennium reflects a ratio of revenues to expenditures and transfers greater than 125 percent and if the actual cash balance in the fund is inadequate, the commissioner, in consultation with the Commissioner of Revenue, must reduce MinnesotaCare provider tax rates for the subsequent calendar year sufficient to reduce the structural balance in the fund. The rate may be reduced to the extent that the projected revenues for the biennium do not exceed 125 percent of the expenditures and transfers. The new rate shall be rounded to the nearest one-tenth of one percent, and the rate reduction shall expire at the end of each calendar year and is subject to an annual redetermination by the commissioner.
Paragraph (c) requires the commissioner to include projected revenues for purposes of the analysis in paragraph (b), regardless of the repeal of the tax, effective January 1, 2020.
Sections 84 to 88 extend effective dates to meet the maintenance of effort requirements under the federal Affordable Care Act.
Section 89 requires the Commissioner of Human Services to submit to the Legislature, by December 15, 2011, a plan to provide care coordination to MA and MinnesotaCare enrollees who are children with high-cost mental health conditions.
Section 90 requires the Commissioner of Human Services to convene a regulatory simplification and report reduction work group.
Section 91 requires the Commissioner of Human Services to evaluate whether providing MA coverage for specialized maintenance therapy will reduce rates of hospitalization for enrollees with serious and persistent mental illness. Requires a report to the Legislature by December 15, 2011.
Section 92 requires the Commissioner of Human Services to provide recommendations to reduce hospitalization rates for state health care program enrollees who are children with high-cost medical conditions.
Section 93 requires the Commissioner of Human Services to issue a request for proposals to prevent and detect Medicaid fraud. The Commissioner shall select a vendor by January 31, 2012.
Section 94, paragraph (a), requires the commissioner to delay a portion of the MinnesotaCare capitation payment to managed care plans and county-based purchasing plan due in May 2013 and the payment due in April 2013 for special needs basic care until July 1, 2013.
Paragraph (b) delays a portion of the MinnesotaCare capitation payment to managed care plans and county-based purchasing plans due in the second quarter of calendar year 2015 and the April 2015 payment for special needs basic care until July 1, 2015.
Section 95 establishes the Minnesota Autism Spectrum Disorder Task Force.
Section 96 requires the Commissioner of Human Services to establish a two-year competitive bidding pilot for nonelderly, nondisabled adults and children in medical assistance and MinnesotaCare in the seven-county metro area.
Section 97, subdivision 1, repeals § 62J.07, subdivisions. 1, 2, and 3 (Legislative Commission on Health Care Access).
Subdivision 2 repeals section 256L.07, subdivision 7 (exemption of certain children transitioned from MA from MinnesotaCare insurance barriers) retroactively from October 1, 2008 (this provision has not yet been approved by the federal government).
Subdivision 3 repeals section 256B.057, subdivision 2c (extended MA coverage for certain children; this provision has not yet been approved by the federal government).
Subdivision 4 repeals section 256B.69, subdivision 9b (reporting provider payment rates – replaced by a new section).
Subdivision 5 repeals provisions providing MinnesotaCare enrollees with a renewal rolling month and a premium grace month (these provisions have not yet been approved by the federal government).
Subdivision 6 repeals the MinnesotaCare provider taxes imposed on gross revenues received after December 31, 2019.
Subdivision 7 repeals changes to renewal of medical assistance eligibility passed in 2009(these provisions have not been approved by the federal government).
ARTICLE 7
CONTINUING CARE
Section 1 (245A.03, subdivision 7) requires the Department of Human Services (DHS) Licensing Division to decrease the licensed capacity for foster homes if a foster care recipient moves out.
Section 2 (256.01, subdivision 24) modifies the Disability Linkage Line by adding information dissemination responsibilities.
Section 3 (subdivision 256.01, subdivision 29) makes conforming language changes related to section 8.
Section 4 (subdivision 256B.04) adds a subdivision creating the Money Follows the Person Rebalancing demonstration project, transferring federal demonstration project grant funds from the medical assistance (MA) account in the general fund to the special revenue fund.
Section 5 (256B.05) adds a subdivision requiring county agencies to act on applications for MA within ten days.
Section 6 (256B.056, subdivision 3) removes obsolete language, corrects an internal reference, and makes this section effective January 1, 2014.
Section 7 (256B.057, subdivision 9) makes technical changes reorganizing the language in this subdivision and removes obsolete language. Excludes spousal assets for purposes of determining eligibility for medical assistance for employed persons with disabilities (MA-EPD). Increases the MA-EPD premium and increases the amount of unearned income that must be paid in addition to the premium. Requires the commissioner to reimburse enrollees with incomes below 200 percent of the federal poverty guidelines for Medicare Part B premiums. Makes this section effective January 1, 2014, for adults age 21 or older, and October 1, 2019, for children age 16 to before child’s 21st birthday.
Section 8 (256B.0625, subdivision 19a) strikes language that made persons with one activity of daily living (ADL) dependency ineligible for personal care assistance (PCA) services effective July 1, 2011.
Section 9 (256B.0652, subdivision 6) applies the existing home care rating system to PCA services recipients with two or more ADL dependencies, and sets home care rating PCA services recipients with one ADL dependency or Level I behavior to no more than two units per day.
Section 10 (256B.0659, subdivision 11) limits payments to personal care assistants (PCA) who are providing services to a relative. Defines “relative” for purposes of this section. Makes this section effective October 1, 2011.
Section 11 (256B.0659, subdivision 28) expands documentation requirements for PCA provider agencies and allows the commissioner to fine agencies that do not comply with documentation requirements.
Section 12 (256B.0911, subdivision 1a) modifies the definition of “long-term care consultation services” to conform to nursing facility level of care.
Section 13 (256B.0911, subdivision 3a) requires counties to notify persons requesting assessment, services planning, or other assistance of alternatives to residential settings, including, but not limited to, foster care settings that are not the primary residence of the license holder.
Section 14 (256B.0911, subdivision 3c) requires long-term care consultation for housing with services and specifies how the long-term care consultation services are delivered. Also specifies how the point of entry service must be provided and the requirements for housing with services establishments. Makes this section effective October 1, 2011.
Section 15 (256B.0911, subdivision 4a) makes conforming changes related to MA maintenance of effort and nursing facility level of care. Makes this effective for individuals 21 years of age or older on July 1, 2012; for individuals under 21 years old, the effective date is October 1, 2019.
Section 16 (256B.13, subdivision 4) modifies eligibility criteria for alternative care to conform to federal maintenance of effort requirements. Makes eligibility changes for individuals assigned a case mix classification A and reduces the monthly budget cap for these individuals.
Section 17 (256B.0915, subdivision 3a) removes an automatic annual adjustment to EW monthly case mix caps related to nursing facility payment rates. Makes eligibility changes for individuals assigned a case mix classification A and reduces the monthly budget cap for these individuals.
Section 18 (256B.0915, subdivision 3b) removes an automatic annual adjustment to EW monthly case mix caps related to nursing facility payment rates. Modifies the monthly conversion budget limit calculation.
Section 19 (256B.0915, subdivision 3e) reduces the individualized monthly payment for customized living for low-needs individuals. Requires the new rate limit to be applied to all new applicants enrolled in the program on or after July 1, 2011, and to all other participants at reassessment. Requires licensed home care providersthat do not participate in or accept Medicare assignment to refer and document the referral of dual-eligible recipients to Medicare providers when Medicare is determined to be the appropriate payer for services and supplies and equipment. Prohibits providers from billing or otherwise charging an elderly waiver participant or their family for additional units of any allowable component service beyond those available under the service rate limits, nor for additional units of any allowable component services beyond those approved in the service plan by the lead agency.
Section 20 (256B.0915, subdivision 3h) increases the criteria for 24-hour customized living. Prohibits providers from billing or otherwise charging an elderly waiver participant or their family for additional units of any allowable component service beyond those available under the service rate limits, nor for additional units of any allowable component services beyond those approved in the service plan by the lead agency.
Section 21 (256B.0915, subdivision 5) makes conforming changes related to MA maintenance of effort and nursing facility level of care.
Section 22 (256B.0915, subdivision 10) removes obsolete language and prohibits medical assistance rates paid to customized living providers by managed care organizations from exceeding the maximum component rates.
Section 23 (256B.0961) creates a new section of law:
Subdivision 1 specifies that the system is a partnership between the Department of Human Services and the State Quality Council established in subdivision 3. Lists the services eligible under this section. Defines “commissioner,” “council,” “Quality Assurance Commission,” and “system.”
Subdivision 2 requires the Commissioner of Human Services to establish the State Quality Council. Requires the commissioner to delegate authority to perform certain licensing functions to a host county in Region 10. Allows the commissioner to conduct random licensing inspections based on outcomes at facilities, programs, and services eligible under this section. Requires the commissioner to ensure that federal home and community-based waiver requirements are met. Requires the commissioner to seek a federal waiver by July 1, 2012, to allow ICFs/DD to participate in this system.
Subdivision 3 creates the State Quality Council, lists members of the council, allows certain council members to receive per diem payment when performing council duties, and lists the duties of the council.
Subdivision 4 requires the Commissioner of Human Services to establish regional quality councils, lists the members of the councils, and lists the duties of the councils.
Subdivision 5 requires the Commissioner of Human Services to conduct an annual independent survey of service recipients. Specifies requirements the survey must meet.
Subdivision 6 makes members of the State Quality Council, regional quality councils, and quality assurance teams mandated reporters under the Maltreatment of Minors and Vulnerable Adults Acts.
Makes subdivisions 1 to 6 effective July 1, 2011. Requires the jurisdictions of the regional quality councils to be defined by July 1, 2012. Requires the Quality Assurance Commission to continue to implement the alternative licensure system during the 2012-2013 biennium.
Section 24 (256B.19, subdivision 1e) clarifies the start date of the intergovernmental transfer program and allows the commissioner to revoke participation rather than withhold funds in the event that an owner fails to make a timely payment of the nonfederal share.
Section 25 (256B.431, subdivision 2r) limits payments for leave days in a nursing facility to 30 percent of that nursing facility’s total payment rate for the involved resident and allows this payment only when the occupancy of the nursing facility, inclusive of bed hold days, is equal to or greater than 96 percent.
Section 26 (256B.431, subdivision 2t) updates resident reimbursement classifications from RUG-III to RUG-IV case-mix, effective January 1, 2012.
Section 27 (256B.431, subdivision 32) renames the subdivision and makes the necessary language changes to reflect the current first 30-day incentive program for new nursing facility residents.
Section 28 (256B.434, subdivision 4) suspends automatic property rate adjustments for the rate years beginning on October 1, 2011, and October 1, 2012.
Section 29 (256B.437, subdivision 6) prohibits the commissioner from accepting applications for planned closure rate adjustments as of July 16, 2011.
Section 30 (256B.438, subdivision 1) updates cross-references and resident reimbursement classifications from RUG-III to RUG-IV effective January 1, 2012.
Section 31 (256B.438, subdivision 3) requires the commissioner to assign a case mix index to each resident class based on the CMS staff time measurement study upon implementation of the 48-group RUG-IV resident classification system. Requires the case mix indices assigned to each resident class to be published in the State Register at least 120 days prior to the implementation
of the RUG-IV resident classification system.
Section 32 (256B.438, subdivision 4) requires the commissioner to determine payment rates to account for the transition to RUG-IV, in a facility-specific, revenue-neutral manner. Effective January 1, 2012.
Section 33 (256B.438, by adding subdivision 8) requires the commissioner to determine payment rates at the time of transition to the RUG-IV-based payment model. Requires nursing facilities to report certain information related to MA resident days to the commissioner for the six-month reporting period ending June 30, 2011. Specifies how the commissioner shall determine the case-mix adjusted component for the January 1, 2012, rate. Specifies that noncase mix components will be allocated to each RUG group as a constant amount to determine the operating payment rate.
Section 34 (256B.441, subdivision 50a) modifies certain nursing facility operating payment rates proximity adjustments.
Section 35 (256B.441, subdivision 55a) clarifies the start date of the intergovernmental transfer program, provides for the continuation of the program when the phase-in of rebasing is complete and specifies a replacement limit to go into effect at that time, allows annual application to participate, and permits the owner to revoke an application.
Section 36 (256B.441, by adding subdivision 61) increases certain low-rate nursing facility reimbursement rates by up to 2.45 percent effective October 1, 2011.
Section 37 (256B.441, by adding subdivision 62) prohibits any further steps toward phase-in of nursing facility rebased operating payment rates from being taken.
Section 38 (256B.49, subdivision 12) makes conforming changes related to MA maintenance of effort and nursing facility level of care.
Section 39 (256B.49, subdivision 14) adds a cross-reference to assessments under long-term care consultation services. Requires the commissioner to develop criteria to identify recipients whose level of functioning is reasonably expected to improve and reassess these recipients to establish a baseline assessment. Requires individuals who meet the commissioner’s criteria to have a comprehensive transitional service plan developed, effective July 1, 2013. Makes counties, case managers, and service providers responsible for conducting these reassessments and for completing them within existing funds.
Section 40 (256B.49, subdivision 15) specifies timelines and requirements in developing and implementing comprehensive transitional service plans and maintenance service plans, effective July 1, 2013. Also specifies requirements at the time of reassessment that local agency case managers must meet related to CADI and TBI recipients who reside in a licensed adult foster care home that is not the primary residence of the license holder, or in which the license holder is not the primary caregiver. Requires this reassessment process to be completed by June 30, 2012.
Section 41 (256B.49, by adding subdivision 23) defines “community-living settings.”
Section 42 (256B.5012, by adding subdivision 9) requires the commissioner to increase the daily rate to $138.23 at a specified ICF/DD in Clearwater County.
Section 43 (256B.5012,by adding subdivision 10) requires the commissioner to decrease operating payment rates for all facilities, with one exception, equal to 0.095 percent of the operating payment rates in effect on June 30, 2011. Specifies how the rate reduction must be applied to each facility by the commissioner.
Section 44 (256B.5012, by adding subdivision 11) decreases operating payment rates equal to 1.5 percent of the operating payment rates in effect on June 30, 2011. Specifies how the commissioner shall apply the rate reduction.
Section 45 (256B.5012, by adding subdivision 12) increases operating payment rates equal to 0.5 percent of the operating payment rates in effect on June 30, 2013. Specifies how the commissioner shall apply the rate increase.
Section 46 (256B.5012, by adding subdivision 13) decreases operating payment rates equal to 1.67 percent of the operating payment rates in effect on June 30, 2012. Specifies how the commissioner shall apply the rate reduction. Makes this section effective only if the federal approval required under section 52 has not been received by June 30, 2012.
Section 47 (Laws 2009, chapter 79, article 8, section 4, the effective date, as amended by Laws 2010, First Special Session chapter 1, article 24, section 12) makes conforming changes related to MA maintenance of effort and nursing facility level of care.
Section 48 (Laws 2009, chapter 79, article 8, section 51, the effective date, as amended by Laws 2010, First Special Session chapter 1, article 17, section 14) makes conforming changes related to MA maintenance of effort and nursing facility level of care.
Section 49 (Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by Laws 2009, chapter 173, article 2, section 1, subdivision 8, and Laws 2010, First Special Session, chapter 1, article 15, section 5, and article 25, section 16) removes a provision related to alternatives to PCA services.
Section 50 creates a nursing facility pilot project to develop a new approach to caring for certain individuals. A report is due to the legislature on November 15, 2011.
Section 51 requires the Commissioner of Human Services to decrease grants, allocations, reimbursement rates, individual limits, and rate limits, as applicable, by 1.5 percent effective July 1, 2011, through June 30, 2013, for services rendered during those dates. Beginning July 1, 2013, requires the Commissioner of Human Services to decrease grants, allocations, reimbursement rates, individual limits, and rate limits, as applicable, by 1.0 percent for services rendered on or after those dates. Specifies the long-term care home and community-based programs these rate changes affect. Specifies how these rate reductions must be applied to managed care organizations and county or tribal contracts for services.
Section 52 requires the commissioner to seek any necessary federal approval in order to implement the changes to level of care criteria on July 1, 2012.
Section 53 creates the Medical Assistance Reform Waiver initiative:
Subdivision 1 specifies the intent of the Legislature to reform components of the MA program for seniors and people with disabilities and other complex needs, and MA enrollees in general, in order to achieve better outcomes.
Subdivision 2 requires the Commissioner of Human Services to develop a proposal to the U.S. Department of Health and Human Services for projects specified in subdivision 4. Requires the commissioner to ensure that all projects are budget neutral or result in savings to the state budget, considering cost changes across all divisions and other agencies that are affected.
Subdivision 3 requires the commissioner to report to the members of the legislative committees with jurisdiction over human services issues by January 15, 2012, regarding the progress of this waiver, and to make recommendations regarding any legislative changes necessary to accomplish the projects in subdivision 4.
Subdivision 4 requires the commissioner to request permission and funding to further several initiatives, including (1) health care delivery demonstration projects; (2) promoting personal responsibility and rewarding healthy outcomes; (3) encouraging utilization of high quality, cost-effective care; (4) limiting assets for certain adults without children; (5) empowering and encouraging work, housing and independence; (6) redesigning home and community-based services; (7) coordinating and streamlining services for people with complex needs, including those with multiple diagnoses of physical, mental, and developmental conditions; (8) implementing nursing home level of care criteria; (9) improving integration of Medicare and Medicaid; (10) providing intensive residential treatment services; (11) seeking federal Medicaid matching funds for Anoka Metro Regional Treatment Center; and (12) seeking waivers to allow Medicaid eligibility for children under age 21 receiving care in residential facilities.
Subdivision 5 authorizes the commissioner to accept and expend federal funds that support the purposes of this section.
Section 54 requires the Commissioner of Human Services to decrease grants, allocations, reimbursement rates, individual limits, and rate limits, as applicable, by 1.67 percent effective July 1, 2012, for services rendered during those dates. Specifies the long-term care home and community-based programs these rate changes affect. Specifies how these rate reductions must be applied to managed care organizations and county or tribal contracts for services. Makes these payment rate reductions, allocation rates, and rate limits expire for services rendered on December 31, 2013. Makes this section effective only if the federal approval required under section 52 has not been received by June 30, 2012.
ARTICLE 8
CHEMICAL AND MENTAL HEALTH
Section 1 (246B.10) increase the county share for person civilly committed to the Minnesota Sex Offender Program from ten percent to 25 percent.
This section is effective for all individuals who are civilly committed to the Minnesota Sex Offender Program on or after August 1, 2011.
Section 2 (253B.212) allows the White Earth Band to enter into agreements with the Indian Health Service for the care and treatment of tribal members committed for care and treatment due to mental illness, developmental disability, or chemical dependency. Adds that White Earth can also contract with the Commissioner of Human Services for treatment of tribal members who have been committed by the tribal court. Requires tribal court commitment procedures to comply with the provisions of Minnesota Statutes, section 253B.05 to 253B.10.
Section 3 (254B.03, subdivision 4) increases the county share under the consolidated chemical dependency treatment fund for chemical dependency treatment costs from 16.14 percent to 22.95 percent. This section is effective for claims processed beginning July 1, 2011.
Section 4 (254B.04, subdivision 2a) increases the assessment level score for an individual to be approved for residential chemical dependency treatment.
Section 5 (254B.06, subdivision 2) makes conforming changes to the allocation of collections related to section 3, which increases the county share for chemical dependency services under the consolidated chemical dependency treatment fund. This section is effective for claims processed beginning July 1, 2011.
Section 6 (256B.0625, subdivision 41) adds “an American Indian tribe” to providers of residential services for children who have a severe emotional disturbance and require residential care that are covered by MA. This section is effective October 1, 2011.
Section 7 (256B.0945, subdivision 4) adds paragraph (c), which states that payment for mental health rehabilitative services provided by tribal organizations must be made according to section 256B.0625, subdivision 34, (MA payments to Indian health services facilities) or other federally approved methodology. This section is effective October 1, 2011.
Section 8 (Community mental health services; use of behavioral health hospitals) instructs the commissioner to issue a report to the Legislature on how the community behavioral health hospitals will be utilized to meet the mental health needs of the regions in which they are located. Requires the report to address future use of the hospitals that are not certified as Medicaid eligible or have less than 65 percent licensed bed occupancy. Requires the commissioner to consult with the regional mental health authorities.
Section 9 (Integrated dual diagnosis treatment) requires the commissioner to require individuals who perform chemical dependency or mental health assessments to use screening tools approved by the commissioner in order to determine co-occurring disorders. The screening must begin no later than December 31, 2011. The commissioner shall adopt rules as necessary and apply for necessary federal waivers.
Section 10 (Regional treatment centers; employees; report) requires the commissioner to issue a report that provides the number of employees in management positions at the Anoka RTC and the Minnesota Security Hospital, and the ratio of management to direct care staff for each facility.
ARTICLE 9
REDESIGNING SERVICE DELIVERY
Section 1 (256.01, subdivision 14b) allows the commissioner to authorize a test project for the White Earth Band to provide child welfare services to tribal children who are residents of Hennepin County. Requires Hennepin County to transfer the proportion of property taxes collected and used to fund child welfare services for this population to the tribe when the tribe assumes responsibility for providing services.
Section 2 (256B.69, subdivision 30) permits prepaid health plans to provide medical assistance enrollees and potential enrollees with required materials in a medium other than paper.
Section 3 (256D.09, subdivision 6) exempts certain GA recipients from recovery of overpayments. Limits establishment of an overpayment to 12 months prior to the month of discovery due to agency error and six years prior to the month of discovery due to client error or an intentional program violation.
Sections 4, 5, and 6 (256D.49, subdivision 3; 256J.38, subdivision 1; 393.07, subdivision 10) make uniform the policy related overpayments of assistance across programs. The new language provides that the establishment of an overpayment is limited to 12 months prior to the month of discovery due to agency error and six years prior to the month of discovery due to client error or a program violation.
Section 7 (section 402A.10, subdivision 4) adds tribal services to the definition of “essential human services” or “essential services.”
Section 8 (section 402A.10, subdivision 5) adds that the commissioner has the authority to assign a county to be a member of a service delivery authority. Adds that a tribe or group of tribes to the definition of “service delivery authority.”
Section 9 (section 402A.15, subdivision 1) removes the requirement for the steering committee to include recommendations on resources and funding needed to achieve performance measures. Eliminates certain considerations such as geography, populations served, and administrative demands when determining performance measures and goals. Requires the steering committee to incorporate federal performance measures when federal funding is contingent on meeting these performance measures.
Subdivision 2 removes the requirement for two members of the steering committee to also serve as representatives to the redesign council.
Section 10 (section 402A.18, subdivision 1) grants the commissioner authority to adjust state and federal funds for an underperforming county.
Subdivision 2 makes technical changes.
Subdivision 2a requires an underperforming county to provide the nonfederal and nonstate funding needed to remedy performance deficiencies to the entity assuming administration of the essential service.
Subdivision 3 makes a technical change.
Section 11 (section 402A.20, subdivision 1) clarifies that recommendations must be approved by a majority of the voting council members. There are nonvoting members of the council.
Subdivision 2 clarifies the duties of the council
Subdivision 3 requires the council to request that the legislative auditor perform a reevaluation of human service administration that was initially reported in 2007.
Section 12 (402A.35, subdivision 1), paragraph (a) provides the requirements for establishing a service delivery authority.
Subdivision 2 lists the statutory mandates. Allows the service delivery authorities to request additional waivers from other statutory and rule mandates in order to allow greater flexibility and control.
Subdivision 3 lists the duties of the service delivery authority.
Subdivision 4 provides the process for establishing a service delivery authority.
Subdivision 5 gives the commissioner authority to grant waivers, but they must be approved by the council.
Section 13 (402A.40) establishes the transition for new bargaining unit structure related to service delivery authorities and their employees.
Section 14 (County electronic verification procedures) the Commissioner of Human Services shall define which public assistance program requirements may be electronically verified for the purposes of determining eligibility, and shall also define procedures for electronic verification. The Commissioner of Human Services shall report back to the chairs and ranking minority members of the legislative committees with jurisdiction over these issues by January 15, 2012, with draft legislation to implement the procedures if legislation is necessary for purposes of implementation.
Section 15 (Alignment of program policy and procedures) requires the commissioner, in consultation with counties and other key stakeholders, to analyze and develop recommendations to align program policy and procedures across all public assistance programs to simplify and streamline program eligibility and access. The commissioner shall report back by January 15, 2013, with recommendations.
Section 16 (Alternative strategies for certain redeterminations) requires the commissioner to develop and implement by January 15, 2012, a simplified process to redetermine eligibility for a specific population who are expected to experience minimal change in income or assets from month to month.
Section 17 (Simplification of eligibility and enrollment process) the Commissioner of Human Services shall issue a request for information for an integrated service delivery system for health care programs, food support, cash assistance, and child care. The commissioner shall determine, in consultation with partners in paragraph (c), if the products meet departments' and counties' functions. The request for information may incorporate a performance-based vendor financing option in which the vendor shares the risk of the project's success. The health care system must be developed in phases with the capacity to integrate food support, cash assistance, and child care programs as funds are available. This section is effective the day following final enactment.
Section 18 (White Earth Band of Ojibwe Human Services Project) the Commissioner of Human Services, in consultation with the White Earth Band of Ojibwe, shall transfer legal responsibility to the tribe for providing human services to tribal members and their families who reside on or off the reservation in Mahnomen County. No later than January 15, 2012, the commissioner shall submit a written report detailing the transfer progress to the chairs and ranking minority members of the legislative committees with jurisdiction over Health and Human Services.
Section 19 repeals: Minnesota Statutes 2010, sections 402A.30 (Designation of Service Delivery Authority); and 402A.45 (Essential Services Outside Jurisdiction of Service Delivery Authority). Minnesota Rules, part 9500.1243, subpart 3, (Recoupment of overpayments).
ARTICLE 10
APPROPRIATIONS
Article 10 is the Health and Human Services Appropriations Article.
ARTICLE 11
EFFECTIVE DATES
This article specifies that this act is effective retroactively from July 1, 2011, unless otherwise specified, and supersedes and replaces funding authorized by court order.
KC/JW/DL/rdr
|