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S.F. No. 2452 - Health and Human Services Finance Omnibus Bill (First Engrossment)
 
Author: Senator Michelle R. Benson
 
Prepared By: Liam Monahan, Senate Analyst (651/296-1791)
Katie Cavanor, Senate Counsel (651/296-3801)
 
Date: April 12, 2019



 

ARTICLE 1

DEPARTMENT OF HEALTH

Section 1 (8.40) creates an account in the special revenue fund for the purpose of providing funds to pay for the litigation costs associated with actions related to the defense of the Pain Capable Unborn Child Protection Act.

Section 2 (18K.03) authorizes a person licensed to grow industrial hemp under chapter 18K to sell hemp products derived from industrial hemp grown in Minnesota to medical cannabis manufacturers.

Sections 3 and 4 (62J.495) eliminate the date by which all hospitals and health care providers must have in place an interoperable health records system.

Section 5 (144.1506, subdivision 2) authorizes primary care residency training grants that are longer than three years to be awarded for the duration of the residency so long as an average of $100,000 per residency per slot is not exceeded.

Section 6 (144.3831, subdivision 1) increases the annual fee-for-service connection to a public water supply.

Section 7 (144.397) requires the commissioner of health to administer statewide tobacco cessation services to assist individuals who are seeking advice or services to help them quit using tobacco products. The commissioner must establish statewide public awareness activities to inform the public of the availability of the services and encourage the public to use the services.

Section 8 (144.552) Paragraph (a) requires the commissioner to return in full payments made by a hospital to the commissioner to cover the costs of a public interest review if the commissioner fails to issue a finding within 150 calendar days of the initial submission of the hospital’s plan to increase its number of licensed beds.

Paragraph (b) requires a hospital to respond to the commissioner’s request for additional information within 14 days of the commissioner’s request.

Paragraph (c) increases the current 90-day default time limit for the commissioner to issue a public interest finding to 150 calendar days, but also eliminates the six-month time limit in extenuating circumstances.

Paragraph (c), clause (1), modifies one of the conditions the commissioner is required to consider when performing a public interest review of a proposed hospital construction moratorium exception: under current practice, the commissioner considers the number of licensed beds when analyzing whether new hospitals or new licensed beds are needed “to provide timely access to care or access to new and improved services.” The amendment to paragraph (c), clause (1), requires the commissioner to consider instead the number of available beds and provides a definition of "available beds."

Section 9 (144.586, subdivision 3) requires hospitals discharging a medically fragile pediatric patient to ensure that arrangements are made and in place to implement the patients discharge plan prior to discharge.

Section 10 (144.591) requires a hospital to provide to a patient within 30 days of discharge an itemized description of billed charges.

Section 11 (144.6502) – Electronic Monitoring in Certain Health Care Facilities

Subdivision 1 provides definitions of “electronic monitoring,” “commissioner,” “department,” “electronic monitoring device,” “facility,” “resident,” and “resident representative.”

Paragraph (f) defines a facility as a nursing home, a boarding care home, or a housing with services establishment that is either an assisted living establishment or that has a special unit, such as a dementia care unit.

Subdivision 2 authorizes a resident or resident representative to conduct electronic monitoring of the resident’s room or private living unit and clarifies that electronic monitoring as defined in this section is not a covered service under the medical assistance home and community-based waiver plans.

Subdivision 3, paragraphs (a) and (b) require the resident to consent in writing to electronic monitoring. If the resident has not affirmatively objected and the resident’s medical professional determines the resident currently lacks the ability to understand and appreciate the consequences of electronic monitoring, the resident representative may consent on the resident’s behalf.

Paragraph (c) provides that the resident may place conditions on monitoring.

Paragraph (d) requires a resident to obtain a roommate’s consent.  The same consent requirements that apply to the resident apply to the roommate.

Paragraph (e) requires a resident to obtain consent from a new roommate.  

Paragraph (f) allows a resident or roommate to withdraw consent at any time.

Subdivision 4 requires a facility to make a reasonable attempt to accommodate a resident who wants to conduct electronic monitoring if a roommate refuses or withdraws consent. A facility is not required to provide a private room if a resident is unable to pay the requisite rate or rent.

Subdivision 5, paragraph (a) requires notice to the facility, except as provided in paragraph (f), prior to a resident beginning electronic monitoring.

Paragraphs (b) and (c) require facilities to maintain signed notification and consent forms on file and make them available for updating. 

Paragraphs (d) and (e) require facilities to remove electronic monitoring devices if the facility does not have a valid consent form on file.

Paragraph (f) provides an exception to the requirement that a resident or resident representative provide notice to a facility prior to conducting electronic monitoring. If the resident meets the listed qualifications, notifies the Office of the Ombudsman for Long-Term Care prior to conducting the electronic monitoring, and adheres to the requirements of this paragraph, then the electronic monitoring without notice to the facility is permitted for up to 14 days.

Subdivision 6 specifies the requirements for the notification and consent form and clarifies that a form submitted to the ombudsman for long-term care is protected data under the ombudsman's existing data protection statute. Beginning January 1, 2020, facilities must make the form available and inform residents of their option to conduct electronic monitoring.

Subdivision 7 specifies that the resident is responsible for the cost of installation and monitoring of an electronic monitoring device. The facility must make a reasonable attempt to accommodate the resident’s installation needs.

Subdivision 8 requires facilities, at their own expense, to post signage stating that electronic monitoring may be occurring in the facility.

Subdivision 9 prohibits anyone from knowingly and without permission interfering with an electronic monitoring device unless it is done at the resident's request or because a resident or roommate withdrew consent.

Subdivision 10 prohibits anyone from accessing any recordings without permission and prohibits dissemination of recordings except to address the health, safety, or welfare of a resident.

Subdivision 11 provides for the admissibility of a recording as evidence in legal proceedings.

Subdivision 12 provides a facility with immunity from state civil or criminal liability as a result of a resident or resident representative disseminating a recording.

Subdivision 13 clarifies that the immunity from liability that applies to the Office of the Ombudsman for Long-Term Care under its general statute also applies when performing its duties under this section.

Subdivision 14 prohibits a facility from refusing to admit or from removing a resident, or retaliating or discriminating against a resident for the resident’s choices with respect to electronic monitoring.  A facility may not prevent the installation or use of electronic monitoring provided the resident has satisfied the requirement that written consent be obtained and notice provided as required under subdivision 5.

Subdivision 15 requires that an employee who is subject to corrective or disciplinary action based on evidence obtained by electronic monitoring be given access to the evidence for the purposes of defending against the employment action.

Subdivision 16 specifies penalties that may be imposed on facilities by the commissioner of health for violations of this section.

Section 12 (144.966, subdivision 2) extends the newborn hearing screening advisory council until June 30, 2025.

Sections 13 to 22 modify regulations for PPEC centers.

Section 13 (144H.01, subdivision 5) modifies the definition of “medically complex or technologically dependent child” to reduce the age of a child who may be served in a PPECC from 20 to 6 years of age.

Section 14 (144H.04, subdivision 1) delays by two years, from 2018 to 2020, the initial licensing of PPECCs.

Section 15 (144H.04, subdivision 1a) extends the phase-in for licensing additional PPECCs by two years.

Section 16 (144H.06) modifies which Minnesota Rules apply to PPECCs by including an existing background study requirement and eliminating a redundant fee requirement.

Section 17 (144H.07, subdivision 1) reduces by 1.5 hours, from 14 to 12.5, the maximum number of hours a PPECC may operate, and restricts the operating hours to normal waking hours.

Section 18 (144H.07, subdivision 2) reduces by 1.5 hours, from 14 to 12.5, the maximum number of hours a child may be served in a PPECC during a 24-hour period.

Section 19 (144H.08, subdivision 8) requires an administrator of a PPECC to have at least 2 years of experience managing the care of medically complex or technologically dependent children.

Section 20 (144H.11, subdivision 2) eliminates the requirement that a registered nurse employed at a PPECC have recent experience caring for acutely ill or chronically ill children.

Section 21 (144H.11, subdivision 3) eliminates the requirement that licensed practical nurses employed by PPECCs need two years of experience in pediatrics.

Section 22 (144H.11, subdivision 4) makes technical changes.

Sections 23 to 30 establish the Pain Capable Unborn Child Protection Act.

Section 23 (145.4131, subdivision 1) adds as part of the data that is required to be reported by a physician or facility performing an abortion information regarding whether a determination of probable post fertilization age was made and the probable post fertilization age determined including: (1) the method used; or (2) if determination was not made before performing the abortion the basis of the determination that a medical emergency existed; and if the abortion was performed after the determination age of 20 or more weeks the basis of the determination that the woman had a condition that necessitated the abortion to avert her death or to avert serious risk of substantial and irreversible physical impairment of a major bodily function that does not include psychological or emotional conditions.

Section 24 (145.4141) defines the following terms: abortion; attempt to perform or induce an abortion; fertilization; medical emergency; physician; post fertilization age; probable post fertilization age of the unborn child; reasonable medical judgment; unborn child or fetus; and woman.

Section 25 (145.4142) sets out legislative findings.

Section 26 (145.4143) prohibits an abortion from being performed except in the case of an medical emergency, unless the physician performing the abortion has made a determination of the probable post fertilization age of the unborn child or relied on the determination made by another physician.

Section 27 (145.4144), subdivision 1 states that no person shall perform or induce or attempt to induce an abortion when it has been determined that the probable post fertilization age of the unborn child is 20 or more weeks unless, within reasonable medical judgment, the woman has a condition which so complicates her medical condition as to necessitate the abortion to avert her death or to avert serious risk of substantial and irreversible physical impairment of a major bodily function, not including psychological or emotional conditions.

Subdivision 2 states that when an abortion is performed on a woman whose unborn child has been determined to have a probable post fertilization age of 20 or more weeks and is not prohibited, the physician must terminate the pregnancy in a manner which provides the best opportunity for the unborn child to survive unless termination of the pregnancy in that manner would pose a greater risk either of the death of the woman or of substantial and irreversible physical impairment of major bodily function not including psychological or emotional conditions, to the woman than would other available methods.

Section 28 (145.4145), subdivision 1 states that any person who intentionally or recklessly performs or induces or attempts to perform an abortion in violation of these sections is guilty of a felony.

Subdivision 2 establishes civil remedies for a woman upon whom an abortion has been performed or induced in violation of these sections or a father of the unborn child who was the subject of an abortion.

Section 29 (145.4146) provides privacy protections in a civil or criminal court proceeding or action brought under these sections.  Authorizes the court to determine whether to be preserved from public disclosure if she does not give her consent to such disclosure.

Section 30 (145.4147) establishes severability if any portion of these sections are found to be unconstitutional.

Section 31 (145.4235, subdivision 2) modifies the grantee requirements for the positive alternative grant program by making a program that has had an alternatives to abortion program in existence for at least two years prior to the date of the grant application eligible for a grant.

Section 32 (145.4242) requires a physician to orally inform the patient of the opportunity to view or decline to view an active ultrasound image of the unborn child if at any time prior to the performance of an abortion the woman undergoes an ultrasound examination or the physician determines that ultrasound imaging will be used during the course of the abortion procedure.

Section 33 (145.4244) requires a health care facility that performs abortions to provide the required printed information under the woman right to know act  on the facility’s website or provide a link to the Department of Health’s website.

Sections 34 and 35 (145.928) modify the goals of the health disparities grant program to include reducing the ethnic and racial disparities in access to and utilization of high quality prenatal care.

Sections 36 to 40 (145.986) modify the statewide health improvement program (SHIP) to permit grants to go for a broader purpose than just obesity and tobacco use. This section also requires projects to be proven-effective stategies and promising practices that can be evaluated with experimental or quasi-experimental designs.

Sections 41 to 49 modify the medical cannabis program.

Section 41 (152.22, subdivision 2) adds a definition of “hemp” in the medical cannabis definition section.

Section 42 (152.22, subdivision 6) add hemp acquired by a medical cannabis manufacturer to the definition of medical cannabis for the purpose of the medical cannabis program.

Section 43 (152.25, subdivision 4) requires the commissioner of health to update the medical cannabis task force on the market demand and supply of hemp products that can be used for medicinal purposes.

Section 44 (152.28, subdivision 1) authorizes a health care practitioner to conduct a registered patient assessment for recertification of a qualifying condition via telemedicine.

Section 45 (152.29, subdivision 1) increases the distribution facilities that a manufacturer must operate from four to eight.  Requires the commissioner to designate the geographic service areas to be served by each manufacturer and limits the manufacturer to no more than two distribution facilities in each geographic service area assigned to that manufacturer.  This section also permits a manufacturer to obtain hemp from a hemp grower licensed under chapter 18K and make the hemp available to patients in one of the permitted forms. It also clarifies that hemp acquired by a manufacturer is subject to the same quality control, security, testing and other requirements as for medical cannabis under the program.  Finally this section requires the manufacturer to include in its operating documents procedures for the delivery and transportation of hemp between hemp growers and the manufacturers.

Section 46 (152.29, subdivision 2) conforming change, requiring a manufacturer to process hemp under the same requirements as medical cannabis.

Section 47 (152.29, subdivision 3) extends the maximum supply that a manufacturer may dispense to a patient from 30 day supply to a 90 day supply.

Section 48 (152.29, subdivision 3a) authorizes a manufacturer to staff a transport vehicle with only one employee if transporting hemp only.

Section 49 (152.31) authorizes the commissioner to execute data sharing arrangements with the commissioner of agriculture to verify licensing information, inspections, and compliance related to licensed hemp growers.

Section 50 (157.22) exempts from the licensure requirement under chapter 157 (food and beverage establishments) a food stand if the stand is operated by a person who is under the age of 14; located on private property with the property owner’s permission; has gross receipts or contributions of $1000 or less; and a sign is posted at the site that states that the products sold at the stand are not subject to state inspection or regulation if the stand offers for sale potentially hazardous food.

Section 51 [Direction to the Commissioner of Health] requires the Commissioner of Health by January 1, 2020, to develop and make available on the department’s website a notification and consent form for electronic monitoring that meets the requirements of Minnesota Statutes, section 144.6502, subdivision 6.

Section 52 [Perinatal Hospice Grants] establishes the perinatal hospice grant program providing grants to eligible entities for the development of new perinatal programs or the expansion of existing programs, for training members of a multidisciplinary team providing perinatal hospice services, and for the creation and distribution of materials promoting the awareness of perinatal hospice programs.

Section 53 [Plan for a Working Group on Links Between Health Disparities and Educational Achivement for Children from American Indian Communities and Communities of Color] Requires the commissioner of health, in consultation with the commissioner of education, to develop a plan to convene a working group to examine health disparities and disparities in educational achivement for children from American Indian communities and communities of color.

Section 54 [Short Title] states that sections 145.4141 to 145.4147 may be cited as the Pain Capable Unborn Child Protection Act.

Section 55 [Study of Breastfeeding Disparities] requires the commissioner of health and community stakeholders to study and identify barriers, challenges, and successes affecting the initiation, duration, and exclusivity of breastfeeding. The commissioner is required to report to the legislature with any recommendations by September 15, 2020.

Section 56 [Transition to Authorized Electronic Monitoring in Certain Health Care Facilities] requires anyone conducting electronic monitoring to comply with the requirements of Minnesota Statutes, section 144.6502, by January 1, 2020.

Section 57 repeales section 144.1464 (summer health interns) and 144.1911 (international medical graduates assistance programs).

 

ARTICLE 2

DEPARTMENT OF HUMAN SERVICES; HEALTH CARE

Section 1 (254A.21) codifies, renames, and consolidates fetal alcohol spectrum disorders and prevention grants awarded by the commissioner of human services.

Section 2 (256B.04, subdivision 14) prohibits the commissioner from utilizing volume purchasing through competitive bidding for incontinence products and related supplies.

Section 3 (256B.056, subdivision 1) requires the commissioner to identify individuals who are enrolled in medical assistance and are absent from the state for more than 30 consecutive days. If the individual is still deemed a resident of Minnesota and still eligible for medical assistance then any services provided to the individual must be paid through the fee for service system and not through managed care.

Section 4 (256B.056, subdivision 3) states that upon renewal a single adult without children must not have more than $1,000,000 in assets to continue to be eligible for medical assistance.

Section 5 (256B.056, subdivision 7a) authorizes a local agency to close an enrollee’s case file if the enrollee is terminated from medical assistance for failure to complete and return the required form and information within four months of termination.

Section 6 (256B.0625, subdivision 56a) eliminates the requirement that a county pay for the nonfederal share of the cost of providing officer involved community based care coordination.                                        

Section 7 (256B.0625, subdivision 66) requires medical assistance to cover PPEC center basic services.

Section 8 (256B.0633) modifies the services covered under medical assistance to parents and caretakers and single adults without children to the services covered under the Minnesota EHB Benchmark Plan or the actuarial equivalent.

Section 9 (256B.69, subdivision 4) specifies that an individual who is absent from the state for more than 30 consecutive days but still eligible for medical assistance is not required to be enrolled in managed care.

Section 10 (256B.69, subdivision 31) reduces the maximum trend increases to the rates paid to managed care plans and county based purchasing plans by 1% for calendar years 2020, 2021, 2023, and 2024.

Section 11 (256B.86) establishes the reimbursement rates for PPEC basic service covered by medical assistance and provided in licensed PPEC centers.

Section 12 (256L.03, subdivision 5) reduces the actuarial value for MinnesotaCare to 87 percent for families or individuals with incomes above 150% of the federal poverty guidelines and qual to or less than 200% of the federal poverty guidelines.

Section 13 (256L.03, subdivision 7) modifies the services covered under MinnesotaCare to the services covered under medical assistance under the Minnesota EHB Benchmark Plan or the actuarial equivalent.

Section 14 [Corrective Plan to Eliminate Duplicate Personal Identification Numbers] requires the commissioner of human services to design and implement a corrective plan to address the issue of MA enrollees being assigned more than one personal identification number.  Requires any fixes or corrections to be made by June 30, 2021. This section also requires the commissioner to submit to the legislature a report on the progress of the corrective plan by February 15, 2020 and information on the number of enrollees that have been assigned two or more personal identification numbers; any possible financial effect of enrollees having supplicate numbers; and any effect on federal payments received by the state.

Section 15 [Direction to the Commissioner of Human Services; Quality Measures For PPEC centers] requires the commissioner of human services to develop quality measures for PPEC centers, procedures for reporting quality measures and methods for the commissioner to make the results of the quality measures available to the public.

Section 16 [Repealer] repeals section 16A.724, subdivision 2 (transfers from the health care access fund to the general fund) and section 256B.0625, subdivision 31c (preferred incontinence product program). Both repeals are effective the day following final enactment.

ARTICLE 3

OPERATIONS

Section 1 (16A.055, subdivision 1a) adds definitions for the results first evaluations conducted by the commissioner of management and budget on grant programs administered by the commissioner of human services.

Section 2 (245I.01) creates a state Office of Inspector General, with an inspector general, who shall be in the unclassified service, appointed by the governor and confirmed by the Senate to a 6 year term. Upon full implementation, the Office of the Inspector General shall assume the duties of the office of the inspector general at the department of human services, the licensing division at the department of health, and the office of health facility complaints at the department of health.

Section 3 (245I.02) phases-in the implementation of the Office of Inspector General by transferring the relevant Department of Human Services duties effective July 1, 2020 and the Department of Health duties effective July 1, 2022.

Section 4 [Information Technology Projects; Performance Requirement] requires the commissioner of human services to incorporate measureable indicators of progress toward completion on every information technology project contract.  The indicators or progress must be periodic and at least measure progress for every 25 percent increment toward the completion of the project. Each contract must withhold at least 10 percent of the total contract amount until the project is complete and must specify that where an indicator is not met that a specified proportion of the contract will be withheld.

Section 5 [Reducing Appropriations for Unfilled Positions] states that the appropriations to the Department of Human Services for agency operations for the biennium ending June 30, 2021 are reduced for salary and benefit amounts attributable to any positions that are not filled within 180 days of the posting of the position.  Requires the commissioner of MMB to report to the legislature on the amount of reductions in appropriations under this section.

Section 6 [Results First Evaluation of Grant Programs; Proven-Effective Practices] requires the commissioner of management and budget, in consultation with the commissioner of human services, to establish a schedule to review each grant program administered by the commissioner of human services to determine if the grant uses or promotes proven-effective or promising practices and can be evaluated using experimental or quasiexperimental design.

Section 7 [Revisor’s Instruction] directs the Revisor, non-partisan legislative staff, and the relevant departments to draft for the 2020 legislative session proposed legislation to implement the transition of duties to the Office of the Inspector General.

ARTICLE 4

MNSURE

Section 1 (62V.05, subdivision 2) permits MNsure to continue to collect up to 3.5% of premiums for health plans sold through MNsure to fund the operations of MNsure through December 31, 2019.  Beginning January 1, 2020 to amount that MNsure can collect in reduced to 2% of total premiums for health plans sold through MNsure and caps the total amount collected per year to 25% of the Minnesota Comprehensive Health Association (MCHA) member assessment collected in calendar year 2012.

Section 2 (62V.05, subdivision 5) specifies that a health plan that meets the minimum certification requirements under the ACA is deemed to be in the interest of qualified individuals and employers.  Prohibits MNsure from establishing certification requirements for health carriers and health plans for participation in MNsure that are in addition to the certification requirements under the ACA.  Also prohibits MNsure from establishing costs, cost sharing elements, or benefits for health plans sold through MNsure.  Updates references to federal law and strikes outdated language.

Section 3 (62V.05, subdivision 10) prohibits the commissioner of human services from bearing insurance risk or entering into an agreement to pay claims for health coverage for a state health care program available for purchase through MNsure as a qualifying health plan or as an alternative to purchasing a qualified health plan through MNsure or an individual health plan outside of MNsure.  Specifies that this does not prohibit the commissioner from administering medical assistance or MinnesotaCare through MNsure’s website, or the department employees from obtaining insurance from the state employee group insurance program (SEGIP).

Section 4 (62V.08) requires MNsure to include the total amount spent on business continuity planning, data privacy protection, and cybersecurity in its annual report to the legislature.

Section 5 [Expanded Access to Qualified Health Plans and Subsidies] requires the commissioner of commerce to submit the necessary federal waivers by October 1, 2019, to allow individuals to purchase a qualified health plan outside of MNsure and receive advanced premium tax credits and cost sharing reductions when purchasing these health plans.

Section 6 [MNSure Program Development] states that no funds shall be appropriated to MNsure for new program development until 834 EDI transmissions are being accurately processed without manual intervention.

Section 7 [Rates for Individual Market Health and Dental Plans] requires health carriers to take into account the reduction in the premium withhold for MNsure operations when setting the rates for individual market health plans and dental plans for calendar year 2020.

Section 8 [Request for Information on a Privatized State-Based Marketplace System] requires the commissioner of human services to develop a request for information to consider the feasibility for a private vendor to run an automated web based broker system to provide the core functions that are currently being provided by MNsure and report to the legislature of the results of the RFI by February 15, 2020.

ARTICLE 5

MISCELLANEOUS

Section 1 (62A.30, subdivision 4) provides health care coverage for preventive mammogram screening that includes digital breast tomosynthesis (3D) for enrollees who are at risk for breast cancer.  At risk of breast cancer included having a family history; testing positive for BRCA1 or BRCA2; having dense breasts; or having a previous diagnosis of breast cancer.

Section 2 (148.59) increases the licensing fees for optometrists to match the increased appropriation to the Board of Optometry passed in 2017.

Section 3 (148E.180) increases the licensing fees for social workers to match the increased appropriation to the Board of Social Work bassed in 2017.

Section 4 (152.126, subdivision 6) requires the Board of Pharmacy to conduct random audits of electronic access by permissable users to the prescription monitoring program by permissable users. This section also requires permissible users of the PBM who has delegated the task of accessing the PBM to an agent or employee to audit the use of the PBM by the agents or employees to ensure compliance with permissable use. 

Section 5 (525A.11) limits the appropriate procurement organization in which an anatomical gift of an eye or a part of an eye can be donated to a nonprofit entity.

Section 6 [Guidelines for authorizing patient assisted medication administration] require the Emergency Medical Services Regulatory Board (EMSRB) to propose guidelines authorizing EMTs, AEMTs, and paramedics to assist a patient in emergency situations with administering certain prescription medications.  Requires the proposed guidelines to be submitted to the legislature by January 1, 2020.

 
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