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State of Minnesota
S.F. No. 4 - Human Services Program Integrity - First Engrossment
Author: Senator Jerry Relph
Prepared By: Liam Monahan, Senate Analyst (651/296-1791)
Date: March 28, 2019


Sections 1, 10, 12, 13, and 39-43 amend the definition of “income” in CCAP, MA, MFIP, housing assistance, GA, MSA, and MinnesotaCare to include deposits into accounts and funds in personal or business accounts that are used to pay personal expenses, and require documentation of the source for loans.  This change in law will allow a more thorough assessment of income from self-employment.

Section 2 (119B.125, subdivision 1c) requires proof of surety bond coverage for child care centers that receive $100,000 or more in CCAP funds per year. If the provider’s revenue is $100,000 or more in the previous year, the provider must purchase a surety bond.  The surety bond must be in a form approved by the commissioner and must be renewed annually, and must allow for recovery of costs and fees in pursuing a claim on the bond. 

Section 3 (119B.125, subdivision 6) requires that CCAP attendance records be provided at the time of request, and records produced at a subsequent date are not valid for purposes of establishing proof that the child was present, and modifies the calculation for overpayments so that if a record is insufficient to support the billing, an overpayment results, regardless of whether the child is subsequently determined eligible due to an excused absence.

Section 4 (144A.479, subdivision 8) inserts a cross-reference in the home care statute notifying home care providers of their obligation to submit labor market data.

Section 5 (245.095) strengthens the authority of the Commissioner of Human Services to prevent individuals and providers from receiving state funds through a DHS administered program after being excluded from any program administered by DHS.

Section 6 (256.476, subdivision 10) contains no changes. This section should have been deleted by a prior amendment.

Sections 7 and 8 (256.98, subdivisions 1 and 8) permanently disqualify clients, families, and providers from participating in the program in which they committed fraud if there is a finding or an action by a federal court or state court.  If the finding or action is by administrative hearing, the first offense results in a two-year disqualification and a second offense is a permanent disqualification. 

Section 9 (256B.02, subdivision 7) modifies the definition of “vendor of medical care” to include all home and community-based service providers, thereby clarifying the commissioner’s authority to exclude and sanction these providers for violations of medical assistance requirements.

Section 11 (256B.04, subdivision 21) modifies requirements for provider enrollment in medical assistance; requires the commissioner to conduct provider screening activities consistent with federal law; requires the commissioner to revalidate enrollment of providers every five years and every three years for PCA providers; and requires individuals providing autism early intensive behavior intervention benefits, consumer-directed community supports, or qualified professional services to enroll in medical assistance as individual providers.

Section 11 also modifies the surety bond requirements for durable medical equipment providers and suppliers.

Section 14 (256B.0625, subdivision 17) requires individual drivers providing NEMT services to enroll as individuals if the NEMT provider by whom they are employed is based in the Twin Cities metropolitan area.

Section 15 (256B.0625, subdivision 17d) requires the commissioner to apply the commissioner’s existing oversight authority to NEMT providers.

Section 16 (256B.0625, subdivision 17e) specifies the length of time during which a terminated NEMT provider is excluded from the NEMT program and the circumstances under which a previously excluded NEMT provider may enroll as an NEMT provider.

Section 17 (256B.0625, subdivision 17f) requires the commissioner to provide documentation requirements training to NEMT providers and drivers.

Section 18 (256B.0625, subdivision 18h) intends to require all nonemergency medical transportation providers to enroll with the Department of Human Services as an NEMT provider.

Section 19 (256B.0625, subdivision 43) modifies the requirements for documenting mental health provider travel time.

Section 20 (256B.064, subdivision 1b) specifies the length of exclusion for medical assistance for a provider sanctioned by a court for a violation of medical assistance requirements.

Section 21 [256B.0646] permits the commissioner to place a recipient of PCA or CFSS services in the Minnesota restricted recipient program upon evidence of abusive or fraudulent billing. Placement in the program is subject to appeal.

Section 22 (256B.0651, subdivision 17) clarifies the authority of the commissioner to notify recipients of services that their provider will be terminated as a medical assistance provider.

Sections 23-24 (256B.0659, subdivisions 3 and 12) modify the service delivery documentation requirements of PCAs.

Section 25 (256B.0659, subdivision 13) requires qualified professionals to enroll as individuals with DHS.

Section 26 (256B.0659, subdivision 14) requires a qualified professional to inform DHS within 30 days that they are no longer employed by the PCA agency with which they were affiliated.

Section 27 (256B.0659, subdivision 19) requires PCA choice agencies to report labor market data.

Section 28 (256B.0659, subdivision 21) modifies provider agency enrollment requirements to include submitting copies of policies related to fraud prevention and preventing inadequate documentation; self-auditing policies; program integrity policies; and, for first-time enrollees, proof of adequate operating capital. Also included is a requirement that PCA agencies provide DHS with payroll documentation and demonstrate that the agency is complying with the existing requirement that 72.5 percent of the provider's revenue from MA for PCA services is passed through to PCAs in the form of wages and benefits.

Section 29 (256B.0659, subdivision 24) Inserts a cross-reference notifying PCA agencies of their obligation to report labor market data.

Section 30 (256B.0949, subdivision 15) requires qualified EIDBI providers to enroll with DHS as individual providers after clearing a background check.

Section 31 (256B.4912, subdivision 1a) establishes new labor market data reporting requirements for HCBS providers.

Section 32-36 (256B.4912, subdivisions 11 to 15) expands the service delivery documentation requirements for home and community-based services offered through the disability waivers.

Section 37 (256B.5014) inserts a cross-reference notifying ICFs of their obligations to submit labor market data.

Section 38 (256B.85, subdivision 10) inserts a cross-reference informing CFSS agencies of their obligation to submit labor market data.

Section 44 establishes electronic visit verification for PCA services and home health care services as required by federal law; specifies that the commissioner cannot enforce electronic visit verification requirements until six months after the commissioner makes available to service providers the state-selected electronic visit verification system, the data aggregator, and training on the system. If during this six-month period the federal government withholds federal financial participation in the PCA or CFSS program, the commissioner shall use state-only funds to backfill the lost federal participation.

Section 45 requires the commissioner to study the impact of individual driver enrollment on the integrity of the NEMT program and to report the study’s findings to the legislature.

Section 46 requires a universal identification number for children participating in early childhood programs to determine the extent of potential duplication in the programs.  The proposal would require that MDE, MDH, and DHS jointly identify what is needed to establish and use a universal identification number.

Section 47 increases funding to counties for fraud prevention investigations under Minnesotsa Statutes, section 256.983.

Section 48 is a Revisor’s instruction to codify the electronic visit verification language.

Section 49 repeals the existing PCA service verification system upon the effective date of the electronic visit verification system.


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