Article 1 – Program Integrity

Section 1 (15C.02) sets the penalties for violation of the Minnesota False Claims Act at the same levels as the penalties for violations of the federal False Claims Act.

Section 2 (119B.09, subdivision 1) imposes an asset limit of $100,000, excluding vehicles, on CCAP eligibility.

Section 3 (119B.09, subdivision 4) amends the definition of “income” in CCAP to include deposits into accounts and funds in personal or business accounts that are used to pay personal expenses, requires documentation of the source for loans, and requires that income and assets be verified with documentary evidence either from the applicant or the source of the income or assets.

Section 4 (119B.09, subdivision 7) sets retroactivity for CCAP reimbursement at a maximum of zero months from the date of application, for applications processed on or after July 1, 2019.

Sections 5 and 6 (119B.09, subdivisions 9 and 9a) preclude the issuance of child care assistance authorizations to more than ten percent of the total licensed capacity for children of employees or controlling individuals of licensed or license-exempt child care centers.

Section 7 (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 8 (119B.125, subdivision 10) requires proof of surety bond coverage for child care centers that receive $250,000 or more in CCAP funds per year. If the provider’s revenue is $250,000 or more in the previous year, the provider must purchase a surety bond of $100,000. The surety bond must be in a form approved by the commissioner, must be renewed annually, and must allow for recovery of costs and fees in pursuing a claim on the bond.

Section 9 (119B.125, subdivision 11) permits county human services agencies to conduct investigations of financial misconduct by child care providers, after the county agency has verified that the provider is not currently being investigated by the Department of Human Services. A county agency may immediately suspend a provider’s CCAP authorization if the investigation uncovers a preponderance of evidence of financial misconduct. The county agency must notify the provider and any affected families of its determination and suspension, and the determination is subject to appeal and a fair hearing.

Section 10 (119B.13, subdivision 6) permits child care providers to bill for CCAP reimbursement only for services documented in attendance records, and permits a county or the commissioner to suspend a provider’s authorization or stop a reimbursement payment if the provider fails to report decreases in child attendance.

Section 11 (119B.13, subdivision 7) sets the CCAP provider reimbursement cap for absent days at 25 per calendar year, defines “absent day” to mean any day that the child is authorized and scheduled to be in care but is absent for the entire day, sets the holidays limit at 10 full days per child per year, requires providers to bill absent days or holidays when they occur, and dictates that a failure to bill an absent day or holiday constitutes an overpayment.

Section 12 (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 13 (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 14 [245A.24] requires all child care licensors, whether at the county or Department of Human Services, to report suspected fraud to county or department investigators.

Section 15 (245E.02, subdivision 1a) clarifies that the definition of “provider” for purposes of CCAP financial misconduct investigations includes individual providers or entities, including the owners and controlling individuals of an entity.

Sections 16 and 17 (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 18 (256.987, subdivision 1) requires that EBT cards include a photograph of the head of household and a list of family members authorized to use the card. It also requires that cardholders show identification before making a purchase.

Section 19 (256.987, subdivision 2) prohibits the receipt of cash for the return of items purchased with an EBT card, requiring that the cost of items purchased with an EBT card be credited back to the card.

Section 20 (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.

Sections 21, 23-24, 57-58, and 61-63 (256B.02, subdivision 20; 256B.056, subdivisions 3 and 4; 256J.08, subdivision 47; 256J.21, subdivision 2; 256L.01, subdivision 5; 256P.04, subdivision 4; 256P.06, subdivision 3) amend the definition of “income” in 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.

Section 22 (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 consumer-directed community supports or qualified professional services to enroll in medical assistance as individual providers; also modifies the surety bond requirements for durable medical equipment providers and suppliers.

Section 25 (256B.056, subdivision 7a) requires the commissioner of human services to annually reverify the eligibility of medical assistance participants, using a prepopulated renewal form that must be corrected and submitted by the participant.

Section 26 (256B.0625, subdivision 17) requires individual drivers providing nonemergency medical transportation NEMT services to enroll as individuals if the NEMT provider by whom they are employed is based in the Twin Cities metropolitan area.

Section 27 (256B.0625, subdivision 17d) requires the commissioner to apply the commissioner’s existing oversight authority to NEMT providers, and permits the commissioner to do so through a contract with a vendor.

Section 28 (256B.0625, subdivision 17e) excludes for five years from the NEMT program a terminated NEMT provider and specifies the circumstances under which a previously excluded NEMT provider may enroll as an NEMT provider.

Section 29 (256B.0625, subdivision 17f) requires the commissioner to provide documentation requirements training to NEMT providers and drivers.

Section 30 (256B.0625, subdivision 18h) requires all NEMT providers to enroll with the Department of Human Services as an NEMT provider.

Section 31 (256B.0625, subdivision 43) modifies the requirements for documenting mental health provider travel time.

Section 32 (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 33 (256B.064, subdivision 2) establishes that funds that are the subject of medical assistance fraud shall be forfeited to the commissioner of human services, either as a result of a criminal conviction or a repeat violation.

Section 34 (256B.064, subdivision 3) requires the commissioner of human services to maintain and post a list of each excluded individual and entity that was convicted of a crime related to medical assistance fraud, and excludes from medical assistance eligibility vendors who employ or conduct business with individuals or entities on the list. Vendors employing or doing business with individuals or entities on the list may be subject to administrative sanctions or a civil penalty of up to $25,000.

Section 35 [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 36 (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.

Section 37 (256B.0659, subdivision 3) clarifies that medical assistance will not cover the services of a qualified professional if those services are provided outside the statutorily required timelines.

Section 38 (256B.0659, subdivision 12) modifies the service delivery documentation requirements of PCAs.

Section 39 (256B.0659, subdivision 13) requires qualified professionals to enroll as individuals with DHS.

Section 40 (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 41 (256B.0659, subdivision 19) requires PCA choice agencies to report labor market data.

Section 42 (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 43 (256B.0659, subdivision 24) inserts a cross-reference notifying PCA agencies of their obligation to report labor market data.

Section 44 (256B.27, subdivision 3) permits the commissioner of human services to demand immediate access to medical records from a vendor suspected of a Medicaid overpayment, without prior notice and during regular business hours, provided that the commissioner has first conferred with the Office of Inspector General and has documented the evidentiary basis for the decision to demand immediate access to the records. Denying access to records is cause for immediate suspension of payment or termination of the vendor’s eligibility.

Section 45 (256B.4912, subdivision 1a) establishes new labor market data reporting requirements for HCBS providers.

Sections 46-50 (256B.4912, subdivisions 11 to 15) expand the service delivery documentation requirements for home and community-based services offered through the disability waivers.

Section 51 (256B.5014) inserts a cross-reference notifying ICFs of their obligations to submit labor market data.

Section 52 (256B.85, subdivision 10) inserts a cross-reference informing CFSS agencies of their obligation to submit labor market data.

Section 53 (256D.024, subdivision 3) expands the ineligibility for general assistance of offenders fleeing from prosecution, custody, or confinement to include any crime.

Section 54 [256D.0245] requires local probation agencies to regularly provide a list of individuals who tested positive for an illegal controlled substance to the welfare fraud division of the local social services agency, for purposes of determining ineligibility for general assistance.

Section 55 (256D.0515) imposes an asset limit on food stamp households of $100,000, excluding vehicles.

Section 56 (256D.0516, subdivision 2) requires food support recipients to report any changes in income, assets, or employment that affect eligibility within ten days of the change.

Section 59 (256J.26, subdivision 3) expands the ineligibility for MFIP of offenders fleeing from prosecution, custody, or confinement to include any crime.

Section 60 [256J.265] requires local probation agencies to regularly provide a list of individuals who tested positive for an illegal controlled substance to the welfare fraud division of the local social services agency, for purposes of determining ineligibility for MFIP.

Section 64 (Laws 2017, First Special Session chapter 6, article 3, section 49) 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; prohibits reduction of reimbursement rates as a result of federal enforcement of electronic visit verification implementation requirements.

Section 65 (Direction to the Commissioner; NEMT driver enrollment impact) 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 66 (Direction to commissioners; universal child identification number) requires the commissioners of MDE, MDH, and DHS to jointly identify what is needed to establish and use a universal identification number for children participating in early childhood programs to determine the extent of potential duplication in the programs, report to the legislature on their findings by July 1, 2020, and implement the system by July 1, 2021. Universal identification numbers would be considered private data on individuals, but could be shared between MDE, MDH, and DHS.

Section 67 (Direction to the Commissioner; federal waivers) directs the commissioner of human services to seek any necessary federal waivers for the removal of self-attestation when establishing eligibility for medical assistance.

Section 68 (Revisor’s instruction) is a Revisor’s instruction to codify the electronic visit verification language from Minnesota Laws 2017, First Special Session chapter 6, article 3, section 49.

Section 69 (Repealer) repeals the existing PCA service verification system upon the effective date of the electronic visit verification system.

Article 2 – Children and Families Services

Sections 1 and 3 (252.27, subdivision 2a; 256B.14, subdivision 2) eliminate TEFRA parental contribution fees.

Section 2 (256.4751) establishes a grant program for organizations to support parent-to-parent programs that provide education and peer support for families of children and youth with special health care needs.

Sections 4 and 5 (256M.41, subdivisions 3 and 4) require the commissioner of human services to make annual child protection performance-based payments to counties by July 10 each year, and authorize the commissioner to require an underperforming county to develop a plan to improve its child protection performance. The commissioner may redirect up to 20% of an underperforming county’s child protection payment amount toward its performance-improvement plan.

Section 6 (260C.216) creates a grant program to facilitate partnerships between counties and community groups or faith communities in order to develop and utilize innovative, nontraditional shared recruitment methods to increase and stabilize the number of available foster care families, while also incorporating efforts to provide additional support services for families in crisis, as an alternative to foster care.

Section 7 (260C.218) permits the commissioner of human services to use available parent support outreach program funds to provide mentoring, guidance, and support services for parents, including through peer-to-peer support groups.

Section 8 (518A.32, subdivision 3) removes the statutory exception that considers a parent who is incarcerated for nonpayment of child support to be voluntarily unemployed, underemployed, or employed on a less than full-time basis, for purposes of imputing income for setting a child support obligation.

Section 9 (518A.51) increases the annual fee for child support collection services from $25 to $35, for individuals that have received at least $550 in child support payments through a county’s collection services, effective October 1, 2019. The fee must be retained by the collecting county from the collected support, but may not be retained from the first $550 of collected support.

Section 10 (Direction to the Commissioner; TEFRA application improvement) directs the commissioner of human services to develop content explaining the medical assistance-TEFRA option to online applicants. It also directs the commissioner to develop a cover letter explaining the medical assistance-TEFRA option enrollment and renewal processes to be disseminated with materials sent to applicants who may qualify for the TEFRA option. It finally directs the commissioner to convene a stakeholder group to consider improvements to the TEFRA option enrollment and renewal processes. The stakeholder group shall report to the commissioner the recommended improvements and associated costs by December 31, 2020.

Section 11 (Pathways to Prosperity pilot project) authorizes the commissioner of human services to develop a pilot project in conjunction with Dakota and Olmsted Counties, to test an alternative benefit delivery system for the distribution of public assistance benefits to certain families, provided that the counties submit documentation of the program’s features, funding, and implementation plan.

Section 12 (Direction to the commissioner; CCAP redesign) directs the commissioner of human services to redesign the child care assistance program to improve features of the current program, in a proposal that could be implemented July 1, 2020. The proposal would be submitted to the legislature by January 15, 2020. The redesigned system would be funded with federal money for fiscal year 2020, and then add state money beginning in fiscal year 2021.

Section 13 (Appropriation) appropriates money to fund the redesigned CCAP program in fiscal years 2022 and 2023.

Section 14 (Revisor’s instruction) instructs the Revisor to replace the terms “food support” and “food stamps” with “Supplementation Nutrition Assistance Program” or “SNAP” throughout statute, where appropriate.

Sections 15 (Revisor’s instruction) and 16 (Repealer) repeal the statutes, rules, and laws relating to the child care assistance program, basic sliding fee child care, and MFIP child care, and instruct the Revisor to remove statutory references to the program, effective July 1, 2020.

Section 16 also repeals the session law relating to the Pathways to Prosperity pilot project.

Article 3 – Chemical and Mental Health

Sections 1 and 27 (13.851, subdivision 11; 641.15, subdivision 3a) permit local corrections departments to share data regarding inmates who have or may have a mental illness with the local county services agency and refer individuals for services where necessary.

Section 2 (245.4889, subdivision 1) authorizes the commissioner of human services to make grants for promoting and developing mental health providers’ capacity to deliver multigenerational treatment and services. It also clarifies that the commissioner may make grants for respite care for children with severe emotional disturbances, whether or not the child is receiving case management services.

Section 3 (254A.03, subdivision 3) establishes that where a screen results positive for alcohol or substance misuse, the individual may receive an initial set of substance use disorder services, which may include four hours of individual or group substance use disorder treatment, two hours of substance use disorder treatment coordination, or two hours of substance use disorder peer support services.

 Section 4 (254A.19) permits chemical use assessments to be conducted by telemedicine.

Sections 5-13 and 24-26 (254B.02, subdivision 1; 254B.03, subdivisions 2 and 4; 254B.04, subdivision 1; 254B.05, subdivision 1a; 254B.06, subdivisions 1 and 2; 256B.0625, subdivisions 24 and 24a; 256I.04, subdivisions 1 and 2f; 256I.06, subdivision 8) align the billing and payment for substance use disorder services with mental health services in the medical assistance benefit set, and set the county share for MA-covered chemical dependency services and for chemical dependency housing room and board at 10%.

Section 6, paragraph (c) also permits the commissioner to deny certification to a new chemical dependency services vendor, if the commissioner determines that the local area has sufficient available services to meet the local need.

Sections 14-22 (256B.0757) authorize the development of and set the standards for behavioral health home models.

Section 14 (256B.0757, subdivision 1) makes a technical conforming change.

Section 15 (256B.0757, subdivision 2) authorizes the commissioner of human services to develop health home models for individuals with a mental illness or an emotional disturbance, in accordance with federal law.

Section 16 (256B.0757, subdivision 4) makes a technical conforming change.

Section 17 (256B.0757, subdivision 9) establishes the criteria to discharge an individual from a behavioral health home. An individual may be discharged if the provider cannot locate the individual for more than three months, or if the individual refuses to receive services. The provider must offer an in-person meeting with the individual and the individual’s supports to discuss the options available to the individual, which include continuing behavioral health home services.

Section 18 (256B.0757, subdivision 10) lists the requirements for behavioral health home services providers to follow, including enrollment as a Minnesota Health Care Programs provider, provision of services covered by medical assistance, use of electronic records and registry, and implementation of immediate needs assessments, 60-day health and wellness assessments, and 90-day health action plans.

Section 19 (256B.0757, subdivision 11) lists behavior health home service provider training requirements, which include training on evidence-based service practices, culturally responsive services, and practice transformation activities to support providing integrated services.

Section 20 (256B.0757, subdivision 12) lists the qualification requirements for behavioral health home service staff, which permit use of community health workers, peer support and recovery specialists, or community paramedics in certain situations.

Section 21 (256B.0757, subdivision 13) establishes the standards for behavioral health home service delivery, which include use of a team-based model of care, evidence-based practices tailored to each individual’s background and needs, person-centered planning practices, delivery of services in locations and settings that meet each individual’s needs, a central point of contact, provision of wellness and prevention education, health coaching, connection to support services, and a continuous quality improvement process. For individuals with a managed care plan, the provider must notify the designated contact that the individual has begun receiving services, and must follow the managed care plan. Prior to terminating services, the provider must give 60 days notice and refer all individuals receiving services to a new provider.

Section 22 (256B.0757, subdivision 14) establishes the process for the commissioner of human services to grant a variance to the provider, training, staff, or services standard requirements for a behavioral health home program, if such a variance would relieve a hardship, is in the public interest, and would not decrease the level of services provided.

Section 23 [256B.0759] codifies the provider standards necessary for Minnesota to implement the substance use disorder demonstration waiver upon CMS approval, and increases the rates for participating providers by 15% for the treatment portion of the residential rate, effective July 1, 2020, and by 10% for outpatient individual and group services and comprehensive assessments, effective January 1, 2021.

Section 28 (Repealer) repeals the statute setting the county share for MA-covered substance use disorder services at 30%, and repeals rules related to the assessment of need for treatment programs and county board responsibility to review program needs.

Article 4 – Continuing Care for Older Adults

Section 1 (144A.073, subdivision 16) authorizes the commissioner of health to approve nursing home construction projects such as renovations of, or additions to existing facilities provided the annualize increased costs to medical assistance does not exceed 2 million dollars.

Section 2 (256R.25) makes conforming changes related to the rate add-on for border city facilities under 256R.481.

Section 3 (256R.481) establishes an external fixed costs payment rate add-on effective for rate years beginning on or after January 1, 2021, for nonprofit nursing facilities located in the border cities of Breckenridge and Moorhead. The rate add-on is equal to the difference between the median rate paid in the adjacent North Dakota city for the lowest acuity level residents and the rate paid to the Minnesota facility for residents of the same acuity.

Section 4 (Repealer) repeals the existing language related to a rate exception for non-profit nursing facilities in Breckenridge. Any facility covered by the repealed language is also covered by the new language in 256R.481.

Article 5 – Disability Services

Section 1 (245A.03, subdivision 7), paragraph (a), clause (7) extends an existing foster care licensing moratorium from June 30, 2018, to June 30, 2019, for certain previously unlicensed setting to become licensed.

Paragraph (a), clause (8) excludes from the foster care license moratorium a vacancy created in a foster care setting that has been granted a foster care licensing moratorium exception under clause (7).

Paragraph (c) requires the commissioner of human services to use the resource need determination process to reduce the statewide capacity of corporate adult foster care by one bed within six months of a second bed being permanently vacated.

Section 2 (245A.11, subdivision 2a) allows the commissioner of human services until June 30, 2021 to issue adult foster care and community residential setting licenses with a capacity of six adults for settings licensed before June 30, 2016 provided the existing conditions for a fifth bed are met.

Section 3 (245D.03, subdivision 1) clarifies which services are governed by Minnesota Statutes, chapter 245D (Home and Community-Based Services Licensing Standards), by specifying which the services are provided by each waiver, and changes the name of behavioral support services to positive support services.

Section 4 (245D.071, subdivision 5) amends the home and community-based services standards related to service planning for intensive support services.

Paragraph (a) is editorial.

Paragraph (b) requires a licensed provider of intensive home and community-based services, when conducting a service plan review, to include and document a discussion of how a person receiving intensive services might use technology to help the person meet the person’s goals.

Section 5 (245D.09, subdivision 5) removes the minimum required hours of annual training for direct care staff providing licensed home and community-based services and removes the option for relevant training received for a source other than the license holder to count toward the annual training requires.  The requirement for annual training remains.

Section 6 (245D.09, subdivision 5a) removes the discretion of the commissioner to approve online training and competency-based assessments as an alternative to orientation training provided by individual license holders

Section 7 (245D.091, subdivision 2, clause (12), item (vi)) allows an individual with master’s degree or higher and a demonstrated expertise in positive supports to qualify as a positive supports professional.

Section 8 (245D.091, subdivision 3, paragraph (a), clause (3)), permits a board-certified behavior analyst or assistant behavior analyst to qualify as a positive support analyst.

Paragraph (b), clause (1), modifies additional qualifications for a positive support analyst be requiring four years of supervised experience that includes specific tasks.

Paragraph (b), clause (2), allows a person who meets the other positive support analyst qualifications to qualify as a positive support analyst if the person receives the required training within 90 days following hire and adds additional training requirements.  Under current law, such a person does not qualify as a behavior analyst until after the training is completed.

Paragraph (c) allows a person who qualifies as a positive support professional to qualify as a positive support analyst without meeting the training requirements of paragraph (b).

Section 9 (245D.091, subdivision 4, paragraph (b)) allows a person who meets the other positive support specialist qualifications to qualify as a behavior specialist if the person receives the required training within 90 days following hire.  Under current law, such a person does not qualify as a behavior specialist until after the training is completed.  The bill does change the existing training requirements.

Paragraph (c) allows a person who qualifies as a positive support professional to qualify.

Section 10 (252.275, subdivision 3) reduces the county share for semi-independent living services (SILS) grants from 30 percent to 15 percent.

Section 11 [256.488] establishes a new on-going grant program to promote access to physical fitness training for persons with disabilities.

Section 12 (256B.0625, subdivision 19a) modifies the eligibility criteria for personal care assistance services by requiring a dependence in one critical activity of daily living, rather than one activity of daily living, one level one behavior or one behavior that shows increase vulnerability. This section is effective January 1, 2020, or upon federal approval, whichever is later.

Section 13 (256B.0652, subdivision 6) specifies that recipients of PCA services who have a dependency in one critical activity of daily living receive no more than two units of service a day.

Section 14 (256B.0658) modifies the eligibility criteria for the housing access grant.

Section 15 (256B.0659, subdivision 3a) clarifies that lead agencies may continue to use legacy assessment tools for PCA assessments.

Section 16 (256B.0659, subdivision 11, paragraph (d)) specifies the requirements a personal care attendant must meet in order for the services the personal care attendant provides to qualify for an enhanced rate.

Section 17 (256B.0659, subdivision 17a) establishes an enhanced rate of 110 percent of the non-enhanced rate for PCA services rendered to a client requiring ten or more hours of services.

Section 18 (256B.0659, subdivision 21, paragraph (a), clause (10)) requires provider agencies to document whether a personal care attendant has received the training that would qualify the services the personal care attendant provides for an enhanced rate.

Section 19 (256B.0659, subdivision 24, clause (15)) requires a provider agency to document that it passed through the entire value of the enhanced rate in the form of wages and benefits to the personal care attendants who provide the services that qualify for the enhanced rate.

Section 20 (256B.0659, subdivision 28) requires provider agencies to document whether a personal care attendant has received the training that would qualify the services the personal care attendant provides for an enhanced rate.

Section 21 (256B.0911, subdivision 1a, paragraphs (a) and (b)) clarifies language related to assessments for developmental disabilities waiver services; removes from the MnCHOICES assessment process service eligibility determinations for home care nursing, for home care targeted case management; for adult targeted case management, and for Rule 185 case management services; also removes long-term care consultation services (otherwise known as a MnCHOICES assessment) as the required process for determining whether the family of a minor with a disability is eligible for a support grant.

Section 22 (256B.0911, subdivision 3a, paragraph (a)) makes conforming changes by striking from the MnCHOICES statute references to home care nursing.

Paragraph (c) requires the MnCHOICES assessment process to be conversational in nature.

Paragraph (d) removes a requirement that a legal representative of a person receiving a MnCHOICES assessment be physically present during an assessor’s face-to-face assessment of the person seeking long-term care, and permits the legal representative to participate in the assessment remotely instead. Also requires a provider to submit information to be considered at an asssessment at least 60 days prior to an assessment.

Paragraph (e) removes the existing requirement that a MnCHOICES assessor completea community support plan within 40 calendar days of the assessment. DHS will determine a new deadline for completing the community support plan, but the total time for the assessor to complete the community support plan and the case manager to complete the coordinated service and support plan must not exceed 60 days.

Paragraph (j), clause (9), requires a certified assessor to point out in the assessment documents the location of the statement concerning the person’s right to appeal the results of an assessment.

Paragraph (k) allows the results of a MnCHOICES assessment to establish service eligibility for developmental disability waiver services for up to 60 days from the time of the assessment.

Paragraph (k) also interacts with existing paragraph (m) to permit a service eligibility update for developmental disability waiver services to extend the validity of a MnCHOICES assessment for an additional 30 days. These changes align the service eligibility timelines for developmental disability waiver services with the timelines for the other home and community-based waiver and alternative care services.

Section 23 (256B.0911, subdivision 3f, paragraph (a)) requires a certified assessor to review a person’s most recent assessment prior to a reassessment, and requires DHS to establish timelines for a MnCHOICES assessor, following an annual MnCHOICES reassessment, to complete an updated coordinated support plan and a case manager to complete an updated coordinated service and support plan.

Section 24 (256B.0911, subdivision 3g) permits a person receiving only Rule 185 case management services to decline annual MnCHOICES assessments.

Section 25 (256B.0911, subdivision 5), paragraph (c) requires the Commissioner of Human Services, in cooperation with lead agencies, to develop and collect data on a set of measures of increasing efficiency in the MnCHOICES assessment process, and to report an analysis of that data to lead agencies and to the Legislature.  Paragraphs (a) and (b) contain existing requirements that the commissioner make the assessment process more efficient.  This paragraph requires the commissioner to demonstrate that the process is becoming more efficient.

Section 26 (256B.0915, subdivision 6), paragraph (a), clause (1) removes the current ten-day deadline for case managers to complete coordinated service and support plans for people receiving any home and community-based waiver services or alternative care.  DHS will determine a new deadline for completing coordinated service and support plans, but the total time for a MnCHOICES assessor to complete the community support plan and the case manager to complete the coordinated service and support plan must not exceed 60 days.

Section 27 (256B.0915, subdivision 10) modifies the elderly waiver capitation payments to managed care organizations to incorporate the value of the rate adjustment for designated disproportionate share establishments.

Section 28 (256B.0915, subdivision 18), paragraphs (a) to (d) creates an application process for housing with services establishments to become designated disproportionate share establishments if at least 50 percent of the residents of the establishment are participants in the elderly waiver program.

Paragraphs (e) and (f) establish a variable rate adjustment from 101 percent to 110 percent of the customized living rate depending on the percentage of elderly waiver participants residing in a designated establishment.

Paragraph (g) specifies that the value of the rate adjustment will not be included in an individuals monthly case mix budget cap.

Section 29 (256B.092, subdivision 1b), paragraph (a), clause (1) removes the current ten-day deadline for case managers to complete coordinated service and support plans for people receiving any home and community-based waiver services or alternative care.  DHS will determine a new deadline for completing coordinated service and support plans, but the total time for a MnCHOICES assessor to complete the community support plan and the case manager to complete the coordinated service and support plan must not exceed 60 days.

Section 30 (256B.092, subdivision 12a) limits the growth in the developmental disabilities waiver by allowing new recipients to access the waivers only after an existing waiver recipient permanently exits the waiver or an existing ICF/DD permanently converts to waiver services.

Section 31 (256B.0921) modifies the name of the grant program.

Section 32 (256B.49, subdivision 11b) limits the growth in the community access for disability inclusion waiver by allowing new recipients to access the waivers only after an existing waiver recipient permanently exits the waiver.

Section 33 (256B.49, subdivision 13), paragraph (a), clause (1) removes the current ten-day deadline for case managers to complete coordinated service and support plans for people receiving any home and community-based waiver services or alternative care.  DHS will determine a new deadline for completing coordinated service and support plans, but the total time for a MnCHOICES assessor to complete the community support plan and the case manager to complete the coordinated service and support plan must not exceed 60 days.

Section 34 (256B.49, subdivision 14) requires a provider to submit within 60 days prior to an assessment any information to be considered at an assessment.

Section 35 (256B.4914, subdivision 2) defines “Direct care staff” for the purposes of DWRS, and modifies the definition of "unit of service" for the purposes of prevocational services, reducing a unit from one hour to 15 minutes.

Section 36 (256B.4914, subdivision 3) makes conforming and editorial changes.

Section 37 (256B.4914, subdivision 5), paragraph (b) establishes a competitive workforce factor of 4.7 percent and requires providers to use additional revenue created by the competitive workforce factor to increase wages and benefits for direct care staff.

Paragraph (c) requires the commissioner to conduct a biennial analysis of the competitive workforce factor and make recommendations to the legislature related to adjusting the factor.

Paragraph (j) decreases the frequency of future wage index rebasing from every 5 years to every two years, but also uses older data when performing the rebasing.

Paragraph (k) decreases the frequency of future inflation adjustments from every 5 years to every two years, but also uses older data when performing the inflation adjustment.

Paragraph (l) removes all after framework adjustments from DWRS rates upon implementation of the next rebasing and inflation adjustment beginning July 1, 2022.

Paragraph (m) preemptively removes any rate adjustments not specified in 256B.4914 from DWRS rates each time a wage index rebasing and inflation adjustment occurs.

Paragraph (o) requires the commissioner to update the general administrative support ratios under DWRS in the event that chapter 245D licensing fees are required.

Section 38 (256B.4914, subdivision 10) makes conforming changes; strikes obsolete language; modifies the frequency of required analysis of the regional adjustment factor; delays by one year the next full report on the data analysis DHS is performing related to the DWRS; and adds a new requirement that DHS and stakeholders study value-based payment methodologies for waiver services.

Section 39 (256B.4914, subdivision 10a), paragraph (f) requires providers to report the additional revenue attributable to the competitive workforce factor and prepare a written plan for distributing that revenue to direct care workers.

Paragraph (g) requires providers to submit labor market data to the commissioner.

Paragraph (h) requires the commissioner to publish an annual report based on the labor market data submitted by providers.

Paragraph (i) permits the commissioner to withhold payments until providers comply with the data reporting requirements.

Section 40 (256B.493, subdivision 1) requires the commissioner of human services to use the existing planned closure process to close licensed corporate foster care settings in order to achieve the reduction in statewide corporate foster care capacity required under 245A.03, subdivision 7, paragraphs (c) and (d), which were amended earlier in the bill.

Section  41 (256B.5013, subdivision 1), paragraph (a) modifies the conditions under which an intermediate care facility for persons with developmental disabilities is eligible for an increased ICF/DD rate to enable the facility to meet a particular individual’s documented increase in need. This paragraph also removes an existing 12-month limit on the increased rate and allows the increased rate to remain in place unless the needs of the particular individual for whom the increased rate was granted change.

New Paragraph (b) requires the county of financial responsibility to act on an increased rate request within 30 days of the request.

Old paragraphs (c) to (e) remove various requirements of counties and facilities related to justifying the use of funds made available through an increased rate, reporting on the uses of the funds, and preventing funds from being diverted away from providing services to the individual for whom the increased rate was granted.

New paragraph (c) adds an additional circumstance under which a county can recommend that a requested increased rate be granted.

New Paragraph (d) specifies the information a facility must provide when making a request for an increased rate.

Section 42 (256B.5013, subdivision 6) makes a conforming change to the duties of the commissioner of human services.

Section 43 (256B.5015, subdivision 2), paragraph (a) increases the rate for services during the day from 75% of the rate that would have been paid for an individual to participate in day training and habilitation to 100% of that rate.

Paragraph (b) specifies the conditions under which an individual qualifies for services during the day, and thus for reimbursement for those services under paragraph (a).

Section 44 (256B.85, subdivision 3) modifies the eligibility criteria for community first services and supports by requiring a dependence in one critical activity of daily living, rather than one activity of daily living, one level one behavior or one behavior that shows increase vulnerability.

Section 45 (256B.85, subdivision 8), paragraph (b) makes conforming changes to the CFSS home care ratings, and specifies that individuals with the lowest home care rating qualify for two units of service per day.

Paragraph (c) establishes CFSS eligibility for pregnant women.

Section 46 (256C.23, subdivision 7) defines “family and community intervener.”

Section 47 (256C.261) defines the services provided by a family or community intervener.

Section 48 (256I.03, subdivision 8) amends the definition of “supplementary services” by adding a cross-reference to the requirements under Minnesota Statutes, section 256I.04, subdivision 2h.

Section 49 (256I.04, subdivision 2b) requires that providers of housing supports confirm in their housing support agreement that the provider will not limit or restrict the number of hours an applicant or recipient chooses to be employed, as specified in subdivision 5.

Section 50 (256I.04, subdivision 2h) is a new subdivision that requires providers of supplementary services to ensure that recipients have, at a minimum, assistance with services identified in the individual’s professional statement of need.  This section also requires all providers to maintain case notes with the date and description of services provided to individual recipients.

Section 51 (256I.04, subdivision 5) is a new subdivision that prohibits a provider from limiting or restricting the number of hours an applicant or recipient is employed.

Section 52 (256I.05, subdivision 1r) provides a supplementary rate to an Anoka County housing support provider for six of the provider’s 12 beds.

Section 53 [268A.061] requires the Department of Employment and Economic Development to enter into limited-use vendor operating agreements with day training and habilitation (DT&H) providers to allow DT&H providers to provide vocational rehabilitative services to their existing disability waiver clients if the client makes an informed choice to stay with the DT&H provider when receiving vocational rehabilitative services. Limited-use vendor operating agreements are an existing type of vendor agreement for the provision of vocational rehabilitation services by providers who are not accredited with the Commission on Accreditation of Rehabilitation Facilities.

Section 54 (Expansion of CDCS budget methodology exception) corrects a cross-reference.

Section 55 (Consumer-directed community supports budget methodology) allows people who have elected the consumer-directed community supports option to elect to establish a shared services arrangement with other people who have elected the consumer-directed community supports option. This subdivision specifies requirements for shared service arrangements and grants the commissioner authority to set rates for shared services.

Section 56 (Day training and habilitation disability waiver rate system transition grants) establishes a four–year grant program for day training and habilitation providers who serve at least 100 waiver recipients and who will experience reductions in revenue under full implementation of DWRS of at least 15 percent and $300,000.  Grant recipients must develop and implement a sustainability plan to close their funding gaps, and must demonstrate progress in closing the funding gap to qualify for a grant renewal.

Section 57 (Direction to the Commissioner; MnCHOICES 2.0) requires the Commissioner of Human Services to ensure that the updates to the MnCHOICES assessment tool incorporates a qualitative approach to interviewing, requires the commissioner to include members of the disability community in the planning process for modifying MnCHOICES, and permits counties to use legacy assessment tools rather than the MnCHOICES tool until MnCHOICES 2.0 is fully implemented.

Section 58 (Direction to the Commissioner; Capitation payments for LTSS assessment activities) requires the commissioner to develop a proposal to replace the random moment time study payment methodology for county human services activities with a per activity fee based on the historical data collected through prior time studies.

Section 59 (Direction to the Commissioner; Barriers to independent living) requires the commissioner to submit to the legislature a report describing state and federal regulations that create barriers to independent living for people with disabilities.

Section 60 (Adult foster care moratorium exception) exempts a licensed family adult foster care setting from the moratorium on new corporate foster care licenses, thereby allowing the setting to convert to a corporate setting.

Section 61 (Direction to the Commissioner; Authorize redistribution of housing with services capacity) permits an existing housing with services establishment providing customized living services under the BI and CADI waivers to redistribute its service capacity to other establishments.

Section 62 (Direction to the Commissioner; PCA comparability waiver) directs the commissioner to submit a request to waiver the Medicaid comparability requirement for the purposes of the modified PCA eligibility criteria.

Section 63 (Direction to the commissioner; Transition period for modified eligibility for personal care assistance services) requires the commissioner not to apply the new PCA eligibility requirements to people receiving PCA services on December 31, 2019 until the latest date permissible under federal law, and requires the commissioner to allow for a transition period of up to one year following the date upon which the new PCA eligibility criteria are applied to people receiving PCA services on December 31, 2019.

Section 64 (Direction to the commissioner; Report on eligibility for PCA and access to DD and CADI waivers) requires the commissioner to submit to the legislature a report on the effects of the modified PCA eligibility requirements and the limit on the growth of the DD and CADI waivers.

Section 65 (Direction to the commissioner; Intermediate care facility for persons with developmental disabilities level of care criteria) requires the commissioner to prepare draft legislation to codify the commissioner’s existing criteria for determinations of need for an ICF/DD level of care.

Section 66 (Direction to the commissioner; direct-care workforce rate methodology study) requires the commissioner to evaluate the feasibility of developing a reimbursement methodology for direct-care workers similar to the DWRS methodology, and report to the legislature by February 1, 2020.

Section 67 (Direction to the commissioner; home care services payment reform proposal) requires the commissioner to develop a proposal for medical assistance reimbursement for home care services based on the Medicare prospective payment methodology for home health.

Section 68 (Revisor’s instruction)

Paragraph (a) instructs the revisor of statutes to correct inconsistent terminology related to the DD waiver, and to codify existing session law related to the consumer-directed community support opinions under the home and community-based waivers.

Paragraph (b) instructs the Revisor to codify existing law related to the consumer-directed community supports option.

Section 69 (Repealer) repeals section 256I.05, subdivision 3, which requires housing support providers to charge the same room and board rate to all residents.

Article 6 – Direct Care and Treatment

Section 1 (246.54, subdivision 3) establishes an administrative review process for a county to dispute the cost of care for clients in state-operated facilities, when the client’s discharge is delayed due to lack of notice that the client no longer qualifies for the facility’s services, due to the facility’s disagreement with the county’s recommended discharge plan, or due to incomplete paperwork. The section also precludes the commissioner of human services from recovering from the client any remaining cost following the administrative review.

Section 2 (Direction to the Commissioner; delayed discharge reduction) directs the commissioner of human services to report to the legislature by January 1, 2023, regarding efforts to reduce the number of days that clients spend in state-operated facilities after discharge is determined to be appropriate. The report must also include the fiscal impact of these discharge delays.

Section 3 (Direction to the Commissioner; MSOCS Coon Rapids Ilex closure) directs the commissioner of human services to close the MSOCS Coon Rapids Ilex state-operated community services program. The commissioner is prohibited from reopening or redesigning the program.

Section 4 (Repealer) repeals statutory sections relating to the State-Operated Services Account.

Article 7 – Operations

Sections 1 and 6-8 add criteria for the commissioner of health to set aside a disqualification for an individual seeking to work or working in the substance use disorder treatment field.

Section 1 (144.057, subdivision 3) requires the commissioner of health to use the same set aside criteria as the commissioner of human services with respect to individuals employed or seeking employment in the substance use disorder field.

Section 6 (245C.02, subdivision 20) defines “substance use disorder treatment field” as a licensed, registered program exclusively serving individuals 18 years old and older for substance use disorder treatment or recovery.

Section 7 (245C.22, subdivision 4) specifies the criteria for setting aside a disqualification for an individual seeking employment in the substance use disorder field.

Section 8 (245C.22, subdivision 5) provides an exception for a set-aside for a person employed in the substance use disorder field, under subdivision 4, where the individual received a previous set aside for a different program or agency.

Section 2 (245A.04, subdivision 7) allows the commissioner of human services to issue a temporary change of ownership license or provisional license, but prohibits the commissioner from issuing or reissuing a license if the applicant had been denied a license, including a license following expiration of a provisional license, within the past two years.

Section 3 (245A.04, subdivision 7a), paragraph (a) requires a license holder to notify the commissioner and obtain approval before making any changes that would alter the license information.

Paragraph (b) requires a license holder to notify the commissioner at least 30 days before the change is effective, in writing, of certain listed changes.

Paragraph (c) requires a license holder to provide amended articles of incorporation or other documents reflecting a change to business structure or services.

Section 4 [245A.043] establishes procedures for a license application after a change of ownership.

Subdivision 1 specifies that a license is not transferable or assignable.

Subdivision 2 requires submission of a new license application when the commissioner determines that a change in ownership will occur. Specifies what constitutes a change in ownership.

Subdivision 3, paragraph (a) requires written notice to the commissioner of any proposed sale or change of ownership at least 60 days prior to the anticipated change, when the new owner intends to assume operation without interruption.

Paragraph (b) requires a prospective new owner or operator to submit a license application at least 30 days prior to the change, and comply with all statutory requirements.

Paragraph (c) allows the commissioner to develop application procedures for when the applicant is a current license holder, and the program is currently licensed by DHS and in substantial compliance.

Paragraph (d) specifies that the existing license holder is responsible for operating the program until a license is issued to the new owner or operator.

Paragraph (e) allows the commissioner to waive a new owner or operator’s licensing inspection, under certain circumstances.

Paragraph (f) requires a new owner or operator to submit a letter identifying how and when they will resolve any outstanding correction orders, if applicable.

Paragraph (g) specifies that any licensing actions taken against the existing license holder when the new owner or operator is applying for a license will remain in effect until the grounds for the action are corrected or no longer exist.

Paragraph (h) requires the commissioner to evaluate a license application according to statute.

Paragraph (i) allows the commissioner to deny an application according to statute, and allows for appeals.

Paragraph (j) specifies that this subdivision does not apply to a home-based program or service.

Subdivision 4 establishes a temporary change of ownership license for a new owner or operator while the commissioner evaluates the new owner or operator’s license application, and allows commissioner to establish criteria for issuing such licenses.

Section 5 (245A.065) expands the rules and statutes eligible for fix-it tickets during inspection of a licensed child care provider, to include violations that do not present imminent danger, cannot be corrected at the time of the inspection, and are not a repeat violation. A fix-it ticket may not be used for violations corrected at the time of the inspection. The section also lists rules and statutes that may qualify only for fix-it tickets, if violated.

Section 9 [256.0113] permits counties and tribes receiving human services grants funded exclusively with state dollars to, at the start of the fourth fiscal quarter each year, re-allocate unspent grant dollars for any county or tribal human services purpose. Any proposed re-allocation must be approved by majority vote of the county board or governing tribal body, and all approved re-allocations must be reported to the commissioner of human services.

Section 10 (256B.04, subdivision 21) provides an exception to provider enrollment requirements under medical assistance for pediatric therapy providers if the only reason the provider would be denied enrollment is that the provider has not billed the Medicare program.

Section 11 (Repealer) repeals the statutory subdivisions imposing staffing credentials on individuals performing comprehensive assessments and providing care coordination services for counties.

Article 8 – Heath Care

Section 1 (13.69, subdivision 1) exempts from the data classification “private” the last four digits of social security numbers in diver’s license and motor vehicle registration records for the purposes of sharing this data with the commissioner of human services to aid in the recovery of health care benefits paid.

Section 2 (256.9365) modifies healthcare coverage for individuals living with HIV to include the cost of health plan premiums as well as cost sharing for prescriptions including co-payments, deductibles, and co-insurance, with the exception of those portions of a premium paid for by the individual’s employer.

Section 3 (256B.056, subdivision 3) provides a mechanism for people enrolled in medical assistance for employed persons with disabilities for 24 consecutive months without a laps in medical assistance eligibility prior to turning 65 to protect many of their assets when they turn 65 by establishing a designated employment incentives asset account.

Section 4 (256B.056, subdivision 5c) between January 1, 2020 and June 30, 2021, increases from 81 percent to 82 percent the medical spenddown requirement for persons whose medical assistance eligibility is based on blindness, disability or being 65 or older. Beginning July 1, 2021, the MA spenddown is eliminated.

Section 5 (256B.0625, subdivision 18d) adds a taxicab owner to the nonemergency medical transportation advisory committee.

Section 6 (Pain Management) requires the Health Services Policy Committee, established by the Commissioner of Human Services, to evaluate the integration and make recommendations based on best practices for effective treatment for musculoskeletal pain provided by certain health practitioners and covered by Medical Assistance.  Requires the commissioner to consult with certain health practitioners and report to the Legislature by August 1, 2020, on the commissioner's recommendations. The final report to the Legislature must include a pilot program to assess integrated nonpharmacologic, multidisciplinary treatments for managing musculoskeletal pain.