Senate Counsel, Research
and Fiscal Analysis
Minnesota Senate Bldg.
95 University Avenue W. Suite 3300
St. Paul, MN 55155
(651) 296-4791
Tom Bottern
Director
   Senate   
State of Minnesota
 
 
 
 
 
H.F. No. 2414 - Omnibus Health and Human Services Appropriations (UEH2414-1)
 
Author: Senator Michelle R. Benson
 
Prepared By: Katie Cavanor, Senate Counsel (651/296-3801)
Patrick Hauswald, Senate Counsel (651/296-5079)
Liam Monahan, Senate Analyst (651/296-1791)
 
Date: May 2, 2019



 

 

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 (256.983, subdivision 5) authorizes counties to investigate financial misconduct by any DHS-licensed provider, provided that the department is not actively investigating the provider, and to suspend available assistance payments upon finding a preponderance of evidence of financial misconduct. The section provides for a fair hearing for affected providers.

Section 19 (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 20 (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 21 (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 22, 24-25, 58-59, and 62-64 (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 23 (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 26 (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 27 (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 28 (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 29 (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 30 (256B.0625, subdivision 17f) requires the commissioner to provide documentation requirements training to NEMT providers and drivers.

Section 31 (256B.0625, subdivision 18h) requires all NEMT providers to enroll with the Department of Human Services as an NEMT provider.

Section 32 (256B.0625, subdivision 43) modifies the requirements for documenting mental health provider travel time.

Section 33 (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 34 (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 35 (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 36 [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 37 (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 38 (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 39 (256B.0659, subdivision 12) modifies the service delivery documentation requirements of PCAs.

Section 40 (256B.0659, subdivision 13) requires qualified professionals to enroll as individuals with DHS.

Section 41 (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 42 (256B.0659, subdivision 19) requires PCA choice agencies to report labor market data.

Section 43 (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 44 (256B.0659, subdivision 24) inserts a cross-reference notifying PCA agencies of their obligation to report labor market data.

Section 45 (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 46 (256B.4912, subdivision 1a) establishes new labor market data reporting requirements for HCBS providers.

Sections 47-51 (256B.4912, subdivisions 11 to 15) expand the service delivery documentation requirements for home and community-based services offered through the disability waivers.

Section 52 (256B.5014) inserts a cross-reference notifying ICFs of their obligations to submit labor market data.

Section 53 (256B.85, subdivision 10) inserts a cross-reference informing CFSS agencies of their obligation to submit labor market data.

Section 54 (256D.024, subdivision 3) expands the ineligibility for general assistance of offenders fleeing from prosecution, custody, or confinement to include any crime.

Section 55 [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 56 (256D.0515) imposes an asset limit on food stamp households of $100,000, excluding vehicles.

Section 57 (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 60 (256J.26, subdivision 3) expands the ineligibility for MFIP of offenders fleeing from prosecution, custody, or confinement to include any crime.

Section 61 [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 65 (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 66 (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 67 (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 68 (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 69 (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 70 (Repealer) repeals the existing PCA service verification system upon the effective date of the electronic visit verification system.

ARTICLE 2 – CHILDREN AND FAMILIES SERVICES

Section 1 (13.46, subdivision 2) authorizes the Department of Human Services to share welfare data about child care assistance program participants, applicants, and providers with the Department of Education.

Section 2 (13.46, subdivision 4) makes child care provider correction orders or fines due to licensing violations private or nonpublic if the correction order or fine is at least seven years old.

Section 3 (13.461, subdivision 28) provides cross-references in chapter 13 (Minnesota Government Data Practices Act) for data classified in the sections governing the child care assistance program.

Section 4 (119B.02, subdivision 6) defines “child care assistance program data” as data for a specific time period showing that a child care assistance program payment was made and the amount of the payment to the child care center. Certain payment data is public but any data identifying a child is private.

Section 5 (124D.142, subdivision 2a) requires all providers electing to participate in the Parent Aware program to undergo an evaluation before receiving a star rating, dictates that failing to comply with training and background study requirements may result in a one-star rating reduction, and dictates that failing to comply with technical requirements that do not affect the quality of care or education shall not reduce a provider’s rating.

Section 6 (245A.03, subdivision 2) permits legal nonlicensed childcare providers to care for up to six unrelated children, with a combined maximum of two toddlers and infants.

Section 7 (245A.04, subdivision 4) precludes the commissioner of human services from issuing a correction order or negative action for a licensing violation found during an inspection but not discussed during an exit interview. Provides that inspection results must not be publicly available on the DHS website for a period longer than the minimum time imposed by federal law.

This section also establishes that inspections of family child care providers shall follow the provisions of section 245A.055, and stipulates that the presence of a family child care provider’s relative in the residence does not constitute a violation, unless the relative is an employee of the child care center or provides a sufficient amount of child care services to exceed the threshold for being subject to the statutory training requirements.

Section 8 (245A.04, subdivision 18) directs the commissioner of human services to consult with relevant child care stakeholders to develop, publicly post, and distribute a plain-language handbook for family child care providers to understand the application and licensing process, and all applicable rules and statutes, by January 1, 2020.

Section 9 (245A.055) establishes the statutory requirements, procedures, and standards for inspections of family child care providers.

Subdivision 1 reiterates that family child care providers shall be inspected annually, as required under current law.

Subdivision 2 defines four types of inspections: initial inspection, full inspection, abbreviated inspection, and follow-up inspection. A full inspection covers all applicable rules and statutes for family care providers. An abbreviated inspection covers certain key indicators that statistically predict full compliance with all applicable rules and statutes. Providers qualify for abbreviated inspections by having a clean inspection history for at least three years. Failure to comply with any key indicator during an abbreviated inspection triggers a full inspection. A follow-up inspection is a full inspection that takes place within six months an inspection that finds a violation that warrants a correction order.

Subdivision 3 establishes that the risk of the violation determines the type of corrective action that may be issued by a county licensor, as follows:

  • Level 1: violation presents no risk of harm or a minimal risk of harm and warrants verbal technical assistance from the licensor
  • Level 2: violation presents a low risk of harm and warrants a written technical assistance notice from the licensor
  • Level 3: violation presents moderate risk of harm and warrants a fix-it ticket
  • Level 4: violation presents a substantial risk of harm and warrants a correction order or conditional license

By January 1, 2020, the commissioner is directed to consult with the relevant industry stakeholders to propose which rules and statutes, if violated, fall into each risk level, as well as which rules and statues may fall into multiple risk levels, depending on the nature of the violation. The commissioner is also directed to identify which violations must be enforced under federal law. By July 1, 2020, the commissioner must provide training to implement the risk-based violation levels during family child care inspections.

Subdivision 4 establishes that a follow-up inspection shall take place within six months of an investigation that finds more than one Level 4 violation. The follow-up inspection date does not alter the provider’s typical annual inspection date.

Section 10 (245A.06, subdivision 1) amends the correction order statute to permit licensors to issue correction orders for Level 4 violations, or a failure to correct a Level 3 violation, found during an inspection of a family child care provider.

Section 11 (245A.06, subdivision 10) requires a county licensor to seek clarification from the Department of Human Services in writing if a child care provider disputes the interpretation of a licensing requirement, before the licensor may issue a correction order to the child care provider

Section 12 (245A.065) amends the fix-it ticket statute to permit licensors to issue fix-it tickets for Level 3 violations found during an inspection of a family child care provider, beginning July 1, 2020. The commissioner of human services may not publicly post a fix-it ticket unless required by federal law. Effective immediately, this section 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 issued 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, and requires publicly posted fix-it tickets to identify the federal law requiring publication.

Section 13 [245A.066] establishes the authority for county licensors to issue verbal technical assistance for level 1 violations, and written technical assistance notices for Level 2 violations, found during an inspection of a family child care provider. The commissioner of human services may not publicly post a written technical assistance order unless required by federal law.

Section 14 (245A.14, subdivision 4) authorizes the commissioner of human services to grant a special family day care license to individuals that provide child care services out of a portion of a commercial or other building that meets certain building code standards.

Section 15 (245A.14, subdivision 16) permits child care centers to provide drinking water in bottles to children, so long as the bottles are washed, rinsed, and sanitized daily after use and stored in a clean and dry manner.

Section 16 (245A.16, subdivision 1) makes conforming technical changes to accommodate the differential monitoring inspection model.

Section 17 (245A.50, subdivision 1) requires child care providers who relocate within the state to continue to satisfy their annual, ongoing training requirements, but relocating providers are not required to complete initial training requirements that the provider completed prior to licensure. If the provider relocates to a new county, the county may not require the relocating provider to complete orientation or training required for new providers.

Section 18 (245A.50, subdivision 2) removes the annual requirement for family child care providers to complete two hours of child development and learning and behavior guidance training and replaces that requirement with completion of an annual refresher training course, which will include those topics.

Sections 19, 20, and 22 (245A.50, subdivisions 3, 4, and 6) clarify the statutory requirements that family child care providers must repeat first aid training and CPR training every two years, prior to the date that the provider’s annual license expires. The same clarification is made for the statutory requirements that family child care providers must repeat child passenger restraint systems training every five years.

The section also requires that providers serving or transporting children 8 years old and younger to have received the child passenger restraint systems training.

Section 21 (245A.50, subdivision 5) adds Sudden Unexpected Infant Death and Abusive Head Trauma training to the annual refresher course.

Section 23 (245A.50, subdivision 7) reduces the number of ongoing training hours for family child care providers to 10 hours and establishes that the annual refresher course shall count toward that hours requirement.

Section 24 (245A.50, subdivision 9) clarifies the statutory requirement that family child care providers must repeat the full supervising for safety training every five years, prior to the date that the provider’s annual license expires, and replaces the requirement to complete an annual two-hour supervising for safety course with completion of an annual refresher course, which will include this topic.

Section 25 (245A.50, subdivision 12) replaces certain ongoing training requirements for family child care providers with an annual course of up to two hours that refreshes child care provider training on active supervision, child development and behavior guidance, sudden unexpected infant death, head trauma, and any training required by the child care development block grant, beginning January 1, 2020. The course must be available to complete online or through self-study.

Section 26 (245A.50, subdivision 13) exempts relatives of children in child care programs from having to complete child care training requirements in order to care for or have contact with the related child at the child care site. Relatives that are designated caregivers, helpers, or substitutes for the child care program must complete the training requirements.

Section 27 (245A.50, subdivision 14) exempts substitute caregivers from completing child care training and background study requirements when providing care during an emergency situation.

Section 28 (245A.51, subdivision 3) eliminates the requirement for a licensed child care provider to post in a prominent location and provide a physical or electronic copy of its emergency preparedness plan to a child’s parent or legal guardian upon enrollment.

Section 29 (245A.52) permits family child care providers to use substitute caregivers for up to 720 hours in a 12-month period.

Section 30 (245A.60) creates and funds a new Office of the Ombudsperson for Child Care Providers. It directs the governor to appoint an ombudsperson for child care providers to serve a six-year term and carry out duties to support and inform family and legal nonlicensed child care providers with all areas of concern related to the provision of child care services, including licensing and regulatory compliance correction orders and appeals, service improvement, and application assistance. The ombudsperson is authorized to hire staff, to access data necessary for discharging the duties of the office, and to receive copies of all provider correction orders, penalty assessments, and complaint investigations on a quarterly basis. The ombudsperson must operate independently of the department of human services and must have experience providing child care as a family child care provider, interpretation of laws and regulations, investigations, record keeping, report writing, public speaking, and management. A person is not eligible to serve as ombudsperson while holding public office and cannot have been previously employed by the child care licensing division of the Department of Human Services or as a county licensor. The commissioner of human services must provide the ombudsperson with office space, supplies, and other support, and must post provide child care providers with the contact information for the ombudsperson.

Sections 31 and 33 (252.27, subdivision 2a; 256B.14, subdivision 2) eliminate TEFRA parental contribution fees beginning July 1, 2021.

Section 32 (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 34 and 35 (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 36 (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 37 (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 38 (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 39 (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 40 (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 41 (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 42 (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. 

Section 43 (Direction to Commissioner; Abbreviated Inspections) directs the commissioner of human services to consult with relevant industry stakeholders to develop the key indicators to be used during abbreviated inspections, and to report the proposed indicators to the legislature by January 1, 2020. The section also directs the commissioner to develop training to implement the abbreviated inspections beginning July 1, 2020.

Section 44 (Direction to Commissioner; Training Requirements) directs the commissioner of human services to develop an annual refresher course for family child care providers to cover certain subjects, and to propose legislative changes to eliminate duplicative training requirements.

Section 45 (Direction to Commissioner; Correction Order Enforcement Review) directs the commissioner of human services to develop and implement a process to review licensing inspection results at the county level, to identify trends of over- or under-enforcement and issue additional guidance and training as needed to correct any imbalance or inaccuracy in correction order enforcement. The commissioner shall include the results of this work in the annual report on child care.

Section 46 (Family Child Care Task Force) establishes an 18-member task force intended to increase the number of family child care providers and improve the quality of family child care services throughout the state, to be comprised of legislators, child care providers, family child care associations, child care licensors, and business associations. The task force will meet monthly beginning August 1, 2019, and must identify licensing requirements that have led to the closure of family child care programs, recommend business development and technical assistance resources to promote provider recruitment and retainment, identify alternative family child care provider business models, identify and recommend family child care regulatory reforms that improve licensing efficiencies, review Parent Aware participation to identify obstacles and improvements, and review the Revisor’s recodification of Minnesota Rules, chapters 9502 and 9503, and Minnesota Statutes, chapter 245A. The task force’s report is due by March 1, 2020.  

Section 47 (Direction to Commissioner; Licensing and Background Study Review) instructs the commissioner of human services to review the rules and statutes relating to child care provider licensing and background study requirements and propose legislation to eliminate unnecessary and duplicative record keeping or documentation requirements. The commissioner is also directed to create a process for child care providers to electronically submit information requested by the department of human services for these purposes.

Section 48 (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 49 (Revisor’s instruction) and 53 (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 50 (Revisor Instruction) instructs the Revisor of Statutes to consult with nonpartisan legislative staff and the Department of Human Services to recodify the rules governing day care facility licensing as statutes.

Section 51 (Revisor Instruction) instructs the Revisor of Statutes to consult with nonpartisan legislative staff and the Department of Human Services to recodify the rules governing child care facility licensing as statutes.

Section 52 (Revisor Instruction) instructs the Revisor of Statutes to consult with nonpartisan legislative staff and the Department of Human Services to prepare legislation for the 2020 session that recodifies Minnesota Statutes, chapter 245A, and repeals and enacts as statutes the rules governing day care licensing.

Section 53 also repeals the session law relating to the Pathways to Prosperity pilot project.

ARTICLE 3 – CHEMICAL AND MENTAL HEALTH

Sections 1 and 31 (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 (245.4663) creates a grant program to fund the cost of the services provided through officer-involved community-based care coordination programs in counties operating such programs throughout the state. The programs must be evaluated by the commissioner of management and budget as part of the results first initiative, and the commissioner of human services must annually report on grant recipients, amounts, services provided, and individuals served under the grant program.

Section 3 (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 4 (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 5 (254A.19) permits chemical use assessments to be conducted by telemedicine.

Sections 6-14 and 26-28 (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 7, 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.

Section 15 (256B.0625, subdivision 56a) amends the statutory provisions regarding post-arrest community-based service coordination by replacing the term “post-arrest community-based service coordination” with “officer-involved community-based care coordination,” expanding the service to include contract employees for tribes, alcohol and drug counselors, and supervised recovery peers, and removing the county share of the nonfederal cost for providing the services.

Sections 16-24 (256B.0757) authorize the development of and set the standards for behavioral health home models.

Section 16 (256B.0757, subdivision 1) makes a technical conforming change.

Section 17 (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 18 (256B.0757, subdivision 4) makes a technical conforming change.

Section 19 (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 20 (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 21 (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 22 (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 23 (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 24 (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 25 [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 29 (256K.45, subdivision 2) adds a requirement for the commissioner of human services to report on the shelter-linked youth mental health grant program as part of the biennial report on the issue of homeless youth.

Section 30 [256K.46] establishes a shelter-linked mental health grant program for housing providers to partner with community-based mental health practitioners to provide mental health services to homeless or sexually exploited youth. Applicants for the two-year grants must demonstrate that they have received targeted trauma training on sexual exploitation and adolescent homelessness, and grant funds may be used to develop programming or training, to provide mental health services, or to build capacity to provide services via telemedicine. Grant recipients must promote and assist participants with obtaining health insurance, and report their activities to the commissioner annually.

Sections 32 and 33 (Children’s Residential Treatment Payment Provisions) extend the effective dates from April 30, 2019 to June 30, 2019 for two laws. The first affected law established medical assistance coverage for residential facilities providing children’s necessary mental health services. The second affected law established a county share of the cost for rehabilitative mental health services. Both provisions now expire July 1, 2019.

Section 34 (Direction to the Commissioner; Substance Use Disorder Treatment) directs the commissioner to propose a plan to identify systems improvements to minimize paperwork for substance use disorder programs.

Section 35 (Direction to Commissioner; Telepresence Platform Expansion) directs the commissioner of human services to develop a proposal that would expand a common, interoperable, person-centered telepresence platform for delivery of behavior health and other health care services statewide.

Section 36 (Direction to Commissioner; School-Linked Mental Health Improvement) directs the commissioner of human services to assess the school-linked mental health program to develop improvements that promote stability, effectiveness, sustainability, data evaluation, and analysis of the impact of school-linked mental health programs. The commissioner must report the findings and any recommendations to the legislature by January 15, 2020.

Section 37 (Officer-Involved Community Based Care Coordination Planning Grants) authorizes the commissioner of human services to award up to 10 planning grants of $10,000 in 2020 for the start-up costs of new county officer-involved community-based care coordination

Section 38 (Community Competency Restoration Task Force) establishes a task force to evaluate and research community competency restoration programs, beginning no later than August 1, 2019, to propose recommendations to the legislature to improve the services, resources, and diversionary programs to address the growing number of individuals deemed incompetent to stand trial. The task force must submit a report of its progress and findings to the legislative committees with jurisdiction over mental health and corrections by February 1, 2020, and a final report of its recommendations by February 1, 2021.

Section 39 (Specialized Mental Health Community Supervision Pilot Project) authorizes the commissioner of human services to award a grant to Anoka County to conduct a pilot project that would provide enhanced assessment, case management, treatment services, and community supervision for offenders with mental illness on probation, parole, supervised release, or pretrial status in Anoka County.

Section 40 (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 nonprofit 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 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 statutory requirements for a fifth bed are met; and removes the June 30, 2019, expiration of the commissioner’s authority to issue licenses for the fifth or sixth beds.

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 individual's 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 of 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.

Sections 38 to 41 (256B.4914, subdivision 6 to 9) make conforming changes to cross-refernces.

Section 42 (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 43 (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 44 (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  45 (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) permits a county to recommend an increased rate for a cognitive need.

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

Section 46 (256B.5013, subdivision 6) makes a conforming change to the duties of the commissioner of human services.

Section 47 (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 48 (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 49 (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 50 (256C.23, subdivision 7) defines “family and community intervener.”

Section 51 (256C.261) defines the services provided by a family or community intervener.

Section 52 (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 53 (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 54 (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 55 (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 56 (256I.05, subdivision 1r) provides a supplementary rate to an Anoka County housing support provider for six of the provider’s 12 beds.

Section 57 [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 58 (Expansion of CDCS budget methodology exception) corrects a cross-reference.

Section 59 (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 60 (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 61 (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 62 (Direction to the Commissioner; Payments for county human services 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 63 (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 64 (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 65 (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 66 (Direction to the Commissioner; PCA comparability waiver) directs the commissioner to submit a request to waive the Medicaid comparability requirement for the purposes of the modified PCA eligibility criteria.

Section 67 (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 68 (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 69 (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 70 (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 71 (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 72 (Direction to commissioner; interagency plan for supported employment) requires the commissioners of human services, education, and employment and economic development to develop a plan to assist people between the ages of 14 and 24 with significant disabilities to maximize their opportunities to achieve integrated competitive employment.

Section 73 (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 73 (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

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 (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.

Sections 5, 7, and 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 5 (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.

Sections 6 (245C.10, subdivision 14) and 9 (245C.32, subdivision 2) set a fee of $110 for background studies for guardians or conservators, beginning January 1, 2020.

Section 10 (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 six-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 11 (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 12 (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 13 (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 14 (524.5-118) extends time period for background studies of guardians and conservators from two years to five years, updates terminology to use “national criminal history record check,” requires signed privacy notice to subject of study, establishes requirements to share background study results with courts, and establishes requirements for DHS to review disciplinary sanctions from the background study subject’s affiliated agencies, if any, all to be effective January 1, 2020.

Section 15 (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 16 (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 quasi-experimental design.

Section 17 (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.

Section 18 (Repealer) repeals the statutory subdivisions imposing staffing credentials on individuals performing comprehensive assessments and providing care coordination services for counties.

ARTICLE 8 - DEPARTMENT OF HUMAN SERVICES; HEALTH CARE

Section 1 (13.69, subdivision 1) requires the Department of Public Safety to provide to DHS the last four digits of a driver’s Social Security number for purposes of recovery of Minnesota health care program benefits paid.

Section 2 (254A.21) codifies, renames, and consolidates fetal alcohol spectrum disorders and prevention grants awarded by the commissioner of human services.

Section 3 (256.9365) conforms the program that provides health care 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, and makes other conforming eligibility requirements for the program.

Section 4 (256.937) creates the insulin assistance program.

            Subdivision 1 requires the commissioner to implement an insulin assistance program by     July 1, 2020.  Requires the commissioner to:

  1. pay participating pharmacies;
  2. maintain a list of eligible individuals; and
  3. ensure there is pharmacy participation across the state.

The commissioner may contract with a private entity or enter into an interagency agreement to implement the program.

Subdivision 2, paragraph (a), specifies that to be eligible for the program, an individual must:

  1. be a resident of Minnesota;
  2. not be eligible for  Medicare, medical assistance, or MinnesotaCare;
  3. have a family income that is equal to or less than 400 percent of FPG; and
  4. be uninsured or have no prescription drug coverage.

Paragraph (b) requires the commissioner to develop an application form and make the application available to pharmacies, providers, and on the department’s website.  States that the commissioner shall require an applicant to submit information to verify eligibility if deemed necessary.

Paragraph (c) states that if deemed eligible, the commissioner shall issue the individual an identification card that is valid for 30 days from the date of issuance, to be used at a participating pharmacy.  Specifies that an individual is not eligible for renewal until 12 months from the card’s expiration date.

Subdivision 3, paragraph (a), specifies that participation by a pharmacy is voluntary. To participate, a pharmacy is required to register with the commissioner and agree to reimbursement and other contract terms.  Allows a pharmacy to withdraw from participation by providing the commissioner with written notice. 

Paragraph (b) requires the pharmacy to dispense insulin to eligible individuals who present a valid prescription and an ID card.

Paragraph (c) requires eligible individuals to pay an insulin co-payment that is equal to the prescription co-payment required under the MinnesotaCare program.

Paragraph (d) requires the pharmacy to process the insulin in accordance with the eligible individual’s health plan, if the individual has coverage.

Section 5 (256.938) establishes the insulin assistance account in the special revenue fund in the state treasury.  Requires the insulin registration fees collected by the Board of Pharmacy under section 151.252 to be deposited in the account.  Appropriates the money in the account to the commissioner to fund the insulin assistance program.

Section 6 (256B.04, subdivision 14) prohibits the commissioner from utilizing volume purchasing through competitive bidding for incontinence products and related supplies. This section is effective the day following final enactment.

Section 7 (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 8 (256B.056, subdivision 3) Paragraph (a) provides a mechanism for people enrolled in medical assistance for employed persons with disabilities for 24 consecutive months without a lapse 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.

Paragraph (b) 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.  This paragraph is effective only upon federal approval.

Section 9 (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 10 (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 11 (256B.0625, subdivision 9) eliminates medical assistance coverage for dental services for nonpregnant adults who are not aged, blind, or disabled.

Section 12 (256B.0625, subdivision 12) eliminates medical assistance coverage for vision services, eyeglasses, and dentures for nonpregnant adults who are not aged, blind, or disabled.

Sections 13 to 15 (section 256B.0625, subdivisions 13, 13e, and 13f) modify the outpatient pharmacy reimbursement for outpatient prescription drugs under fee-for-service medical assistance to comply with federal requirements.

Section 13 (256B.0625, subdivision 13) strikes language specifying the quantity of over-the-counter medications to be dispensed.

Section 14 (256B.0625, subdivision 13e) specifies that the usual and costmary price means the lowest price charged by the provider to a patient who pays for the drug and includes prices charged to a patient enrolled in a prescription savings club or discount club administered by the pharmacy or pharmacy chain.  This section also requires that prescription drugs be reimbursed on the actual acquisition cost according to nationally recognized benchmarks.  It also increases the dispensing fee for pharmacy providers from $3.85 to $10.48 and establishes ongoing cost dispensing surveys to be conducted every three years.  It also aligns reimbursement for drugs purchased through the federal 340B program requiring that reimbursement for these drugs be at the provider’s cost.

Section 15 (256B.0625, subdivision 13f) strikes language that prohibits the commissioner from requiring prior authorization from being used for antihemophilic factor drug where there is no generically equivalent drug in conjunction with  a supplemental drug rebate program or multistate preferred drug program.

Section 16 (256B.0625, subdivision 18d) adds a taxicab owner to the nonemergency medical transportation advisory committee.

Section 17 (256B.0625, subdivision 66) requires medical assistance to cover PPEC center basic services.

Section 18 (256B.064, subdivision 1a) authorizes the commissioner to impose sanctions against a pharmacy provider for failure to respond to a cost of dispensing survey required under section 256B.0625, subdivisions 13e, paragraph (h).

Section 19 (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 20 (256B.69, subdivision 31) reduces the maximum trend increases to the rates paid to managed care plans and county based purchasing plans by 1.6% for calendar years 2020, 2021, 2023, and 2024.

Section 21 (256B.86) establishes reimbursement rates for PPEC basic services covered by medical assistance and provided in licensed PPEC centers.

Section 22 (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 equal to or less than 200% of the federal poverty guidelines.

Section 23 (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 24 [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 25 [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 26 (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.

Section 27 [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 9 - 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 (62J.84) establishes prescription drug price transparency.

Subdivision 1 permits this section to be cited as the "Prescription Drug Price Transparency Act.”

Subdivision 2 defines the following terms: biosimilar, brand name drugs, commissioner, generic drugs, manufacturer, new prescription drug, patient assistance program, prescription drug, and price.

Subdivision 3, paragraph (a) requires drug manufacturers beginning July 1, 2020, to submit to the commissioner of health for each drug for which the price was $100 or greater for a 30-day supply or for a course of treatment lasting less than 30 days; and for brand name drugs, there was a net increase of ten percent or greater within the previous 12-month period, and for generic drugs there was a net increase of 100 percent or greater in the price over the previous 12-month period.

Subdivision 3, paragraph (b) requires the following information, if applicable, to be submitted within 60 days after the price goes into effect:

  1.   the name and price of the drug and the net increase;
  2.   the factors contributing to the increase;
  3.   the name of any generic version available;
  4. the introductory price of the drug when it was approved by the FDA and the net    yearly increase in the price over the previous five years;
  5.  the direct costs incurred by the manufacturer associated with the drug to     manufacture, market, and distribute;
  6.   the total sales revenue for the drug during the previous 12 month period;
  7. the manufacturer’s net profit attributable to the drug during the previous 12  month period;
  8. the total amount of financial assistance the manufacturer has provided through  patient assistance programs;
  9. any agreement between a manufacturer and other entity contingent on any delay in offering to market a generic  version of the drug;
  10. the patent expiration date if under patent;
  11. the name and locations of the company that manufactured the drug; and
  12. the ten highest prices paid for a brand name drug during the previous year in any country other than the US.

Subdivision 3, paragraph (c) permits the manufacturer to submit any documentation necessary to support the information reported.

Subdivision 4, paragraph (a) requires a drug manufacturer beginning March 15, 2020, to submit to the commissioner no later than 60 days after the manufacturer introduces a new brand name drug with a price that is greater than $500 for a 30-day supply or a new generic or biosimilar drug with a price that is greater than $500 for a 30-day supply and is not at least 15% lower than the referenced brand name drug when the generic or biosimilar drug is launched, the following information, if applicable:

  1. the price of the drug; 
  2. whether the FDA granted the new drug a breakthrough therapy designation or a priority review; 
  3. the direct costs incurred by the manufacturer associated with the drug to manufacture, market, and distribute; and
  4. the patent expiration date if under patent. 

Subdivision 4, paragraph (b), permits the manufacturer to submit any documentation necessary to support the information reported.

Subdivision 5, paragraph (a), requires a drug manufacturer beginning July 1, 2020, to submit to the commissioner for every newly acquired drug for which the price increases by more than $100 for a 30-day supply from the price before the acquisition and the price after the acquisition, no later than 60 days after the acquiring manufacturer begins to sell the newly acquired drug the following information, if applicable:

  1. the price of the drug at the time of the acquisition and in the year before the acquisition;
  2. the name of the company from which the drug was acquired, the date acquired, and the purchase price;
  3. the year the drug was introduced on the market and the price at the time of introduction;
  4. the price of the drug for the previous five years;
  5. any agreement between a manufacturer and other entity contingent on any delay in offering to market a generic  version of the drug; and
  6. the patent expiration date of the drug if the drug is under patent.

 Paragraph (b) permits the manufacturer submit any documentation necessary to support the information reported.

Subdivision 6, paragraph (a), requires the commissioner to post on the department’s website or contract with a private entity or consortium the list of drugs that have been reported by the manufacturers under this section and the information reported on these drugs by the manufacturer. 

Paragraph (b) requires the information to be published in an easy-to-read format and in a manner that identifies the information on a per-drug basis. 

Paragraph (c) specifies that the commissioner or a contracting entity shall not post any information if the information is not public data under section 13.02; or is trade secret information under section 13.37; or is information that is not already available in the public domain. 

Paragraph (d) states if any information is withheld from public disclosure the commissioner shall post a report describing the nature of the information and the basis for withholding the information from disclosure.

Subdivision 7, paragraph (a), permits the commissioner to consult with a private entity or consortium, the University of Minnesota, or the commissioner of commerce in issuing the form and format for reporting the information required; in posting the information; and in taking any other action pursuant to implementing this section. 

Paragraph (b) permits the commissioner to consult with representatives of the manufacturers to establish a standard format for reporting information to minimize administrative burdens to the state and to the manufacturers.

Subdivision 8 states that the commissioner may impose a civil penalty on a manufacturer for failing to submit timely reports; failing to provide required information; failing to respond in a timely manner to a written request of the commissioner; or providing inaccurate or incomplete information.

Subdivision 9 requires the commissioner to annually submit to the legislature beginning January 15, 2021, a report on the implementation of this section including its effectiveness in promoting transparency in pharmaceutical pricing; enhancing the understanding of pharmaceutical spending trends; and assisting the state and other payers in managing pharmaceutical costs.

Section 6 (144.057, subdivision 3) requires the commissioner 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 7 (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 8 (144.3831, subdivision 1) increases the annual fee-for-service connection to a public water supply, from $6.36 to $9.72.

Section 9 (144.397) requires the commissioner 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.

Sections 10 to 17 modify the Minnesota Clean Indoor Air Act (MCAA) to include e-cigarettes in the act.

Section 10 (144.412) adds to the public policy of the MCAA to protect against involuntary exposure to aerosol or vapor from electronic delivery devices.

Section 11 (144.413, subdivision 1) makes a conforming citation change.

Section 12 (144.413, subdivision 4) modifies the definition of smoking to include the burning or carrying of a lighted or heated cigar, cigarette, pipe, or any other lighted or heated product containing, made, or derived from nicotine, tobacco, marijuana, or other plant that is intended for inhalation.  Specifies that the definition includes carrying or using an activated electronic delivery device.

Section 13 (144.414, subdivision 2) makes a conforming change.

Section 14 (144.414, subdivision 3) makes a conforming change.

Section 15 (144.416) modifies this section to permit a proprietor of a business to take more stringent measures to protect individuals from involuntary exposure to aerosol or vapor from electronic delivery services.

Section 16 (144.4165) modifies this section to prohibit carrying or using an activated electronic delivery device in public schools.

Section 17 (144.417) modifies this section to permit a local government to pass more stringent measures to protect individuals from involuntary exposure to aerosol or vapor from electronic delivery devices.

Section 18 (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 19 (144.586, subdivision 3) requires hospitals discharging a medically fragile pediatric patient to ensure that arrangements are made and in place to implement the patient's discharge plan prior to discharge.

Section 20 (144.591) requires a hospital to provide to a patient within 30 days of discharge an itemized description of billed charges that includes a notation for each drug dispensed to the patient, the charge for which was increased by 5% or more over the hospital’s acquisition cost.

Section 21 (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 seven 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 22 (144.966, subdivision 2) extends the newborn hearing screening advisory council until June 30, 2025.

Sections 23 to 32 modify regulations for PPEC centers.

Section 23 (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 24 (144H.04, subdivision 1) delays by two years, from 2018 to 2020, the initial licensing of PPECCs.

Section 25 (144H.04, subdivision 1a) extends the phase-in for licensing additional PPECCs by two years.

Section 26 (144H.06) modifies which Minnesota Rules apply to PPECCs by including an existing background study requirement and eliminating a redundant fee requirement.

Section 27 (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 28 (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 29 (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 30 (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 31 (144H.11, subdivision 3) eliminates the requirement that licensed practical nurses employed by PPECCs need two years of experience in pediatrics.

Section 32 (144H.11, subdivision 4) makes technical changes.

Sections 33 to 40 establish the Pain Capable Unborn Child Protection Act.

Section 33 (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 postfertilization age was made and the probable postfertilization 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 34 (145.4141) defines the following terms: abortion; attempt to perform or induce an abortion; fertilization; medical emergency; physician; postfertilization age; probable postfertilization age of the unborn child; reasonable medical judgment; unborn child or fetus; and woman.

Section 35 (145.4142) sets out legislative findings.

Section 36 (145.4143) prohibits an abortion from being performed except in the case of a medical emergency, unless the physician performing the abortion has made a determination of the probable postfertilization age of the unborn child or relied on the determination made by another physician.

Section 37 (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 postfertilization 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 postfertilization 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 38 (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 39 (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 40 (145.4147) establishes severability if any portion of these sections are found to be unconstitutional.

Section 41 (145.4235, subdivision 2) modifies the grantee requirements for the positive alternative grant program by making a program that has had an alternative to abortion program in existence for at least two years prior to the date of the grant application eligible for a grant.

Section 42 (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 43 (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.

Section 44 (145.908, subdivision 1) specifies that the commissioner shall provide grants for screening and treatment for pre and postpartum mood and anxiety disorders within the limits of available appropriations (instead of within federal funds that are available).

Sections 45 and 46 (145.928) modify the goals of the health disparities grant program to include reducing ethnic and racial disparities in access to and utilization of high-quality prenatal care.

Sections 47 to 51 modify the statewide health improvement program (SHIP).

Section 47 (145.986, subdivision 1) permits grants to go for a broader purpose than just obesity and tobacco use.

Section 48 (145.986, subdivision 1a) requires projects to be proven-effective strategies and promising practices that can be evaluated with experimental or quasi-experimental designs.

Section 49 (145.986, subdivision 4) specifies that the evaluation use the most appropriate experimental or quasi-experimental design suitable to the activity or project.

Section 50 (145.986, subdivision 5) requires the reports to the legislature to include a description of the evaluation systems used.

Section 51 (145.986, subdivision 6) makes conforming changes to the broader purposes of the SHIP grants.

Section 52 (151.72) regulates the sale of certain cannabinoid products.

            Subdivision 1 defines hemp and labeling.

 Subdivision 2, paragraph (a), specifies that this section applies to the sale of any product, other than food, intended for human or animal consumption that contains cannabinoids extracted from hemp.

            Paragraph (b) specifies that a product that meets the requirements of this section may be sold for human or animal consumption.

            Paragraph (c) requires the product to be tested by an independent accredited third-party analytical laboratory.

            Paragraph (d) requires the product to bear a label that meets certain requirements.

            Paragraph (e) specifies when a product regulated under this section would be considered an adulterated drug.

            Paragraph (f) specifies when a product regulated under this section would be considered misbranded.

 Paragraph (g) states that no person who sells a product regulated under this section shall make a false, misleading, or unsubstantiated claim concerning health benefits.

 Paragraph (h) authorizes the Board of Pharmacy to issue cease and desist orders under the board’s current authority to embargo misbranded and adulterated drugs and to seek injunctive relief for any violations of this section.

Sections 53 to 59 modify the medical cannabis program.

Section 53 (152.22, subdivision 5a) adds a definition of “hemp” in the medical cannabis definition section.

Section 54 (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 55 (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 56 (152.28, subdivision 1) authorizes a health care practitioner to conduct a registered patient assessment for recertification of a qualifying condition via telemedicine.

Section 57 (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 58 (152.29, subdivision 2) conforming change, requiring a manufacturer to process hemp under the same requirements as medical cannabis.

Section 59 (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 60 (152.29, subdivision 3a) authorizes a manufacturer to staff a transport vehicle with only one employee if transporting hemp only.

Section 61 (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 62 (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 63 [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 64 [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 65 [Plan for a Working Group on Links Between Health Disparities and Educational Achievement 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 achievement for children from American Indian communities and communities of color.

Section 66 (Sale of Certain Cannabinoid Products Workgroup) requires the commissioner of health to convene a workgroup to advise the legislature on how to regulate products that contain cannabinoids extracted from hemp.  The results of the study must be submitted to the legislature by January 15, 2020.

Section 67 (Short Title) states that sections 145.4141 to 145.4147 may be cited as the Pain Capable Unborn Child Protection Act.

Section 68 (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 69 (Study of Health Care Costs and Reimbursement Rates) requires the commissioner of health to study and report to the legislature by February 1, 2020, the cost of health care in this state, including a comparison of reimbursement rates paid to providers under Medicare, medical assistance, and private commercial markets, and an analysis of the impact on hospitals if the commercial market were to reimburse hospitals at the Medicare rate.

Section 70 (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 71 (Targeted Grant Program to Address Outbreaks of Vaccine-Preventable Diseases) requires the commissioner of health to award two-year grants to community health boards to fund immunization-related activities to address outbreaks of vaccine-related diseases and lower the risk of outbreaks of vaccine-preventable diseases in communities with low immunization rates.

Section 72, paragraph (a), repeals section 144.1464 (summer health interns) and section 144.414, subdivision 5 (electronic cigarettes prohibited in certain locations) effective July 1, 2019.

            Paragraph (b) repeals sections 214.17 to 214.25 (infection control law for regulated persons) effective January 1, 2020.

ARTICLE 10 - 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 11 - HEALTH LICENSING BOARDS

Section 1 (147.037, subdivision 1) modifies the licensure requirements for graduates of foreign medical schools by requiring the applicant to present evidence to the Board of Medical Practice of the completion of one year of graduate, clinical training in a program accredited by a national accrediting organization or other graduate training approved by the board.

Section 2 (147.0375, subdivision 1) modifies the licensure requirements for eminent physicians by requiring the applicant to present evidence to the Board of Medical Practice of the completion of one year of graduate, clinical medical training in a program accredited by a national accrediting organization or other graduate training approved by the board.

Section 3 (148.59) increases the licensing fees for optometrists to match the increased appropriation to the Board of Optometry passed in 2017.

Section 4 (148E.180) increases the licensing fees for social workers to match the increased appropriation to the Board of Social Work based in 2017.

Section 5 (150A.06, subdivision 3) eliminates the requirement that the postdoctoral general dentistry residency program be Minnesota-based for purposes of waiving the clinical examination for licensure.

Section 6 150A.06, subdivision 10) establishes an emeritus inactive license for a licensed dental professional who retires from active practice. Specifies that the emeritus inactive licensee may not practice in a dental profession, and that the license is a formal recognition of the completion of the licensee’s career in good standing.

Section 7 (150A.06, subdivision 11) establishes an emeritus active license for a licensed dental professional who retires, to practice only on a pro bono or volunteer basis, or limited paid consulting or supervision practice. Specifies practice limitations and renewal requirements.

Section 8 (150A.91, subdivision 19) adds application fee for emeritus inactive dental license.

Section 9 (150A.091, subdivision 20) adds application fees for emeritus active licenses in dentistry, dental therapy, dental hygiene, and dental assisting.

Section 10 (151.01, subdivision 23) makes a conforming change.

Section 11 (151.06, subdivision 6, paragraph (a)) requires the Board of Pharmacy to publish a page on the board’s website that provides information on:

  1. patient assistance programs offered by drug manufacturers;
  2. patient assistance programs implemented by the Board on Aging;
  3. websites to access information on public health program eligibility;
  4. availability of providers participating in the 340b program;
  5. discussing alternatives to a prescribed drug with the pharmacist or provider; and
  6. any other resources the board deems useful.

Paragraph (b) requires the board to prepare educational materials based on the information provided on the website under paragraph (a).

Paragraph (c) requires pharmacists and pharmacies to make available to patients information on the availability of the website established under paragraph (a).

Section 12 (151.211, subdivision 2) makes a conforming change.

Section 13 (151.211, subdivision 3) permits a pharmacist to dispense a legend drug without a current prescription drug order from a licensed practitioner if certain conditions are met.  Specifies that the amount dispensed must not exceed a 30-day supply or the quantity originally prescribed, whichever is less.  Limits a pharmacist from dispensing the same drug to the same patient as provided in this section more than one time in a 12-month period.  Requires the pharmacist to notify the practitioner no later than 72 hours after the drug is dispensed.  Requires the pharmacy to maintain a record of a drug dispensed under this section in the same manner as required for any other prescription drug orders.

Section 14 (151.254) establishes an insulin registration fee.

            Subdivision 1 defines manufacturer and wholesaler.

Subdivision 2, paragraph (a), requires each manufacturer and wholesaler of insulin to annually report to the Board of Pharmacy every sale, delivery, or other distribution within or into the state that is made during the previous calendar year, beginning March 1, 2020.  Requires the board to specify the manner and format of reporting, and authorizes the board to assess an administrative penalty of $100 a day if a manufacturer or wholesaler fails to report the required information.  Any penalty collected is to be deposited in the insulin assistance account.

Paragraph (b) requires owners of pharmacies with at least one location in the state to report to the board intracompany deliveries or distributions of insulin into the state that occurred during the previous calendar year, if not already reported by a wholesaler. Requires the board to specify the manner and format of reporting, and requires the name of the manufacturer or wholesaler from which the pharmacy purchased the insulin, the amount purchased, and the date of the purchase.

Subdivision 3, paragraph (a), requires the board to annually assess manufacturers a registration fee that in the aggregate equals the total cost of the insulin assistance program for the previous fiscal year.  The manufacturer’s fee shall be prorated and based on the manufacturer’s percentage of the total number of units reported to the board.  Requires the commissioner of human services to estimate the cost of the program for the first year.

Paragraph (b) requires the board to notify each manufacturer of the amounts of the manufacturer’s registration fee.

Paragraph (c) permits manufacturers to dispute the registration fee assessed by the board within 30 days after notification.  Requires the board to make a decision on the dispute within 60 days.

Subdivision 4 excludes biosimilars produced or distributed pursuant to a biologics license application from this section.

Section 15 (152.126, subdivision 6) requires the Board of Pharmacy to conduct random audits of electronic access by permissible users to the prescription monitoring program by permissible 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 permissible use. 

Section 16 (214.122) requires the Boards of Medical Practice and Nursing to annually inform licensees who are authorized to prescribe drugs of the availability of the Board of Pharmacy’s website information under section 151.06, and the materials prepared by the board under section 151.06, paragraph (b).  Requires licensees to make available to patients information on sources of lower cost prescription drugs and on the availability of the website established by the Board of Pharmacy under section 151.06.

Section 17 [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.

ARTICLE 12 - 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 (62A.65, subdivision 2) Paragraph (a) clarifies in statute that any individual health plan offered, sold, issued, or renewed in Minnesota must be guaranteed issued and guaranteed renewable.

            Paragraph (b) permits a health carrier to close a product offering if it covers less than 50 individuals, provided the carrier offers each covered individual on a guaranteed-issue basis the option to purchase another health plan currently being offered by the health carrier.

Section 3 (62D.12, subdivision 20) Paragraph (a) specifies that for-profit HMOs may pay dividends or make distributions or transfers in accordance with section 60D.20, subdivision 2.

 Paragraph (b) specifies that if a nonprofit HMO plans on transferring an amount that together with other transfers made within the preceding 12 months exceeds the greater of: 10% of the HMO’s net worth; or the HMO’s net income for the preceding 12-month period, it must meet the requirements of paragraph (c).

Paragraph (c) requires a nonprofit HMO to notify the commissioner of the transfer.  Requires the commissioner to review the proposed transfer to determine whether the proposed transfer is reasonable in relation to the HMO’s outstanding liabilities and the quality of the HMO’s earnings.  Specifies that no transfer shall be made until 30 days after the commissioner has received notice and the commissioner has not disapproved the transfer; or the commissioner has approved the transfer within the 30-day period.

Paragraph (d) defines affiliate.

Paragraph (e) specifies that the commissioner of health shall enforce this section.

Section 4 (62K.07) requires a health plan company to provide information to the commissioner of commerce when they file rate information on prescription drugs that are reimbursed by the health plan company under health plans issued in this state.

Section 5 (62Q.01, subdivision 6b) defines nonquantitative treatment limitations, or NQTL.

Section 6 (62Q.47) Paragraph (d) specifies that a health plan company must not impost an NQTL with respect to mental health and substance abuse disorders unless comparable to those applied to medical and surgical benefits in the same classification.

Paragraph (f) authorized the commissioner to require information from health plan companies to confirm that mental health parity is being implemented by the health plan company.

Paragraph (g) specifies that mental health therapy visits and medication maintenance visits shall be considered primary care visits for the purpose of applying enrollee cost-sharing requirements.

Paragraph (h) requires the commissioner of commerce to submit an annual report to the legislature on compliance with and oversight of the federal regulations regarding mental health parity, this section, and section 62Q.53

Section 7 (62Q.48) limits the total amount of cost sharing that an enrollee is required to pay at point of sale for insulin at an amount that does not exceed the net price of the insulin.  Defines net price as the health plan company’s cost of the drug, including any rebates or discounts received on or accrued to the health plan company from a manufacturer or pharmacy benefit manager.

Section 8 (62Q.528) requires a health plan that covers prescription drugs to provide coverage for a drug dispensed by a pharmacist in an emergency situation pursuant to section 151.211, subdivision 3, under the same terms that would apply if dispensed pursuant to a prescription.

Section 9 (525A.11) states that when an anatomical gift document does not specify the person that is to receive the anatomical gift, the anatomical gift must not be directly processed by or distributed to a for-profit entity if the anatomical gift involves an eye or eye part.

Section 10 (Moratorium on Conversion Transactions) extends the moratorium on conversion transactions by a nonprofit health maintenance organization or a nonprofit services plan corporation to an entity other than a nonprofit corporation or a nonprofit hospital that is part of the same integrated health system for four more years until July 1, 2023.

 

 

 
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