The 2015 Minnesota regular legislative session ended on May 19 at midnight. In the
final days and nights of the legislative session, most of the large omnibus funding bills
were passed based on a budget agreement struck by legislative leaders and Governor
Dayton, including the health and human services finance bill.
Even after the gavel dropped, however, there is still legislative work to be done. Some
of the final budget pieces are not finished—the jobs/economic development, E-12
education, and state government finance bills were vetoed by Governor Dayton and the
Legacy bill (funding for environment, arts, and cultural projects) were not passed by the
Senate. The three finance bills are necessary to keep state programs operating in those
budget areas beginning July 1. Governor Dayton called legislators into a special session
on Friday, June 12. At the time of this report’s submission, the special session is in
process.
As of this update, special session negotiations are ongoing. Many of the disagreements on
policy and funding initiatives between the governor and House have been resolved, but
final details are forthcoming. It is expected that the governor will call lawmakers back
only when an agreement is reached and the special session will be short in duration. At
this time, it is planned that the House and Senate will meet as whole bodies in hearing
rooms in the State Office Building for the special session.
This legislative summary is a look back at the 2015 legislative session and an overview of
the final health and human services finance bill. If you have questions regarding further
details, please do not hesitate to contact either Eric Ratzmann, MACSSA Executive
Director, at 651-789-4340 or [email protected], or Elizabeth Emerson, Goff
Public, at 651-717-4174 or [email protected].
Budget Framework
At the outset of the legislative session, the governor, House, and Senate each set spending
targets for the health and human services bill. Below is a quick snapshot of those targets
and what ultimately was agreed to and signed into law:
As you can see, there were three competing philosophies when it came time to solving the
final budget pieces, and health and human services funding was no exception. Ultimately,
health and human services did have a negative spending target. However, much of the
potentially negative impacts of such a cut were mitigated by a $455 million transfer from
the Health Care Access Fund to the general fund and general fund savings found through
a payment delay to managed care organizations, efficiencies in managed care administrative
costs, and public program data matching (details below).
Health and Human Services Policy Bill (HF1535) – Chapter 78
The human services policy bill was ultimately fairly limited to technical modifications
recommended by Department Human Services (DHS). The new provisions signed into law
include:
• Children and Family Services (Article 1): modifications to definitions and licensing
specifications for child care assistance programs (CCAP), technical changes to the
Minnesota Indian Family Preservation Act
• Chemical and Mental Health Services (Article 2): modifications to children’s
therapeutic services and supports, chemical and mental health services administrative
changes
• Direct Care and Treatment (Article 3): permissive language for the DHS
Commissioner to contract directly with Indian tribes (White Earth and Red Lake) and
Indian Health Services to receive payment for treatment of tribal members who are
civilly committed
• Operations (Article 4): technical changes to the Office of Inspector General and
licensing division to promote better recognition of fraud
• Health Care (Article 5): modifications to controls around use of electronic tablets and
authorization for use by waivered services recipient
• Continuing Care (Article 6): removes an exemption allowing city and state agencies to
employ unlicensed social workers, modifications to license suspension and hearings,
changes to Community First Services and Supports, appeals process for 245D
providers
One issue that MACSSA worked on with DHS is a provision that will require counties
to notify DHS when a client is demitted from a residential home so that the department
is aware of a need for new placement. The policy bill includes a 30-day temporary stay of
demission when the individual seeking the stay is doing so on the basis that the county has
yet to finalize an alternative for the residential facility, program or services.
One controversial element, added by the House but deleted by the Senate and not included
in the final bill, was around mandated electronic health records. This issues was pervasive
throughout the legislative session and likely one that will be revisited in future sessions.
2
Health and Human Services Finance Bill (SF1458) – Chapter 71
Many of MACSSA’s legislative initiatives were addressed in this final legislation. Figures
included in this summary are for the 2016-17 fiscal year, unless otherwise noted. You can
find a full spreadsheet of the appropriations here.
Some of the key elements of this finance bill include a large funding shift from the Health
Care Access Fund (HCAF) to general fund of $455 million, a premium increase for
individuals on MinnesotaCare totaling $27.8 million, and more than $40 million in new
funding for mental health services. A quick look at how MACSSA priorities fared this
session:
• Child protection – $52.18 million appropriation
o $46.7 million (2016-17) for child protection staffing
o $3.30 million (2016-17) for child welfare disparities grants
o $2.18 million in DHS staffing and administrative costs
o Policy modifications based on initial task force recommendations
• Administrative simplification - $278,000 (2016-17), $420,000 (2017-18)
appropriation
o Full implementation of second phase of simplification efforts
• Mental health – more than $43 million in various mental health programs and
services for children and adults
• Child support – modifications to arrears processes, $100 income disregard for MFIP
families, removal of unused medical support, administrative process for income
withholding, modification of income calculation formula, continuation of formal
Child Support Work Group
• Coordination of care – elimination of data sharing barriers between agencies within a
county to promote coordination of care
• Text4Life - $1 million for statewide expansion of this text message suicide prevention
and mental health service
• Childcare - $10.3 million dedicated to Basic Sliding Fee childcare aimed at reducing
the waitlist
• Long-term care - $5.2 million (2016-17) and $15.18 million (2018-19) for modified
treatment of assets in long-term care eligibility
3
Article 1 – Children and Family Services
Child Protection
A top priority for MACSSA and AMC, child protection was one of the more complex
issues the Legislature contemplated this year. Part of this was because the timeline for
the Governor’s Task Force on the Protection of Children did not perfectly align with the
legislative timeline, leaving little time for full committee discussion of the entire set of policy
recommendations and examination of funding requests.
The legislative discussion on child protection began with the introduction of HF191/
SF4, which primarily provided guidance on screening and reports based on the initial
task force recommendations. As this bill moved through the legislative process, it was
clear that legislators around the state had many concerns about the role of counties, law
enforcement, schools, and parents/guardians in the child protection system. There was
also significant discussion around the racial and ethnic disparities within the system.
Many of these discussions occurred before a price tag was placed on the entire initial set of
recommendations.
The final bill contained policy provisions (outlined below) and was funded at nearly the
amount requested by MACSSA, AMC, and DHS to fund the initial recommendations.
$23.35 million each year is allocated to address child protection staffing and services. An
additional $1.65 million each year is allocated to address child welfare disparities. The total
child protection allocation is $52 million, with the funds not specified above allocated to
DHS for staffing and oversight costs (approximately $2 million).
The final child protection policy provisions include:
• Directs that child protection workers or social services staff with responsibility for
child protective duties must undergo background checks, which may be conducted by
DHS or the county (with flexibility for those counties that contract for such services)
• Establishes a state child fatality and near fatality review team to lead onsite review
of cases of child actual/near fatalities due to maltreatment, and cases occurring in
licensed facilities that are not due to natural causes
• Incorporates sexual abuse into current statute with the same treatment as substantial
child endangerment
• Adds striking a child between the ages of 1 and 4 on the face or head (resulting in
an injury) to the actions that are not reasonable and moderate for the purposes of
defining abuse
• Changes the definition of “report” to any communication received by local welfare
agency, police department, county sheriff, or child protection agency that describes
neglect or physical/sexual abuse of a child and contains sufficient content to identify
the child and any person that may have been responsible for abuse
• Aligns cross reporting procedures for screened-in and screened-out reports
4
• Directs local welfare agencies to consider all previous history, including screened-out
reports, when determining whether a report will be screened in or out and whether an
investigation or family assessment must be conducted
• Requires counties to use DHS Screening Guidelines as guidance for screening reports
and requires any modifications to be preapproved by DHS
• Creates new statutory language regarding the notification between police/sheriff and
responsible agency
• Directs the local agency to provide relevant private data to the mandated reporter who
made the initial report, unless it is not in the best interests of the child, and permits
that the data be shared with other mandated reporters with ongoing responsibility for
the child
• Requires that the local agency shall consult with the county attorney to determine the
appropriateness of filing a CHIPS petition under certain circumstances
• Requires child protection reports that were not accepted for assessment or investigation
to be maintained for a period of five years, and extends the retention period for
accepted reports from four to five years
• Directs the commissioner:
o to develop a plan to perform quality assurance reviews of local agencies’ screening
practices and decisions beginning at least by September 30, 2015
o to update child maltreatment screening guidelines to require agencies to consider
prior reports that emphasize intervention and prevention efforts focused on child
safety and health
o to establish requirements for competency-based initial training, support, and
continuing education for child protection supervisors
o to evaluate the funding formulas and recommend an updated, equitable
distribution formula to address county and tribal costs associated with staffing and
expanded services
• Creates a legislative task force to review the Governor’s Task Force recommendations,
expand child welfare efforts, evaluate child protection disparities grants, and identify
additional areas in need of reform within the child welfare system
o 4 legislators who serve on Governor’s Task Force
o 2 House members (one majority member, one minority member)
o 2 Senate members (one majority member, one minority member)
o Continues through 2016 legislative session
Funding for child protection activities is allocated through two mechanisms:
• Disparities grants – may be used for the development, implementation, and evaluation
of activities to address racial disparities and disproportionality in the child welfare
system
o DHS, child protection task force, and state minority councils will develop and
implement coordinate plan for grant awards, including measurable outcomes,
criteria/procedures for allocation.
5
o Up to 20 percent of grants may be for planning grants
o Eligible applicants include faith-based organizations, social services organizations,
counties, and tribal governments
o Of the total appropriation, each tribe providing child welfare services receives
$75,000 (two tribes)
• Staffing allocation formula – will be used by the commissioner to annually appropriate
to county boards
o 50 percent distributed on the basis of the child population within the county
o 25 percent distributed on the basis of the number of screened-in reports of child
maltreatment
o 25 percent distributed on the basis of the number of open child protection case
management cases, as determined by DHS
o Minimum allocation of $75,000 per county
o Payments made in following manner:
◊ 80 percent of allocation on or before July 10
◊ 10 percent withheld until DHS determines the county has met the performance
outcome threshold of 90 percent based on timely face-to-face contact with
alleged child victims
◊ 10 percent withheld until DHS determines county has met the performance
outcome threshold of 90 percent based on face-to-face visits of children
receiving child protection services by the case manager (children in foster care
only for 2015)
o Language that prohibits this funding from supplanting current county
expenditures for child protection staffing
o Direction to DHS and stakeholders to develop recommended outcome measures
for counties in order to receive withheld funds (due January 2018)
Child Support Modifications
There were roughly eight bills introduced this legislative session to address custody and child
support laws. The bills ranged from a complete revamp of custody best-interest factors to
smaller changes in how the state computes interest on family court judgements. The bills
evolved from the Minnesota Custody Dialogue Group, which was created in 2012 after
several failed attempts at passing a consensus bill.
Here is a quick look at some of the provisions from the various bills that were included in the
final bill:
• $100 income disregard for MFIP families
• Modifies recognition of parentage form requirements
• Eliminates presumption that a person who has primary physical custody is not an
obligor
• Modifies one method of determining potential income—the amount of income
a parent could earn working full-time at 150 percent of the current federal/state
minimum wage is changed to working 30 hours per week at 100 percent
6
• Authorizes a court to elect not to order a party who has between 10 and 45 percent
parenting time to pay basic support if there is a significant enough disparity of income
between parties that the order would be detrimental to the child
• Amends the law governing the effect of a recognition of parentage—awards of
temporary custody or parenting time
• Requires reporting to consumer reporting agency for obligor that is in arrears greater
than 3 times the monthly court ordered support obligations
• Removes Minnesota Care from definition of public assistance for purposes of a child
support referral to county and assignment of child support rights (Affordable Care Act
conformity)
• Allows a child support order to be modified for medical support
• Allowing for a medical support-only modification of a support order
• Modifies what court may order for a parent contribution for health care coverage if
neither parent has appropriate health care coverage
• Discontinues the $25 application fee for child support IV-D services
• Allows the court to order a specific monthly payback amount for arrears
• Formal Child Support Working Group
Childcare
There were a number of bills introduced this session to address childcare, including those
to provide funding for Basic Sliding Fee childcare, modifications to Parent Aware rating
systems, and changes to childcare attendance record keeping.
Ultimately, there was a little more than $10 million allocated to reducing the waiting list
for Basic Sliding Fee (BSF) childcare. The Legislature also projected $3.02 million in 2016
savings within the BSF childcare program by reallocating, or clawing back, unspent 2015
dollars. There were also changes to overpayment claim procedures and childcare assistance
attendance record audits that expect to produce a savings of $206,000 to the state.
Homeless Youth Act
The Homeless Youth Act provides funding to agencies for program activities including
outreach, shelter services, transitional housing, and drop-in services to runaway youth,
homeless youth, and youth at risk of homelessness. This year, the age of eligibility was
extended from 21 to 24. Legislators also expressed concerns that previous years’ funding had
not reached Greater Minnesota to the same extent that it reached the metro, so language
was added to direct the commission to provide outreach, technical assistance, and program
development to increase the program’s state capacity.
In addition to the policy changes, the program received $2 million per biennium.
Safe Harbor
The MN Human Trafficking Task Force recommended increased funding for the Safe Harbor
for Sexually Exploited Youth to address increased trafficking of youth throughout the state.
7
The program received $1.6 million through the Department of Human Services budget
for outreach and shelter and $1.4 million for regional navigators and training through the
Department of Health budget.
In line with this topic, there were policy changes in the bill that require local social services
agencies to begin immediate efforts to locate any child who is missing from foster care. The
bill also requires local social services agency to report info on a missing child immediately
(within 24 hours) to local law enforcement and the National Center for Missing and
Exploited children.
Group Residential Housing (GRH)
The biggest change to the GRH program is the reform of payment rates, to be implemented
and assessed by DHS annually, with the first report due in December 2016. The payment
reform is projected to save the state $868,000 in the first biennium and $2.688 million
ongoing. There were also clarifying changes on background check requirements for providers
and a change in the definition of professional statement of need required for payments in
excess of the MSA equivalent.
Indian Child Welfare Act/Out of Home Placements
Two separate bills making broad changes to out-of-home placements did not end up in
the omnibus HHS bill. Many of the changes made in the final bill were closely linked to
federal compliance. The final language does include direction to DHS to enter into contracts
with tribal social services agencies so that they may provide the recruitment and adoption
placements for Indian children under tribal court jurisdiction. Other modifications include
definitional changes to “relative” and “sibling” to broaden possible placement options for
children. The bill also makes changes to the development of a child’s out-of-home placement
plan.
In one of the original bills, there was proposed funding for county aid payments for 100
percent of the nonfederal share of the cost of out-of-home placements under ICWA. That
bill moved through the House and Senate committee processes but ultimately stalled in the
tax omnibus bill, which did not pass the Legislature this year.
8
Article 2 – Chemical and Mental Health Services
From the start of the legislative session, there was bipartisan support for increased funding
to support mental health programs. In the end, more than $46 million in new funding was
dedicated to mental health services. In his initial budget recommendations, the governor
recommended the closure of the CABHS program for children in Willmar and CARE
facilities. The following are but a few of the funded initiatives:
• $1 million for Text 4 Life for the expansion of this suicide prevention program
o An additional $449,000 will be appropriated to suicide prevention efforts,
including training and intervention for public school nurses, teachers, and
administrators and examination of statewide data
• $8.57 million for crisis services including expansion of a central support phone
number, crisis beds, and policy language that requires private insurance to cover crisis
teams
o There is also direction to DHS to work with stakeholders to develop children’s crisis
beds without requirement to have a voluntary placement agreement in place with
the county
• $2 million for Beltrami County’s Central Receiving Center for planning and
development of a comprehensive mental health program
• $85,000 each year for Eagle’s Healing Nest in Stearns County which will provide
administrative funding to support this provider of services for veterans (the proposed
bonding bill cued up for consideration in a special session also contains dollars to
support construction of a new roof at the facility)
• Community Addiction Recovery Enterprise (C.A.R.E.) program – governor’s budget
proposed restructuring the C.A.R.E. program by reducing bed capacity to 70 beds
across four sites statewide by June 30, 2016, closing Fergus Falls and Carleton facilities.
Under this bill, both facilities will remain open but will be repurposed as 16-bed
facilities
• 2 percent provider rate increase for chemical dependency providers
• $5.38 million in funding for behavioral health homes (delayed implementation)
• $4.654 million (2016-17) and $6.146 million (2018-19) for supportive housing for
individuals with mental illnesses
• $2 million in support and services for the homeless
• $847,000 for respite care for families of children with mental illnesses
• 10 percent reduction of parental TEFRA fee
• $5.547 million to stabilize intensive mental health services, including Intensive
Residential Treatment Services (IRTS), crisis beds, and Assertive Community
Treatment (ACT) teams
o Funding includes policy languages asking DHS to conduct an analysis and provides
recommendations on how to better fund these services
• $6.616 million for Psychiatric Residential Treatment Facilities – DHS will not use
contract beds in community hospitals but rather will add beds to current hospital
programs (both NAMI and Hospital Association opposed this policy)
9
• $1.322 million to expand ACT teams throughout the state and improve quality
measures
• Requirement that State Operated Services conduct reviews at least every three years for
people committed as mentally ill and dangerous, as well as provide an annual report
on barriers to treatment progress
• DHS directive to develop rate-setting methodology for community-based mental
health services for children and adults
Article 3 – Withdrawal Management Programs
This article creates a new model for detoxifications programs, called Withdrawal
Management. This article establishes the program and directs the commissioner to develop
a payment methodology for services provided in this chapter, seek federal approval for that
methodology, and obtain legislative approval of the program before implementation.
Article 4 – Direct Care and Treatment
Anoka Metro Regional Treatment Center – The bill appropriates $4.108 million to increase
the number of staffed beds at the Anoka Metro Regional Treatment Center by 15 beds,
which will be available June 30, 2015. $1.75 million (2016-17) and $1 million (2018-19)
of this funding comes from an increase of the county cost share to 100 percent for each day
once the client no longer needs that clinical level of care.
MN Sex Offender Program – Both the governor’s and the Senate’s proposed budgets
contemplated increasing the county cost share for provisional discharges for MSOP
participants. The cost share is not contained in this bill.
Article 5 – Simplification of Public Assistance Programs
MACSSA took the lead again this session in advocating for the second stage in administrative
simplification measures aimed at simplifying complex reporting standards for the state’s
cash assistance programs. While the 2014 simplifications toted a heavy price tag, the 2015
initiatives have a state cost of $205,000 for 2016-17 and $420,000 per biennium moving
forward.
This 2015 bill focused on income reporting standards, moving the system from 56 income
exclusions to 15 income inclusions and developing a uniform reporting standard across all
the programs. This year’s legislation includes alignment measures across the cash assistance
programs of MFIP, GA, MSA, GRH, and CCAP. There are some program-specific reporting
requirements that will still exist for MFIP, CCAP and MSA housing assistance in order to
comply with other state and/or federal laws.
The bill, with technical modifications, was included as a whole in the omnibus HHS bill.
10
Article 6 – Nursing Facility Payment Reform and Workforce Development
One of the largest provisions of MACSSA concern in this article is the increase in monthly
cost limits for elderly waiver services. The bill directs that the cost limits for elderly waiver
services, individualized service, and 24-hour customized living services shall be increased
annually by the difference between any legislatively-adopted HCBS provider rate increases
and the average statewide percentage increase in nursing facility operating payment rates. The
provision is only applied if the statewide nursing facility operating payment rates increase is
greater than HCBS rate increases.
This article creates a home and community-based services employee scholarship grant program
to assist providers in funding employee scholarships for education in nursing and related
health care fields. This bill appropriates $1 million annually to the program.
The bill modifies the nursing home bed moratorium to allow an exception for a Polk County
facility constructing 25 beds, and distributes 104 beds among up to three other counties.
There are also nursing facility payment reforms in the bill, costing the state $138.237 million
in 2016-17.
Article 7 – Continuing Care
Disability Waivers Spending –
Among the many provisions in this article, it contains language regarding home and
community-based services (HCBS) waivers. MACSSA worked diligently with low-income
advocates and providers to develop language that addressed those groups’ concerns around
overspending and wait lists while maintaining flexibility for counties of all sizes. The
provisions include direction to DHS that it must manage developmental disability (DD)
waiver allocations in a manner that will maximize the use of all available DD waiver
funding. In terms of overspending of DD waivers, the language states that if a lead agency
overspends its allocation, it must submit a corrective action plan to DHS for approval,
and will have two years to implement the plan. DHS must recoup spending in excess
of the agency allocation, but only if the statewide appropriation for HCBS waivers is
overspent. For a lead agency that underspends its allocation (spends less than 97 percent)
while maintaining a waiting list for waiver services, they must submit a corrective action
plan. If it fails to submit the plan or fails to implement the changes, DHS is required
to make sure that the lead agency’s allocation is used to provide services to all waiver
participants in the county/tribe.
In addition to the DD modifications, the bill also addresses over-authorizations under
community alternatives for disabled individuals (CADI), community alternative care
(CAC), and brain injury (BI) waivers. The language is similar to that adopted for DD
waivers, but also creates a rate adjustment moratorium during the 12-month period
following the end of the existing waiver banding periods for these programs, essentially
11
extending the banding period by one year. Finally, the language increases the training and
resources available to county personnel responsible for administering the CADI, CAC,
and BI waiver rate-setting framework to promote proper implementation.
DHS is also required to develop and implement a methodology to determine appropriate
shared staffing levels for HCBS waiver participants living in shared residential settings.
The language expands the range of providers, the costs of which the commissioner must
research and analyze when refining the rate-setting methodology. The bill also requires
that individual staffing be used when shared staffing is insufficient to meet an individual’s
needs while living in shared residential settings. Finally, DHS is required to adjust the
historical disability waiver rates, residential support services rates, day program rates, unitbased services with programming rates, and unit-based services without programming
rates for each reimbursement rate increase effective on or after July 1, 2015.
This section increases the spenddown standard for persons who are aged, blind, or disabled
from 75 to 80 percent of federal poverty guidelines, a state cost of $3.378 million. It also
reduces the MA-EPD premium from $65 to $35, and reduces the amount of unearned
income that MA-EPD enrollees must pay in addition to the premium from 5 percent to .5
percent, at a state cost of $4.839 million.
This section also contains several provisions (contained originally in SF706) that make changes
to adult foster care providers, including their use of medical monitoring equipment, reviews of
abuse prevention plans, and staff qualifications.
This year, the legislature prioritized creation of the Minnesota ABLE plan. Minnesota ABLE
is a savings plan available for the purpose of encouraging and assisting individuals and families
to save their private funds to support individuals with disabilities so that they may maintain
health, independence, and quality of life. The program carries a one-time state cost of
$105,000 in 2016-17.
The bill increases the reimbursement rate for direct support services provided through a
covered program (if the Legislature ratifies the state – SEIU Healthcare Minnesota contract)
by 1.53 percent in 2015 and an additional .2 percent in 2016. The covered programs include
PCA Choice, Consumer-Directed Community Supports, home and community-based
waivered services, alternative care, consumer support grants, and Community First Services
and Supports.
The final bill also included language that directs DHS to develop an HCBS incentive pool
for innovation in achieving integrated competitive employment, living in the most integrated
settings, and other outcomes. DHS is directed to seek proposals by October 1, 2016, and
move forward in contracting with one or more entities to provide incentive payments for
meeting identified outcomes. The session law language does not specify what entities will be
eligible to apply for these incentive payments.
12
There were amendments adopted in conference committee that added several funding
provisions for HCBS transitions grants and expanded SHIP to fund regional and local
dementia grants. An additional provision added that states that if the SHIP programs result in
savings, then certain dollar amounts may be transferred to the general fund. This provisions
stems from legislative attention paid to the cost-effectiveness of SHIP programs and increased
reporting and data monitoring across SHIP activities.
Article 8 – Health Department and Public Health
This section contains a number of provisions related to the Department of Health, including
increased reporting from the Department of Health regarding the impact of public health
programs on health indicators (diabetes, obesity, dementia, etc) and private/public health care
costs. There is language included in the bill that directs a transfer of $50 million annually
from the general fund to the health care access fund if/when accumulated annual savings from
state-administered health care programs meet or exceed $50 million for that fiscal year.
In terms of funding changes, neither the $35 million reduction in SHIP nor the elimination
of TANF dollars for the Family Home Visiting Program proposed by the House occurred.
The bill expands local public health grants by $2 million, targeted at grants for community
health boards outside the 11-county metro area. There is also a $2.65 million (2016-17)
increase in funds available for evidence-based family home visiting.
There are a number of provisions related to expansion and modifications of health professional
licensing and loan forgiveness programs, as well as creation of the Minnesota Radon Licensing
Act. Many of the policy changes in this section do not apply to MACSSA’s legislative
priorities.
Article 9 – Health Care Delivery
This article addresses the Minnesota Telemedicine Act, which is not part of the MACSSA
legislative platform.
Article 10 – Health Licensing Boards
This articles addresses professional licensing changes and does not contain issues that relate to
MACSSA’s legislative platform.
13
Article 11 – Health Care
Nonemergency Medical Transportation – The task force charged with developing a single
administrative system came forward with recommendations this year that attempt to move
toward county management of the system once paid for by the State.
The recommendations introduced this year included:
•
•
•
•
Repeal of the 4.5 percent rate reduction for NEMT providers
Increased base rates for providers in rural and super-rural areas
New rate structure
Increase in client self-transport of up to 80 percent of the IRS standard mileage rate
and up to 200 percent for volunteer transport
The final agreement appropriated $3.7 million in 2016-17 and $14.6 million in 201819 to address the providers’ rates and modest changes to the self-transport mileage
rate (increase to $.22/mile). There was also language adopted that states that financial
responsibility does not shift to counties until DHS has developed and funded an internetbased single administrative structure and an assessment tool. It also indicates that a local
agency’s financial obligation is limited to the available state/federal funds.
Periodic Data Matching – There was significant legislative debate this year about potential
state savings that could occur through the closer auditing of public program eligibility. The
House version of the omnibus HHS bill contains a verification audit that was projected to
save the state $300 million in the first biennium. MACSSA and AMC expressed serious
concerns over the proposed language because it would create additional duties for county
staff without state funding, be very difficult to administer, and potentially not create the
savings that the House desired. Ultimately, the House and Senate came to compromise
language.
The “periodic data matching” is defined as “updating electronic information about medical
assistance and MinnesotaCare recipients on the MNsure information system from federal
and state data sources accessible to the MNsure information system and using that data to
evaluate continued eligibility between regularly scheduled renewals” (Article 11, Section
17).
The data matching, conducted by DHS, will be done at least once during a recipient’s
12-month eligibility period. If the data indicates a recipient may no longer qualify, DHS
must notify the recipient and allow the individual 30 days to confirm the information or
to provide explanation for the discrepancy to the state or county. If the recipient does not
respond, DHS shall terminate the eligibility.
There is $26,000 (2016-17) and $1.276 million (2018-19) available for county grants
for costs related to implenmenting this periodic data matching. DHS must distribute the
grants in proportion to a county’s total number of affected cases.
14
Health Care Financing – Another topic of legislative debate was the financial solvency
and state role in the financing of MinnesotaCare and MNSure. The governor, Senate, and
House all agreed that these programs should be evaluated to determine their future financial
viability. Of course, all three had different approaches to ensure the programs’ viability. Most
notably, the House proposed the elimination of MinnesotaCare, transfer of those individuals
to the state’s health insurance exchange, and movement of the state’s health care exchange
(MNSure) to the federal exchange.
The governor proposed and the Legislature agreed, to convene a task force to address
health care financing. The task force will advise policymakers on strategies to increase
access to, and improve quality of health care. This includes options for sustainable
financing, coverage, purchasing and delivery for all affordability programs, including
MNSure, medical assistance, MinnesotaCare, and insurance coverage purchased by
individuals with federal tax credits and/or cost-sharing subsidies.
The task force consists of 7 Senate appointees; 7 House appointees; 11 gubernatorial
appointees that include public/private health care experts and consumer representatives;
and representatives from departments of human services, commerce, health and MNSure.
The recommendations are due to policymakers by January 15, 2016.
MinnesotaCare Premium Increases – A late entry into the conference committee debate
was an increase of MinnesotaCare premiums. The bill directs DHS to work with legislative
committee chairs to increase premiums for recipients based on June 2015 enrollment. The
legislation directs the premium increases must be sufficient to raise $27.8 million by June 30,
2017. DHS is directed to publish the premium scale no later than June 15, 2015.
This article also contains changes to the state’s managed health care system, including
financial audits of plans, increased reporting, and delayed payment to managed care
providers.
Article 12 – MNSure
Significant debate about changes to MNSure took place throughout the entire legislative
session. This article was one of the last to be settled in the conference committee. MACSSA
monitored proposed changes to MNSure carried in HF5, particularly as they related to
county representation on the MNSure board and to public program changes.
In the end, legislators agreed not to touch the MNSure governance structure, as there was
strong disagreement on what modifications to make. The adopted provisions included
changes to the rate approval process and appeals; eliminating rulemaking authority
exemptions previously granted; eliminating certain technology agreements between DHS
and the Office of MN.IT Services (MN.IT); direction to the MNSure board and DHS to
develop a proposal to allow small employers the ability to receive the small business health
care tax credit when the employer pays the premiums on behalf of employees enrolled in
15
certain plans; and direction to the Department of Commerce to develop a proposal to allow
individuals to purchase qualified health plans outside of MNSure directly from health plan
companies and maintain eligibility for premium tax credits.
Other Bills of Interest
Return on Taxpayer Investment (ROTI) – This proposal directed the Commissioner of
Management and Budget to develop and implement an ROTI methodology using the
Pew-MacArthur “Results First” framework. This methodology would be used to evaluate
corrections and human services programs that are administered and funded by county and
state governments. The proposal was included as part of the state government finance bill and
appropriated $121,000 (2016) and $122,000 annually starting in 2017. (Chapter 77, Article
1, Section 13)
Healthy Eating Here at Home – A proposal to allow SNAP benefits for purchases of healthy
foods at farmers market was included in the state government finance bill. The program,
administered through the Minnesota Humanities Center, will provide $325,000 annually to
nonprofits that work with farmers markets to provide $10 vouchers to SNAP recipients that
receive EBT benefits and healthy food education outreach. (Chapter 77, Article 1, Section 25)
Child Advocacy Centers – In the omnibus public safety/judiciary finance bill, $400,000
each year was appropriated to child advocacy centers that contract with counties to conduct
screenings. These centers include Corner House (Minneapolis) and Children’s Resource
Center (Saint Paul). This was an initiative of MN Children’s Alliance and MSSA. (Chapter
65, Article 1, Section 11)
Olmstead Implementation – The omnibus jobs/energy finance bill that is slated for
consideration during an upcoming special session contains $1.3 million per year to fund the
Olmstead Implementation office. You can find the latest version of that bill here. (Special
Session, Article 1, Section 2, HF3)
16