/ LEGISLATIVE UPDATE
PG 1 OF 5
Prepared by:
Kevin Goodno
Fredrikson & Byron, P.A.
612.492.7348 (o) or 651.366.7421 (m)
Becky Girvan
Fredrikson & Byron, P.A.
612.492.7861 (o) or 612.423.1322 (m)
SF760 (Abeler/Hann): Omnibus Health and Human Service Finance
This legislation was VETOED by the Governor on May 24, 2011.
SF760 included the following provisions of relevance to MHCA:
DD Waiver Acuity: Governor’s Elimination of 1% DD Waiver Acuity adjustment – this will likely be included in the final proposal;
Aging Grant Reduction: Governor’s proposed one-time reduction in the Aging Grant by $3.6 million per year for FY 2012 and FY2013 (the cut is restored in FY2014);
Elderly Waiver/Alternative Care: The House’s proposal to manage the growth in the elderly waiver and alternative care programs. The Governor initially made recommendations that was supported by the House that included a variety of actions to reduce expenditures for the Elderly Waiver (EW) and Alternative Care (AC) programs resulting in savings of $26.138 million over the 2012-2013 biennium. The adopted provision includes a reduction in rates for component services included under customized living (CL) and 24 hour customized living (24 CL) services by 10%.
Waiver Limits: House proposal to limit the number of people served on the DD, CADI and TBI waivers to the numbers served in March 2010. No growth would be allowed until the March 2010 number is reached, then the growth cannot exceed the March 2010 number. This limitation only applies to the FY2012-13 biennium. A version of this will likely be included in the final proposal;
No Elderly Waiver Growth: Senate proposal to limit the number of people served on the elderly waiver program to the number served on June 30, 2011. No growth would be allowed until the June 2011 number is reached, then the growth cannot exceed the June 2011 number. This limitation only applies to the FY2012-13 biennium.
Separate EW and NF Rates: Governor recommendation to manage the growth in Elderly Waiver (EW) expenditures by removing an automatic annual adjustment to EW monthly case mix caps that is currently tied to the average statewide percentage increase in nursing facility payment rates.
PCA Relative Caregiver Cut: The House proposal hat personal care assistants who are providing care for a relative are limited to being paid a rate that is 80 percent of the rate that would be paid for providing services to nonrelatives. Relative is defined as the parent or adoptive parent of an adult child, a sibling aged 16 years or older, an adult child, a grandparent, or a grandchild.
PCA Provider Agency Documentation Penalty: House proposal that imposes “a fine of up to $500 on provider agencies that do not consistently comply with” the required documentation requirements for personal care assistant agencies.
PCA Service Alternative: House proposal to eliminate funding for an alternative PCA program for current PCA recipients with 1 ADL or a Level I behavior.
Rehab Services Prior Authorization: Governor’s proposal to removes the one-time services thresholds for physical therapy, occupational therapy, and speech language pathology, but instead requires prior authorization for an episode of treatment.
Medicare Crossover Claims: Governor’s proposal to limit for Medicare Part B the MA payment for crossover claims to an amount that, added with the Medicare paid amount, does not exceed the MA payment rate.
Managed Care for Disabled: Senate Proposal to require people with disabilities to enroll in a managed care plan. People with disabilities would be allowed to opt-out of managed care if they wish. This will likely be included in the final proposal;
My Life, My Choices: LSS Proposal to implement the My Life, My Choices concept and establish a task force – this will likely be included in the final proposal.
Congregate Living Rates: Governor’s initial recommendation to reduce the rates paid to congregate living settings for waiver recipients with lower needs residing there on average by 10% in FY 2012 and 2013, and 15% in FY 2014 and 2015.
Provisions NOT INCLUDED in the final version SF760:
Rate Reduction: Medical Assistance provider rate reductions are not included in the compromise;
Elimination of Therapies: The Senate proposal to eliminate all chiropractic coverage, adult physical therapy, adult occupational therapy, adult speech therapy, adult podiatry, adult eyeglasses and contact lenses, and adult prosthetics. Additionally, home care therapies (PT/OT/ST) are proposed to be eliminated for both children and adults.
Pediatric Care Coordination: House proposal to provide Medical Assistance coverage for care coordination services provided to children with high-cost medical conditions or at-risk of recurrent hospitalization for acute or chronic illnesses by advanced practice nurses employed by or under contract with hospitals with a level III neonatal intensive care unit.
SF731 (Gottwalt/Hann) Omnibus Health and Human Service Policy
NOT enacted. This legislation included provisions that increased fraud prevention activities in the Medical Assistance program. It is possible, albeit unlikely, that these policy issues could be enacted during a special session. These provisions will more likely be dealt with next year.
HF1406 (Hamilton/Nienow) Omnibus Continuing Care Policy
NOT enacted. This bill included Personal Care Assistant program modifications language. All parties had reached agreement on the provisions of this bill, but the legislature ran out of time to enact the bill. Provisions included in the bill that were NOT enacted are:
- Changes to the definition of Responsible Party;
- Modifications to the Qualified Professional face-to-face visit requirements
- Correction to allow for telephone supervision; and
- Requirement that Medicare Certified exempt from training be competency tested.
It is possible, albeit unlikely, that these policy issues could be enacted during a special session. These provisions will more likely be dealt with next year.
SF119(Mack/Rosen) Emergency medical technician-community paramedic certification
Signed by the Governor. This legislation does four things:
- It defines an Emergency medical technician-community paramedic (or EMT-CP) in statute;
- It lists the statutory restrictions on EMT-CP, including a provision that states: A community paramedic is subject to all certification, disciplinary, complaint, and other regulatory requirements that apply to EMT-Ps under this chapter;
- It does NOT put into place any services or payment rates; instead it requires a study and report. This bill directs the commissioner of human services to determine specified services and payment rates for services to be performed by EMT-CPs.
The services may include those that are intended to prevent avoidable ambulance transportation or hospital emergency department use, including the performance of minor medical procedures, initial assessments within the paramedic scope of practice, care coordination, diagnosis related to patient education, and the monitoring of chronic disease management directives in accordance with educational preparation.
Once the commissioner determines the services and rates, he or she is required to submit the list of services covered by MA to the chairs and ranking minority members of the House and Senate HHS Budget and Policy Committees (prior to January 15, 2012). These services shall not be covered by medical assistance until further legislative action is taken.
- This legislation requires the evaluation of EMT-CP services. This is an odd provision as it requires the commissioner to report back by December 1, 2014. The oddness is that the provision expires on June 30, 2013 because it is included as session law and not as statutory law.
At this time, we cannot say with certainty that the legislation allows for the EMT-CP to providehome care services, although it seems possible based on the language in section 3. However, the specificservices to be included will be proposed in the future with input from interested parties. The proponents have committed to working with us during this "study" process to address concerns we may have.
Also, keep in mind that in addition to needing to comeback for legislative approval, CMS (the federal government) will also need to approve coverage for the services provided by EMT-CPs under Minnesota medical assistance--this is also not a sure thing.
HF1754(Gunther) 72.5% Personal care assistance choice option modified
This legislation removes the requirement that PCA Agencies pay individual PCAs 72.5% of the medicaid rate for the services they provide in wages and benefits.
This requirement does not apply to any other medicaid providers and was added as part of a PCA reform effort by employee advocates a few years ago. This has caused some agencies, who are unable to meet the 72.5% requirement, to reduce administrative expenses by closing rural offices (thereby reducing service availability in those areas).
Removing this requirement would allow PCA Agencies to use their business judgment as to how these funds should best be spent. The bill was introduced mid-May and will be pursued during the 2012 session.