2017 Community Supports Administration end of legislative session summary
The Community Supports Administration at the state Department of Human Services prepared the following list of 2017 legislative changes and actions created in Laws of Minnesota 2017, 1st Special Session, chapter 6. Provisions listed relate to work performed in the Community Supports Administration. All sections are effective July 1, 2017, unless otherwise specified. Tracking line references are to the Health & Human Services Finance Senate File 2 spreadsheet.
Home and community-based services rule implementation
(Budget neutral)
Affirmed timelines for compliance with the federal home and community-based services settings rule. Amended the HCBS licensing standards statute, 245D, to comply with the settings rule. These regulations are designed to enhance the quality of home and community-based services for older adults and people with disabilities and provide those who receive these services with additional protection. Effective upon enactment. Article 2, sections 1, 2, 4-9 and 12-14. (Tracking line N/A)
Implementation of the CMS Home Health Care Rule
(Invests $227,000 in fiscal years 2018-19, and $263,000 in fiscal years 2020-21)
Amends the requirements for Minnesota Health Care Programs payment of home health services to comply with a new federal regulation. This regulation requires documentation of a face-to-face encounter with a physician or a non-physician practitioner with the person receiving services prior to lead agency authorization of home care services and certain medical equipment (durable medical equipment). Clarifies that Medicaid home health services and items are not limited to home settings and may be provided in the community where normal life activities take them other than an institutional setting. This aligns with the goals for people to receive person-centered services in the most integrated setting of their choice. Effective July 1, 2017. Article 1, sections 5-12. (Tracking line 225)
MNCHOICES
($19.302 million in savings in fiscal years 2018-19 and $22.302 million in savings in fiscal years 2020-21)
Reduces the amount the state spends on the cost for MnCHOICES to 84.3 percent of the non-federal share in fiscal years 2018 and 2019 and then 81.9 percent in fiscal years 2020 and 2021. Counties will be required to cover the remaining non-federal portion. Includes direction to the commissioner to work with lead agencies to reduce assessment times, create efficiencies and evaluate alternative payment methods for MnCHOICES. This includes a random moment time study evaluation. Effective July 1, 2017. Article 1, sections 17, 18, 51 and 52. (Tracking line 891)
Self-directed workforce negotiations
(Invests $24 million in fiscal years 2018-19 and $24 million in fiscal years 2020-21)
Appropriates $12 million each year to negotiate the terms of a self-directed workforce agreement between the state and SEIU Health Care Minnesota. Article 1, section 53. Article 18, section 2, subdivision 7(f). Article 18, section 2, subdivision 15(b). Effective July 1, 2017. (Tracking line 264)
Electronic service delivery document system
(Invests $617,000 in fiscal years 2018-19 and $644,000 in fiscal years 2020-21)
Requires the commissioner to convene stakeholders. Stakeholders will recommend requirements and standards for an electronic service delivery documentation system to comply with the federal 21st Century Cures Act. Recommendations are due to the Legislature on Jan. 15, 2018. Appropriates funding for the design and implementation of the system. Effective July 1, 2017. Article 3, section 49. Article 18, section 2, subdivision 7(i). (Tracking line 935)
Interactive video case management
(Invests $51,000 in fiscal years 2018-19)
Allows interactive video contact as an eligible service for relocation services targeted case management, adult mental health targeted case management and targeted case management for vulnerable adults and people with development disabilities. Interactive video may be used for up to 50 percent of the minimum required face-to-face contacts if:
The person receiving targeted case management lives in a setting staffed 24 hours a day/7 days a week
The use of interactive video is approved as part of the person’s written personal service or case plan, and
The use of interactive video is deemed appropriate and in the best interest of the person.
This change is subject to federal approval. Article 4, sections 33-34 and 44. (Tracking line 620)
Room and board for residential mental health crisis services
(Invests $370,000 in fiscal years 2018-19)
Provides presumptive eligibility for room and board funding for people who are receiving residential mental health crisis services. Room and board for people receiving residential mental health treatment is paid for through the group residential housing (GRH) program. This change allows providers of short-term residential mental health crisis services to receive the full GRH room and board payment automatically for their clients without the person needing to apply for GRH or the person having to pay a share of the cost. Also allows people who are already using GRH to pay for their housing to maintain their existing GRH benefit while they are receiving residential mental health crisis services. This change is effective Oct. 1, 2017. Article 2, sections 22 and 36. (Tracking line 705)
Provides grants to expand and improve assertive community treatment services, which provide an intensive, comprehensive, non-residential rehabilitative mental health service that uses a team approach. This is a one-time increase in funding for fiscal years 2018 and 2019. Article 18, section 2. (Tracking line 1050)
Children mental health grant activities
(Budget neutral)
Allows children mental health grant funding to be used to support mental health providers to establish new services and programs and allows school-linked mental health grants to be used to provide transportation to students when school is not in session. Article 8, section 7. (Tracking line N/A)
Children’s mental health respite care grants
(Invests $300,000 in fiscal years 2018-19)
Increases grant funding for children’s mental health respite care services, which offer temporary relief to families who are caring for children who have serious mental health needs and who might otherwise require an out-of-home placement. This is a one-time increase in funding for fiscal years 2018 and 2019. Article 18, section 2. (Tracking line 1053)
Diagnostic assessment
(Budget neutral)
Aligns the definitions of diagnostic assessment in statute and rule. Clarifies the definition of a brief diagnostic assessment, which is intended to facilitate more timely access to ongoing treatment,. Allows a person to receive up to three individual or family psychotherapy sessions or family psychoeducation sessions while a diagnostic assessment is being completed. Restores a definition of “functional assessment” for children’s mental health services that was previously repealed. Article 8, sections 1, 3-6. (Tracking line N/A)
Fetal alcohol spectrum disorder grants
(Invests $500,000 in fiscal years 2018-19)
Provides grant funding for at least three projects to provide comprehensive, gender-specific services to pregnant and parenting women suspected of or known to use or abuse alcohol or other drugs. Grants will be administered by the Minnesota Organization on Fetal Alcohol Syndrome. This is one-time funding for fiscal years 2018 and 2019. Article 18, section 2. (Tracking line 1041)
First episode psychosis
(Invests $1 million in fiscal years 2018-19)
Increases grant funding for first episode psychosis programming. Funding may be used to:
Provide intensive treatment and supports to adolescents and adults experiencing or at risk of a first psychotic episode
Conduct outreach, training and guidance to mental health and health care professionals on early psychosis symptoms, screening tools and best practices
Address barriers to people and their families participating in first psychotic episode services, including helping individuals receiving treatment and their families cover housing and transportation expenses.
This is a one-time increase in funding for fiscal years 2018 and 2019 only. Article 18, section 2. (Tracking line 1072)
For-profit mental health center rate increase
(Invests $7,000 in fiscal years 2018-19)
Allows for-profit mental health centers to receive the 23.7 percent community mental health center payment rate enhancement as long as the provider meets all of the requirements to be designated as an essential community provider, other than being a nonprofit. Article 8, section 73. (Tracking line 1056)
Housing with supports for adults with serious mental illness
(Invests $2.15 million in fiscal years 2018-19)
Increases funding for the housing with supports for adults with serious mental illness grant program, which helps people experiencing serious mental illness to access and maintain stable housing as well as connect to mental health care and other supportive services. This is a one-time increase in funding for fiscal years 2018 and 2019 only. Article 18, section 2. (Tracking lines 1022 and 1051)
Intensive children’s mental health services
(Invests $4.781 million in fiscal years 2018-19)
Provides time-limited state funding for children’s residential mental health treatment programs that are expected to become ineligible for federal funding because they are designated as institutions of mental disease (IMD). State funding to replace the lost federal funding will be available July 1, 2017, until May 1, 2019. No new children’s residential treatment programs that are considered IMDs will be eligible to enroll as Medical Assistance providers during this period. Provides funding for an in-depth analysis and recommendations for how to redesign Minnesota’s continuum of intensive mental health services for children and adolescents, with a report due to the Legislature by November 2018. Article 8, sections 71-72 and 74. (Tracking line 333)
Mental health crisis response grants
(Invests $800,000 in fiscal years 2018-19)
Increases grant funding for mental health crisis response services, which help a person experiencing a mental health crisis to cope with that crisis and stay in his or her own home and community. The funding may be used to develop a co-responder mental health crisis response model and to expand:
Mobile crisis services
Residential crisis services
Co-location of mobile crisis services in urgent care clinics and psychiatric emergency departments.
This is a one-time increase in funding for fiscal years 2018 and 2019. Article 18, section 2. (Tracking 1054)
Mental health innovation grant program
(Invests $2.171 million in fiscal years 2018-19)
Establishes a new grant program to improve access to and the quality of community-based, outpatient mental health services. The program will also reduce the number of people admitted to regional treatment centers and community behavioral health hospitals. Funding may be used to establish new intensive residential treatment service programs, create stand-alone mental health urgent care programs, expand other community mental health services, or other innovative projects that further the goals of the program. The grant program is funded out of a new special revenue account that will receive up to $1 million per year from the revenue generated by the county share of treatment costs for people receiving care at Anoka Metro Regional Treatment Center and the Community Behavioral Health Hospitals. A report is due to the Legislature by Dec. 1, 2019, on the outcomes of projects funded. Article 8, sections 2 and 36-37. (Tracking line 612)
Post-arrest community-based service coordination
(Invests $4,000 in fiscal years 2018-19)
Creates a new service to support people with a mental illness or substance use disorder who have come into contact with law enforcement and have agreed to receive services in lieu of incarceration. Post-arrest community-based service coordination is intended to connect people with the services they need to address their mental health, chemical health, social, economic and housing needs. These services will be provided by counties or providers under contract with a county. The county providing the services will be responsible for the non-federal share. Article 4, section 36. (Tracking line 697)
Psychiatric residential treatment facility standards and start-up
(Budget neutral)
Establishes admission and discharge criteria, service standards and a payment rate methodology for psychiatric residential treatment facility services to align with the proposed state plan and the funding provided by the 2015 Legislature. Article 8, sections 68-70. (Tracking line N/A)
Substance use disorder continuum of care redesign
(Saves $569,000 in fiscal years 2018-19)
Transforms Minnesota’s substance use disorder continuum of care. Streamlines the process for accessing treatment by allowing individuals to go directly to providers to receive an assessment. Allows licensed providers to be reimbursed directly for services and provide services outside of site-based treatment programs. Adds three new services — care coordination, peer recovery support and withdrawal management — to the continuum of care. Funds an analysis of the payment rate structure and treatment models for substance use disorder services serving people with the highest needs to develop a system that meets people’s needs and that is fiscally sustainable for state and local governments. A report is due to the Legislature by Dec. 2018. Article 8, sections 12-35, 38-65, 67 and 75-77. (Tracking line 288)
Substance use disorder provider payment rate increase
(Invests $2.427 million in fiscal years 2018-19)
Increases provider payment rates for substance use disorder treatment services by 1 percent. Article 8, sections 66 and 77. (Tracking line 1076)
Telemedicine services provided by mental health practitioners
(Budget neutral)
Allows mental health practitioners, under the supervision of a mental health professional, to deliver services via telemedicine. A change made in 2015 limited telemedicine services so that they could only be provided by a licensed mental health professional. This change reinstates the previous policy. Article 4, section 33. (Tracking line N/A)
Wadena County peer-run respite center planning grant
(Invests $100,000 in fiscal year 2018)
Provides grant funding to Wadena County to plan and develop a peer-run respite center for people experiencing mental health conditions or co-occurring substance abuse disorder. The peer-run respite center is intended to serve individuals who need peer support in a small residential setting (no more than six beds) on a short-term basis (no longer than five days) and will not provide clinical services. The planning grant is contingent on Wadena County providing to the commissioner of Human Services a plan to fund, operate and sustain the program. Article 18, section 2. (Tracking line 733)
Central office operating adjustment – Deaf and Hard of Hearing Services (DHHS) increase
(Invests $612,000 in fiscal years 2018-19 and $612,000 in fiscal years 2020-21)
Provides funding for structural deficit in the DHHS budget on an ongoing basis. Effective July 1, 2017. (Tracking line 515).
Sustaining Deaf and Hard of Hearing Services
(Invests $2.142 million in fiscal years 2018-19 and $2.114 million in fiscal year 20-21)
Sustains the current level of services for the DHS Deaf and Hard of Hearing Services Division and modernizing the Deaf and Hard of Hearing Services Act to improve the delivery of services to Minnesotans who are deaf, deafblind and hard of hearing. It also updates a number of definitions, duties, terminology and responsibilities. Article 1, sections 32-42. Article 18, section 2, subdivisions 7(b) and 28. (Tracking line 321)
($250,000 in fiscal years 2018-19 and $0 in fiscal years 2020-21)
Creates a grant to a provider in Richfield to provide life-skills training to young adults with learning disabilities to meet the needs of people with autism spectrum disorder. The appropriation may be used to create a best practices curriculum for serving people with autism spectrum disorder in residential placements with therapeutic programming and to expand facilities by adding safety features, living spaces and academic areas. Effective July1, 2017. Article 18, section 2, subdivision 29. (Tracking line 1037)
Corporate foster care reform
(Invests $129,000 in fiscal years 2018-19 and saves $123,000 in fiscal years 2020-21)
Establishes two exceptions to the moratorium on corporate foster care: one for people transitioning from the residential care waiver to foster care services and another for people living in an unlicensed site for which a license is required. Further, it provides the commissioner with the additional authority to close or relocate foster care homes in order to address the needs-determination findings. Effective July 1, 2017. Article 2, sections 3, 11 and 15-18. (Tracking line 727)
Disability waiver consolidation study
($250,000 in fiscal years 2018-19)
Provides funding to conduct a study on consolidating the four disability home and community-based services waivers into one program. The study and recommendations are due on Jan. 15, 2019. Effective July 1, 2017. Article 18, section 2, subdivision 7(h). (Tracking lines 849)
Disability waiver rate setting methodology
($4.946 million in savings in fiscal years 2018-19 and $14.729 million in savings in fiscal years 2020-21)
Modifies the disability waiver rate system by adding certain costs to the rate calculations, adjusting the base wage index and specifying situations under which the commissioner must authorize rate exceptions. Creates four new services to be added to DWRS:
Individualized home supports
Employment exploration
Employment development
Employment support.
The new services will be licensed under 245D when they become available. Adds a potential seventh year to the banding of historic rates. Requires providers to report their business costs every five years. Updates wage and component values to reflect these costs every five years. Repeals the budget neutrality factor from DWRS, as required by CMS. Removes respite services from DWRS so it may be billed at a market rate. Allocates $30,000 in fiscal year 2018 for grants to be made available to providers who are projected to receive a 10 percent decrease in revenues because of the end of banding. This item also includes funding for a transportation study ($250,000 in fiscal year 2017). Article 1, sections 20-31, 48 and 54. Article 18, section 2, subdivisions 7(a) and 29(a). Sections are either effective upon enactment or upon federal approval. (Tracking line 647)
Eliminate home care nursing interpreter-communicator service
($30,000 in savings in fiscal years 2018-19. $30,000 in savings in fiscal years 2020-21)
This proposal repeals Minnesota Statutes, §256B.64, eliminating the ability of home care nursing and personal care assistance service providers to bill for communicator services for people who are dependent on a ventilator upon admission to the hospital. This is a duplication of services that are required to be provided by the hospital. Effective July 1, 2017. Article 4, section 67. (Tracking line 221)
Grants for statewide self advocacy and support organization
(Invests $496,000 in fiscal years 2018-19, $0 in fiscal years 2020-21)
Appropriates money for a grant to a disability advocacy organization to maintain and promote self-advocacy services and supports for people with intellectual and developmental disabilities throughout the state. In fiscal years 2020-21, the grant only includes the original base funding. Article 1, section 4. Article 18, section 2, subdivision 29. Effective July 1, 2017. (Tracking line 629)
Home and community-based services incentive pool
(Invests $2 million in fiscal years 2018-19 and $0 in fiscal years 2020-21)
Appropriates an additional $1 million in fiscal year 2018 and fiscal year 2019 to the HCBS incentive pool, a competitive grant program that provides incentives for innovation in achieving integrated competitive employment, living in the most integrated setting and other outcomes determined by the commissioner. Adds the outcome of “achieving integrated competitive employment for youth under age 25 upon their graduation from school.” Effective July 1, 2017. Article 1, section 19. Article 18, section 2, subdivision 26. (Tracking line 693)
ICF/DD payment modifications for vacant beds and therapeutic leave days
(Invests $455,000 in fiscal years 2018-19 and $273,000 in fiscal years 2020-21)
Modifies treatment of vacant beds in intermediate care facilities for the purposes of payments for therapeutic leave days. Counts a vacant bed in an intermediate care facility for people with developmental disabilities as a reserved bed when determining occupancy rates and eligibility for payment of a therapeutic leave day. Article 3, section 26. (Tracking line 846)
Individual CDCS budget methodology
(Invests $325,000 in fiscal years 2018-19 and $0 in fiscal years 2020-21)
Creates an exception to the consumer-directed community supports (CDCS) budget methodology for people leaving institutions. Expands the CDCS methodology for people who require greater resources than currently allowed in order to increase the amount of time they can work, transition to their own home or develop a positive-support plan. Requires a CDCS revised budget methodology report due by Dec. 15, 2018. Article 1, sections 44-46. Article 18, section 2, subdivision 7(c). (Tracking line 981)
Murray County ICF/DD rate increase
(Invests $834,000 in fiscal years 2018-19 and $870,000 in fiscal years 2020-21)
Provides an operating payment rate increase for an ICF/DD located in Murray County. The daily rate for these beds will be $400, in addition to any other increase that is effective July 1, 2017. Article 3, section 27. (Tracking line 969)
Anoka County group residential housing provider supplemental service rate increase (Invests $486,000 in fiscal years 2018-19)
Provides a supplemental service rate enhancement for a group residential housing provider in Anoka County. Article 2, section 33. (Tracking line 684)
Emergency services grants (Invests $200,000 in fiscal years 2018-19)
Increases funding for the emergency services grant program, which provides funding for operating emergency shelters and providing essential services to homeless families and people. This is a one-time increase in funding for fiscal years 2018 and 2019 only. Article 18, section 2. (Tracking line 1027)
Emergency shelter pilot program (Budget neutral)
Allows counties to pilot a new methodology for financing emergency shelter stays using group residential housing (GRH) funding. Under this pilot, the state would directly allocate GRH funding to counties to pay for existing homeless shelters. The amount of funding would be based on the previous year with increase based on yearly GRH utilization trends, rather than providing GRH funding based on each client’s individual eligibility. Article 2, section 34. (Tracking line N/A)
Group residential housing metro demonstration expansion (Saves $36,000 in fiscal years 2018-19)
Increases the number of beds available for the group residential housing (GRH) “metro” demonstration project from 190 to 226. This project tests an alternative way of helping people to afford housing through the GRH program. Under this project, people only pay 30 percent of their income toward housing costs, instead of paying almost all of their income to their housing provider. Article 2, section 25. (Tracking line 800)
Individual community living (Invests $2.716 million in fiscal years 2018-19)
Changes the name of the GRH program to “Housing Support” to reflect the fact that the program is not limited to “group” or congregate settings, but may also be used to support people in their own homes in the community.
Expands eligibility for Minnesota Supplemental Aid (MSA) housing assistance to include people moving out of housing support settings and increases benefits so that more people may live in the community. The change will be effective on July 1, 2020.
Establishes two new Medical Assistance benefits: 1) housing transition services to help people find and obtain housing; and 2) tenancy support services to help people maintain stable housing. This change is subject to federal approval.
Provides grant funding to develop local infrastructure, including:
Outreach to people who are homeless or in institutions or segregated setting regarding housing options
Technical assistance on available housing resources in the area
Administration and monitoring of Housing Support
Funds the development of a website and application to track available housing for people with disabilities in real time and continues funding for the Housing Benefits 101 website. Article 2, sections 10, 19-30, 35-37 and 39 and Article 18, section 2. (Tracking line 275)
Long-term homeless supportive services (Invests $750,000 in fiscal years 2018-19)
Increases funding for the long-term homeless supportive services grant program, which funds integrated services to help stabilize people, families and youth living in supportive housing. This is a one-time increase in funding for fiscal years 2018 and 2019 only. Article 18, section 2. (Tracking line 1024)
Olmsted County group residential housing provider supplemental service rate increase (Invests $1.529 million in fiscal years 2018-19)
Provides a supplemental service rate enhancement for a group residential housing provider in Olmsted County. Article 2, section 32. (Tracking line 701)
Plan for reviewing supplemental housing service rates (Budget neutral)
Directs DHS to develop a plan to:
Review all housing support supplemental service rates
Identify a process to modify rates that are inadequate or excessive
Identify a process for reviewing supplemental service rates to inform the Legislature in deciding when and if to modify a supplemental service rate.
A report is due to the Legislature by Dec. 1, 2018. Article 2, section 38. (Tracking line N/A)
St. Louis County group residential housing provider supplemental service rate increase (Invests $117,000 in fiscal years 2018-19)
Provides a supplemental service rate enhancement for a group residential housing provider in St. Louis County. Article 2, section 31. (Tracking line 583)
Transfer of emergency shelter funds (Budget neutral)
Allows counties to use a new methodology for financing emergency shelter stays using housing support funding. Under this system, the state would allocate housing support funding directly to counties to pay for existing homeless shelters. The amount of funding would be based on the previous year with increase based on yearly housing support utilization trends, rather than providing housing support funding based on each client’s individual eligibility. Article 2, section 34. (Tracking line N/A)
Transitional housing grants (Invests $400,000 in fiscal years 2018-19)
Increases grant funding to establish, maintain or operate transitional housing programs. This is a one-time increase in funding for fiscal years 2018 and 2019 only. Article 18, section 2. (Tracking line 1026)
Delayed until June 30, 2019, the moratorium on issuing adult foster care licenses for a residential program with a capacity of five adults. Amended the DHS background study chapter of law by adding language to differentiate between family foster care and corporate foster care. Added language to Minnesota Statutes, 245D, intended to align Minnesota law with the final HCBS settings rule.
Commission on Deaf, DeafBlind and Hard of Hearing Minnesotans
(Invests $740,000 in fiscal years 2018-19 and $740,000 in fiscal years 2020-21)
This funding will supplement the ongoing operational expenses of the Commission of Deaf, DeafBlind and Hard of Hearing Minnesotans. Increases the base budget by $370,000 per year, which is in the special revenue fund. Article 1, section 7. Effective July 1, 2017. (Tracking line 345 of the Jobs and Economic Growth tracking.)
Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit modifications
EIDBI is a service under MA that was authorized by the Centers for Medicare and Medicaid Services (CMS) in 2015. EIDBI provides services for children with autism spectrum disorder and related conditions. This bill modified provisions of the EIDBI benefit including the eligibility requirements, covered services and provider qualifications.
Allows mental health practitioners to work in day-treatment programs before obtaining 2,000 hours of supervised experience as long as they meet certain training and supervision requirements. Outlines an inclusive list of degrees that qualify a person to become a mental health practitioner. Allows provider staff other than mental health professionals and mental health practitioners to use restrictive procedures, as long as they have completed required training and have the clinical supervision of a mental health professional. Eliminates the requirement that certified peer specialists and certified family peer specialists have a high school diploma or its equivalent. This law is effective May 24, 2017. Sections 1-5, 8.
Intermediate school district mental health projects (Invests $4.9 million in fiscal years 2018-19)
Creates grant program to fund innovative projects to improve mental health outcomes for youth attending intermediate school districts. Grants will be awarded to mental health providers who will design the projects in collaboration with the school districts they intend to serve. This provision is effective July 1, 2017. This is a one-time grant for fiscal years 2018 and 2019 only. Article 3, section 56. (Tracking line 80 | E-12 Finance)
Clarify that children’s mental health service plan development, which pays for the development of an individual treatment plan, may be provided before the treatment plan is complete, given that the service is to develop the plan. Also clarifies that payment for this service is contingent on an individual treatment plan being completed. This law is effective May 24, 2017. Sections 6-7.
Replaces outdated terms with person-centered language. For instance, “disabled persons” is replaced with “persons with a disability” and “disabled workers” is replaced with the term “workers with a disability.”
TEFRA fee reduction
(invests $1.030 million in fiscal years 2018-19 and $1.030 million in fiscal years 2020-21)
Reduces TEFRA parental fees by 13 percent effective July 1, 2017. Article 7, section 25 (Tracking line 674)
