$14 billion human services finance law includes numerous rate increases

For disability, aging, and behavioral health services, as well as opioid overdose prevention and opiate epidemic response, the human services finance law will appropriate $14.06 billion over the 2024-25 biennium, $1.35 billion of which is new spending.

Rep. Mohamud Noor (DFL-Mpls) and Sen. John Hoffman (DFL-Champlin) sponsor the law that takes effect July 1, 2023, unless otherwise noted.

HF2847/SF2934*/CH61

Where’s the money?

Most of the budget, $12.32 billion, will go to forecasted program spending, including:

• $12.02 billion for medical assistance;

• $194.8 million for the behavioral health fund;

• $101.42 million for alternative care;

• $2.38 million for housing support; and

• $100,000 for MinnesotaCare (Art. 9, Sec. 2).

Major spending for grant and loan programs includes:

• $100 million to establish a financially distressed nursing facility loan program;

• $90 million onetime to establish long-term services and supports workforce incentive grants for recruiting and retaining direct support professionals;

• $30 million onetime dollars to establish long-term care workforce grants for new Americans;

• $23.16 million for phase II of the vulnerable adult act redesign;

• $18.83 million in onetime funds to establish provider capacity grants for rural and underserved communities;

• $18.16 million one time for safe recovery sites start-up and capacity building grants;

• $12.1 million one time for HIV/AIDS support services grants;

• $11.26 million in onetime funds to establish startup and capacity building grants for substance use disorder treatment programs that serve parents with children, as well as an opioid treatment program work group;

• $9.23 million onetime to establish new American legal and social services grants;

• $8 million onetime for harm reduction and culturally specific grants to address the impacts of the opioid epidemic in respective communities; and

• $5.76 million to establish both a statewide disability employment technical assistance center and lead agency capacity grants to support people with disabilities exploring and maintaining competitive, integrated employment options.

The law will also ratify the memorandums of understanding, labor agreements and subsequent consumer-directed community supports budget increases during the 2024-25 biennium between the state and SEIU Healthcare Minnesota. This includes $50.75 million for onetime retention bonuses and $1.6 million for one-time stipends for individual providers. (Art. 1, Secs. 7-8, 10, 59-60, 64-66; Art. 2, Secs. 7, 12; Art. 4, Secs. 13, 22, 24; Art. 5, Sec. 15; Art. 9, Sec. 2)

Rate increases and other rate-related changes

New rate adjustment costs, effective Jan. 1, 2024, or upon federal approval, whichever is later, include:

• $271.99 million for personal care assistance and community first services and supports rate framework modifications, effective Jan. 1, 2024, or 90 days after federal approval, whichever is later, though this initial increase will expire and be replaced with a higher one on Jan. 1, 2025, or 90 days after federal approval, whichever is later;

• $138.98 million for an elderly waiver rate increase and consumer-directed community supports parity. At least 80% of the marginal increase in revenue must be used to increase compensation-related costs for employees, which is not applicable for community access for disability inclusion customized living and brain injury customized living;

• $90.51 million for modifications to the disability waiver rate system inflation adjustments, beginning Jan. 1, 2024, with subsequent updates every two years;

• $42.26 million for the brain injury and community access for disability inclusion customized living rate increase;

• $36.64 million for disability and elderly waiver homemaker rate alignment;

• $18.16 million for home care nursing rate increase; and

• $14.48 million for other home and community-based service rate increase, such as home health aide, skilled nursing and therapies, early intensive developmental and behavioral intervention, intermediate care facilities for persons with developmental disabilities day training and habilitation, home delivered meals, chore services, community living assistance, and family caregiver (Art. 1, Secs. 29, 40, 54, 57, 68, 70, 71-73; Art. 2, Sec. 17).

The law will modify critical access nursing facility adjustments, allowing for a supplemental payment above a facility’s operating payment rate, effective July 1, 2023, or upon federal approval, whichever is later. (Art. 2, Secs. 9-10)

Additional changes effective Jan. 1, 2024, or upon federal approval, whichever is later, include:

• the Department of Human Services will establish rates for various homemaker services for different disability waivers;

• the minimum daily operating rate for a class A intermediate care facility for persons with developmental disabilities will be $275 and $316 for class B facilities; the daily operating rate will be increased by $40 for both;

• the department will establish a rate system for shared homemaker services and shared chore services;

• every two years, beginning Jan. 1, 2024, the department must evaluate the elderly waiver rate framework, and providers will have to submit cost data to the department at least once every five years;

• ambulance services reimbursement will have an established monthly fuel cost adjustor, pegged to $3 per gallon; and

• the law will establish rates for substance use disorder treatment services with medications for opioid use disorder (Art. 1, Secs. 26, 48-49, 78; Art. 2, Sec. 16; Art. 3, Sec. 6; Art. 4, Sec. 11).

Effective Jan. 1, 2024, managed care plans and county-based purchasing plans will need to provide a rate adjustment for nonemergency medical transportation fuel adjustments. (Art. 3, Secs. 5, 8)

A worker retention component, effective Jan. 1, 2025, will be established for personal care assistance services and community first services and supports. (Art. 1, Secs. 54-55)

Beginning Jan. 1, 2025, and annually thereafter, intermediate care facilities for persons with developmental disabilities rates must be updated based on the percentage change in the Consumer Price Index, effective Jan. 1, 2025, or upon federal approval, whichever is later. (Art. 1, Sec. 50)

Providers paid through the disability waiver rate system will need to use a minimum of 66% of generated revenue for direct care staff compensation, effective Jan. 1, 2025. (Art. 1, Sec. 44)

Moreover, the department will create rates for family residential services and life-sharing services based on an individual’s assessed need. These rates must be 10% higher than the corresponding family residential services rate. This provision will go into effect Jan. 1, 2026, or upon federal approval, whichever is later. (Art. 1, Sec. 47)

The law makes various changes to the base wage index for most elderly waiver services, modifying and establishing several inputs involving overhead, program costs, and supervision of unlicensed staff. (Art. 2, Secs. 18-19)

Further, the law specifies the calculation rate of several services, including home management and support services; home care aide services; home health aide services; chore services; companion services; homemaker assistance with personal care; homemaker cleaning; homemaker home management; in-home respite care services; out-of-home respite care services; individual community living support; home-delivered meals; adult day services; and adult day services bath (Art. 2, Secs. 20-34).

Disability services

The new law will establish a joint labor and management trust, called the Home Care Orientation Trust, to render orientation training to individual providers of direct support services.

Modifying MnCHOICES certified assessor qualifications, the law will remove the required years of home and community-based experience.

The law will establish a direct support professional annual labor market survey.

With or without family training, the number of recipients who may share individualized home supports will increase from two to three.

The law will allow the Department of Human Services to disseminate and use data gathered under the administration of the Minnesota Unemployment Insurance Law to evaluate medical assistance services.

Should they have a valid driver’s license, personal care assistants will be able to bill medical assistance for time spent driving a recipient, effective 90 days after federal approval. The change will cost $1.69 million.

If, in the month prior to becoming eligible for continuing Medicaid coverage, an individual is receiving Minnesota Supplemental Aid benefits, they will keep getting payments, so long as they remain in continuing Medicaid coverage status. This provision is effective May 25, 2023.

Under the consumer-directed community supports option for personal assistance services, the total number of weekly hours the parent of a minor can be paid to provide will double from 40 to 80 when more than one parent provides the service and 60 hours for only one parent or a spouse. The same increase will go into effect for parents and spouses providing community first services. These provisions will be effective July 1, 2023, or upon federal approval, whichever is later.

The law will create a new foster care moratorium exception and expand an existing one to include people receiving services under the elderly waiver, available until Dec. 31.

Effective Jan. 1, 2024, or upon federal approval, whichever is later, the qualifications for Level II early intensive developmental and behavioral intervention treatment providers will include an individual be certified by a tribal nation.

Effective Jan. 1, 2024, community residential settings will receive an exemption from meeting variance requirements to utilize alternate overnight supervision. Additionally, community residential settings will have new licensing requirements for remote overnight supervision, such as signed informed consent, establishing a maximum permissible response time and use of a device with live two-way communication.

Case manager training requirements under the brain injury, community alternative care, community access for disability inclusion, and developmental disabilities waivers will double from 10 to 20 hours and the training must include informed choice, cultural competency, employment planning, community living planning, self-direction options, and use of technology supports. Case managers must complete the training course by Aug. 1, 2024, or within six months for those hired after this date.

The list of residential supports and services for home- and community-based services standards will include life sharing, effective Jan. 1, 2026, or upon federal approval, whichever is later.

The sunset for Governor’s Council on an Age-Friendly Minnesota will be moved from June 30, 2024, to June 30, 2027. (Art. 1, Secs. 1-6, 12-13, 15-17, 18-20, 23-24, 27, 39-40, 52, 56, 58; Art. 2, Sec. 35)

Health care and behavioral health

The law will eliminate what’s often referred to as “TEFRA fees,” or the requirement that parents of children with disabilities who access medical assistance through the Tax Equity and Fiscal Responsibility Act option must contribute to the cost of services by making monthly payments.

Effective Jan. 1, 2024, or upon federal approval, whichever is later, asset limits will not be considered for eligibility of medical assistance for employed persons with disabilities.

An Office of Addiction and Recovery will be created within Minnesota Management and Budget.

Sober homes will have new requirements, a bill of rights, complaint process and private right of action.

To support the transition to ASAM standards, the Human Services Department will establish training opportunities for substance use disorder treatment providers to increase knowledge, develop skills, and adopt evidence-based and promising practices.

To continue to receive medical assistance payments, licensed nonresidential substance use disorder treatment programs must enroll in the federal demonstration project and meet requirements by Jan. 1, 2025.

The department must conduct a survey to identify sober home settings and collect data about services provided (Art. 3, Secs. 1, 3-4; Art. 4, Secs. 1-2, 14-16, 26).

Opioid epidemic response and overdose prevention

Several locations will need to maintain a supply of opiate antagonists, such as school districts at each school, community corrections programs at each correctional site, licensed substance use disorder treatment programs for emergency treatment, and site-based or group housing support settings.

Individuals with known or stated histories of opioid use disorder will receive emergency opiate antagonist rescue kits upon release from prison.

The Department of Human Services will establish a statewide opioid overdose surge text message alert system.

The law will modify the opioid prescribing improvement program by requiring the department’s quality improvement program to support patient-centered care consistent with community standards of care, as well as discouraging unsafe tapering practices and patient abandonment by providers.

The program will sunset either when the recommended criteria are met or Dec. 31, 2024, whichever is sooner. (Art. 5, Secs. 1, 3, 5-6, 12; Art. 6, Secs. 4, 6)

Licensing, direct care and treatment

The new law will modify licensing statutes, including chapter 245A involving license revocation and issuance, immediate suspensions, and involuntary receivership (Art. 7).

A new agency will be established, effective Jan. 1, 2025. The Department of Direct Care and Treatment will be separated from the Department of Human Services, which will retain authority and responsibilities until an executive board is developed. The transition of authority provision will go into effect July 1, 2023. Employees transferred to the new department will receive some protections, including assurance that all collective bargaining and compensation plans will continue in full force, effective July 1, 2024. (Art. 8, Secs. 8-11)

SF2934* / HF2847 / CH61