Health law lifts abortion restrictions, provides $1.78 billion in new overall spending

Addressing health care affordability and delivery, health disparities and reproductive health care protections, including repealing numerous abortion regulations, a health finance law will also appropriate $9.34 billion — $1.78 billion in new spending — during the 2024-25 biennium.

Nearly $8.5 billion will go to the Department of Human Services while $849.63 million will reach the Department of Health.

Sponsored by Rep. Tina Liebling (DFL-Rochester) and Sen. Melissa Wiklund (DFL-Bloomington), the new law takes effect July 1, 2023, unless otherwise noted.

HF2930/SF2995*/CH70

Cash on cash on cash

New spending in the law includes:

• $316.1 million for Great Start compensation support payments (Art. 13, Sec. 20; Art. 20, Sec. 2);

• $146.43 million for the child care assistance program maximum rate update (Art. 12, Secs. 10, 24, 26; Art. 20, Sec. 2);

• $100 million for emergency shelter grants (Art. 11, Sec. 14; Art. 20, Sec. 2);

• $68.82 million to transition to standard medical assistance and MinnesotaCare eligibility functions (Art. 20, Sec. 2);

• $42.54 million for child care stabilization grants transition payments (Art. 13, Sec. 26);

• $41.05 million for information technology projects for service delivery transformation (Art. 15, Sec. 10; Art. 20, Sec. 2);

• $33.54 million for modifications to medical education and research costs financing methodology and distribution requirements (Art. 5, Secs. 1-5, 13-14);

• $31.68 million for integrated services for children and families (Art. 15, Sec. 10; Art. 20, Sec. 2);

• $30.27 million for additional funding for the Homeless Youth Act (Art. 20, Sec. 2);

• $30.04 million to reinstate comprehensive medical assistance adult dental benefit set and rebase dental rates (Art. 1, Sec. 11);

• $30.03 million to improve Minnesota Eligibility Technology System functionality (Art. 15, Sec. 10; Art. 20, Sec. 2);

• $30 million for additional funding for Basic Sliding Fee child care assistance (Art. 15, Sec. 9);

• $30 million for additional funding for the emergency services program (Art. 20, Sec. 2);

• $24.42 million to establish the Comprehensive Drug Overdose and Morbidity Prevention Act (Art. 4, Sec. 15);

• $6.1 million for the appropriation portion of the “Keeping Nurses at Bedside Act” for loan forgiveness for eligible nurses and violence prevention efforts (Art. 20, Sec. 3);

$4.36 million to establish the Office of African American Health (Art. 4, Sec. 17);

• $4.18 million establish the Office of American Indian Health (Art. 4, Sec. 20); and

• $3.6 million for a 988 suicide and crisis lifeline. (Art. 4, Secs. 17, 20, 57, 84-90)

Article 19 of the law features $1.46 billion in savings for forecast adjustments available for the fiscal year ending June 30, 2023.

Before implementing any of the new grant programs in this act that includes program outcomes, evaluation metrics or requirements, progress indicators or other related measurements, and with a budget of $750,000 or more per fiscal year, the department administering the program will submit draft measurements to and consult with the Department of Management and Budget. (Art. 15, Sec. 11)

Abortion and reproductive health care

Abortion specific changes that took effect May 25, 2023, unless otherwise noted, include:

• permitting abortions in birth centers;

• expanding MinnesotaCare coverage of abortions;

• removes language limiting coverage of abortion services under medical assistance, to reflect a Minnesota Supreme Court decision;

• eliminating the informed consent in writing requirement and a mandatory 24-hour waiting period before an abortion;

• stop requiring state-mandated printed information prior to certain reproductive health care services;

• increase payment rates by 20% for family planning and abortion services on or after Jan. 1, 2024;

• modify the “born alive” infant provision to clarify an infant who is born alive will require care consistent with good medical practice, not necessarily life-preserving efforts; and

• ensure that recipients of sexual and reproductive health services grants, previously known as family planning grants, can perform abortions, provide state-mandated listed information, and providers will not be criminalized for coercing a person to undergo an abortion or sterilization by threatening their public health insurance coverage, effective July 1, 2023. (Art. 1, Secs. 18, 37-38, 43; Art. 4, Secs. 43, 56, 61, 113)

Providers reporting on abortions will have less required information, removing details, such as the reason for the abortion, number of prior abortions and who paid for the abortion. Physicians must submit the form to the Department of Health by Sept. 30 for abortions performed in the previous calendar year. (Art. 4, Secs. 53-54)

Health care facilities and providers will allow at least one designated support person for pregnant patients receiving health care services. (Art. 4, Sec. 44)

Effective Jan. 1, 2024, parts of the law covering contraceptive coverage and doula services will require:

• hospitals and primary care providers to provide medical assistance and MinnesotaCare enrollees with comprehensive and scientifically accurate information on contraceptive options;

• health plans to cover contraceptive methods and services without imposing cost-sharing requirements or referral requirements;

• the Department of Human Services and managed care organizations to provide a separate reimbursement to hospitals for long-acting reversible contraceptives provided immediately postpartum in the inpatient hospital setting;

• medical assistance and health plans to cover a 12-month prescribed supply for any contraceptive;

• doula services reimbursement rates to increase to $100 per prenatal or postpartum visit and $1,400 for attending and providing doula services at birth; and

• the department to enroll doula agencies and individual treating doulas, effective Jan. 1, 2024, or upon federal approval, whichever is later. (Art. 1, Secs. 1, 7, 13, 19, 28, 33; Art. 2, Sec. 27)

MinnesotaCare/Medical assistance

Minnesotans who are Deferred Action for Childhood Arrival recipients will have access to federally funded medical assistance and MinnesotaCare, effective upon the date of final regulations published by the Centers for Medicare and Medicaid Services and expiring on June 30, 2025.

Medical assistance will no longer have cost-sharing or deductibles, effective Jan. 1, 2024, and eligibility for MinnesotaCare will expand to serve undocumented residents, effective Jan. 1, 2025.

Cost-sharing measures (i.e. copayments, coinsurance, or deductibles) under MinnesotaCare will not apply to pre-exposure prophylaxis, postexposure prophylaxis, tobacco and nicotine cessation services and any additional diagnostic services or testing after a mammogram.

The Department of Human Services must develop an implementation plan for a direct payment system for MinnesotaCare and medical assistance, which will consider allowing individuals to opt out of managed care and assess the feasibility of an outpatient prescription drug benefit carve-out from managed care.

Another implementation plan for the MinnesotaCare “public option” will require actuarial and economic analyses of public option models, including a MinnesotaCare buy-in. If the Legislature does not enact a law relating to the provision by June 1, 2024, the Department of Commerce can submit a waiver request to the federal government to implement the public option. If the federal waiver is approved and any necessary legislation enacted, the commissioner of commerce must implement a public option to be available to consumers beginning Jan. 1, 2027. These provisions took effect May 25, 2023.

The law will ensure continuous medical assistance eligibility for children from birth to the month they turn age 6. People ages 1-20 will receive continuous eligibility for 12 months. The provision of 12-month for children under the age of 19 goes into effect Jan. 1, 2024 or upon federal approval and the implementation of required administrative and system changes, and the remaining provisions take effect Jan. 1, 2025, subject to federal approval.

Authority for the Department of Human Services to recover medical assistance and MinnesotaCare overpayments provided during a pending appeal will be limited. Medical assistance eligibility currently includes people under the age of 26 who were in foster care when they turned age 18. The law will expand this stipulation to cover people meeting the same conditions but were in foster care in another state. This provision took effect May 25, 2023.

When infants are medical assistance enrollees, the Department of Human Services will reimburse physicians in broader circumstances for costs incurred for testing newborns for heritable and congenital disorders.

After receiving returned mail, the department will not disenroll anyone from MinnesotaCare or medical assistance without making two attempts by phone, email or other methods to contact the individual, giving them at least 30 days to respond to each attempt.

Effective the later of Jan. 1, 2024, or federal approval, annual inflationary adjustments will occur for assertive community treatment; adult residential crisis stabilization services; intensive treatment services; and intensive nonresidential rehabilitative mental health services Also increases payment rates and provides annual inflationary adjustments for certain outpatient behavioral health services.

the law will require the department of human services to make contracts with vendors public, along with previous versions of the drug list, beginning Jan. 1, 2024, and also modifies other procedures related to the medical assistance preferred drug list.

The law requires medical assistance to cover, effective Jan. 1, 2024:

• all medically necessary dental services for adults;

• seizure detection devices and their monitoring;

• tobacco and nicotine cessation services, drugs to treat tobacco and nicotine addiction or dependence, or drugs to help individuals discontinue use;

• recuperative care services; and

• services related to the diagnosis, monitoring and treatment of a rare disease or condition. (Art. 1, Secs. 2, 9-11, 21, 23, 25-29, 34-35, 39, 42; Art. 2, Sec. 2; Art. 16, Secs. 9, 11-15, 20-22)

Economic health-related changes

Health care providers and facilities must comply with the federal “No Surprises Act” to protect patients from unexpected medical bills.

The commissioner of health must analyze the benefits and costs of a universal health care financing system, and report to the legislature by January 15, 2026.

Also effective May 25, 2023, a moratorium on conversion transactions for-profit health maintenance organizations will extend to 2026, meaning these entities will have to maintain nonprofit status.

Hospitals, outpatient surgical centers and a handful of other medical or dental practices will need to make public their current standard charges for all items and services by following specific file format guidelines. This takes effect Aug. 1, 2023, for most applicable facilities; Jan. 1, 2024, for hospitals; and Jan. 1, 2025, for practices with more than $50 million in annual revenue or outpatient surgical centers.

Money received by the state from litigation about electronic nicotine delivery systems will go into the to-be-established tobacco use prevention account, effective April 1, 2023. The account creation provision goes into effect May 25, 2023.

The law will establish a $275 permit fee for a submerged closed loop heat exchanger and require a permit for its installation in a water supply well, effective May 25, 2023. Newly established monitoring and reporting requirements will expire on Dec. 31, 2025. (Art. 1, Secs. 5, Art. 2, Secs. 5, 7, 23, 24, 30; Art. 4, Sec. 4, 8, 10, 39, 93, 107; Art. 16, Sec. 19)

Health policy

The requirement that the department of human services report to the Legislature every three years on the cost of dispensing prescription drugs will not expire, effective May 25, 2023.

The law will update membership requirements for the Formulary Committee beginning May 25, 2023, such as barring members who have a personal interest in a pharmaceutical company, pharmacy benefits manager or a health plan company. Additionally, the committee must give a public 30-day notice prior to a meeting.

For admissions occurring on or after July 1, 2023, the law will modify long-term hospital rates by requiring payments to be the higher of the per diem amount under existing methodology or the cost-based methodology currently applicable to critical access hospitals.

To provide quitline services, the Department of Human Services may use volume purchase through competitive bidding and negotiation, effective Jan. 1, 2024.

At least one version of liquid methadone, a medication commonly used to treat Opioid Use Disorder, must be available without prior authorization, and for those utilizing an enteral feeding tube, prior authorization will be automatically approved within 24 hours.

An enrolled Indian Health Service facility or tribal health center operating under a 638 contract will also be allowed to enroll as a tribal Federally Qualified Health Center, and the department will establish an alternative payment method. Additionally, federally qualified health clinics that double as urban Indian organizations will have the option of being reimbursed under an all inclusive rate established by the Indian Health Services..

Providers will have to accept the established payment for services if a managed care or county-based purchasing plan has an established contractual medical assistance payment with an out-of-network provider for a service related to a rare disease or condition.

The temporary use of audio-only telehealth for certain services will extend to June 30, 2025.

Licensed child care providers will, by July 1, 2024, need to develop a plan to test for the presence of lead in drinking water and test all taps every five years. Remediation steps must be included in the plan should lead be present.

A minor, age 16 or older, will be able to give consent for nonresidential mental health services with no other person’s consent required. (Art. 1, Secs. 6, 8, 13-16, 20, 31-32, 34, 41; Art. 2, Sec. 4; Art. 4, Secs. 37, 62)

New departments, offices, councils

The Health Department is to establish:

• Advisory Council on Water Supply Systems and Wastewater Treatment Facilities;

• A center for health care affordability, which among other duties must report on federal 340B program drug spending and reimbursement issues;

• a cultural communications program that advances culturally and linguistically appropriate communication services for communities most impacted by health disparities;

• Office of African American Health;

• Office of American Indian Health;

• African American Health State Advisory Council;

• special emphasis grant programs for African American health and American Indian health;

• a labor trafficking services grant program to provide comprehensive, trauma-informed, and culturally specific services for victims of labor trafficking or labor exploitation;

• an annual grant program “to award infrastructure capacity building grants to help metro and rural community and faith-based organizations serving people of color, American Indians, LGBTQIA+ communities, and people living with disabilities in Minnesota who have been disproportionately impacted by health and other inequities to be better equipped and prepared for success in procuring grants and contracts at the department and addressing inequities”; and

• community solutions for healthy child development grant program. (Art. 4, Secs. 12, 16-20, 38, 46; Art. 12, Sec. 18)

Health insurance

Reporting for prescription drug price increases will have updated requirements, such as listing the 10 highest prices paid in 10 other countries for brand name drugs. New prescription drug price reporting will also have additional requirements.

The Department of Health will put on its website a list of prescription drugs of substantial public interest to provide greater consumer awareness related to cost. This provision must be met by at least Jan. 31, 2024, and then completed quarterly.

Prescription drug manufacturers, pharmacies, pharmacy benefit managers, and wholesale drug distributors will have to submit specific listed information to the department for any drug of substantial public interest, beginning Jan. 1, 2024.

Health plan companies must not restrict enrollees’ choice as to where they receive services for diagnosis, monitoring or treatment of a rare disease or condition. Further, the law will impose cost-sharing limitations and prohibit denial of coverage solely based on an out-of-network provider, all of which goes into effect Jan. 1, 2024.

Health plans must cover biomarker testing to diagnose, treat, manage and monitor illness or disease if done for clinical utility, effective Jan. 1, 2025. (Art. 2, Secs. 9-10, 15-19, 25-26)

Health care affordability and delivery

The law will establish a health subcabinet to coordinate public and private health care delivery and payment reform, foster sustainability in spending, ensure affordable coverage and reduce health disparities.

To receive information about potential eligibility for financial assistance and health insurance enrollment options, income tax filers can designate a request for their return information to reach the MNsure board. This provision is effective for taxable years after Dec. 31, 2023.

Health carriers offering individual plans through MNsure will provide a special enrollment period as established through the new easy enrollment health insurance outreach program. These provisions go into effect for taxable years beginning after Dec. 31, 2023, and apply to health plans offered, issued or sold on and after Jan. 1, 2024. (Art. 16, Secs. 1, 6-8, 10, 16-18)

Economic assistance, housing and homelessness

The law will modify general assistance, housing support and the Minnesota Family Investment Program by increasing the general assistance standard of assistance, establishing income exclusions for both census and lived experience engagement income, and modifying testing requirements for general assistance, Minnesota Supplemental Aid, Minnesota Family Investment Program and Supplemental Nutrition Assistance Program applicants and recipients.

Unlike other general assistance, Supplemental Nutrition Assistance Program, Minnesota Family Investment Program, and Minnesota Supplemental Aid recipients with a felony-level drug offense in the last 10 years may be subject to random drug testing and the county will provide information about substance use disorder treatment programs to anyone who tests positive. This takes effect Aug. 1, 2023. (Art. 10, Secs. 19, 47, 95-96)

Housing transition costs for stabilization services will include security deposits, as well as essential furnishings and supplies, effective the earlier of Jan. 1, 2024, or upon federal approval. (Art. 11, Sec. 2)

Tribal per capita payments will not qualify as unearned income when determining assistance unit income, effective Jan. 1, 2024. (Art. 10, Sec. 79)

Effective Oct. 1, 2024, a single adult on general assistance who lives with their parent or parents will receive $350 per month. This rate will adjust annually by a percentage equal to the change in the consumer price index, beginning Oct. 1, 2025. (Art. 10, Sec. 18)

Changes to the Family Assets for Independence in Minnesota program include:

• adding credit building to the list of financial education requirements and saving for emergencies or a child’s education to asset-specific training;

• doubling the lifetime matching limit for recipients to $12,000 and the lifetime limit for matching contributions from a state grant, nonstate or Temporary Assistance to a Needy Family funds to $6,000;

• putting the amount of contributions to Minnesota 529 savings plans and emergency savings accounts on the quarterly report by fiduciary organizations participating in the program; and

• income received from lived-experience engagement and family asset bank accounts and individual development accounts will not count while determining the equity value of personal property for economic assistance program eligibility, effective Aug. 1, 2023. (Art. 10, Sec. 30-32, 73-75)

Census income will not count towards the asset limit of the child care assistance program; the equity value of personal property; or economic assistance eligibility. (Art. 10, Secs. 72, 76, 81)

Furthermore, income received from lived-experience engagement will not count towards economic assistance eligibility. (Art. 10, Sec. 80)

Instead of 10% of a Minnesota Supplemental Aid recipient’s gross income, or $25, the representative payee fee will equal the maximum monthly amount allowed by the Social Security Administration. (Art. 10, Sec. 22)

Individuals with disabilities leaving Minnesota prisons will have presumptive eligibility for housing support for up to three months. (Art. 11, Sec. 3)

Task forces, advisory councils, collaboratives and studies

The law creates the:

• Advisory Council on Water Supply Systems and Wastewater Treatment Facilities;

• Minnesota One Health Antimicrobial Stewardship Collaborative;

• African American Health State Advisory Council;

• Minnesota Partnership to Prevent Infant Mortality;

• Minnesota Perinatal Quality Collaborative;

• Health Equity Advisory and Leadership Council;

• Psychedelic Medicine Task Force;

• Equitable Health Care Task Force;

• Task Force on Pregnancy and Health and Substance Use; and

• Community Resource Center Advisory Council.

A study of the development of a statewide registry for provider orders for life-sustaining treatment is called for as are studies to look at the environmental and health impacts of green burials and housing support supplementary service rates. (Art. 4, Sec. 12, 14, 18, 65-66, 70, 99-100, 102, 105, 110; Art. 11, Secs. 12, 27; Art. 14, Sec. 42)

Children and families, child care workforce and child support

A family, friend, and neighbor grant program is to be established by the Human Services Department “to promote children's social-emotional learning and healthy development, early literacy, and other skills to succeed as learners and to foster community partnerships that will help children thrive when they enter school.”

The department is also to develop a diaper distribution program to award grants “to provide diapers to under resourced families statewide,” and a prepared meals grant program “to provide hunger relief to Minnesotans experiencing food insecurity and who have difficulty preparing meals due to limited mobility, disability, age, or limited resources to prepare their own meal.”

Effective April 28, 2025, the Department of Human Services will implement a centralized provider registration for child care assistance program providers.

Tribes are currently notified within seven days if a family assessment or investigation involves a child who may be indigenous. The law will add a noncaregiver sex trafficking assessment as another reason to give notice to tribes. A local welfare agency will give immediate notice within 24 hours for the same reasons. On top of that, local welfare agencies will not have to have face-to-face contact during noncaregiver sex trafficking assessments nor inform or interview the alleged offender. These provisions go into effect July 1, 2024.

Additionally, effective July 1, 2024, local welfare agencies will conduct a sex trafficking assessment when a maltreatment report alleges child sex trafficking by a noncaregiver sex trafficker. During an assessment, the local welfare agency will initiate an immediate investigation if there is reason to believe a child’s parent, caregiver or household member allegedly engaged in child sex trafficking.

Provisions that take effect Jan. 1, 2025:

• to satisfy late payments, Social Security or apportioned veterans’ benefits, received for the benefit of the child, may be used after a motion to modify child support;

• disability benefits received for the benefit of the joint child or past earnings in excess of child support obligations will not count as an arrearage or future payment;

• when a parent is eligible for general assistance or supplemental Social Security Income, they are not considered voluntarily unemployed, underemployed or employed on a less than full-time basis; therefore, income earned by the parent may be considered when calculating child support;

• as for Temporary Assistance to a Needy Family recipients, parents receiving Minnesota Family Investment Program benefits will not have their potential income imputed. (Art. 14, Secs. 27-30)

The law also modifies medical support and the suspension of driver’s licenses within child support obligations, effective Jan. 1, 2025, and Jan. 1, 2026, respectively. (Art. 14, Sec. 35) (Art. 12, Secs. 12, 18, 21, 33; Art. 13, Secs. 1, 5, 7-16, 23, 24; Art. 14, Secs. 6, 20-22)

Adoption

In addition to many technical and procedural updates, the law requires the state registrar, upon request, to provide an adopted person who is now an adult with a copy of their original birth record and any contact preference forms if filled out. For those adopted as an adult, they may obtain birth records that existed prior to the adoption.

When applying for an original birth record, the Department of Health must inform the applicant of any unrevoked consent to disclosure or affidavit of nondisclosure on file, effective July 1, 2024. A birth parent’s consent to disclosure or affidavit of nondisclosure filed with the department will expire on June 30, 2024. These provisions go into effect July 1, 2024. (Art. 4, Secs. 32, 34)

Behavioral health

The law will add a new training requirement for mental health rehabilitation workers, as well as Level I and Level II mental health behavioral aides.

Programs providing children’s residential health services, besides those for child protection or voluntary foster care for treatment placements, will be added to a list of eligible vendors for room and board payments out of the behavioral health fund.

A new staff qualification will require at least six hours of the already required training for mental health crisis stabilization staff be specific to working with families and providing services to children.

At least one staff member during normal sleeping hours at a psychiatric residential treatment facility must be trained to provide emergency medical response. Likewise, a registered nurse must be available within one hour to assess a child’s needs.

The new law will allow services related to, but still separate, from psychiatric residential treatment services to be delivered within the same facility.

Effective, Jan. 1, 2024, or upon federal approval, whichever is later, the Department of Human Services will increase adult day treatment reimbursement rates by 50% over the June 30, 2023, rates.

The department must also update the behavioral health fund room-and-board-rate schedule. (Art. 9, Secs. 7-8, 25, 31-35, 40-41)

Certified community behavioral health clinics

The modifies and adds standards and requirements related to the certified community behavioral health clinic model, specifying that it is an integrated payment and service delivery model and outlining assessment requirements. Some of the new language simply reorganizes or slightly tweaks existing requirement/standards.

The Department of Human Services will establish a state recertification process, a transition period and a decertification process for certified community behavioral health clinics, as well as issue a list of required evidence-based practices.

Medical assistance will cover peer services provided by one of these clinics when medically necessary, effective Jan. 1, 2024, or upon federal approval, whichever is later.

The department will be required to provide a formal written notice to applicants outlining the determination process and any necessary corrective action; require a comprehensive evaluation for all new clients within 60 calendar days following preliminary screening and risk assessment; and request federal approval to re-enter the demonstration program established by Section 233 of the Protecting Access to Medicare Act and, if approved, to continue participation as long as federal funding persists.

Other changes will:

• specify requirements for a clinic to contract with a designated collaborating organization when providing non-core services;

• permit a clinic to receive prospective payments for services without a county contract or approval should it meet certain requirements;

• require a clinic to apply for certification every 36 months;

• demand a clinic meet minimum staffing requirements;

• necessitate completion of either an initial evaluation or a comprehensive evaluation;

• have clinics finish an integrated treatment plan within 60 calendar days following preliminary screening and risk assessment and update it at least every six months or upon a change in circumstance; and

• grant a clinic’s service recipients access to grievance procedures that satisfy minimum requirements. (Art. 18, Secs. 2-15, 18-22)

Background studies, licensing

The law outlines requirements for maltreatment and state licensing agency checks on guardians and conservators, such as requiring requests for maltreatment data about guardians and conservators to mention if they have been a perpetrator of substantiated maltreatment of a vulnerable adult or minor. All data collected by the Department of Human Services for data checks is private data.

It also allows the Department of Human Services to use background study systems to share documentation electronically with entities and background study subjects.

While some drug sale crimes will be subject to a 15-year disqualification, all felony-level drug crimes and convictions involving alcohol or drug use will be removed from consideration, effective on or after Aug. 1, 2024.

Also on that date, the five-year disqualification category will see numerous drug-related offenses added to the list, such as sale of synthetic cannabinoids, that were previously under the 15-year disqualification category. Background study requirements for legal non-licensed child care providers will see additions, one of which will require an individual to be fingerprinted and photographed, either at reauthorization or during any necessary new background study. This provision goes into effect April 28, 2025. (Art. 6, Secs. 1-36; Art. 7, Secs. 8-9, 34-35)

SF2995* / HF2930 / CH70