MinnesotaCare provisions remain intact, nursing homes gain reforms in passed HHS bill

The House passed a $12.54 billion health and human services budget bill 99-31 early Monday.

Sponsored by Rep. Matt Dean (R-Dellwood) and Sen. Tony Lourey (DFL-Kerrick), HF1638/SF1458* now goes to the governor. The Senate repassed it 49-16 on Sunday.

“It is a bill that is about $302 million under base. This bill does some really good things, particularly for the most vulnerable Minnesotans for the elderly, the frail, and disabled,” Dean said.

Nursing home payment reform

The House Aging and Long-term Care Policy Committee work to improve conditions at nursing homes and to address workforce shortages in care facilities would be the largest reform in 30 years. However, the House proposal came out of conference committee different than it went in, according to Rep. Joe Schomacker (R-Luverne).

A proposed rate increase had been tied to increased wages for nursing home staff, but Schomacker said the formula became too cumbersome so it was scrapped. Rep. Leon Lillie (DFL-North St. Paul) argued steadily in committee hearings to give 100 percent of nursing home payment increases to workers. Wage increases could still be expected but the bill would not require a particular percentage of the payment increase go to wages.

The House didn’t get Senate support for another 5 percent pay increase for Home and Community Based Services in 2015 and 2016, which would have passed 75 percent of the new revenue on to personal care attendants. The campaign was part of HF564 sponsored by Rep. Rod Hamilton (R-Mountain Lake).

“The 5 percent campaign is a disappointment that I had, and many of the conferees had on our side, that we were not able to incorporate that with the Senate in order to move forward. That is work yet to be done,” Dean said.

MNsure and MinnesotaCare

A federal waiver would be requested to allow individuals to purchase health plans outside of MNsure and still qualify for the premium tax credits, which was a House amendment by conferee Rep. Tara Mack (R-Apple Valley), chair of the House Health and Human Services Reform Committee. Another federal waiver would be requested to allow small employers to receive the small business health care tax credit when the employer pays the premium on behalf of the employee.

However, a House provision to repeal MNsure is no longer in the bill.

“I, for one, would have liked to have gone further and done more to create a sustainable program that looks out further. However, we did listen to the Senate and many other folks who wanted to go forward with that. It retains the MinnesotaCare program,” Dean said.

Children and families

Conferees added an amendment to disregard up to $100 in child support payments for one child or up to $200 for two or more children when determining eligibility for the Minnesota Family Investment Program. MFIP enrollees are expected to work and are supported with both cash and food assistance for up to 60 months.

The bill also would fund a new $2 million program to combat hunger in rural Minnesota with mobile food shelf trucks.

Individuals with disabilities have income limitations for receiving some public services. Having critical services cut off or cost more because they earn more discourages people with disabilities from seeking employment advancement, according to earlier testimony in committee hearings. The bill would allow them to earn more without penalty.

Medical Assistance-TEFRA is for children with disabilities whose parents earn too much income to qualify for other public health programs, or who qualify but the cost would be prohibited. Because the fees are based on a sliding scale based on income, the more parents make, the more they pay in fees. Under the bill, those fees would be reduced 10 percent.

Achieving a Better Life Experience Act would allow disabled or blind Minnesotans to set up a tax-free ABLE savings account, where they could save up to $100,000 without losing government benefits, and make withdrawals for expenses such as housing, health care and employment training.              

Chemical and mental health

It would become state policy to treat individuals with drug or alcohol addictions in withdrawal management services, regardless of their ability to pay. Within 12 hours of being admitted, clients would have a plan to address their individual needs and goals toward sobriety.

Several new solutions for treating people with chemical dependence or mental health disorders would be funded. Among the innovative programs are a $1 million statewide program using texting for the prevention of teen suicides and $2 million for Beltrami County to divert minor offenders with mental illness to treatment rather than incarcerating them. Also, a statewide opiod prescribing program would be created to help reduce opioid dependency and substance abuse.

Minnesota is under a court order to improve conditions for those civilly committed to a state institution. A special review board would be tasked with reviewing a client’s petition for release if denied. The board must identify obstacles that prevent clients from advancing in their treatment and make recommendations for achieving progress.

Staff at the facilities have suffered permanent injuries resulting from assaults by inmates, clients or patients. The bill would require the state to continue contributions to former injured employee’s retirement plans.

Oversight

Another conferee amendment was a package of reforms for managed care organizations to control their reimbursable expenses. After UCare wrote a $30 million check to the state during the 2011 deficit, work began in earnest to audit managed care plans and revise their rate setting policies. The bill would prohibit certain expenses, such as alcoholic beverages, from being an allowable administrative expense when setting rates.

In addition, provisions for auditing public health eligibility rolls is now estimated to save about $24 million rather than the previous House estimate of $300 million, Dean said.

Health Department

More students could take advantage of education loan forgiveness if they agree to work in certain settings for a designated time period. Advanced dental therapists, dental therapists, mental health professionals and public health nurses could apply for the program, which is administered by the Health Department.

A Senate-only provision to help equip immigrant medical graduates to work in Minnesota was added to the bill. The international medical graduate’s assistance program would provide grants to nonprofit organizations that provide career and support services in immigrant medical professionals who are looking to work on their primary care residency or clinical preparation.

Another Senate initiative would establish the Minnesota Radon Licensing Act, which would require radon testing companies or individuals to be licensed.