Omnibus HHS law increases investments to strengthen public health

The omnibus health and human services policy and finance law appropriates $16.25 billion from the General Fund in the 2022-23 biennium.

In addition to funding the Human Services and Health departments, the law expands access to child care, increases efforts to reduce tobacco and vaping use, extends Medical Assistance coverage, and increases wages for personal care attendants and home care nursing providers.

Other state programs, offices and boards funded by the law include health-related licensing boards, Emergency Medical Services Regulatory Board, Council on Disability, ombudsman for mental health and developmental disabilities, ombudspersons for families and the ombudsperson for American Indian families. Minnesota’s reinsurance program, the state’s premium security plan, is extended through the 2022 benefit year.

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The law is sponsored by Rep. Tina Liebling (DFL-Rochester) and Sen. Michelle Benson (R-Ham Lake), and took effect July 1, 2021, unless otherwise noted.

2021 Special Session: SSHF33*/SSSF37/SSCH7

Child care assistance and protection initiatives include:

• modifying from July 1, 2021 to May 31, 2024, how families are prioritized on the basic sliding free program waiting list;

• effective Jan. 1, 2022, modifying the formula for allocating money to counties for their basic sliding fee programs;

• permitting the Department of Human Services to initiate efforts to recover child care assistance overpayments from families and providers. This is effective Aug. 1, 2021;

• effective Nov. 15, 2021, increasing the maximum rates paid to providers for child care assistance and rates paid to legal, non-licensed family child care providers;

• limiting retroactive payments under the child care assistance program to three months, rather than six;

• directing the Department of Human Services to spend $304.4 million in federal COVID-19 relief money for grants to child care and early learning providers

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• requiring counties to appoint a public defender to all financially eligible parents, guardians and custodians who ask for one prior to a first family court hearing, and at all stages of child protection proceedings where loss of custody is possible; and

• requiring employees and supervisors of public or private youth recreation programs to report certain child abuse to the appropriate local welfare, social services, or law enforcement agency. (Art. 1, Sec. 16; Art. 8, Secs. 1-3, 5-7, 11; Art. 9, Sec. 5; Art. 10, Secs. 1-2)

Task forces, working groups and programs established include:

• a legislative task force on child protection is created to study the child welfare system, maltreatment reports and responses, mandatory reporters, and the intersection of educational neglect and child protection. A report is due to the Legislature and governor by Feb. 1, 2024;

• appropriating $694,000 to the commissioner of health to develop programs to address and better understand racial disparities in maternal and infant mortality and morbidity;

• allocating $31.7 million from the federal community mental health services block grant funds and the federal substance abuse prevention and treatment block grant funds for school-linked mental health services and community-based substance abuse prevention services statewide;

• creating an ombudsperson for American Indian Families;

• establish a competitive grant program in the Department of Human Services to expand access to licensed family child care providers or licensed child care centers for children with disabilities including medical complexities;

• establishing the Great Start for All Minnesota Children Task Force to develop strategies to ensure that a child’s access to high-quality, affordable early care and education is not determined by the child’s race, family income or ZIP code and that “Minnesota's early childhood educators are qualified, diverse, supported, and equitably compensated regardless of setting”;

• spending $5.76 million on statewide tobacco cessation services;

• a legislative task force is established to review statutes relating to human services background study eligibility and disqualifications. A final report is due the Legislature by Dec. 16, 2022;

• funding a task force to develop a plan to phase out subminimum wage to persons with disabilities;

• a Maternal Mortality Review Committee is established to conduct maternal death study reviews, make recommendations and share summary information with the public; and

• a Culturally Informed and Culturally Responsive Mental Health Task Force is established “to evaluate and make recommendations on improving the provision of culturally informed and culturally responsive mental health services throughout Minnesota.” (Art, 2, Sec. 73; Art. 3, Secs. 21, 39; Art. 10, Sec. 3; Art. 11, Secs. 8, 42-47; Art. 14, Secs. 1, 15, 18; Art. 16, Secs. 3, 13; Art. 17, Sec. 14)

Department of Human Services-related changes include:

• effective Aug. 1, 2021, requiring implementation of a Supplemental Nutrition Assistance Program employment and training program that meets federal requirements. Nonexempt SNAP recipients who do not meet federal SNAP work requirements are required to participate in an employment and training program, unless residing in an area covered by a time-limited waiver;

• updating a 2007 legislative report on runaway and homeless youth using existing data, studies and analysis provided by state, county and other entities. A report is due to the Legislature by Dec. 15, 2022;

• extending Medical Assistance coverage for pregnant women from 60 days to 12 months postpartum. This takes effect the later of July 1, 2022 or upon federal approval;

• expanding Medical Assistance coverage of dental services to include coverage of nonsurgical treatment for periodontal disease, including scaling and root planing once every two years, plus maintenance procedures;

• allowing a 90-day supply of some prescription medications to be dispensed under Medical Assistance, effective Jan. 1, 2022;

• allowing Medical Assistance to cover drugs or active pharmaceutical ingredients used for weight loss;

• increasing the dispensing fee for prescription drugs from $10.48 to $10.77 and requiring the statewide cost of dispensing to be calculated separately for specialty and non-specialty drugs;

• providing a monthly public transit pass for the nonemergency medical transportation needs of Medical Assistance recipients who are well-served by public transit;

• providing Medical Assistance coverage for enhanced asthma care;

• in conjunction with the Health Department, beginning April 15, 2022, a biennial report must be submitted to the Legislature on the effectiveness of state maternal and infant health policies and programs in addressing disparities in prenatal and postpartum health outcomes; and

• by Dec. 15 of each year, beginning in 2021, the department must report to the Legislature on managed care and county-based purchasing plan provider reimbursement rates. (Art. 1, Secs. 4-8, 11, 13, 16, 20, 23; Art. 2, Secs. 17-18, 33-52, 55; Art. 7, Secs. 1-6, 29)

Department of Health-related provisions include:

• hospitals with obstetric care and birth centers must develop or access a continuing education curriculum on anti-racism training and implicit bias and make the curriculum available to staff who routinely care for pregnant or postpartum women;

• exploring ways to make midwife and doula training more culturally responsive to groups with the most significant disparities in maternal and infant morbidity and mortality; and promote racial, ethnic and cultural diversity in the midwife and doula workforce;

• establishment of The Vivian Act, which requires the department to make available information about congenital CMV (human herpesvirus cytomegalovirus), establish an awareness and education program and consider congenital CMV for addition to the newborn screening program;

• effective July 1, 2025, making alcohol and drug counselors who practice in designated rural areas or underserved urban communities — and persons enrolled in a training or education program to become an alcohol and drug counselor — eligible for loan forgiveness under the health professional education loan forgiveness program;

• for applications for and issuance of certified birth records on or after Jan. 1, 2022, procedures and documentation requirements are established for a homeless youth to obtain a certified birth record;

• requiring notice to the department and the public and a public hearing before a hospital closes, curtails operations, relocates services or stops offering certain services;

• allowing Regions Hospital in St. Paul to add 45 new licensed beds;

• allowing PrairieCare to add up to 30 licensed beds to its psychiatric hospital for children and adolescents in Brooklyn Park;

• until June 30, 2025, the department can award grants under the health professional education loan forgiveness program to alcohol and drug counselors, medical residents and mental health professionals who agree to either deliver at least 25 percent of their patient encounters to patients who are state public health care program enrollees or to patients who receive sliding fee schedule discounts; and

• developing a grant program to fund continuing education for social workers, marriage and family therapists, psychologists and professional clinical counselors to become supervisors for persons pursuing licensure in mental health professions. Eligible persons must be members of a community of color or underrepresented community, work for a community mental health provider and agree to serve certain patient populations. (Art. 3, Secs. 11, 21, 23-24, 27, 30-31, 43-44)

Telehealth

As part of the Minnesota Telehealth Act, a health plan sold, issued, or renewed by a health carrier in Minnesota must cover benefits delivered through telehealth in the same manner as any other benefits covered under the health plan. Private insurers and the Medical Assistance and MinnesotaCare programs are required to cover telemonitoring services in specified situations.

Additionally, a health carrier cannot restrict or deny coverage of a covered health care service because the service is not provided in-person or based on the communication technology or application used to deliver the service through telehealth, provided the technology or application complies with statute.

Health carriers are to reimburse providers for telehealth services on the same basis and at the same rate had the service been delivered in-person.

Per the law, “A health carrier must not require a health care provider to use specific telecommunications technology and equipment as a condition of coverage … provided the health care provider uses telecommunications technology and equipment that complies with current industry interoperable standards and complies with (federal) standards.”

The article expands the use of telehealth in the private sector and for the MA and MinnesotaCare programs, by replacing the definition of “telemedicine” with a new “telehealth” definition, expanding the list of providers who can provide telehealth services, and allowing the use of audio-only communication as a telehealth service, through June 30, 2023.

The Department of Human Services, in consultation with the Health and Commerce departments, is to study the impact of telehealth expansion and payment parity on the coverage and provision of health care services under public health care and private sector programs. The preliminary report due Jan. 15, 2023 must include recommendations on whether audio-only communication should be allowed as a telehealth option beyond June 30, 2023. (Art. 6, Secs. 1-29)

Other changes

• the governor must appoint an ombudsperson to assist family child care providers with licensing, compliance and other issues;

• for issuances starting Jan. 1, 2022, a homeless youth can obtain a state identification card without paying transaction or filing fees;

• establishment of background study requirements for personal care assistance provider agencies enrolled to provide personal care assistance services under Medical Assistance;

• background studies are be conducted of individuals providing direct contact services in residential and detention facilities;

• clarifying who must undergo a background check in areas including individuals providing special transportation services or providers of group residential housing or supplementary services;

• permitting alternative background studies in some instances;

• increase fee caps the department can recover related to background studies;

• adding personal care assistant services to list of activities prohibited prior to receipt of background study notices;

• lists felony-level convictions that permanently disqualify an individual applying for a family foster setting license;

• expand the age range eligibility for intensive nonresidential rehabilitative mental health services from ages 16-20 to ages 8-26;

• require the Department of Human Services to develop protocols to address and attempt to resolve any future overpayment involving tribal nations in Minnesota;

• increase wages for personal care attendants and home care providers;

• effective Sept. 30, 2021, provides a 90-day review for a child’s length of stay in residential treatment;

• expands services eligible for children’s mental health grant funding to include, as part of mental health services for people from cultural and ethnic minorities, supervision of clinical trainees who are Black, indigenous, or people of color providing services in certain clinics;

• beginning Jan. 1, 2022, provides a 5% rate increase for substance use disorder treatment services provided by culturally specific or culturally responsive programs or disability responsive programs;

• establishes the Minnesota inclusion initiative grant program to encourage self-advocacy groups of persons with intellectual and developmental disabilities to, in part, develop and organize projects that increase the inclusion of persons with intellectual and developmental disabilities in the community;

• requires the commissioner to annually adjust payments for home health agency services and home care nursing services to reflect federal changes;

• provide an additional $50 per month housing benefit for low-income individuals eligible for housing support;

• increase rates for home care nursing, intermediate care facilities and waiver rates for older adults to live independently; and

• provide an ongoing cost of living increase, plus a one-time payment of $435, to individuals in the Minnesota Family Investment Program, which helps low-income families meet basic needs as they seek employment. (Art. 2, Secs. 3, 17-18, 33-52, 55, 73; Art. 10, Sec. 29; Art. 11, Secs. 3, 6, 12, 39; Art. 12, Sec. 8, 11-12; Art. 13, Secs. 55-56, 74; Art. 16, Sec. 21)

HF0033* / SF0037 / CH7