The Medical Assistance Reform Report from the Department of Human Services (DHS) has been sent to the Legislature and has been posted to the DHS website. Read the report at https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6484-ENG. The report was developed in response to a legislative directive contained in the special session omnibus health and human services bill:

Sec. 53. MEDICAL ASSISTANCE REFORM WAIVER.
Subdivision 1. Intent. It is the intent of the legislature to reform components of the medical assistance program for seniors and people with disabilities or other complex needs, and medical assistance enrollees in general, in order to achieve better outcomes, such as community integration and independence; improved health; reduced reliance on institutional care; maintained or obtained employment and housing; and long-term sustainability of needed services through better alignment of available services that most effectively meet people's needs, including other state agencies' services.
Subd. 2. Proposal. The commissioner shall develop a proposal to the United States Department of Health and Human Services, which shall include any necessary waivers, state plan amendments, requests for new funding or realignment of existing funds, and any other federal authority that may be necessary for the projects specified in subdivision 4. The commissioner shall ensure all projects are budget neutral or result in savings to the state budget, considering cost changes across all divisions and other agencies that are affected.
Subd. 3. Legislative proposals; rules. The commissioner shall report to the members of the legislative committees having jurisdiction over human services issues by January 15, 2012, regarding the progress of this waiver, and make recommendations regarding any legislative changes necessary to accomplish the projects in subdivision 4.

The list of “projects” included in the legislation was pages long, and kept many divisions at DHS busy for months! In order to accomplish this goal, the legislature designated twelve initiatives to be examined. These initiatives are:

a. Health care delivery demonstration
b. Promote personal responsibility and encourage and reward health outcomes
c. Encourage utilization of high quality, cost-effective care
d. Adults without children eligibility proposal
e. Empower and encourage housing, work and independence
f. Redesign home and community based services
g. Coordinate and streamline services for individuals with complex needs
h. Implement nursing facility level of care criteria
i. Improve integration of Medicare and Medicaid
j. Redesign intensive residential treatment services
k. Waive the institution for mental disease (IMD) exclusion for Anoka Metro Regional Treatment Center (AMRTC)
l. Seek exception to the IMD exclusion for individuals under age 21

In working on these initiatives over the past few months, there were working groups established that included staff and members of the Association. We were not involved in all of the groups; however, there were several initiatives where we were active participants, including:

a) Redesign home and community-based services. This project realigns existing funding, services, and supports for people with disabilities and older Minnesotans to ensure community integration and a more sustainable service system. Starting on page 25 of the report, the goals are tough to disagree with. There is, however, a lack of detail about specific changes to programs/services and data about who would be impacted by any of the changes. As the report notes in pages 36–37, there are decisions that need to be made about the reforms to home and community based services. More in-depth data and fiscal analysis is currently being conducted by Thomson Reuters to determine the “most appropriate and cost-neutral vehicles to obtain federal authority to implement the desired changes.”

b) Implement nursing home level of care criteria. This project involves obtaining any necessary federal approval in order to implement the changes to the level of care criteria in Minnesota Statutes, section 144.0724, subdivision 11. We provided significant comments expressing our concerns about how this would be implemented, and the options available for those seniors who would no longer be Medicaid eligible.

A draft section 1115 waiver and necessary state plan amendments will be completed by March 15, and released for a public comment and tribal consultation period. After the public comment period has closed, the section 1115 waiver will be submitted in mid to late April 2012. DHS will negotiate the terms and conditions of the waiver and any state plan amendments over the course of the next eight months with the intent to complete negotiations by December 2012. DHS will then present to the legislature the authority we receive and the department will bring forward budget and policy changes necessary to implement these projects.

The legislature required these proposals, in the aggregate, to be cost neutral to the state budget. Prior to the submission of the section 1115 waiver, budget and forecasting staff, in consultation with Minnesota Management and Budget (MMB), will undertake a fiscal analysis to ensure that the overall proposal meets the cost neutral requirement. Therefore, any individual proposal outlined in the “Medical Assistance Reform Report” may change or be removed if it does not meet the budget neutrality requirement.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org