HF 1854

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/08/2021 04:44pm

A bill for an act
relating to human services; modifying policy provisions governing health care;
exempting coverage mandates for managed care plans or county-based purchasing
plans when the plan is providing coverage to enrollees under medical assistance
or MinnesotaCare; clarifying duties and changing composition of the Health
Services Advisory Council; removing sunset provision for Formulary Committee;
providing the commissioner of human services certain authority to administer early
and periodic screening, diagnosis, and treatment services; changing requirements
for qualified professionals; adding two members to the opioid prescribing working
group; changing distribution of annual prescribing reports relating to the opioid
prescribing improvement program; making technical and conforming changes;
amending Minnesota Statutes 2020, sections 62C.01, by adding a subdivision;
62D.01, by adding a subdivision; 62Q.02; 256B.0625, subdivisions 3c, 3d, 3e,
13c, 58; 256B.0638, subdivisions 3, 5, 6; 256B.0659, subdivision 13; proposing
coding for new law in Minnesota Statutes, chapters 62A; 62J; repealing Minnesota
Rules, parts 9505.0275; 9505.1693; 9505.1696, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9,
11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22; 9505.1699; 9505.1701; 9505.1703;
9505.1706; 9505.1712; 9505.1715; 9505.1718; 9505.1724; 9505.1727; 9505.1730;
9505.1733; 9505.1736; 9505.1739; 9505.1742; 9505.1745; 9505.1748.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62A.002] APPLICABILITY OF CHAPTER.
new text end

new text begin Any benefit or coverage mandate included in this chapter does not apply to managed
care plans or county-based purchasing plans when the plan is providing coverage to state
public health care program enrollees under chapter 256B or 256L.
new text end

Sec. 2.

Minnesota Statutes 2020, section 62C.01, is amended by adding a subdivision to
read:

new text begin Subd. 4. new text end

new text begin Applicability. new text end

new text begin Any benefit or coverage mandate included in this chapter does
not apply to managed care plans or county-based purchasing plans when the plan is providing
coverage to state public health care program enrollees under chapter 256B or 256L.
new text end

Sec. 3.

Minnesota Statutes 2020, section 62D.01, is amended by adding a subdivision to
read:

new text begin Subd. 3. new text end

new text begin Applicability. new text end

new text begin Any benefit or coverage mandate included in this chapter does
not apply to managed care plans or county-based purchasing plans when the plan is providing
coverage to state public health care program enrollees under chapter 256B or 256L.
new text end

Sec. 4.

new text begin [62J.011] APPLICABILITY OF CHAPTER.
new text end

new text begin Any benefit or coverage mandate included in this chapter does not apply to managed
care plans or county-based purchasing plans when the plan is providing coverage to state
public health care program enrollees under chapter 256B or 256L.
new text end

Sec. 5.

Minnesota Statutes 2020, section 62Q.02, is amended to read:

62Q.02 APPLICABILITY OF CHAPTER.

(a) This chapter applies only to health plans, as defined in section 62Q.01, and not to
other types of insurance issued or renewed by health plan companies, unless otherwise
specified.

(b) This chapter applies to a health plan company only with respect to health plans, as
defined in section 62Q.01, issued or renewed by the health plan company, unless otherwise
specified.

(c) If a health plan company issues or renews health plans in other states, this chapter
applies only to health plans issued or renewed in this state for Minnesota residents, or to
cover a resident of the state, unless otherwise specified.

new text begin (d) Any benefit or coverage mandate included in this chapter does not apply to managed
care plans or county-based purchasing plans when the plan is providing coverage to state
public health care program enrollees under chapter 256B or 256L.
new text end

Sec. 6.

Minnesota Statutes 2020, section 256B.0625, subdivision 3c, is amended to read:

Subd. 3c.

Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end .

(a) The commissioner,
after receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a deleted text begin 13-member deleted text end new text begin 14-member new text end Health Services deleted text begin Policy Committee deleted text end new text begin Advisory
Council new text end , which consists of deleted text begin 12 deleted text end new text begin 13 new text end voting members and one nonvoting member. The Health
Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end shall advise the commissioner regarding new text begin (1) new text end
health services pertaining to the administration of health care benefits covered under deleted text begin the
medical assistance and MinnesotaCare programs deleted text end new text begin Minnesota health care programs (MHCP);
and (2) evidence-based decision-making and health care benefit and coverage policies for
MHCP. The Health Services Advisory Council shall consider available evidence regarding
quality, safety, and cost-effectiveness when advising the commissioner new text end . The Health Services
deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end shall meet at least quarterly. The Health Services deleted text begin Policy
Committee deleted text end new text begin Advisory Council new text end shall annually deleted text begin elect deleted text end new text begin select new text end a deleted text begin physician deleted text end chair from among its
members deleted text begin , deleted text end who shall work directly with the commissioner's medical director deleted text begin , deleted text end to establish
the agenda for each meeting. The Health Services deleted text begin Policy Committee shall also deleted text end new text begin Advisory
Council may new text end recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.

(b) The commissioner shall establish a dental deleted text begin subcommittee deleted text end new text begin subcouncil new text end to operate under
the Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end . The dental deleted text begin subcommittee deleted text end new text begin
subcouncil new text end consists of general dentists, dental specialists, safety net providers, dental
hygienists, health plan company and county and public health representatives, health
researchers, consumers, and a designee of the commissioner of health. The dental
deleted text begin subcommittee deleted text end new text begin subcouncil new text end shall advise the commissioner regarding:

(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;

(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;

(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;

(4) the development of dental delivery models; and

(5) dental services to be added or eliminated from subdivision 9, paragraph (b).

deleted text begin (c) The Health Services Policy Committee shall study approaches to making provider
reimbursement under the medical assistance and MinnesotaCare programs contingent on
patient participation in a patient-centered decision-making process, and shall evaluate the
impact of these approaches on health care quality, patient satisfaction, and health care costs.
The committee shall present findings and recommendations to the commissioner and the
legislative committees with jurisdiction over health care by January 15, 2010.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end The Health Services deleted text begin Policy Committee shall deleted text end new text begin Advisory Council may new text end monitor and
track the practice patterns of deleted text begin physicians providing services to medical assistance and
MinnesotaCare enrollees deleted text end new text begin health care providers who serve MHCP recipients new text end under
fee-for-service, managed care, and county-based purchasing. The deleted text begin committee deleted text end new text begin monitoring
and tracking new text end shall focus on services or specialties for which there is a high variation in
utilization new text begin or quality new text end across deleted text begin physicians deleted text end new text begin providers new text end , or which are associated with high medical
costs. The commissioner, based upon the findings of the deleted text begin committee deleted text end new text begin Health Services Advisory
Council new text end , deleted text begin shall regularly deleted text end new text begin may new text end notify deleted text begin physicians deleted text end new text begin providers new text end whose practice patterns indicate
new text begin below average quality or new text end higher than average utilization or costs. Managed care and
county-based purchasing plans shall provide the commissioner with utilization and cost
data necessary to implement this paragraph, and the commissioner shall make deleted text begin this deleted text end new text begin these new text end
data available to the deleted text begin committee deleted text end new text begin Health Services Advisory Council new text end .

deleted text begin (e) The Health Services Policy Committee shall review caesarean section rates for the
fee-for-service medical assistance population. The committee may develop best practices
policies related to the minimization of caesarean sections, including but not limited to
standards and guidelines for health care providers and health care facilities.
deleted text end

Sec. 7.

Minnesota Statutes 2020, section 256B.0625, subdivision 3d, is amended to read:

Subd. 3d.

Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end members.

(a) The
Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end consists of:

(1) deleted text begin seven deleted text end new text begin six new text end voting members who are licensed physicians actively engaged in the practice
of medicine in Minnesota, deleted text begin one of whom must be actively engaged in the treatment of persons
with mental illness, and deleted text end three of whom must represent health plans currently under contract
to serve deleted text begin medical assistance deleted text end new text begin MHCP new text end recipients;

(2) two voting members who are new text begin licensed new text end physician specialists actively practicing their
specialty in Minnesota;

(3) two voting members who are nonphysician health care professionals licensed or
registered in their profession and actively engaged in their practice of their profession in
Minnesota;

new text begin (4) one voting member who is a health care or mental health professional licensed or
registered in the member's profession, actively engaged in the practice of the member's
profession in Minnesota, and actively engaged in the treatment of persons with mental
illness;
new text end

deleted text begin (4) one consumer deleted text end new text begin (5) two consumers new text end who shall serve as deleted text begin a deleted text end voting deleted text begin member deleted text end new text begin members new text end ; and

deleted text begin (5) deleted text end new text begin (6) new text end the commissioner's medical director who shall serve as a nonvoting member.

(b) Members of the Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end shall not be
employed by the deleted text begin Department of Human Services deleted text end new text begin state of Minnesota new text end , except for the medical
director. new text begin A quorum shall comprise a simple majority of the voting members. Vacant seats
shall not count toward a quorum.
new text end

Sec. 8.

Minnesota Statutes 2020, section 256B.0625, subdivision 3e, is amended to read:

Subd. 3e.

Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end terms and
compensation.

deleted text begin Committee deleted text end Members shall serve staggered three-year terms, with one-third
of the voting members' terms expiring annually. Members may be reappointed by the
commissioner. The commissioner may require more frequent Health Services deleted text begin Policy
Committee deleted text end new text begin Advisory Council new text end meetings as needed. An honorarium of $200 per meeting and
reimbursement for mileage and parking shall be paid to each deleted text begin committee deleted text end new text begin council new text end member
in attendance except the medical director. The Health Services deleted text begin Policy Committee deleted text end new text begin Advisory
Council new text end does not expire as provided in section 15.059, subdivision 6.

Sec. 9.

Minnesota Statutes 2020, section 256B.0625, subdivision 13c, is amended to read:

Subd. 13c.

Formulary Committee.

The commissioner, after receiving recommendations
from professional medical associations and professional pharmacy associations, and consumer
groups shall designate a Formulary Committee to carry out duties as described in subdivisions
13 to 13g. The Formulary Committee shall be comprised of four licensed physicians actively
engaged in the practice of medicine in Minnesota new text begin , new text end one of whom must be actively engaged
in the treatment of persons with mental illness; at least three licensed pharmacists actively
engaged in the practice of pharmacy in Minnesota; and one consumer representative; the
remainder to be made up of health care professionals who are licensed in their field and
have recognized knowledge in the clinically appropriate prescribing, dispensing, and
monitoring of covered outpatient drugs. Members of the Formulary Committee shall not
be employed by the Department of Human Services, but the committee shall be staffed by
an employee of the department who shall serve as an ex officio, nonvoting member of the
committee. The department's medical director shall also serve as an ex officio, nonvoting
member for the committee. Committee members shall serve three-year terms and may be
reappointed by the commissioner. The Formulary Committee shall meet at least twice per
year. The commissioner may require more frequent Formulary Committee meetings as
needed. An honorarium of $100 per meeting and reimbursement for mileage shall be paid
to each committee member in attendance. deleted text begin The Formulary Committee expires June 30, 2022.
deleted text end

Sec. 10.

Minnesota Statutes 2020, section 256B.0625, subdivision 58, is amended to read:

Subd. 58.

Early and periodic screening, diagnosis, and treatment services.

new text begin (a) new text end Medical
assistance covers early and periodic screening, diagnosis, and treatment services (EPSDT).
new text begin In administering the EPSDT program, the commissioner shall, at a minimum:
new text end

new text begin (1) provide information to children and families, using the most effective mode identified,
regarding:
new text end

new text begin (i) the benefits of preventative health care visits;
new text end

new text begin (ii) the services available as part of the EPSDT program; and
new text end

new text begin (iii) assistance finding a provider, transportation, or interpreter services;
new text end

new text begin (2) maintain an up-to-date periodicity schedule published in the department policy
manual, taking into consideration the most up-to-date community standard of care; and
new text end

new text begin (3) maintain up-to-date policies for providers on the delivery of EPSDT services that
are in the provider manual on the department website.
new text end

new text begin (b) The commissioner may contract for the administration of the outreach services as
required within the EPSDT program.
new text end

new text begin (c) new text end The payment amount for a complete EPSDT screening shall not include charges for
health care services and products that are available at no cost to the provider and shall not
exceed the rate established per Minnesota Rules, part 9505.0445, item M, effective October
1, 2010.

Sec. 11.

Minnesota Statutes 2020, section 256B.0638, subdivision 3, is amended to read:

Subd. 3.

Opioid prescribing work group.

(a) The commissioner of human services, in
consultation with the commissioner of health, shall appoint the following voting members
to an opioid prescribing work group:

(1) two consumer members who have been impacted by an opioid abuse disorder or
opioid dependence disorder, either personally or with family members;

(2) one member who is a licensed physician actively practicing in Minnesota and
registered as a practitioner with the DEA;

(3) one member who is a licensed pharmacist actively practicing in Minnesota and
registered as a practitioner with the DEA;

(4) one member who is a licensed nurse practitioner actively practicing in Minnesota
and registered as a practitioner with the DEA;

(5) one member who is a licensed dentist actively practicing in Minnesota and registered
as a practitioner with the DEA;

(6) two members who are nonphysician licensed health care professionals actively
engaged in the practice of their profession in Minnesota, and their practice includes treating
pain;

(7) one member who is a mental health professional who is licensed or registered in a
mental health profession, who is actively engaged in the practice of that profession in
Minnesota, and whose practice includes treating patients with chemical dependency or
substance abuse;

(8) one member who is a medical examiner for a Minnesota county;

(9) one member of the Health Services Policy Committee established under section
256B.0625, subdivisions 3c to 3e;

(10) one member who is a medical director of a health plan company doing business in
Minnesota;

(11) one member who is a pharmacy director of a health plan company doing business
in Minnesota; deleted text begin and
deleted text end

(12) one member representing Minnesota law enforcement deleted text begin . deleted text end new text begin ; and
new text end

new text begin (13) two consumer members who are Minnesota residents and who have used or are
using opioids to manage chronic pain.
new text end

(b) In addition, the work group shall include the following nonvoting members:

(1) the medical director for the medical assistance program;

(2) a member representing the Department of Human Services pharmacy unit; and

(3) the medical director for the Department of Labor and Industry.

(c) An honorarium of $200 per meeting and reimbursement for mileage and parking
shall be paid to each voting member in attendance.

Sec. 12.

Minnesota Statutes 2020, section 256B.0638, subdivision 5, is amended to read:

Subd. 5.

Program implementation.

(a) The commissioner shall implement the programs
within the Minnesota health care program to improve the health of and quality of care
provided to Minnesota health care program enrollees. The commissioner shall annually
collect and report to new text begin provider groups the sentinel measures of data showing individual new text end opioid
deleted text begin prescribers data showing the sentinel measures of their deleted text end new text begin prescribers' new text end opioid prescribing
patterns compared to their anonymized peers. new text begin Provider groups shall distribute data to their
affiliated, contracted, or employed opioid prescribers.
new text end

(b) The commissioner shall notify an opioid prescriber and all provider groups with
which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing
pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber
and any provider group that receives a notice under this paragraph shall submit to the
commissioner a quality improvement plan for review and approval by the commissioner
with the goal of bringing the opioid prescriber's prescribing practices into alignment with
community standards. A quality improvement plan must include:

(1) components of the program described in subdivision 4, paragraph (a);

(2) internal practice-based measures to review the prescribing practice of the opioid
prescriber and, where appropriate, any other opioid prescribers employed by or affiliated
with any of the provider groups with which the opioid prescriber is employed or affiliated;
and

(3) appropriate use of the prescription monitoring program under section 152.126.

(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices do not improve so that they are consistent with community
standards, the commissioner shall take one or more of the following steps:

(1) monitor prescribing practices more frequently than annually;

(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel
measures; or

(3) require the opioid prescriber to participate in additional quality improvement efforts,
including but not limited to mandatory use of the prescription monitoring program established
under section 152.126.

(d) The commissioner shall terminate from Minnesota health care programs all opioid
prescribers and provider groups whose prescribing practices fall within the applicable opioid
disenrollment standards.

Sec. 13.

Minnesota Statutes 2020, section 256B.0638, subdivision 6, is amended to read:

Subd. 6.

Data practices.

(a) Reports and data identifying an opioid prescriber are private
data on individuals as defined under section 13.02, subdivision 12, until an opioid prescriber
is subject to termination as a medical assistance provider under this section. Notwithstanding
this data classification, the commissioner shall share with all of the provider groups with
which an opioid prescriber is employed new text begin , contracted, new text end or affiliated, deleted text begin a report identifying an
opioid prescriber who is subject to quality improvement activities deleted text end new text begin the data new text end under subdivision
5, paragraph new text begin (a), new text end (b) new text begin , new text end or (c).

(b) Reports and data identifying a provider group are nonpublic data as defined under
section 13.02, subdivision 9, until the provider group is subject to termination as a medical
assistance provider under this section.

(c) Upon termination under this section, reports and data identifying an opioid prescriber
or provider group are public, except that any identifying information of Minnesota health
care program enrollees must be redacted by the commissioner.

Sec. 14.

Minnesota Statutes 2020, section 256B.0659, subdivision 13, is amended to read:

Subd. 13.

Qualified professional; qualifications.

(a) The qualified professional must
work for a personal care assistance provider agency, meet the definition of qualified
professional under section 256B.0625, subdivision 19c, deleted text begin and enroll with the department as
a qualified professional after clearing deleted text end new text begin clear new text end a background study new text begin , and meet provider training
requirements new text end . Before a qualified professional provides services, the personal care assistance
provider agency must initiate a background study on the qualified professional under chapter
245C, and the personal care assistance provider agency must have received a notice from
the commissioner that the qualified professional:

(1) is not disqualified under section 245C.14; or

(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.

(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of personal
care assistance services. The qualified professional shall:

(1) develop and monitor with the recipient a personal care assistance care plan based on
the service plan and individualized needs of the recipient;

(2) develop and monitor with the recipient a monthly plan for the use of personal care
assistance services;

(3) review documentation of personal care assistance services provided;

(4) provide training and ensure competency for the personal care assistant in the individual
needs of the recipient; and

(5) document all training, communication, evaluations, and needed actions to improve
performance of the personal care assistants.

(c) deleted text begin Effective July 1, 2011, deleted text end The qualified professional shall complete the provider training
with basic information about the personal care assistance program approved by the
commissioner. Newly hired qualified professionals must complete the training within six
months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired by
another agency, if they have completed the training within the last three years. The required
training must be available with meaningful access according to title VI of the Civil Rights
Act and federal regulations adopted under that law or any guidance from the United States
Health and Human Services Department. The required training must be available online or
by electronic remote connection. The required training must provide for competency testing
to demonstrate an understanding of the content without attending in-person training. A
qualified professional is allowed to be employed and is not subject to the training requirement
until the training is offered online or through remote electronic connection. A qualified
professional employed by a personal care assistance provider agency certified for
participation in Medicare as a home health agency is exempt from the training required in
this subdivision. When available, the qualified professional working for a Medicare-certified
home health agency must successfully complete the competency test. The commissioner
shall ensure there is a mechanism in place to verify the identity of persons completing the
competency testing electronically.

Sec. 15. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes must change the term "Health Services Policy Committee" to
"Health Services Advisory Council" wherever the term appears in Minnesota Statutes and
may make any necessary changes to grammar or sentence structure to preserve the meaning
of the text.
new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Rules, parts 9505.0275; 9505.1693; 9505.1696, subparts 1, 2, 3, 4, 5, 6, 7,
8, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, and 22; 9505.1699; 9505.1701; 9505.1703;
9505.1706; 9505.1712; 9505.1715; 9505.1718; 9505.1724; 9505.1727; 9505.1730;
9505.1733; 9505.1736; 9505.1739; 9505.1742; 9505.1745; and 9505.1748, new text end new text begin are repealed.
new text end

APPENDIX

Repealed Minnesota Rule: 21-03099

9505.0275 EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT.

Subpart 1.

Definition.

"Early and periodic screening, diagnosis, and treatment service" means a service provided to a recipient under age 21 to identify a potentially disabling condition and to provide diagnosis and treatment for a condition identified according to the requirements of the Code of Federal Regulations, title 42, section 441.55 and parts 9505.1693 to 9505.1748.

Subp. 2.

Duties of provider.

The provider shall sign a provider agreement stating that the provider will provide screening services according to standards in parts 9505.1693 to 9505.1748 and Code of Federal Regulations, title 42, sections 441.50 to 441.62.

9505.1693 SCOPE AND PURPOSE.

Parts 9505.1693 to 9505.1748 govern the early and periodic screening, diagnosis, and treatment (EPSDT) program.

Parts 9505.1693 to 9505.1748 must be read in conjunction with section 1905(a)(4)(B) of the Social Security Act, as amended through December 31, 1981, and the Code of Federal Regulations, title 42, part 441, subpart B, as amended through October 1, 1987, and section 6403 of the Omnibus Budget Reconciliation Act of 1989. The purpose of the EPSDT program is to identify potentially disabling conditions in children eligible for medical assistance, to provide diagnosis and treatment for conditions identified, and to encourage parents and their children to use health care services when necessary.

9505.1696 DEFINITIONS.

Subpart 1.

Applicability.

As used in parts 9505.1693 to 9505.1748, the following terms have the meanings given them.

Subp. 2.

Child.

"Child" means a person who is eligible for early and periodic screening, diagnosis, and treatment under part 9505.1699.

Subp. 3.

Community health clinic.

"Community health clinic" means a clinic that provides services by or under the supervision of a physician and that:

A.

is incorporated as a nonprofit corporation under Minnesota Statutes, chapter 317A;

B.

is exempt from federal income tax under Internal Revenue Code of 1986, section 501(c)(3), as amended through December 31, 1987;

C.

is established to provide health services to low-income population groups; and

D.

has written clinic policies describing the services provided by the clinic and concerning (1) the medical management of health problems, including problems that require referral to physicians, (2) emergency health services, and (3) the maintenance and review of health records by the physician.

Subp. 4.

Department.

"Department" means the Minnesota Department of Human Services.

Subp. 5.

Diagnosis.

"Diagnosis" means the identification and determination of the nature or cause of a disease or abnormality through the use of a health history; physical, developmental, and psychological examination; and laboratory tests.

Subp. 6.

Early and periodic screening clinic or EPS clinic.

"Early and periodic screening clinic" or "EPS clinic" means an individual or facility that is approved by the Minnesota Department of Health under parts 4615.0900 to 4615.2000.

Subp. 7.

Early and periodic screening, diagnosis, and treatment program or EPSDT program.

"Early and periodic screening, diagnosis, and treatment program" or "EPSDT program" means the program that provides screening, diagnosis, and treatment under parts 9505.1693 to 9505.1748; Code of Federal Regulations, title 42, section 441.55, as amended through October 1, 1986; and Minnesota Statutes, section 256B.02, subdivision 8, paragraph (12).

Subp. 8.

EPSDT clinic.

"EPSDT clinic" means a facility supervised by a physician that provides screening according to parts 9505.1693 to 9505.1748 or an EPS clinic.

Subp. 9.

EPSDT provider agreement.

"EPSDT provider agreement" means the agreement required by part 9505.1703, subpart 2.

Subp. 11.

Follow-up.

"Follow-up" means efforts by a local agency to ensure that a screening requested for a child is provided to that child and that diagnosis and treatment indicated as necessary by a screening are also provided to that child.

Subp. 12.

Head Start agency.

"Head Start agency" refers to the child development program administered by the United States Department of Health and Human Services, Office of Administration for Children, Youth and Families.

Subp. 13.

Local agency.

"Local agency" means the county welfare board, multicounty welfare board, or human service agency established in Minnesota Statutes, section 256B.02, subdivision 6, and Minnesota Statutes, chapter 393.

Subp. 14.

Medical assistance.

"Medical assistance" means the program authorized by title XIX of the Social Security Act and Minnesota Statutes, chapters 256 and 256B.

Subp. 15.

Outreach.

"Outreach" means efforts by the department or a local agency to inform eligible persons about early and periodic screening, diagnosis, and treatment or to encourage persons to use the EPSDT program.

Subp. 16.

Parent.

"Parent" refers to the genetic or adoptive parent of a child.

Subp. 17.

Physician.

"Physician" means a person who is licensed to provide health services within the scope of the person's profession under Minnesota Statutes, chapter 147.

Subp. 18.

Prepaid health plan.

"Prepaid health plan" means a health insurer licensed and operating under Minnesota Statutes, chapters 60A, 62A, and 62C, and a health maintenance organization licensed and operating under Minnesota Statutes, chapter 62D to provide health services to recipients of medical assistance entitlements.

Subp. 19.

Public health nursing service.

"Public health nursing service" means the nursing program provided by a community health board under Minnesota Statutes, section 145A.04, subdivisions 1 and 1a.

Subp. 20.

Screening.

"Screening" means the use of quick, simple procedures to separate apparently well children from those who need further examination for possible physical, developmental, or psychological problems.

Subp. 21.

Skilled professional medical personnel and supporting staff.

"Skilled professional medical personnel" and "supporting staff" means persons as defined by Code of Federal Regulations, title 42, section 432.2, as amended through October 1, 1987.

Subp. 22.

Treatment.

"Treatment" means the prevention, correction, or amelioration of a disease or abnormality identified by screening or diagnosis.

9505.1699 ELIGIBILITY TO BE SCREENED.

A person under age 21 who is eligible for medical assistance is eligible for the EPSDT program.

9505.1701 CHOICE OF PROVIDER.

Subpart 1.

Choice of screening provider.

Except as provided by subpart 3, a child or parent of a child who requests screening may choose any screening provider who has signed an EPSDT provider agreement and a medical assistance provider agreement.

Subp. 2.

Choice of diagnosis and treatment provider.

Except as provided by subpart 3, a child or parent of a child may choose any diagnosis and treatment provider as provided by part 9505.0190.

Subp. 3.

Exception to subparts 1 and 2.

A child who is enrolled in a prepaid health plan must receive screening, diagnosis, and treatment from that plan.

9505.1703 ELIGIBILITY TO PROVIDE SCREENING.

Subpart 1.

Providers.

An EPSDT clinic or a community health clinic shall be approved for medical assistance reimbursement for EPSDT services if it complies with the requirements of parts 9505.1693 to 9505.1748. A Head Start agency shall be approved as provided by subpart 2.

Subp. 2.

EPSDT provider agreement.

To be eligible to provide screening and receive reimbursement under the EPSDT program, an individual or facility must sign an EPSDT provider agreement provided by the department and a medical assistance provider agreement under part 9505.0195 or be a prepaid health plan.

Subp. 3.

Terms of EPSDT provider agreement.

The EPSDT provider agreement required by subpart 2 must state that the provider must:

A.

screen children according to parts 9505.1693 to 9505.1748;

B.

report all findings of the screenings on EPSDT screening forms; and

C.

refer children for diagnosis and treatment if a referral is indicated by the screening.

The EPSDT provider agreement also must state that the department will provide training according to part 9505.1712 and will train and consult with the provider on billing and reporting procedures.

9505.1706 REIMBURSEMENT.

Subpart 1.

Maximum payment rates.

Payment rates shall be as provided by part 9505.0445, item M.

Subp. 2.

Eligibility for reimbursement; Head Start agency.

A Head Start agency may complete all the screening components under part 9505.1718, subparts 2 to 14 or those components that have not been completed by another provider within the six months before completion of the screening components by the Head Start agency. A Head Start agency that completes the previously incomplete screening components must document on the EPSDT screening form that the other screening components of part 9505.1718, subparts 2 to 14, have been completed by another provider.

The department shall reimburse a Head Start agency for those screening components of part 9505.1718, subparts 2 to 14, that the Head Start agency has provided. The amount of reimbursement must be the same as a Head Start agency's usual and customary cost for each screening component or the maximum fee determined under subpart 1, whichever is lower.

Subp. 3.

Prepaid health plan.

A prepaid health plan is not eligible for a separate payment for screening. The early and periodic screening, diagnosis, and treatment screening must be a service included within the prepaid capitation rate specified in its contract with the department.

9505.1712 TRAINING.

The department must train the staff of an EPSDT clinic that is supervised by a physician on how to comply with the procedures required by part 9505.1718 if the EPSDT clinic requests the training.

9505.1715 COMPLIANCE WITH SURVEILLANCE AND UTILIZATION REVIEW.

A screening provider must comply with the surveillance and utilization review requirements of parts 9505.2160 to 9505.2245.

9505.1718 SCREENING STANDARDS FOR AN EPSDT CLINIC.

Subpart 1.

Requirement.

An early and periodic screening, diagnosis, and treatment screening must meet the requirements of subparts 2 to 15 except as provided by part 9505.1706, subpart 2.

Subp. 2.

Health and developmental history.

A history of a child's health and development must be obtained from the child, parent of the child, or an adult who is familiar with the child's health history. The history must include information on sexual development, lead and tuberculosis exposure, nutrition intake, chemical abuse, and social, emotional, and mental health status.

Subp. 3.

Assessment of physical growth.

The child's height or length and the child's weight must be measured and the results plotted on a growth grid based on data from the National Center for Health Statistics (NCHS). The head circumference of a child up to 36 months of age or a child whose growth in head circumference appears to deviate from the expected circumference for that child must be measured and plotted on an NCHS-based growth grid.

Subp. 4.

Physical examination.

The following must be checked according to accepted medical procedures: pulse; respiration; blood pressure; head; eyes; ears; nose; mouth; pharynx; neck; chest; heart; lungs; abdomen; spine; genitals; extremities; joints; muscle tone; skin; and neurological condition.

Subp. 5.

Vision.

A child must be checked for a family history of maternal and neonatal infection and ocular abnormalities. A child must be observed for pupillary reflex; the presence of nystagmus; and muscle balance, which includes an examination for esotropia, exotropia, phorias, and extraocular movements. The external parts of a child's eyes must be examined including the lids, conjunctiva, cornea, iris, and pupils. A child or parent of the child must be asked whether he or she has concerns about the child's vision.

Subp. 6.

Vision of a child age three or older.

In addition to the requirements of subpart 5, the visual acuity of a child age three years or older must be checked by use of the Screening Test for Young Children and Retardates (STYCAR) or the Snellen Alphabet Chart.

Subp. 7.

Hearing.

A child must be checked for a family history of hearing disability or loss, delay of language acquisition or history of such delay, the ability to determine the direction of a sound, and a history of repeated otitis media during early life. A child or parent of the child must be asked whether he or she has any concerns regarding the child's hearing.

Subp. 8.

Hearing of a child age three or older.

In addition to the requirements of subpart 7, a child age three or older must receive a pure tone audiometric test or referral for the test if the examination under subpart 7 indicates the test is needed.

Subp. 9.

Development.

A child must be screened for the following according to the screening provider's standard procedures: fine and gross motor development, speech and language development, social development, cognitive development, and self-help skills. Standardized tests that are used in screening must be culturally sensitive and have norms for the age range tested, written procedures for administration and for scoring and interpretation that are statistically reliable and valid. The provider must use a combination of the child's health and developmental history and standardized test or clinical judgment to determine the child's developmental status or need for further assessment.

Subp. 10.

Sexual development.

A child must be evaluated to determine whether the child's sexual development is consistent with the child's chronological age. A female must receive a breast examination and pelvic examination when indicated. A male must receive a testicular examination when indicated. If it is in the best interest of a child, counseling on normal sexual development, information on birth control and sexually transmitted diseases, and prescriptions and tests must be offered to a child. If it is in the best interest of a child, a screening provider may refer the child to other resources for counseling or a pelvic examination.

Subp. 11.

Nutrition.

When the assessment of a child's physical growth performed according to subpart 3 indicates a nutritional risk condition, the child must be referred for further assessment, receive nutritional counseling, or be referred to a nutrition program such as the Special Supplemental Food Program for Women, Infants, and Children; food stamps or food support; Expanded Food and Nutrition Education Program; or Head Start.

Subp. 12.

Immunizations.

The immunization status of a child must be compared to the "Recommended Schedule for Active Immunization of Normal Infants and Children," current edition. Immunizations that the comparison shows are needed must be offered to the child and given to the child if the child or parent of the child accepts the offer. The "Recommended Schedule for Active Immunization of Normal Infants and Children," current edition, is developed and distributed by the Minnesota Department of Health, 717 Delaware Street Southeast, Minneapolis, Minnesota 55440. The "Recommended Schedule for Active Immunization of Normal Infants and Children," current edition, is incorporated by reference and is available at the State Law Library, Judicial Center, 25 Rev. Dr. Martin Luther King Jr. Blvd., Saint Paul, Minnesota 55155. It is subject to frequent change.

Subp. 13.

Laboratory tests.

Laboratory tests must be done according to items A to F.

A.

A Mantoux test must be administered yearly to a child whose health history indicates ongoing exposure to tuberculosis, unless the child has previously tested positive. A child who tests positive must be referred for diagnosis and treatment.

B.

A child aged one to five years must initially be screened for lead through the use of either an erythrocyte protoporphyrin (EP) test or a direct blood lead screening test until December 31, 1992. Beginning January 1, 1993, a child age one to five must initially be screened using a direct blood lead screening test. Either capillary or venous blood may be used as the specimen for the direct blood lead test. Blood tests must be performed at a minimum of once at 12 months of age and once at 24 months of age or whenever the history indicates that there are risk factors for lead poisoning. When the result of the EP or capillary blood test is greater than the maximum allowable level set by the Centers for Disease Control of the United States Public Health Service, the child must be referred for a venous blood lead test. A child with a venous blood lead level greater than the maximum allowable level set by the Centers for Disease Control must be referred for diagnosis and treatment.

C.

The urine of a child must be tested for the presence of glucose, ketones, protein, and other abnormalities. A female at or near the age of four and a female at or near the age of ten must be tested for bacteriuria.

D.

Either a microhematocrit determination or a hemoglobin concentration test for anemia must be done.

E.

A test for sickle cell or other hemoglobinopathy, or abnormal blood conditions must be offered to a child who is at risk of such abnormalities and who has not yet been tested. These tests must be provided if accepted or requested by the child or parent of the child. If the tests identify a hemoglobin abnormality or other abnormal blood condition, the child must be referred for genetic counseling.

F.

Other laboratory tests such as those for cervical cancer, sexually transmitted diseases, pregnancy, and parasites must be performed when indicated by a child's medical or family history.

Subp. 14.

Oral examination.

An oral examination of a child's mouth must be performed to detect deterioration of hard tissue, and inflammation or swelling of soft tissue. Counseling about the systemic use of fluoride must be given to a child when fluoride is not available through the community water supply or school programs.

Subp. 14a.

Health education and health counseling.

Health education and health counseling concerning the child's health must be offered to the child who is being screened and to the child's parent or representative. The health education and health counseling are for the purposes of assisting the child or the parent or representative of the child to understand the expected growth and development of the child and of informing the child or the parent or representative of the child about the benefits of healthy lifestyles and about practices to promote accident and disease prevention.

Subp. 15.

Schedule of age related screening standards.

An early and periodic screening, diagnosis, and treatment screening for a child at a specific age must include, at a minimum, the screening requirements of subparts 2 to 14 as provided by the following schedule:

Schedule of age related screening standards

A.

Infancy:

Standards	Ages
	By 1 month	2 months	4 months	6 months	9 months	12 months
Health History	X	X	X	X	X	X
Assessment of Physical Growth:
Height	X	X	X	X	X	X
Weight	X	X	X	X	X	X
Head Circumference	X	X	X	X	X	X
Physical Examination	X	X	X	X	X	X
Vision	X	X	X	X	X	X
Hearing	X	X	X	X	X	X
Development	X	X	X	X	X	X
Health Education/Counseling	X	X	X	X	X	X
Sexual Development	X	X	X	X	X	X
Nutrition	X	X	X	X	X	X
Immunizations/Review		X	X	X	X	X
Laboratory Tests:
Tuberculin	if history indicates
Lead Absorption	if history indicates					X
Urinalysis	←	←	←	X	←	←
Hematocrit or Hemoglobin	←	←	←	←	X	X
Sickle Cell		at parent's or child's request
Other Laboratory Tests		as indicated
Oral Examination	X	X	X	X	X	X

X = Procedure to be completed.

← = Procedure to be completed if not done at the previous visit, or on the first visit.

B.

Early Childhood:

Standards	Ages
	15 months	18 months	24 months	3years	4years
Health History	X	X	X	X	X
Assessment of Physical Growth:
Height	X	X	X	X	X
Weight	X	X	X	X	X
Head Circumference	X	X	X	X	X
Physical Examination	X	X	X	X	X
Vision	X	X	X	X	X
Hearing	X	X	X	X	X
Blood Pressure				X	X
Development	X	X	X	X	X
Health Education/Counseling	X	X	X	X	X
Sexual Development	X	X	X	X	X
Nutrition	X	X	X	X	X
Immunizations/Review	X	X	X	X	X
Laboratory Tests:
Tuberculin	if history indicates
Lead Absorption	if history indicates		X	if history indicates
Urinalysis	←	←	X	←	←
Bacteriuria (females)					X
Hematocrit or Hemoglobin	←	←	←	←	←
Sickle Cell	at parent's or child's request
Other Laboratory Tests	as indicated
Oral Examination	X	X	X	X	X

X = Procedure to be completed.

← = Procedure to be completed if not done at the previous visit, or on the first visit.

C.

Late childhood:

Standards	Ages
	5 years	6 years	8 years	10 years	12 years
Health History	X	X	X	X	X
Assessment of Physical Growth:
Height	X	X	X	X	X
Weight	X	X	X	X	X
Physical Examination	X	X	X	X	X
Vision	X	X	X	X	X
Hearing	X	X	X	X	X
Blood Pressure	X	X	X	X	X
Development	X	X	X	X	X
Health Education/Counseling	X	X	X	X	X
Sexual Development	X	X	X	X	X
Nutrition	X	X	X	X	X
Immunizations/Review	X	X	X	X	X
Laboratory Tests:
Tuberculin	if history indicates
Lead Absorption	if history indicates
Urinalysis	←	←	X	←	←
Bacteriuria (females)	←	←	X	←	←
Hemoglobin or Hematocrit	←	←	X	←
Sickle Cell	at parent's or child's request
Other Laboratory Tests	as indicated
Oral Examination	X	X	X	X	X

X = Procedure to be completed.

← = Procedure to be completed if not done at the previous visit, or on the first visit.

D.

Adolescence:

Standards	Ages
	14 years	16 years	18 years	20 years
Health History	X	X	X	X
Assessment of Physical Growth:
Height	X	X	X	X
Weight	X	X	X	X
Physical Examination	X	X	X	X
Vision	X	X	X	X
Hearing	X	X	X	X
Blood Pressure	X	X	X	X
Development	X	X	X	X
Health Education/Counseling	X	X	X	X
Sexual Development	X	X	X	X
Nutrition	X	X	X	X
Immunizations/Review	X	X	X	X
Laboratory Tests:
Tuberculin	if history indicates
Lead Absorption	if history indicates
Urinalysis	←		X
Bacteriuria (females)	←		←
Hemoglobin or Hematocrit	←		X
Sickle Cell	at parent's or child's request
Other Laboratory Tests	as indicated
Oral Examination	X		X

X = Procedure to be completed.

← = Procedure to be completed if not done at the previous visit, or on the first visit.

Subp. 15a.

Additional screenings.

A child may have a partial or complete screening between the ages specified in the schedule under subpart 15 if the screening is medically necessary or a concern develops about the child's health or development.

9505.1724 PROVISION OF DIAGNOSIS AND TREATMENT.

Diagnosis and treatment identified as needed under part 9505.1718 shall be eligible for medical assistance payment subject to the provisions of parts 9505.0170 to 9505.0475.

9505.1727 INFORMING.

A local agency must inform each child or parent of a child about the EPSDT program no later than 60 days after the date the child is determined to be eligible for medical assistance. The information about the EPSDT program must be given orally and in writing, indicate the purpose and benefits of the EPSDT program, indicate that the EPSDT program is without cost to the child or parent of the child while the child is eligible for medical assistance, state the types of medical and dental services available under the EPSDT program, and state that the transportation and appointment scheduling assistance required under part 9505.1730 is available.

The department must send a written notice to a child or parent of a child who has been screened informing the child or parent that the child should be screened again. This notice must be sent at the following ages of the child: six months, nine months, one year, 18 months, two years, four years, and every three years after age four.

Each year, on the date the child was determined eligible for medical assistance entitlements, the department must send a written notice to a child or parent of a child who has never been screened informing the child or parent that the child is eligible to be screened.

9505.1730 ASSISTANCE WITH OBTAINING A SCREENING.

Within ten working days of receiving a request for screening from a child or parent of a child, a local agency must give or mail to the child or parent of the child:

A.

a written list of EPSDT clinics in the area in which the child lives; and

B.

a written offer of help in making a screening appointment and in transporting the child to the site of the screening.

If the child or parent of the child requests help, the local agency must provide it.

Transportation under this item must be provided according to part 9505.0140, subpart 1.

9505.1733 ASSISTANCE WITH OBTAINING DIAGNOSIS AND TREATMENT.

An EPSDT clinic must notify a child or parent of a child who is referred for diagnosis and treatment that the local agency will provide names and addresses of diagnosis and treatment providers and will help with appointment scheduling and transportation to the diagnosis and treatment provider. The notice must be on a form provided by the department and must be given to the child or parent of the child on the day the child is screened.

If a child or parent of a child asks a local agency for assistance with obtaining diagnosis and treatment, the local agency must provide that assistance within ten working days of the date of the request.

9505.1736 SPECIAL NOTIFICATION REQUIREMENT.

A local agency must effectively inform an individual who is blind or deaf, or who cannot read or understand the English language, about the EPSDT program.

9505.1739 CHILDREN IN FOSTER CARE.

Subpart 1.

Dependent or neglected state wards.

The local agency must provide early and periodic screening, diagnosis, and treatment services for a child in foster care who is a dependent or neglected state ward under parts 9560.0410 to 9560.0470, and who is eligible for medical assistance unless the early and periodic screening, diagnosis, and treatment services are not in the best interest of the child.

Subp. 2.

Other children in foster care.

The local agency must discuss the EPSDT program with a parent of a child in foster care who is under the legal custody or protective supervision of the local agency or whose parent has entered into a voluntary placement agreement with the local agency. The local agency must help the parent decide whether to accept early and periodic screening, diagnosis, and treatment services for the child. If a parent cannot be consulted, the local agency must decide whether to accept early and periodic screening, diagnosis, and treatment services for the child and must document the reasons for the decision.

Subp. 3.

Assistance with appointment scheduling and transportation.

The local agency must help a child in foster care with appointment scheduling and transportation for screening, diagnosis, and treatment as provided by parts 9505.1730 to 9505.1733.

Subp. 4.

Notification.

The department must send a written notice to the local agency stating that a child in foster care who has been screened should be screened again. This notice must be sent at the following ages of the child: six months, nine months, one year, 18 months, two years, four years, and every three years thereafter.

Each year, by the anniversary of the date the child was determined eligible for medical assistance entitlements, the department must send a written notice to the local agency that a child in foster care who has never been screened is eligible to be screened.

If a written notice under this subpart pertains to a child who is a dependent or neglected state ward, the local agency must proceed according to subpart 1. The local agency must proceed according to subpart 2 if the written notice pertains to a child who is not a dependent or neglected state ward.

9505.1742 DOCUMENTATION.

The local agency must document compliance with parts 9505.1693 to 9505.1748 on forms provided by the department.

9505.1745 INTERAGENCY COORDINATION.

The local agency must coordinate the EPSDT program with other programs that provide health services to children as provided by Code of Federal Regulations, title 42, section 441.61(c), as amended through October 1, 1986. Examples of such agencies are a public health nursing service, a Head Start agency, and a school district.

9505.1748 CONTRACTS FOR ADMINISTRATIVE SERVICES.

Subpart 1.

Authority.

A local agency may contract with a county public health nursing service, a community health clinic, a Head Start agency, a community action agency, or a school district for early and periodic screening, diagnosis, and treatment administrative services. Early and periodic screening, diagnosis, and treatment administrative services include outreach; notification; appointment scheduling and transportation; follow-up; and documentation. For purposes of this subpart, "community action agency" means an entity defined in Minnesota Statutes, section 256E.31, subdivision 1, and "school district" means a school district as defined in Minnesota Statutes, section 120A.05, subdivisions 5, 10, and 14.

Subp. 2.

Federal financial participation.

The percent of federal financial participation for salaries, fringe benefits, and travel of skilled professional medical personnel and their supporting staff shall be paid as provided by Code of Federal Regulations, title 42, section 433.15(b)(5), as amended through October 1, 1986.

Subp. 3.

State reimbursement.

State reimbursement for contracts for EPSDT administrative services under this part shall be as provided by Minnesota Statutes, section 256B.19, subdivision 1, except for the provisions under subdivision 1 that pertain to a prepaid health plan.

Subp. 4.

Approval.

A contract for administrative services must be approved by the local agency and submitted to the department for approval by November 1 of the year before the beginning of the calendar year in which the contract will be effective. A contract must contain items A to L to be approved by the department for reimbursement:

A.

names of the contracting parties;

B.

purpose of the contract;

C.

beginning and ending dates of the contract;

D.

amount of the contract, budget breakdown, and a clause that stipulates that the department's procedures for certifying expenditures will be followed by the local agency;

E.

the method by which the contract may be amended or terminated;

F.

a clause that stipulates that the contract will be renegotiated if federal or state program regulations or federal financial reimbursement regulations change;

G.

a clause that stipulates that the contracting parties will provide program and fiscal records and maintain all nonpublic data required by the contract according to the Minnesota Government Data Practices Act and will cooperate with state and federal program reviews;

H.

a description of the services contracted for and the agency that will perform them;

I.

methods by which the local agency will monitor and evaluate the contract;

J.

signatures of the representatives of the contracting parties with the authority to obligate the parties by contract and dates of those signatures;

K.

a clause that stipulates that the services provided under contract must be performed by or under the supervision of skilled medical personnel; and

L.

a clause that stipulates that the contracting parties will comply with state and federal requirements for the receipt of medical assistance funds.