HF 4106

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/21/2024 03:39pm

A bill for an act
relating to human services; modifying timelines for medical assistance eligibility
determinations for certain hospital patients; providing supplemental payments for
certain disability waiver services; modifying long-term care assessment provisions;
permitting direct referrals from hospitals to the state medical review team; amending
Minnesota Statutes 2022, sections 256.01, subdivision 29; 256B.05, by adding a
subdivision; 256B.0911, subdivision 20, by adding subdivisions; 256B.49, by
adding a subdivision; Minnesota Statutes 2023 Supplement, section 256B.0911,
subdivision 13.

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

Section 1.

Minnesota Statutes 2022, section 256.01, subdivision 29, is amended to read:

Subd. 29.

State medical review team.

(a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under sections
256B.055, subdivisions 7, paragraph (b), and 12, and 256B.057, subdivision 9, the
commissioner shall review all medical evidence and seek information from providers,
applicants, and enrollees to support the determination of disability where necessary. Disability
shall be determined according to the rules of title XVI and title XIX of the Social Security
Act and pertinent rules and policies of the Social Security Administration.

(b) Prior to a denial or withdrawal of a requested determination of disability due to
insufficient evidence, the commissioner shall (1) ensure that the missing evidence is necessary
and appropriate to a determination of disability, and (2) assist applicants and enrollees to
obtain the evidence, including, but not limited to, medical examinations and electronic
medical records.

(c) Any appeal made under section 256.045, subdivision 3, of a disability determination
made by the state medical review team must be decided according to the timelines under
section 256.0451, subdivision 22, paragraph (a). If a written decision is not issued within
the timelines under section 256.0451, subdivision 22, paragraph (a), the appeal must be
immediately reviewed by the chief human services judge.

new text begin (d) The state medical review team must accept directly from a hospital all referrals for
a disability determination for an applicant who in the judgment of the applicant's attending
physician will require upon discharge long-term services and supports provided under
medical assistance. The commissioner must establish a mechanism for direct submission
of referrals by hospitals.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.05, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Expedited medical assistance applications. new text end

new text begin (a) Notwithstanding subdivision
5 and Minnesota Rules, part 9505.0090, subparts 2 and 3, the local agency must act on an
application for medical assistance within five calendar days of receipt of a request for
medical assistance for a patient eligible for discharge, as determined by the hospital, but
who requires post-acute care covered by medical assistance to be safely discharged.
new text end

new text begin (b) If all information needed to act on the application is not obtained within the time
limit, the local agency must immediately inform the applicant about the deficiencies of the
application and the reason for the delay in determining the applicant's eligibility. If the
reason for the delay is the applicant's inability to obtain or provide the required information,
the local agency must assist the applicant in obtaining the required information within three
calendar days and act on the application immediately upon receipt of the required information.
new text end

new text begin (c) If the reason for the continued delay in determining the applicant's eligibility is that
the required information cannot be obtained even with the assistance of the local agency,
the local agency, the applicant, the applicant's representative, or a person interested in the
applicant's welfare may request the commissioner's assistance. Immediately upon receipt
of a request for assistance, the commissioner must assist in gathering the required application
materials and determining eligibility for medical assistance.
new text end

Sec. 3.

Minnesota Statutes 2023 Supplement, section 256B.0911, subdivision 13, is
amended to read:

Subd. 13.

MnCHOICES assessor qualifications, training, and certification.

(a) The
commissioner shall develop and implement a curriculum and an assessor certification
process.

(b) MnCHOICES certified assessors must:

(1) either have a bachelor's degree in social work, nursing with a public health nursing
certificate, or other closely related field or be a registered nurse deleted text begin with at least two years of
home and community-based experience deleted text end ; and

(2) have received training and certification specific to assessment and consultation for
long-term care services in the state.

(c) Certified assessors shall demonstrate best practices in assessment and support
planning, including person-centered planning principles, and have a common set of skills
that ensures consistency and equitable access to services statewide.

(d) Certified assessors must be recertified every three years.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Minnesota Statutes 2022, section 256B.0911, is amended by adding a subdivision
to read:

new text begin Subd. 17a. new text end

new text begin Expedited MnCHOICES assessment visits. new text end

new text begin (a) Notwithstanding subdivision
17, paragraph (a), a patient awaiting discharge from an acute care hospital requesting
long-term care consultation services must be visited by a long-term care consultation team
within three calendar days after the date on which an assessment was requested or
recommended.
new text end

new text begin (b) If the lead agency fails to complete an assessment within the time line described in
paragraph (a), the local agency, the person, the person's legal representative, or the hospital
in which the person is a patient may request assistance from the commissioner's acute care
transition team. Immediately upon receipt of a request for assistance, the commissioner's
acute care transition team must either direct the lead agency to conduct an assessment
immediately, transfer authority to conduct the assessment to another lead agency with the
capacity to do so immediately, or permit any certified assessor who is either an employee
of the hospital in which the person is a patient or an employee of the health system with
which the hospital is affiliated to perform the assessment.
new text end

Sec. 5.

Minnesota Statutes 2022, section 256B.0911, subdivision 20, is amended to read:

Subd. 20.

MnCHOICES assessments; duration of validity.

(a) An assessment that is
completed as part of an eligibility determination for multiple programs for the alternative
care, elderly waiver, developmental disabilities, community access for disability inclusion,
community alternative care, and brain injury waiver programs under chapter 256S and
sections 256B.0913, 256B.092, and 256B.49 is valid to establish service eligibility for no
more than deleted text begin 60 calendar days deleted text end new text begin one year new text end after the date of the assessment.

(b) The effective eligibility start date for programs in paragraph (a) can never be prior
to the date of assessment. If an assessment was completed more than deleted text begin 60 days deleted text end new text begin one year new text end before
the effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (a)
cannot be prior to the completion date of the most recent updated assessment.

(c) If an eligibility update is completed within 90 days of the previous assessment and
documented in the department's Medicaid Management Information System (MMIS), the
effective date of eligibility for programs included in paragraph (a) is the date of the previous
in-person assessment when all other eligibility requirements are met.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
new text end

Sec. 6.

Minnesota Statutes 2022, section 256B.0911, is amended by adding a subdivision
to read:

new text begin Subd. 29a. new text end

new text begin Expedited support planning. new text end

new text begin Notwithstanding subdivision 29, paragraph
(a), the certified assessor and the individual responsible for developing the support plan
must complete the assessment summary and the support plan no more than five calendar
days after an expedited assessment visit conducted according to subdivision 17a.
new text end

Sec. 7.

Minnesota Statutes 2022, section 256B.49, is amended by adding a subdivision to
read:

new text begin Subd. 30. new text end

new text begin Residential support services supplemental payments. new text end

new text begin (a) For the purposes
of this subdivision, "residential support services" means the following residential support
services reimbursed under section 256B.4914: (1) 24-hour customized living services; (2)
community residential services; (3) customized living services; (4) family residential services;
and (5) integrated community supports.
new text end

new text begin (b) The commissioner shall make emergency supplemental payments to providers who
provide residential support services to a person who is discharged from an acute care hospital
and immediately enrolls in a home and community-based waiver for persons with disabilities
following an expedited assessment visit and expedited support planning conducted under
section 256B.0911. The amount of the supplemental payments must be equal to the amount
required to increase the total payments for the first 30 days of residential support services
to the 99th percentile of nonrate exception daily rates for individuals on the same waiver.
new text end

new text begin (c) The commissioner shall seek federal financial participation in emergency supplemental
payments under this subdivision. If federal financial participation is denied, the commissioner
must make emergency supplemental payments under this subdivision from state-only money.
new text end