SF 4395

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/13/2026 09:20 a.m.

A bill for an act
relating to human services; modifying home and community-based services case
management; establishing a waiver case management quality working group;
requiring reports; amending Minnesota Statutes 2024, section 256S.07, subdivision
1; Minnesota Statutes 2025 Supplement, sections 256B.092, subdivision 1a;
256B.49, subdivision 13.

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

Section 1.

Minnesota Statutes 2025 Supplement, section 256B.092, subdivision 1a, is
amended to read:

Subd. 1a.

Case management services.

(a) Each recipient of a home and community-based
waiver shall be provided case management services by qualified vendors as described in
the federally approved waiver application.

(b) Case management service activities provided to or arranged for a person include:

(1) development of the person-centered support plan under subdivision 1b;

(2) informing the individual or the individual's legal guardian or conservator, or parent
if the person is a minor, of service options, including all service options available under the
waiver plan;

(3) consulting with relevant medical experts or service providers;

(4) assisting the person in the identification of potential providers of chosen services,
including:

(i) providers of services provided in a non-disability-specific setting;

(ii) employment service providers;

(iii) providers of services provided in settings that are not controlled by a provider; and

(iv) providers of financial management services;

(5) assisting the person to access services and assisting in appeals under section 256.045;

(6) coordination of services, if coordination is not provided by another service provider;

(7) evaluation and monitoring of the services identified in the support plan, which must
incorporate at least one annual face-to-face visit by the case manager with each person;

(8) reviewing support plans and providing the lead agency with recommendations for
service authorization based upon the individual's needs identified in the support plan; and

(9) assisting and cooperating with facilities licensed under chapter 144G with the
licensee's obligations under section 144G.55.

(c) Case management service activities that are provided to the person with a
developmental disability shall be provided directly by county agencies or under contract.
If a county agency contracts for case management services, the county agency must provide
each recipient of home and community-based services who is receiving contracted case
management services with the contact information the recipient may use to file a grievance
with the county agency about the quality of the contracted services the recipient is receiving
from a county-contracted case manager. If a county agency provides case management
under contracts with other individuals or agencies deleted text begin and deleted text end new text begin , new text end the county agency deleted text begin utilizes deleted text end new text begin must
utilize new text end a competitive proposal process for the procurement of contracted case management
services deleted text begin , the competitive proposal process must include deleted text end new text begin at least once every two years.
Contracts must include provisions for oversight to ensure high-quality case management
services. The competitive proposal process must include new text end evaluation criteria to ensure that
the county maintains a culturally responsive program for case management services adequate
to meet the needs of the population of the county. For the purposes of this section, "culturally
responsive program" means a case management services program that: (1) ensures effective,
equitable, comprehensive, and respectful quality care services that are responsive to
individuals within a specific population's values, beliefs, practices, health literacy, preferred
language, and other communication needs; and (2) is designed to address the unique needs
of individuals who share a common language or racial, ethnic, or social background. new text begin
Beginning July 1, 2029, a county agency must not enter into any new contracts or renew
contracts for case management services.
new text end

(d) Case management services must be provided by a public or private agency that is
enrolled as a medical assistance provider determined by the commissioner to meet all of
the requirements in the approved federal waiver plans. Case management services must not
be provided to a recipient by a private agency that has a financial interest in the provision
of any other services included in the recipient's support plan. For purposes of this section,
"private agency" means any agency that is not identified as a lead agency under section
256B.0911, subdivision 10.

(e) Case managers are responsible for service provisions listed in paragraphs (a) and
(b). Case managers shall collaborate with consumers, families, legal representatives, and
relevant medical experts and service providers in the development and annual review of the
person-centered support plan and habilitation plan.

(f) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

(g) The Department of Human Services shall offer ongoing education in case management
to case managers. Case managers shall receive no less than 20 hours of case management
education and disability-related training each year. The education and training must include
appropriate service authorization, person-centered planning, informed choice, informed
decision making, cultural competency, employment planning, community living planning,
self-direction options, and use of technology supports. Case managers must annually complete
an informed choice curriculum and pass a competency evaluation, in a form determined by
the commissioner, on informed decision-making standards. By August 1, 2024, all case
managers must complete an employment support training course identified by the
commissioner of human services. For case managers hired after August 1, 2024, this training
must be completed within the first six months of providing case management services. For
the purposes of this section, "person-centered planning" or "person-centered" has the meaning
given in section 256B.0911, subdivision 10. Case managers must document completion of
training in a system identified by the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, and applies to contracts
entered into or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2025 Supplement, section 256B.49, subdivision 13, is amended
to read:

Subd. 13.

Case management.

(a) Each recipient of a home and community-based waiver
shall be provided case management services by qualified vendors as described in the federally
approved waiver application. The case management service activities provided must include:

(1) finalizing the person-centered written support plan within the timelines established
by the commissioner and section 256B.0911, subdivision 29;

(2) informing the recipient or the recipient's legal guardian or conservator of service
options, including all service options available under the waiver plans;

(3) assisting the recipient in the identification of potential service providers of chosen
services, including:

(i) available options for case management service and providers;

(ii) providers of services provided in a non-disability-specific setting;

(iii) employment service providers;

(iv) providers of services provided in settings that are not community residential settings;
and

(v) providers of financial management services;

(4) assisting the recipient to access services and assisting with appeals under section
256.045;

(5) coordinating, evaluating, and monitoring of the services identified in the service
plan; and

(6) assisting and cooperating with facilities licensed under chapter 144G with the
licensee's obligations under section 144G.55.

(b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including:

(1) finalizing the person-centered support plan;

(2) ongoing assessment and monitoring of the person's needs and adequacy of the
approved person-centered support plan; and

(3) adjustments to the person-centered support plan.

(c) Case management services must be provided by a public or private agency that is
enrolled as a medical assistance provider determined by the commissioner to meet all of
the requirements in the approved federal waiver plans. If a county agency provides case
management under contracts with other individuals or agencies deleted text begin and deleted text end new text begin , new text end the county agency
deleted text begin utilizes deleted text end new text begin must utilize new text end a competitive proposal process for the procurement of contracted case
management services deleted text begin , the competitive proposal process must include deleted text end new text begin at least once every
two years. Contracts must include provisions for oversight to ensure high-quality case
management services. The competitive proposal process must include new text end evaluation criteria
to ensure that the county maintains a culturally responsive program for case management
services adequate to meet the needs of the population of the county. For the purposes of
this section, "culturally responsive program" means a case management services program
that: (1) ensures effective, equitable, comprehensive, and respectful quality care services
that are responsive to individuals within a specific population's values, beliefs, practices,
health literacy, preferred language, and other communication needs; and (2) is designed to
address the unique needs of individuals who share a common language or racial, ethnic, or
social background. new text begin Beginning July 1, 2029, a county agency must not enter into any new
contracts or renew contracts for case management services.
new text end

(d) Case management services must not be provided to a recipient by a private agency
that has any financial interest in the provision of any other services included in the recipient's
support plan. For purposes of this section, "private agency" means any agency that is not
identified as a lead agency under section 256B.0911, subdivision 10.

(e) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

(f) The Department of Human Services shall offer ongoing education in case management
to case managers. Case managers shall receive no less than 20 hours of case management
education and disability-related training each year. The education and training must include
appropriate service authorization, person-centered planning, informed choice, informed
decision making, cultural competency, employment planning, community living planning,
self-direction options, and use of technology supports. Case managers must annually complete
an informed choice curriculum and pass a competency evaluation, in a form determined by
the commissioner, on informed decision-making standards. By August 1, 2024, all case
managers must complete an employment support training course identified by the
commissioner of human services. For case managers hired after August 1, 2024, this training
must be completed within the first six months of providing case management services. For
the purposes of this section, "person-centered planning" or "person-centered" has the meaning
given in section 256B.0911, subdivision 10. Case managers shall document completion of
training in a system identified by the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, and applies to contracts
entered into or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2024, section 256S.07, subdivision 1, is amended to read:

Subdivision 1.

Elderly waiver case management provided by counties and tribes.

(a)
For participants not enrolled in a managed care organization, the county of residence or
tribe must provide or arrange to provide elderly waiver case management activities under
section 256S.09, subdivisions 2 and 3.

(b) If a county agency provides case management under contracts with other individuals
or agencies deleted text begin and deleted text end new text begin , new text end the county agency deleted text begin utilizes deleted text end new text begin must utilize new text end a competitive proposal process for
the procurement of contracted case management services deleted text begin , the competitive proposal process
must include deleted text end new text begin at least once every two years. Contracts must include provisions for oversight
to ensure high-quality case management services. The competitive proposal process must
include new text end evaluation criteria to ensure that the county maintains a culturally responsive program
for case management services adequate to meet the needs of the population of the county.
For the purposes of this section, "culturally responsive program" means a case management
services program that:

(1) ensures effective, equitable, comprehensive, and respectful quality care services that
are responsive to individuals within a specific population's values, beliefs, practices, health
literacy, preferred language, and other communication needs; and

(2) is designed to address the unique needs of individuals who share a common language
or racial, ethnic, or social background.

new text begin (c) Beginning July 1, 2029, a county agency must not enter into any new contracts or
renew contracts for case management services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, and applies to contracts
entered into or renewed on or after that date.
new text end

Sec. 4. new text begin WAIVER CASE MANAGEMENT QUALITY WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of human services shall convene a
waiver case management quality working group to develop recommendations related to
county provision of home and community-based waiver case management services without
the use of contractors.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin At a minimum, the working group must include the following
members:
new text end

new text begin (1) two individuals receiving waiver services or their family members or advocates,
appointed by the commissioner, in consultation with organizations representing individuals
with lived experience of disability and waiver services;
new text end

new text begin (2) three county representatives, appointed by the Minnesota Association of County
Social Service Administrators;
new text end

new text begin (3) at least three representatives of contracted case management agencies, appointed by
the Minnesota Social Service Association, including:
new text end

new text begin (i) at least one representative of a contracted case management agency located in a
metropolitan county, as defined in Minnesota Statutes, section 473.121, subdivision 4; and
new text end

new text begin (ii) at least two representatives of contracted case management agencies located outside
of a metropolitan county;
new text end

new text begin (4) one staff member from the Minnesota Social Service Association, appointed by the
Minnesota Social Service Association;
new text end

new text begin (5) one member of a Tribal Nation, appointed by the commissioner;
new text end

new text begin (6) two representatives of disability advocacy organizations, appointed by the
commissioner; and
new text end

new text begin (7) additional nonvoting participants as determined by the commissioner, which may
include staff from the Department of Human Services and other interested parties.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin (a) The working group shall make recommendations to ensure that
clients are receiving high-quality case management services, including but not limited to:
new text end

new text begin (1) requiring written documentation of visits with clients in order to receive payment;
new text end

new text begin (2) requiring initial and annual case management training conducted by the Department
of Human Services, with input from the counties related to core competencies and the
training curriculum;
new text end

new text begin (3) requiring a county to accept a client transfer and continue services at the level provided
by the previous county without the client reapplying for services;
new text end

new text begin (4) prohibiting a county from arbitrarily reducing the level and type of services a client
receives;
new text end

new text begin (5) requiring case management service providers to submit to a yearly financial audit
and random inspections of files and documentation;
new text end

new text begin (6) requiring counties that contract for case management services to utilize a competitive
process for the procurement of contracted case management services at least once every
three years;
new text end

new text begin (7) requiring case management service providers to implement a grievance process for
clients that must document all complaints and responses to and resolutions of complaints;
and
new text end

new text begin (8) requiring contracted case management service providers to annually report to the
county their case load numbers and staff turnover rates.
new text end

new text begin (b) The working group shall make recommendations to transition from a contract-based
case management services system to a system in which counties provide case management
services without contracting for those services. The recommendations must include but are
not limited to:
new text end

new text begin (1) ways to reduce complaints and improve quality of waiver case management services;
new text end

new text begin (2) an evaluation of the impact of current funding levels, administrative structures, and
workforce capacity on case management service delivery;
new text end

new text begin (3) an examination of alternative accountability and oversight models that protect access,
provider flexibility, and case management service quality;
new text end

new text begin (4) creation of a variance process, including county oversight and contractor site visits,
to allow a county to continue to use contracted case management services; and
new text end

new text begin (5) legislative or administrative changes to strengthen the waiver case management
services system.
new text end

new text begin Subd. 4. new text end

new text begin Compensation; expenses. new text end

new text begin Members of the working group may receive
compensation and expense reimbursement as provided in Minnesota Statutes, section 15.059,
subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Meetings; administrative support. new text end

new text begin (a) The first meeting of the working group
must be convened no later than August 1, 2026. The working group must meet at least
monthly. Meetings are subject to Minnesota Statutes, chapter 13D. The working group may
meet by telephone or interactive technology consistent with Minnesota Statutes, section
13D.015.
new text end

new text begin (b) The Department of Human Services shall provide staff and administrative support
to convene the working group, facilitate working group meetings, and prepare the final
report.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin By September 1, 2027, the commissioner shall submit a report of the
working group's findings and recommendations, including any legislative language necessary
to implement the recommendations, to the chairs and ranking minority members of the
legislative committees with jurisdiction over human services policy and finance.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The working group expires upon submission of the report required
under subdivision 6.
new text end

Sec. 5. new text begin DIRECTION TO COMMISSIONER; CASE MANAGEMENT AND HOME
AND COMMUNITY-BASED SERVICES RATES STUDY.
new text end

new text begin (a) The commissioner of human services shall analyze the current rate-setting
methodology for all case management and medical assistance home and community-based
services waivers and make recommendations to improve rate-setting methodologies to more
accurately reflect service costs. By January 1, 2027, the commissioner shall issue a request
for proposals to analyze the rate frameworks and current rate-setting practices. The
commissioner must consult with lead agencies and providers across the spectrum of services
and regions of the state and with culturally responsive providers in the development of the
request for proposals and for the duration of the contract.
new text end

new text begin (b) By January 15, 2028, the commissioner must submit a report to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services policy
and finance on the initial results of the analysis required under this section. By January 15,
2029, the commissioner must submit a final report to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services policy and
finance that includes legislative language necessary to modify existing or implement new
rate methodologies and a detailed fiscal analysis.
new text end