On the positive side, the House and Senate both adopted
policy changes and funding to allow private agencies to assist
persons of any age who want to leave nursing facilities. Also, both
bills contain cost-of-living adjustments (COLA) for community services
and long-term care providers of 2 percent each year for the next
biennium. The House language requires 66 percent of the COLA to
be used for all employees, whereas, the Senate requires all of the
COLA to be used for direct care staff. Reductions in parent fees
for families with children with significant disabilities are contained
in both bills with different sliding scales and policy changes for
$2.6 million in the House (sliding scale changes only) and $3 million
in the Senate (includes non-custodial parent fee changes and requires
sliding scale changes).
On the negative side
of the ledger, both the House and Senate have adopted significant
caseload restrictions for the home and community waiver programs
serving those otherwise eligible for nursing facility care
(CADI), those eligible for traumatic brain injury services (TBI)
and those eligible for the waiver for persons with developmental
disabilities (DD waiver). However, the Senate lessens the House’s
and the Governor’s reductions to these waiver programs
by 10 percent, thus allowing 320 additional persons to access
home and community-based waiver services during the next two-year
period.
The
House adopted several provisions from the Consortium for Citizens
with Disabilities bill, including an inter agency work group of
DHS, Housing Finance agency and the Council on Disability, payment
of Medicare Part B premiums for all those using Medical Assistance
for Employed Persons with Disabilities (MA-EPD) and a study of dental
access problems for persons with disabilities. The Senate bill
does not include these provisions.
The House adopted the
Governor’s proposals to eliminate MinnesotaCare
for adults without children (affecting 27,000 persons), while the
Senate has not. The House also restricts the General Assistance Medical
Care (GAMC) spend down program to 50 percent of the Federal Poverty
Level ($388 per month), 25 percent lower than the Governor’s
proposal and takes the funding from the Health Care Access Fund rather
than the General Fund. The House included the Governor’s
proposal to cut hospitals another 5 percent for the coming biennium,
but the Senate does not make this cut in hospital payments.
The Senate removes
the co-payments for Medical Assistance (MA) and General Assistance
Medical Care and repeals the $500 annual dental service limit for
adults with MA, GAMC and Minnesota-Care. The House does not.
Both
the House and Senate have adopted a new “medical therapy
management service” for the Medical Assistance program, with
different funding amounts. Both bodies have also included the Governor’s
proposal to establish intensive medical care management for those
with high MA costs and chronic conditions which is projected to save
money by reducing healthcare utilization. In addition, the House
and Senate both also agreed to fund the Governor’s proposal
to establish a Medical Director at the Department of Human Services
(DHS), a Health Services Policy Committee and evidence-based practices
to inform whether healthcare services will be covered or not. The
House and Senate both make changes to accommodate the new Medicare
Part D drug coverage for seniors and persons with disabilities. The
House adopts most of the Governor’s recommendations in this
area, including a repeal of the state prescription drug program.
The Senate did not adopt the administrative costs associated with
the Governor’s proposal. Among other drug coverage changes,
the Senate establishes a new program to allow those without drug
coverage to buy medicine at the lower Medicaid rates.
The House increased home care rates for home-health aide, skilled
nurse and therapy visits 5 percent in addition to the 2 percent cost-of-living
increases provided each year of the next biennium. The Senate does
not include funding for this item. The House funds the Region 10
Quality Assurance Commission in Southeastern Minnesota, as well as
a study on how to improve quality assurance statewide. The House
also reduces the county share for ICF/MR services from 20 percent
to 5 percent which would move $15.3 million in costs from counties
to the state. The Senate did not include funding for this but did
establish a $600,000 ICF/MR downsizing fund which facilities can
apply for through a process at the Department of Human Services.
Both
bodies adopted a number of the Governor’s proposals
to improve mental health services in the MA program, including
treatment foster care for children (the Senate requires
a 25 percent county share for this new service) and intensive
rehabilitation mental health services for youth transitioning
to adulthood.
The Senate repealed
the $125 per month reduction for low-income families using the
Minnesota Family Investment Plan (MFIP) who have a disabled family
member who receives Supplemental Security Income (SSI). This provision
affects about 6,500 low income families.
The Senate also makes some
changes to the Personal Care Assistant (PCA) program which saves
$6 million for the next biennium. These changes were sought by
managed care health plans serving PMAP (Prepaid Medical Assistance)
recipients (not including persons with disabilities who are not required
to be in MA managed care at this time) and based on a DHS Health
Services study conducted by consultant Michael Bailit. During the
course of the study, there were a few concerns voiced about PCA services
being misused and some cases of fraud raised by DHS staff charged
with oversight and compliance with the requirements for MA payments.
Unfortunately, a draft report from Mr. Bailit attacked PCA services
based mainly on unfounded and inaccurate information which he later
removed from the final report. However, the draft had been distributed
and the health plans used it to propose changes in the PCA program.
The
PCA changes in the Senate bill include restricting the
flexible use option to those who receive prior authorization from
DHS and limiting flexible use to six-month periods with no ability
to carry over hours not used during the six-month period. The PCA
changes also include new documentation and record keeping requirements
for providers. Before any services are billed, a current
statement of medical necessity from a physician must be in the person’s
file. Also, information on the amount of hours used for
those with the flexible option will be provided by both the PCA provider
and the Department of Human Services if the person is likely
to exceed their authorized hours for the month. These changes
were compromises to reduce the negative effects of the health
plan proposals. There is no dispute that persons with disabilities
do not want limited PCA funding to be fraudulently used.
Hopefully the record keeping of providers will improve with the new
requirements to assure that no one is being paid for services not
appropriately provided.
Both
the House and Senate include numerous policy changes which do not
require spending. Among the many policy items in both bills is
language on consumer directed community supports to establish a limited
exception process for those using the waiver for persons with developmental
disabilities (DD waiver) whose budgets will be reduced and who
will lose staffing hours as a result. This item is cost neutral.
Also, both bodies require the development of a managed care arrangement
for those still using fee-for-service MA (likely persons with disabilities)
by January 2007. An advisory group is required.
In the next several
weeks the House and Senate conferees will negotiate over
the differences in the omnibus bills to arrive at a final omnibus
spending bill for the next biennium. Since the Senate spends
more on health and human services, as well as several other areas
of the state budget, such as education, the debate will undoubtedly
include the issue of tax increases. Given the Governor’s position
not to raise taxes, which the House has agreed with, and
the fact that the state budget is in deficit for the fourth year
in a row, the debate over raising revenue will be heated
during the final weeks of the session. The Senate has proposed a
time limited top income tax rate increase for individuals with incomes
over $166,000 and couples over $250,000 as well as some corporate
tax changes which would cover the increase in spending proposed
by the Senate. The Legislature must adjourn by May 23, 2005.
Because Minnesota needs a new state budget to function after
July 1, 2005 there is a lot of pressure on the House and
Senate to work out their differences so that the state can continue
its business on July 1, 2005. If agreement is not reached
by May 23, 2005 it is most likely that a special session would be
called in June.
It is very important for persons
concerned about any of the provisions described or other matters
under consideration at the Legislature to contact their legislators
from both the House and Senate. Information about your legislators
who represent you and how to contact them can be found on the state
legislative website,
www.leg.state.mn.us or
by calling House information at 651-296-2146 and Senate information
at 651-296-0504. In addition, disability advocacy groups have regular
updates and action alerts on various items affecting persons with
disabilities under consideration at the State Capitol.
