Health & Human Services Bill Being Discussed
The House and Senate have nearly completed work on the major spending bills for Health and Human Services for the next two years, beginning July 1, 2005. As expected, there are major differences between the two bills as they move to a conference committee, with significant issues affecting persons with disabilities hanging in the balance.
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.