| Governor's Changes |
| (Dollars in Thousands) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| ACA: MA Eligibility and Enrollment Changes - Revised |
| The Governor recommends making changes to Medical Assistance (MA) processes and eligibility categories to comply |
| with the federal Affordable Care Act. The changes include expanding MA coverage to children leaving foster care until age |
| 26; aligning how income is counted across all insurance affordability programs including MA and premium tax credits; |
| expanding spousal impoverishment protections for people with disabilities in home and community based services; |
| changing enrollment procedures to certify enrollment eligibility annually instead of semi-annually; and permitting hospitals |
| to presume patients' MA eligibility. This proposal has been revised to phase in the ACA mandate that hospitals be |
| permitted to presume MA eligibility of uninsured individuals during inpatient hospital stays. This change recognizes that |
| changes required to implement this change will not be in place until January 1, 2015. This revision reduces the estimated |
| cost of the proposal by $22.8 million in FY14/15. |
| Performance Measures: |
| These eligibility and enrollment process changes will result in an additional average monthly enrollment of 61,000 people |
| in MA. This proposal will reduce Minnesota's rate of uninsurance for persons below 200% of FPG, as measured by the |
| annual Health Access Survey administered by MDH. |
| 18,460 |
| 119,804 |
| 138,264 |
| 148,014 |
| 161,256 |
| 309,270 |
| Net Change |
| 18,460 |
| 119,804 |
| 138,264 |
| 148,014 |
| 161,256 |
| 309,270 |
| ACA: Expand MA to Maintain Coverage for Children and Pregnant Women up to 275% FPG - Revised |
| The Governor recommends expanding Medical Assistance (MA) eligibilty for children ages 2-18 and pregnant women |
| from 150% FPG to 275% FPG effective January 1, 2014 to maintain the coverage for this population currently available in |
| MinnesotaCare. It uses savings from moving this population from MinnesotaCare to MA to fund a portion of the additional |
| cost of the proposal. This recommendation has been revised due to underlying forecast changes. |
| Performance Measures: |
| Implementation of this proposal will result, by the end of FY2015, in an increased average monthly enrollment in MA of |
| roughly 41,000 children in addition to the roughly 60,000 who would move from being eligible for MinnesotaCare to MA. |
| This proposal will reduce Minnesota's rate of uninsurance for children as measured by the annual Health Access Survey |
| administered by MDH. |
| 45,032 |
| 133,724 |
| 178,756 |
| 176,339 |
| 182,269 |
| 358,608 |
| (27,670) |
| (76,060) |
| (103,730) |
| (84,364) |
| (89,189) |
| (173,553) |
| Net Change |
| 17,362 |
| 57,664 |
| 75,026 |
| 91,975 |
| 93,080 |
| 185,055 |
| Continued EMA Coverage for Cancer and Dialysis - Revised |
| The Governor recommends continuing Emergency Medical Assistance (EMA) coverage for cancer and dialysis. Such |
| coverage is currently set to expire on June 30, 2013. This proposal removes the sunset date from statute, allowing |
| coverage to continue permanently. Emergency Medical Assistance provides joint federal and state funded health care |
| coverage for non-citizens, regardless of their immigration status. |
| Performance Measures: |
| This proposal continues access to services for EMA patients. |
| 1,429 |
| 1,710 |
| 3,139 |
| 1,710 |
| 2,910 |
| 4,620 |
| Net Change |
| 1,429 |
| 1,710 |
| 3,139 |
| 1,710 |
| 2,910 |
| 4,620 |
| Managed Care Organization Contract Savings - Revised |
| The Governor originally recommended capturing savings that occurred as a result of negotiating lower than previously |
| forecast contract rates with managed care providers. These lower rates are now assumed in the current forecast, which |
| reduces the change from forecast to zero. |
| Performance Measures: |
| This proposal recognizes savings realized through active negotiations with Managed Care Organizations. |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| PMAP MERC Investment to Meet Future Workforce Needs |
| The Governor recommends increasing the portion of Medical Education Research Costs (MERC) funding that runs |
| through the Medical Assistance program starting in FY 2014. MERC funding provides grants to health care providers who |
| train medical students. Under current law, the state would spend $36.7 million on all PMAP MERC programming. This |
| proposal increases that to $49.5 million or 34%, restores funding to the FY 2011 level, and generates a 50% federal match |
| of these dollars. |
| Performance Measures: |
| The Medical Education and Research Costs Fund investment offsets lost patient care revenue for teaching institutions |
| engaged in clinical training key to the health and economic well-being of Minnesotans. |
| 6,404 |
| 6,404 |
| 12,808 |
| 6,404 |
| 6,404 |
| 12,808 |
| Net Change |
| 6,404 |
| 6,404 |
| 12,808 |
| 6,404 |
| 6,404 |
| 12,808 |
| MA Rate Increase for Targeted Service Categories - Revised |
| The Governor recommends increasing Medical Assistance payment rates for specific categories of service to maintain |
| provider access for public program participants. Specifically, this increase applies to inpatient hospital, outpatient, mental |
| health, basic care, and physician and professional services in MA fee-for-service, and to dental services in both |
| fee-for-service and managed care. The physician and professional services include primary care, podiatry, chiropractic, |
| audiology, vision, radiology, and mental health. This recommendation has been amended to also include an MA rate |
| increase, in fee-for-service and managed care, for clinic-based family planning services. This revised recommendation is |
| effective January 1, 2014 at a cost of $28.4 million to the general fund in the 2014-15 biennium. |
| Performance Measures: |
| These increases will bring MA rates closer to Medicare rates and industry payment standards and help to maintain |
| enrollees' access to care. |
| 6,628 |
| 21,805 |
| 28,433 |
| 23,127 |
| 24,576 |
| 47,703 |
| Net Change |
| 6,628 |
| 21,805 |
| 28,433 |
| 23,127 |
| 24,576 |
| 47,703 |
| ACA: Admin and Systems resources for all health care coverage expansions - New |
| The Governor recommends increased funding to support additional agency administrative costs related to the |
| implementation of the Affordable Care Act. Implementation of the Affordable Care Act in Minnesota significantly increases |
| enrollment in public health care programs for children, pregnant women and lower income individuals and families. These |
| funds provide increased administrative resources to manage costs associated with increased enrollment in Medical |
| Assistance and MinnesotaCare, including increased costs of processing and paying claims. |
| Performance Measures: |
| The eligibility and enrollment process changes associated with this proposal will result in an additional average monthly |
| enrollment of 61,000 people in MA. This proposal will reduce Minnesota's rate of uninsurance for persons below 200% of |
| FPG, as measured by the annual Health Access Survey administered by MDH. |
| 423 |
| 785 |
| 1,208 |
| 930 |
| 930 |
| 1,860 |
| 1,171 |
| 2,204 |
| 3,375 |
| 2,374 |
| 2,463 |
| 4,837 |
| Net Change |
| 1,594 |
| 2,989 |
| 4,583 |
| 3,304 |
| 3,393 |
| 6,697 |
| Supplemental Rebates for Diabetic Test Strips |
| The Governor recommends implementing bulk purchasing for diabetic test strips by deeming certain brands as |
| ''preferred'', allowing the state to negotiate higher rebates from those preferred brands to create savings to the state. |
| Performance Measures: |
| This proposal aligns with other existing department purchasing initiatives and provides savings to the overall budget |
| solution through agency efficiencies. |
| (103) |
| (421) |
| (524) |
| (421) |
| (421) |
| (842) |
| Net Change |
| (103) |
| (421) |
| (524) |
| (421) |
| (421) |
| (842) |
| SMAC for HCPCS Drug Codes |
| The Governor recommends expanding SMAC (State Maximum Allowable Cost) pricing to cover drugs administered in a |
| clinical setting. SMAC pricing caps the rates pharmacies receive from Medical Assistance for drugs. Currently SMAC |
| pricing is just available for drugs administered in a pharmacy and does not include those administered in a clinical setting. |
| This would expand those rates to drugs also administered in a clinical setting to create savings to the state. |
| Performance Measures: |
| Permitting the use of State Maximum Allowable Cost when paying for drugs administered in a clinical setting creates |
| consistency with payment policies for pharmacist administered drugs. |
| (22) |
| (25) |
| (47) |
| (25) |
| (25) |
| (50) |
| Net Change |
| (22) |
| (25) |
| (47) |
| (25) |
| (25) |
| (50) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Child and Teen Check-up Rate Change |
| The Governor recommends recalculating Medical Assistance rates for check-ups for children and teens. The rates, as |
| currently calculated in administrative rule, include reimbursement for vaccines that are free to providers under the |
| ''Vaccines for Kids'' program administered by the Minnesota Department of Health. This law change is required to override |
| the administrative rule and align the rate calculation to new statute. |
| Performance Measures: |
| This rate adjustment is needed to align with the broader context of state law and provides savings to the overall budget |
| solution through agency efficiencies. |
| (349) |
| (590) |
| (939) |
| (714) |
| (742) |
| (1,456) |
| (2) |
| 0 |
| (2) |
| 0 |
| 0 |
| 0 |
| Net Change |
| (351) |
| (590) |
| (941) |
| (714) |
| (742) |
| (1,456) |
| 340B Drug Reimbursement |
| The Governor recommends making changes to drug reimbursement rates for providers enrolled as 340B providers with |
| the United States Department of Health and Human Services to create a more consistent reimbursement methodology. |
| Currently, different reimbursement rates apply to different 340B providers, based on when they negotiated their contract. |
| This would make the methodology used to determine reimbursements consistent across all providers and would create |
| some savings to the state from doing so. |
| Performance Measures: |
| This proposal will result in a consistent state policy for pharmacy claims payments to providers participating in the federal |
| 340B pharmacy discount program in accordance with federal guidance. |
| (1,538) |
| (3,710) |
| (5,248) |
| (3,746) |
| (3,805) |
| (7,551) |
| Net Change |
| (1,538) |
| (3,710) |
| (5,248) |
| (3,746) |
| (3,805) |
| (7,551) |
| Reform 2020: Enhance Vulnerable Adult Protection |
| The Governor recommends increasing protections for vulnerable adults through a multi-prong approach. These include |
| creating a statewide common entry point for reporting suspected abuse, raising awareness of adult maltreatment through |
| expanded public outreach, providing increased support to county adult protection units, and enhancing the state's role in |
| providing quality oversight to the adult protection system. This item is contingent on federal approval. |
| Performance Measures: |
| Enhancing Vulnerable Adult Protection in Minnesota will have a direct and highly visible impact on the Framework for the |
| Future goal of better protecting the state’s vulnerable adults. The success of this proposal will be measured by an |
| increase in the timeliness and responsiveness of the adult protection system. Proposed performance measures include: 1) |
| percent of reports of suspected maltreatment that are forwarded by the common entry point to the lead investigative |
| agency within required timelines (2 working days); 2) percent of reports assigned for investigation within required timelines |
| (5 working days); and percent of reports where protective services were provided in a timely manner. |
| 4,019 |
| 4,499 |
| 8,518 |
| 4,498 |
| 4,481 |
| 8,979 |
| Net Change |
| 4,019 |
| 4,499 |
| 8,518 |
| 4,498 |
| 4,481 |
| 8,979 |
| Reform 2020: Alternative Care and Essential Community Supports FFP - Revised |
| The Governor recommends seeking federal match on two state-only funded programs: Alternative Care (AC) and |
| Essential Community Supports (ECS). This proposal does not alter the eligibility for or services provided through these |
| programs. This item is contingent on federal approval. |
| Performance Measures: |
| This proposal will be successful if federal financial participation is obtained for the Alternative Care and Essential |
| Community Supports programs and the resources generated are reinvested into services that support seniors being |
| served in their homes and communities, measured by the percent of elderly who receive home and community based |
| waiver services at home. |
| (10,450) |
| (11,142) |
| (21,592) |
| (12,178) |
| (15,006) |
| (27,184) |
| Net Change |
| (10,450) |
| (11,142) |
| (21,592) |
| (12,178) |
| (15,006) |
| (27,184) |
| Reform 2020: Improve Access to HCBS for those Age 65 and Older with Ventilator Dependency |
| The Governor recommends removing the requirement that individuals on Elderly Waiver who are dependent on a |
| ventilator must stay in a nursing facility for at least 30 days before being eligible for an enhanced budget that is sufficient to |
| support their needs in the community. This item is contingent on federal approval. |
| Performance Measures: |
| This proposal allows people with vent dependency to be better served in their homes and communities rather than in |
| institutional settings. Success will be measured by an increase in the percentage of elderly waiver recipients with high |
| needs living at home. |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Reform 2020: First Contact- Simplification, Access and Transitions Support - Revised |
| The Governor recommends improving access to services and supports to assist older adults, people with disabilities, and |
| their family members navigate long-term care options. Changes include streamlining the pre-admission screening process |
| and simplifying funding for the MN Choice assessment to flow directly to counties. Additionally, this proposal expands the |
| Return to Community (RTC) model of ongoing follow-up and support to new targeted populations. This item is contingent |
| on federal approval. |
| Performance Measures: |
| This proposal will be successful if more people are served in their communities rather than an institution. Proposed |
| performance measures include: 1) the percent of people who receive home and community-based waiver services at |
| home; 2) the percent of people with low needs who receive services in an institutional setting; and, 3) the percent of |
| people with low needs who receive home and community-based waiver services in a residential setting. |
| 2,536 |
| (2,091) |
| 445 |
| (5,096) |
| (7,948) |
| (13,044) |
| Net Change |
| 2,536 |
| (2,091) |
| 445 |
| (5,096) |
| (7,948) |
| (13,044) |
| Reform 2020: HCBS Critical Access Study and Service Development |
| The Governor recommends funding a variety of efforts aimed at better understanding and addressing the critical access |
| needs of older adults and people with disabilities. Efforts include a one-time critical access study, ongoing support for the |
| biennial gaps analysis survey of the Home and Community-Based Services system, and increased capacity at the regional |
| level through ElderCare Development Partnerships. This item is contingent on federal approval. |
| Performance Measures: |
| This proposal will assess local capacity and availability of home and community based services. Service gaps will be |
| addressed with enhanced funding to nonprofit, quasi-formal providers, helping older Minnesotans remain in their |
| communities. A key performance indicator for this effort is the percent change in availability of HCBS identified by gaps |
| analysis survey as gaps in critical access areas. |
| 2,438 |
| 1,868 |
| 4,306 |
| 2,303 |
| 1,868 |
| 4,171 |
| Net Change |
| 2,438 |
| 1,868 |
| 4,306 |
| 2,303 |
| 1,868 |
| 4,171 |
| Reform 2020: Individual Community Living Support (ICLS) Added to AC and EW - Revised |
| The Governor recommends adding Individual Community Living Support (ICLS) as a service to the Alternative Care |
| program and the Elderly Waiver. The ICLS service offers older adults living in their own homes a coordinated package of |
| services and ongoing awareness of their needs from a single provider of their choice. This allows older adults to remain in |
| their own homes for a longer period of time, delaying use of more expensive long-term care alternatives. This item is |
| contingent on federal approval. |
| Performance Measures: |
| Adding ICLS as a service to the Alternative Care and Elderly Waiver will delay using more expensive services and allow |
| seniors to live in their own homes for a longer period of time. The success of this proposal is measured through the |
| following indicators: 1) the percent of people who receive home and community-based waiver services at home; 2) the |
| percent of people with high needs who receive home and community-based waiver services in their own home; and 3) the |
| percent of people with low needs who receive home and community-based waiver services in a residential setting. |
| (78) |
| (3,510) |
| (3,588) |
| (7,363) |
| (7,975) |
| (15,338) |
| Net Change |
| (78) |
| (3,510) |
| (3,588) |
| (7,363) |
| (7,975) |
| (15,338) |
| Reform 2020: Crisis Diversion and Discharge Planning to Reduce Avoidable Costs |
| The Governor recommends reducing unnecessary hospital admissions by providing more comprehensive support to |
| individuals who meet certain criteria. These support services will be available to individuals on Medical Assistance |
| waivers who have certain behavioral health conditions and have been admitted to a hospital at least twice in the previous |
| year. This item is contingent on federal approval. |
| Performance Measures: |
| This proposal will reduce unnecessary admissions and stays at hospitals, preventing utilization of costly health care |
| services. This proposal will be successful if hospital stays and admissions for the target population are reduced. |
| 62 |
| (905) |
| (843) |
| (1,832) |
| (1,894) |
| (3,726) |
| Net Change |
| 62 |
| (905) |
| (843) |
| (1,832) |
| (1,894) |
| (3,726) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Reform 2020: Community First Services and Supports - Revised |
| The Governor recommends reforming the Personal Care Assistance (PCA) program to a new service called Community |
| First Services and Supports (CFSS). CFSS will provide assistance with daily living, health-related tasks and skills |
| acquisition, which enable individuals to stay in their homes. CFSS will be more flexible and responsive to persons served |
| to remain at home, facilitate transition out of institutional care, and prevent or delay future admissions. Additionally, this |
| proposal will test innovative models of service coordination across home, school and community for children receiving |
| CFSS. This item is contingent on federal approval. |
| Performance Measures: |
| Reforming the PCA program and testing new models of service coordination will make these services more accessible |
| and flexible, and will facilitate transition out of institutional care and prevent or delay future admissions. This proposal will |
| be successful if the number of people being served in their own home or community rather than an institution increases. |
| Key indicators to measure this include the percent of Long Term Care recipients served at home and the percent of Home |
| and Community Based Services recipients served at home. |
| (1,093) |
| 130 |
| (963) |
| (463) |
| (2,311) |
| (2,774) |
| Net Change |
| (1,093) |
| 130 |
| (963) |
| (463) |
| (2,311) |
| (2,774) |
| Reform 2020: Work - Empower and Encourage Independence |
| The Governor recommends funding employment support services to employed individuals with the goal of preventing |
| destabilization and reducing the likelihood of their need for disability benefits. Targeted populations include individuals |
| ages 18 to 26 on Medical Assistance (MA), MA-Expansion group, and MA-Employed Persons with Disabilities. |
| Wrap-around services will be provided by navigators (employed by community organizations) who will offer employment |
| supports and benefits planning services including streamlined access to health insurance benefits information and |
| integrated service delivery. This item is contingent on federal approval. |
| Performance Measures: |
| This new service will help contribute to economic stability and increase access to housing. This proposal will be successful |
| if individuals maintain employment and delay or prevent the need to qualify for disability services. A key measure for this is |
| the percent of monthly earnings over $250/month for people with disabilities. |
| 342 |
| 57 |
| 399 |
| (234) |
| (309) |
| (543) |
| Net Change |
| 342 |
| 57 |
| 399 |
| (234) |
| (309) |
| (543) |
| Reform 2020: Intensive Services for Children with Autism Spectrum Disorder - Corrected |
| The Governor recommends funding for a comprehensive intensive intervention benefit for children with Autism Spectrum |
| Disorder (ASD) who are on Medical Assistance. Covered services will seek to improve communication skills, increase |
| social interactions, and reduce maladaptive behaviors for children with ASD at a critical time in their development. |
| Performance Measures: |
| This proposal provides services for children with autism that support acquisition of skills for optimal participation in their |
| family, schools, and community life and promote successful integration into adulthood, reducing the need for institutional |
| placements. Success will be measured by an increase in the percent of children with autism receiving the early intensive |
| intervention benefit that show a reduced need for intensive intervention over time and demonstrate greater independence |
| and functional participation in home, school, and community life by the time they reach 18 years of age in preparation for |
| adulthood. |
| 1,418 |
| 11,326 |
| 12,744 |
| 14,868 |
| 15,667 |
| 30,535 |
| Net Change |
| 1,418 |
| 11,326 |
| 12,744 |
| 14,868 |
| 15,667 |
| 30,535 |
| Transition Initiatives for Certain Populations - Revised |
| The Governor recommends funding to help ease transitions back to the community for those who do not meet hospital |
| level of care but are still in state-run treatment centers. This funding provides health insurance coverage on Medical |
| Assistance waivers and specialized mental health services. |
| Performance Measures: |
| This proposal will be successful if more people are living in home and community based settings rather than institutions. |
| Success of this proposal will be measured by: 1) Percent of Long-Term Care recipients receiving home and |
| community-based services; 2) Percent of people receiving home and community based services. |
| 3,330 |
| 4,884 |
| 8,214 |
| 5,426 |
| 5,285 |
| 10,711 |
| Net Change |
| 3,330 |
| 4,884 |
| 8,214 |
| 5,426 |
| 5,285 |
| 10,711 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Nursing Facility Rate Increase and Quality Add-On - Corrected |
| The Governor recommends increasing rates and establishing a quality add-on payment for nursing facilities. The quality |
| add-on payment rewards facilities that make investments across five quality measures and funds additional |
| improvements. All facilities will receive a general rate increase beginning October 2013. |
| Performance Measures: |
| Establishing a quality add-on will promote best practices and positive approaches in service delivery and provide the basis |
| for provider incentives. This proposal will be successful if the Nursing Facility Quality of Life and/or Qualify of Care |
| measures tracked by the department improve. |
| 5,632 |
| 13,980 |
| 19,612 |
| 22,046 |
| 30,347 |
| 52,393 |
| Net Change |
| 5,632 |
| 13,980 |
| 19,612 |
| 22,046 |
| 30,347 |
| 52,393 |
| Suspend APS Operating Rate Inflation for Nursing Facilities - Corrected |
| The Governor recommends continuing the suspension of automatic operating rate increases for nursing facilities that has |
| been in effect since 1999. This proposal extends the suspension for four more years. |
| Performance Measures: |
| This proposal provides savings to the overall budget solution through reduced expenditures. |
| (5,133) |
| (12,170) |
| (17,303) |
| (19,305) |
| (27,002) |
| (46,307) |
| Net Change |
| (5,133) |
| (12,170) |
| (17,303) |
| (19,305) |
| (27,002) |
| (46,307) |
| Suspend APS Property Rate Inflation for Nursing Facilities - Revised |
| The Governor recommends continuing the suspension of automatic property rate increases for nursing facilities that has |
| been in effect since 2011. This proposal continues that suspension for four more years. |
| Performance Measures: |
| This proposal provides savings to the overall budget solution through reduced expenditures. |
| (675) |
| (1,599) |
| (2,274) |
| (2,535) |
| (3,545) |
| (6,080) |
| Net Change |
| (675) |
| (1,599) |
| (2,274) |
| (2,535) |
| (3,545) |
| (6,080) |
| HCBS Pay for Performance Initiative - Corrected |
| The Governor recommends creating a performance improvement project program for providers of Home and Community |
| Based Services for older adults and people with disabilities. These ''pay for performance'' programs will be launched in |
| phases beginning with a two-year planning period followed by the start of the increased payments in FY 2016. |
| Performance Measures: |
| The HCBS Pay for Performance Initiative will inform quality measurement of services provided to older Minnesotans and |
| those with disabilities. Future assessment data gathered through the MnCHOICES tool will provide information about a |
| recipient’s satisfaction with their services and providers. A key indicator will be the percent of recipients satisfied with their |
| services. |
| 2,377 |
| 4,177 |
| 6,554 |
| 27,145 |
| 50,393 |
| 77,538 |
| Net Change |
| 2,377 |
| 4,177 |
| 6,554 |
| 27,145 |
| 50,393 |
| 77,538 |
| Waiver Management Improvements |
| The Governor recommends enhancing management flexibility of the disability waivers in the Medical Assistance (MA) |
| program. Changes include shifting waiver allocations between counties if dollars are not being used, managing corporate |
| foster care capacity at the state level, and requiring waiver recipients to access the state MA services before accessing |
| waiver-covered services. |
| Performance Measures: |
| This proposal increases the ability of the Department to more effectively manage the home and community-based |
| services disability waiver programs. Success will be measured by an increase in the percentage of people with disabilities |
| who receive Home and Community-Based Services. |
| 173 |
| 227 |
| 400 |
| 227 |
| 227 |
| 454 |
| Net Change |
| 173 |
| 227 |
| 400 |
| 227 |
| 227 |
| 454 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Quality Initiative: Positive Practice and Behavior Safeguards and Supports - Revised |
| The Governor recommends funding to support the adoption of best practices when addressing challenging behavior and |
| establishing prohibitions on certain practices, such as restraint and seclusion and increasing positive approaches. This |
| proposal will affect DHS-licensed home and community based services and programs for people with developmental |
| disabilities. |
| Performance Measures: |
| Updating Minnesota Rules to reflect best practices in addressing challenging behavior will help ensure that all |
| Minnesotans are healthy. This proposal will be successful if there is a reduction in the number of aversive procedures for |
| people with disabilities. The department will measure and monitor the percent reduction of aversive and deprivation |
| procedures for people with disabilities. |
| 494 |
| 467 |
| 961 |
| 467 |
| 467 |
| 934 |
| Net Change |
| 494 |
| 467 |
| 961 |
| 467 |
| 467 |
| 934 |
| Quality Initiative: Waiver Provider Standards Phase II - Revised |
| The Governor recommends funding to implement standards for home and community-based services (HCBS) waiver |
| programs to meet federal compliance related to new 245D licensing standards for certain home and community-based |
| service providers. Funding provides training and educational opportunities for providers and lead agencies. This |
| educational effort will help providers understand how to conform to the updated standards to better ensure successful |
| licensure. |
| Performance Measures: |
| Waiver Provider Standards will inform quality measurement of services provided to Minnesotans with disabilities. Future |
| assessment data gathered through the MnCHOICES tool will provide information about a recipient’s satisfaction with their |
| services and providers. |
| 747 |
| 971 |
| 1,718 |
| 971 |
| 971 |
| 1,942 |
| Net Change |
| 747 |
| 971 |
| 1,718 |
| 971 |
| 971 |
| 1,942 |
| Enhance Audit Activity Resources for Nursing Facilities - Revised |
| The Governor recommends increasing audit activity with the goal of increasing program integrity and reducing incorrect |
| payments. Savings are identified when auditing activities reveal incorrect billings and erroneous payments. |
| Performance Measures: |
| Enhanced audit activities maintain integrity of nursing facility spending by reducing errors and irregularities. This proposal |
| will result in decreased Medical Assistance expenditures as audit activities reveal errors in payments or rates. The |
| department will measure the percent change in total Medical Assistance nursing facility spending. |
| (12) |
| (133) |
| (145) |
| (307) |
| (474) |
| (781) |
| Net Change |
| (12) |
| (133) |
| (145) |
| (307) |
| (474) |
| (781) |
| Restore Planned Closure Rate Adjustment Authority - Corrected |
| The Governor recommends restoring the nursing facility Planned Closure Rate Adjustment (PCRA) program, which was |
| discontinued in 2011. The PCRA program provides incentive payments for the planned closure of nursing home beds in |
| areas of the state where excess bed capacity exists or where a rebalancing of long-term care services is desirable. |
| Performance Measures: |
| The Planned Closure Rate Adjustment (PCRA) program provides an incentive for nursing facilities to reduce beds, |
| decreasing the number of people served in institutional settings. The department will measure the percent of long-term |
| care recipients receiving institutional services. |
| (491) |
| (1,435) |
| (1,926) |
| (2,215) |
| (2,827) |
| (5,042) |
| (397) |
| (1,194) |
| (1,591) |
| (1,790) |
| (2,187) |
| (3,977) |
| Net Change |
| (94) |
| (241) |
| (335) |
| (425) |
| (640) |
| (1,065) |
| HIV Rebate Adjustment |
| The Governor recommends correcting a double appropriation for supplemental insurance premiums and case |
| management services for people living with HIV/AIDS starting in SFY 2014. This proposal will not impact recipients. |
| Performance Measures: |
| HIV/AIDS drug rebate funding will be used instead of the 2012 payback funding and as a result, the proposal will not |
| impact recipients. |
| (4,462) |
| (2,038) |
| (6,500) |
| (2,038) |
| (2,038) |
| (4,076) |
| Net Change |
| (4,462) |
| (2,038) |
| (6,500) |
| (2,038) |
| (2,038) |
| (4,076) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Reform 2020: Housing Stability Services Demonstration - Corrected |
| The Governor recommends funding a demonstration project that seeks to increase housing stability for low-income |
| individuals with chronic health conditions. This project targets certain groups in General Assistance and Group |
| Residential Housing and provides them coordinated services across multiple systems, tenancy supports, and community |
| living assistance. This item is contingent on federal approval. |
| Performance Measures: |
| It is expected that this proposal will increase access to necessary and appropriate levels of health and community living |
| supports, improved housing stability, a reduction to costly emergency medical services and improved consistency of care. |
| Measures include assessment of service utilization and housing stability at enrollment, annually and at termination; and |
| fewer inpatient and psychiatric hospitalizations, emergency room visits and ambulance transports. |
| (458) |
| (3,216) |
| (3,674) |
| (3,799) |
| (4,821) |
| (8,620) |
| Net Change |
| (458) |
| (3,216) |
| (3,674) |
| (3,799) |
| (4,821) |
| (8,620) |
| Increase Access to Quality Care for Children with High Needs - Corrected |
| The Governor recommends improving access to high quality child care through changes that include simplifying the |
| current rates structure and setting updated rates for some providers. Additionally, it funds a quality add-on to rates for |
| providers with three and four-star ratings through Parent Aware and guarantees child care for eligible teen parents to |
| ensure they receive services. |
| Performance Measures: |
| By setting higher maximum rates, families’ access to child care will improve. Access is defined as the percent of provider |
| rates that are covered by the CCAP maximum rates. Increasing maximum rates supports families’ access to more |
| providers and to providers who offer higher quality care. The percent of children receiving CCAP in high quality programs |
| is expected to increase. This is measured by the percent of families receiving Child Care Assistance who use 3- or 4-star |
| rated child care providers. |
| 7,577 |
| 15,364 |
| 22,941 |
| 17,295 |
| 17,660 |
| 34,955 |
| Net Change |
| 7,577 |
| 15,364 |
| 22,941 |
| 17,295 |
| 17,660 |
| 34,955 |
| Northstar Care for Children - Revised |
| The Governor recommends increasing child permanency by equalizing the adoption assistance, relative custody |
| assistance (RCA), and foster care rates. Currently, foster care rates can be more than double adoption assistance and |
| RCA rates creating a financial incentive to not adopt children. This proposal eliminates that incentive by consolidating the |
| three existing programs into a single program to support permanency for children for new placements, effective January 1, |
| 2015. |
| Performance Measures: |
| Implementation of Northstar Care should reduce the number of children in out-of-home care; reduce the length of stay in |
| out-of-home care; and, increase the percent of children adopted within 24 months of entry in foster care. |
| 554 |
| 2,014 |
| 2,568 |
| 4,989 |
| 8,242 |
| 13,231 |
| Net Change |
| 554 |
| 2,014 |
| 2,568 |
| 4,989 |
| 8,242 |
| 13,231 |
| Rebuilding an Effective MFIP Program - Revised |
| The Governor recommends improving MFIP program outcomes and simplifying program administration by targeting |
| resources to establish home visiting initiatives for teen parents, increasing benefits for working families, providing |
| additional supports to improve parents' employment outcomes, and suspending the Work Benefit program. |
| Performance Measures: |
| Among the outcomes positively impacted by these investments are improved employment outcomes for parents and |
| improved high school graduation rates among teen parents on MFIP. |
| 0 |
| 0 |
| 0 |
| 2,000 |
| 2,000 |
| 4,000 |
| 6,705 |
| 6,928 |
| 13,633 |
| 2,044 |
| 1,720 |
| 3,764 |
| Net Change |
| 6,705 |
| 6,928 |
| 13,633 |
| 4,044 |
| 3,720 |
| 7,764 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Expand Parent Support Outreach Program Statewide |
| The Governor recommends expanding the Parent Support Outreach Program (PSOP) statewide. PSOP is an early |
| intervention response to screened-out reports of child maltreatment that provides early intervention, outreach, and |
| supportive services to families. |
| Performance Measures: |
| The department will monitor the rate per thousand of substantiated child abuse and neglect reports. During the first four |
| years of the PSOP pilot project, the Institute of Applied Research conducted an intensive study of the impact of PSOP in |
| the counties where it was instituted. The final report, Minnesota Parent Support Outreach Program Evaluation |
| (http://iarstl.org/papers/PSOPFinalReport.pdf) found that families with high levels of need related to poverty or to chemical |
| dependency, who received services targeted to those issues, were less likely to have a subsequent accepted report in the |
| child protection system than families with similar identified problems who received no services. The research also showed |
| that those counties with high levels of PSOP implementation had greater reduction of screened-in child maltreatment |
| reports in the final two years of the pilot program than counties that had a low level of implementation or did not offer |
| PSOP at all. |
| 2,250 |
| 2,250 |
| 4,500 |
| 2,250 |
| 2,250 |
| 4,500 |
| Net Change |
| 2,250 |
| 2,250 |
| 4,500 |
| 2,250 |
| 2,250 |
| 4,500 |
| Electronic Benefit Transaction Fee |
| The Governor recommends eliminating the four cent fee paid to grocers for Electronic Benefit Transfer (EBT) card |
| transactions made under the Supplemental Nutrition Assistance Program. This fee originated during the early years of |
| payment card technology to encourage retailers to adopt the new payment method, but this incentive is now unnecessary |
| given the widespread use of electronic payments. |
| Performance Measures: |
| This proposal provides savings to the overall budget solution through agency efficiencies without impacting SNAP |
| recipients. |
| (213) |
| (213) |
| (426) |
| (213) |
| (213) |
| (426) |
| Net Change |
| (213) |
| (213) |
| (426) |
| (213) |
| (213) |
| (426) |
| Adoption Assistance Forecast Adjustment |
| The Governor recommends capturing surplus dollars in the adoption assistance program that result from reduced |
| caseload projections |
| Performance Measures: |
| This proposal will result in savings to the state due to a reduction in projected caseload need, and does not impact |
| services for people. |
| (1,069) |
| (706) |
| (1,775) |
| (706) |
| (706) |
| (1,412) |
| Net Change |
| (1,069) |
| (706) |
| (1,775) |
| (706) |
| (706) |
| (1,412) |
| Match Supportive Service Expenditures |
| The Governor recommends seeking federal match on the Supplemental Nutrition Assistance Employment and Training |
| Program. The federal government provides a 50% match on support services to eligible SNAP recipients. This proposal |
| uses existing state expenditures under the Child Care Assistance Program and the Diversionary Work Program. |
| Performance Measures: |
| This proposal provides savings to the overall budget solution by reducing state expenditures, without impacting services |
| for people. |
| 4,400 |
| 4,400 |
| 8,800 |
| 4,400 |
| 4,400 |
| 8,800 |
| Net Change |
| (4,400) |
| (4,400) |
| (8,800) |
| (4,400) |
| (4,400) |
| (8,800) |
| Expansion of School-linked Grants |
| The Governor recommends expanding access to mental health services for children with complex, high-cost conditions |
| through increased funding to schools. Schools focus on improving outcomes by integrating services otherwise siloed by |
| requiring comprehensive assessment, care coordination, and integrated treatment and supports planning. |
| Performance Measures: |
| Success of this proposal will be measured as follows: 1) An increase in the number of first-time users of mental health |
| services funded by the School-Linked Mental Health Grants; 2) An increase in the number of schools providing mental |
| health services; and, 3) An increase in the number of students of cultural minority groups receiving mental health services |
| funded by the School-Linked Mental Health Grant. |
| 2,527 |
| 4,907 |
| 7,434 |
| 4,907 |
| 4,907 |
| 9,814 |
| Net Change |
| 2,527 |
| 4,907 |
| 7,434 |
| 4,907 |
| 4,907 |
| 9,814 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Establish a Clinical Care Coordination Benefit in MA |
| The Governor recommends expanding provider reimbursement for time spent in clinical consultation with a patient's other |
| clinicians to coordinate their care. Coordination of clinical care for people with complex and chronic conditions remains |
| inadequate for most Minnesotans receiving publicly and privately financed behavioral health care services. This will incent |
| clinicians to coordinate care among providers by reimbursing them for their time spent doing so. This change will be |
| funded by reallocating $2.15 million currently used to provide targeted case management through a local share grant |
| program. |
| Performance Measures: |
| The department will measure the success of this proposal by tracking an expected reduction in the number of children |
| with high-cost mental health conditions (''high cost'' is defined as expenditures of $50,000 or greater in a 12-month |
| period). A Children’s Mental Health Care Coordination benefit in MA will create a financial incentive for treatment providers |
| to ensure consistency of care across primary care, social services, schools, probation, and other specialty care providers |
| and, based on treatment outcomes, adjust services as necessary to improve outcomes. Failure to coordinate care has |
| been identified as major cause of high-cost cases. |
| (347) |
| (347) |
| (694) |
| (347) |
| (347) |
| (694) |
| Net Change |
| (347) |
| (347) |
| (694) |
| (347) |
| (347) |
| (694) |
| Establish a Family Psycho-education Benefit in Medical Assistance |
| The Governor recommends repurposing existing funding for the psychotherapy benefit in the Minnesota Health Care |
| Plans (MHCPs) to instead be used for a psychoeducation benefit. The psychoeducation benefit will be used to teach |
| family members skills to deal with a child's mental health illness, allowing them to participate in a child's treatment. |
| Because a child spends more time with family members than with a therapist, this benefit will enlist family members in the |
| child's treatment to provide a more useful and cost effective treatment model. |
| Performance Measures: |
| Because the first challenge of implementing a new benefit is to train providers on effective practice and documentation, |
| the initial measures will be to establish a baseline and increase the number of mental health professionals who |
| successfully complete training in the delivery, documentation and billing of the Family Psycho-education benefit. |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Expand Mental Health Crisis Response Services |
| The Governor recommends expanding mental health crisis response services to an additional sixteen counties and two |
| tribes. These services help individuals cope with mental health crisis in their own home rather than in a more restrictive |
| and expensive setting. These services are currently available in 59 counties and one tribe. |
| Performance Measures: |
| Four new mobile crisis response teams will be developed which will cover sixteen counties and two tribes. Improved |
| access to mental health crisis services is expected to reduce rates of suicide, hospitalizations, and law enforcement |
| involvement. |
| 1,000 |
| 1,000 |
| 2,000 |
| 750 |
| 750 |
| 1,500 |
| Net Change |
| 1,000 |
| 1,000 |
| 2,000 |
| 750 |
| 750 |
| 1,500 |
| Adjust Adult Rehabilitative Mental Health Services Payment Rate and Provisions of Services - Revised |
| The Governor recommends increasing payment rates for the Adult Rehabilitative Mental Health Services (ARMHS) |
| currently provided and expands the range of services offered under ARMHS. ARMHS helps adults with serious mental |
| illness gain emotional stability and learn new coping skills needed when thinking, concentrating or caring for oneself is |
| severely impaired by symptoms of mental illness. Current rates do not cover service costs. This proposal aims to ensure |
| the sustainability of these services. |
| Performance Measures: |
| The department expects that on average, individuals receiving ARMHS will have a 25 percent reduction in mental health |
| hospital inpatient days. |
| 0 |
| 0 |
| 0 |
| 0 |
| 1,084 |
| 1,084 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 1,084 |
| 1,084 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Mental Health Specialty Treatment Service |
| The Governor recommends establishing a pilot program for a 24 hour a day, seven days a week medically monitored |
| mental health specialty treatment service. This service will serve as a transition from psychiatric hospitalization for |
| individuals with complex treatment needs, and will seek to fill a gap in services for individuals who are ready for hospital |
| discharge, but who for various reasons are not able to transition to non-hospital treatment settings. |
| Performance Measures: |
| This change is expected to reduce the total number of non-acute bed days for psychiatric hospital length of stay (excluding |
| rule 20 stays) at Anoka Metropolitan Regional Treatment Center (AMRTC). While this affects a relatively small number of |
| individuals each year, the treatment needs of these individuals have been identified as using the majority of hospital bed |
| days where hospital level-of-care is no longer demonstrated. DHS AMRTC Continued Stay Criteria reports will be used to |
| monitor this performance. |
| 1,000 |
| 1,000 |
| 2,000 |
| 1,000 |
| 1,000 |
| 2,000 |
| 1,000 |
| 1,000 |
| 2,000 |
| 1,000 |
| 1,000 |
| 2,000 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Health Workforce – Substance Abuse Screening, Brief Intervention and Referral to Treatment |
| The Governor recommends funding training for primary care clinicians, so that they can use a screening tool that helps |
| identify people with risky drug or alcohol use. This tool better integrates primary care and substance abuse treatment by |
| enabling clinicians to reach more people who are at risk and connect them with services. This screening tool is known as |
| Screening, Brief Intervention, and Referral for Treatment (SBIRT). |
| Performance Measures: |
| There is no current baseline, however the Department will measure the numbers of primary care physicians trained and |
| utilizing the evidence-based practice of SBIRT. |
| 300 |
| 300 |
| 600 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 300 |
| 300 |
| 600 |
| 0 |
| 0 |
| 0 |
| Eliminate Alternative to Moose Lake Grant |
| The Governor recommends eliminating grants used to subsidize programs in the non-metro community hospitals after the |
| closure of Moose Lake Treatment Center. Since that time, the department has closed facilities in other parts of the state |
| without providing similar subsidies. |
| Performance Measures: |
| This proposal provides savings to the overall budget solution through reduced expenditures. |
| (2,653) |
| (2,653) |
| (5,306) |
| (2,653) |
| (2,653) |
| (5,306) |
| Net Change |
| (2,653) |
| (2,653) |
| (5,306) |
| (2,653) |
| (2,653) |
| (5,306) |
| One-time Reduction in CCDTF Carryforward |
| The Governor recommends a one-time transfer of unspent funds in the Consolidated Chemical Dependency Treatment |
| Fund (CCDTF) to the general fund. The transfer is possible because of lower-than-forecasted spending in the CCDTF |
| over the past few years. This transfer does not affect services eligible recipients will receive or the number of people that |
| will be served. |
| Performance Measures: |
| This is a one-time reduction in funds appropriated to a forecasted program and not used in a prior year. |
| 18,188 |
| 0 |
| 18,188 |
| 0 |
| 0 |
| 0 |
| 18,188 |
| 0 |
| 18,188 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Mental Health Transitions Services - Revised |
| The Governor recommends funding new mental health services. These funds will be used to support the development of |
| new mental health specialty transitional treatment services and to assist individuals transitioning out of treatment at state |
| operated facilities. The goal of these services is to improve the flow of individuals transitioning back to the community from |
| state institutions, by providing flexible funding for an array of needs that are one-time or time-limited in nature. This in turn |
| will help relieve some historical pressures like waiting lists, jail holds, and community hospital bed space. This proposal |
| has been reduced by $2 million per biennium from the Governor’s original proposal. This reduction allows another |
| proposal to fund the continued operations of the Minnesota Specialty Treatment Services Willmar site from the same |
| dedicated State Operated Services account to go forward. |
| Performance Measures: |
| This change will be successful if there is an annual 10 percent reduction in the total number of non-acute bed days |
| (excluding Rule 20 bed days) for psychiatric hospital length of stay at Anoka Metropolitan Regional Treatment Center |
| (AMRTC). DHS AMRTC Continued Stay Criteria reports will be used to monitor this performance. |
| (400) |
| (400) |
| (800) |
| (400) |
| (400) |
| (800) |
| 400 |
| 400 |
| 800 |
| 400 |
| 400 |
| 800 |
| 1,000 |
| 1,000 |
| 2,000 |
| 1,000 |
| 1,000 |
| 2,000 |
| 600 |
| 600 |
| 1,200 |
| 600 |
| 600 |
| 1,200 |
| 400 |
| 400 |
| 800 |
| 400 |
| 400 |
| 800 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Change County Share of Cost of Care Rate for Anoka Regional Treatment Center |
| The Governor recommends an increase to the county share of costs for the Anoka Regional Treatment Center. The goal |
| of the proposal is to encourage more timely patient discharge from the treatment center to a less restrictive, less costly |
| setting as soon as it is appropriate for the patient. |
| Performance Measures: |
| This change will be successful if the length of stay for clients and the number of non-acute bed days are reduced. When a |
| client can move through the system and return quickly to the community there is a greater chance they will retain their |
| support system and living arrangement. |
| 946 |
| 946 |
| 1,892 |
| 946 |
| 946 |
| 1,892 |
| Net Change |
| (946) |
| (946) |
| (1,892) |
| (946) |
| (946) |
| (1,892) |
| Change County Share of Cost of Care Rate for Minnesota Security Hospital |
| The Governor recommends increasing the county share of the cost of care for clients served in the Minnesota Security |
| Hospital (MSH). The goal is to encourage a more timely return of clients to their home communities once a reduction in |
| custody has been received. When clients are not able to quickly return to their home communities, they remain at an |
| inappropriate, more expensive level of care and custody that is no longer conducive to their treatment progress. |
| Performance Measures: |
| A key measure of success for this item is a reduction in the length of stay once a client has been deemed appropriate for |
| discharge and the client has been provisionally discharged from the program. |
| 3,146 |
| 3,146 |
| 6,292 |
| 3,146 |
| 3,146 |
| 6,292 |
| Net Change |
| (3,146) |
| (3,146) |
| (6,292) |
| (3,146) |
| (3,146) |
| (6,292) |
| MN Sex Offender Program Growth |
| The Governor recommends increasing funding for the Minnesota Sex Offender Program (MSOP) to address current |
| estimates for increases in the number of commitments to MSOP. |
| Performance Measures: |
| 3,693 |
| 6,669 |
| 10,362 |
| 6,669 |
| 6,669 |
| 13,338 |
| 923 |
| 1,667 |
| 2,590 |
| 1,667 |
| 1,667 |
| 3,334 |
| Net Change |
| 2,770 |
| 5,002 |
| 7,772 |
| 5,002 |
| 5,002 |
| 10,004 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Implement New Fee Schedule for HCBS Providers - Revised |
| The Governor recommends establishing a fee structure to recover the costs of licensing home and community-based |
| services (HCBS) as required by the federal Medicaid program. These licensing standards were passed by the 2012 |
| Legislature, and the corresponding fee structure is now recommended to be implemented. The agency will collect a fee |
| from HCBS providers to cover the costs of licensing all HCBS services and will centrally monitor provider performance and |
| standards. |
| Performance Measures: |
| As a result of this change, program integrity will be enhanced through sanctions and recovery of payments for services not |
| provided. Performance measures will identify the number of programs licensed, extent and type of monitoring activities, |
| and enforcement actions taken. |
| 500 |
| 2,700 |
| 3,200 |
| 2,700 |
| 2,700 |
| 5,400 |
| 500 |
| 2,700 |
| 3,200 |
| 2,700 |
| 2,700 |
| 5,400 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Application Fee for Provider Screening |
| The Governor recommends implementing federal provider enrollment requirements to conduct additional screenings, |
| including additional FBI checks for high risk providers. This fee, which is set by the federal government, will be paid by all |
| newly enrolled Medicaid providers at the time of enrollment. The intention of this change is to avoid significant ''pay and |
| chase'' activity by preventing fraudulent or illegitimate Medicaid providers from enrolling in the first place. |
| Performance Measures: |
| The performance measure for this item will be the number of high risk and moderate risk providers that will receive pre |
| and post enrollment visits, and the number of managers and owners identified as high risk providers who will have FBI |
| background study checks. |
| 311 |
| 290 |
| 601 |
| 290 |
| 290 |
| 580 |
| 522 |
| 533 |
| 1,055 |
| 533 |
| 533 |
| 1,066 |
| 522 |
| 533 |
| 1,055 |
| 533 |
| 533 |
| 1,066 |
| Net Change |
| 311 |
| 290 |
| 601 |
| 290 |
| 290 |
| 580 |
| Child Care Licensing Changes - Corrected |
| The Governor recommends changes to child care licensure to address the issue of child mortality in child care settings. |
| This recommendation includes various elements and strategies, including strengthening of child care provider licensing |
| and testing, and both improving and subsidizing training for providers. The goal of these changes is to increase child |
| safety, particularly related to safe sleep practices. |
| Performance Measures: |
| It is expected that implementing these changes will reduce the incidence of deaths in licensed family child care homes. |
| 1,053 |
| 1,298 |
| 2,351 |
| 1,298 |
| 1,298 |
| 2,596 |
| Net Change |
| 1,053 |
| 1,298 |
| 2,351 |
| 1,298 |
| 1,298 |
| 2,596 |
| Child Care Provider Investigations & Data Analytics - Revised |
| The Governor recommends establishing a team of inspectors to address child care provider fraud. This team will identify |
| provider fraud, investigate negligent or fraudulent providers, and refer cases for criminal or administrative prosecutions as |
| appropriate. |
| Performance Measures: |
| The performance measure tracked will be the number of investigations and quantity of program savings and recoveries |
| through fines, penalties and overpayments that result from new investigations of fraudulent and abusive financial conduct |
| by child care providers. |
| 597 |
| 535 |
| 1,132 |
| 535 |
| 535 |
| 1,070 |
| 279 |
| 470 |
| 749 |
| 636 |
| 663 |
| 1,299 |
| Net Change |
| 318 |
| 65 |
| 383 |
| (101) |
| (128) |
| (229) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Expansion of Internal Audits Capacity - Corrected |
| The Governor recommends expanding the agency's capacity to conduct internal compliance and financial audits of public |
| programs and operations. The goal is to ensure that these programs are administered in accordance with federal and |
| state laws, rules and regulations, and that program funds are directed to where they are needed most. As the size of |
| human service programs has increased, it has become a challenge to accomplish this goal with existing resources. The |
| increased internal audits capacity would enable the agency to better address known internal control deficiencies and |
| program inefficiencies based on assessed risk, while still providing sufficient resources to respond to emerging high |
| priority incidents. |
| Performance Measures: |
| Performance measures for this outcome would include costs savings / cost avoidance from issued audit reports, and also |
| less tangible benefits such as improved internal controls, lower overall business risk, and improved efficiencies. |
| 346 |
| 323 |
| 669 |
| 323 |
| 323 |
| 646 |
| Net Change |
| 346 |
| 323 |
| 669 |
| 323 |
| 323 |
| 646 |
| Expansion of Surveillance and Integrity Review |
| The Governor recommends expanding the capacity to investigate Medical Assistance (MA) providers to prevent fraud and |
| abuse of the MA program. This expansion will increase staff to investigate those providers identified as high risk, as well |
| as allow investigators to cover additional provider types. |
| Performance Measures: |
| This change will be successful if the agency is able to expand investigations to more provider types. |
| 430 |
| 402 |
| 832 |
| 402 |
| 402 |
| 804 |
| 750 |
| 750 |
| 1,500 |
| 750 |
| 750 |
| 1,500 |
| Net Change |
| (320) |
| (348) |
| (668) |
| (348) |
| (348) |
| (696) |
| MA Provider Recoveries |
| The Governor recommends increasing authority to pursue Medicaid provider recoveries through new recovery |
| mechanisms. By adding to the tools available to pursue Medicaid provider recoveries, amounts recovered will increase. |
| Performance Measures: |
| If successful, this change will improve fraud prevention and lead to increased collections of overpayments. |
| 101 |
| 94 |
| 195 |
| 94 |
| 94 |
| 188 |
| 500 |
| 500 |
| 1,000 |
| 500 |
| 500 |
| 1,000 |
| Net Change |
| (399) |
| (406) |
| (805) |
| (406) |
| (406) |
| (812) |
| Background Studies Scope Expanded - Revised |
| The Governor recommends improving background studies by expanding their scope to include routine access to the |
| Predatory Offender Registry (in many states, this is referred to as the "sex offender registry"), which is |
| maintained by the state Department of Public Safety (DPS).The Governor’s original proposal also included |
| expanding background study requirements to include mental health centers and clinics. That portion of the proposal has |
| been withdrawn. |
| Performance Measures: |
| The goal of this change is not to increase disqualifications, but instead to protect persons served in licensed programs. |
| The specific performance measure tracked will be the number of disqualifications resulting from the access to the |
| Department of Public Safety information. |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Background Studies - Access to MNCIS Information |
| The Governor recommends improving background studies by expanding their access to the Minnesota Court Information |
| System (MNCIS). This proposal creates a “rap back” system where data from MNCIS will automatically be |
| retrieved from the courts when there is new arrest data on a subject who has previously completed a background study. |
| The rap back system will make background studies more accurate and complete. This recommendation will also allow the |
| agency to convert from a name based background study system to a fingerprint based system. |
| Performance Measures: |
| The goal of this change is not to increase number of disqualifications, but rather to protect persons served in licensed |
| programs. It is estimated that new arrest information on 500 individuals each year will be newly available thanks to this |
| change, which will likely result in 25 additional disqualifications per year. The performance measure tracked will be the |
| number of disqualifications resulting from access to MNCIS through the rap back process. |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Modernization of DHS Technology Systems - Revised |
| The Governor recommends funding to implement the agency's systems modernization plan. This funding will leverage a |
| substantial amount of federal funding made available through 2015 as a results of the Affordable Care Act. This proposal |
| funds implementation of critical elements of the modernization plan including infrastructure, software and hardware |
| required for systems integration, eligibility systems improvement, and modernization of the agency's child support system. |
| Included in this funding recommendation is $4.327 million in FY2014-15 and $6.259 million in FY2016-17 for the state |
| share of technology costs associated with the Health Insurance Exchange. A portion of this item is contingent on federal |
| approval of Reform 2020. |
| Performance Measures: |
| A key measure will be how well the goal of integrated human service eligibility systems is achieved. An integrated system |
| would eliminate the need and administrative complexity of supporting and using multiple systems with aging technology |
| and incompatible data systems. Implementation of the integrated system will also result in greater efficiency in the delivery |
| of human services at the county level. |
| 11,169 |
| 17,960 |
| 29,129 |
| 9,143 |
| 4,829 |
| 13,972 |
| 24,018 |
| 38,803 |
| 62,821 |
| 23,260 |
| 12,072 |
| 35,332 |
| 12,849 |
| 20,843 |
| 33,692 |
| 14,117 |
| 7,243 |
| 21,360 |
| 11,169 |
| 17,960 |
| 29,129 |
| 9,143 |
| 4,829 |
| 13,972 |
| Net Change |
| 11,169 |
| 17,960 |
| 29,129 |
| 9,143 |
| 4,829 |
| 13,972 |
| County Performance Management System - Revised |
| The Governor recommends funding to support the development of a performance management system for the |
| state-county human services system. This includes funding for the administration of an advisory committee, development |
| of performance standards, and technical assistance to support improvement of low-performing counties. |
| Performance Measures: |
| The goal of this initiative is to create a performance management system that will transform the state-county relationship |
| in the delivery of human services. This change will also re-focus the state supervisory role to ensure, through support and |
| enforcement, that counties are achieving desired outcomes. |
| 796 |
| 704 |
| 1,500 |
| 704 |
| 704 |
| 1,408 |
| Net Change |
| 796 |
| 704 |
| 1,500 |
| 704 |
| 704 |
| 1,408 |
| Family Assets for Independence (FAIM) Minnesota - New |
| The Governor recommends restoring base funding for the Family Assets for Independence –Minnesota (FAIM) program. |
| The program provides matched savings to low-wage workers to help them build assets. Participants save earned income |
| each month that is matched at a 3:1 ratio by public and private resources. In addition to the matched savings accrued |
| through this initiative, participants receive general financial management training as well as training tailored to their |
| particular savings goal. Matched funds may be used for home ownership, post-secondary education or small business |
| development. |
| Performance Measures: |
| Number of participants who increased their savings through IDA or other savings accounts and the aggregated amount of |
| savings. This measure will also track the number of participants using the savings to capitalize a small business; pursue |
| post-secondary education or purchase a home. |
| 250 |
| 250 |
| 500 |
| 250 |
| 250 |
| 500 |
| Net Change |
| 250 |
| 250 |
| 500 |
| 250 |
| 250 |
| 500 |
| All-Day Kindergarten impact on MFIP Child Care - New |
| The Governor recommends a reduction in funding for the MFIP Child Care program due to his recommendation to |
| increase spending on all-day kindergarten. The expansion of the all-day kindergarten program will result in lowered usage |
| of MFIP Child Care assistance. |
| Performance Measures: |
| Expanded all-day kindergarten will reduce the achievement gap and increase achievement for all, including an increase in |
| third grade reading proficiency. |
| 0 |
| (1,368) |
| (1,368) |
| (1,399) |
| (1,408) |
| (2,807) |
| Net Change |
| 0 |
| (1,368) |
| (1,368) |
| (1,399) |
| (1,408) |
| (2,807) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| Mental Health Care Treatment Permitted in Foster Care - New |
| This proposal will allow child mental health treatment services to be delivered in any foster care home, by updating service |
| delivery requirements to current community standards. |
| Performance Measures: |
| The department will measure the success of this proposal by tracking the child’s level of functioning and mental health |
| symptomology utilizing standardized assessment tools, number of days in out of home placements, hospitalization days, |
| length of stay in foster care and the status of the child/adolescent after completing the program. It is expected that there |
| will be an increase in the number of children/adolescents completing the program and returning to their home |
| environment. |
| (146) |
| (85) |
| (231) |
| (161) |
| 322 |
| 161 |
| Net Change |
| (146) |
| (85) |
| (231) |
| (161) |
| 322 |
| 161 |
| Youth Homelessness Prevention Program - New |
| The Governor recommends funding for a youth homelessness prevention program to provide support for unaccompanied |
| homeless youth. These additional resources will be used to work with communities to develop additional capacity to meet |
| the unmet service needs in their area. With additional resources DHS will be better able to fund the full continuum of |
| homeless youth programming, ranging from prevention to permanent housing. |
| Performance Measures: |
| The number of homeless youth who are provided services from street outreach and drop-in center programs; obtain safe |
| temporary shelter; exit transitional living programs to stable housing; are in Transitional Living Programs or Supportive |
| Housing programs and access mainstream services; maintain stable housing in supportive housing programs. |
| 2,500 |
| 2,500 |
| 5,000 |
| 2,500 |
| 2,500 |
| 5,000 |
| Net Change |
| 2,500 |
| 2,500 |
| 5,000 |
| 2,500 |
| 2,500 |
| 5,000 |
| 1.67% LTC Rate Reduction Buyback - New |
| The Governor recommends repealing the 1.67% rate reduction for Long-Term Care providers, effective July 1, 2013. This |
| rate reduction was enacted in Minnesota Laws 2011, 1st Special Session Chapter 9, Article 7, Sections 46 and 54 and |
| was originally effective from July 1, 2012 to December 31, 2013. In the 2012 session, implementation of the 1.67% |
| provider rate and grant reductions was delayed until July 1, 2013. This change increases expenditures by $12.835 million |
| in FY2014. |
| Performance Measures: |
| Long term care providers are critical to serving people with disabilities and seniors in their homes and communities. This |
| proposal will increase the percent of people with disabilities and seniors to be served in their homes and communities |
| rather than in institutional settings. |
| 12,835 |
| 0 |
| 12,835 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 12,835 |
| 0 |
| 12,835 |
| 0 |
| 0 |
| 0 |
| MA Coverage of Electronic Tablets as Augmentative Communication Devices - New |
| The Governor recommends expanding the definition of MA-covered ''durable medical equipment'' to include electronic |
| tablets and related software and equipment when such devices are used by recipients as augmentative communication |
| devices. |
| Performance Measures: |
| This proposal promotes cost-effective services. |
| (7) |
| (15) |
| (22) |
| (21) |
| (21) |
| (42) |
| Net Change |
| (7) |
| (15) |
| (22) |
| (21) |
| (21) |
| (42) |
| Adjust Transfers Between the HCAF and GF - Revised |
| The Governor recommends adjusting a current law transfer between the health care access fund and the general fund by |
| $48 million. The transfer is reduced by $48 million in FY 2014 and increased by $48 million in FY 2015. The Governor's |
| original budget recommended adjusting the transfer by $44.986 million. |
| Performance Measures: |
| This proposal provides savings to the overall budget solution through reduced expenditures in FY 2014. |
| (48,000) |
| 48,000 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| (48,000) |
| 48,000 |
| 0 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| ACA: Primary Care Rate Bump - New |
| The Governor recommends funding the one-time systems cost associated with implementing a new federally funded |
| Medicaid payment rate increase. The Affordable Care Act requires states to increase Medicaid payment rates for certain |
| primary care providers for the 2013 and 2014 calendar years to the lesser of the corresponding Medicare rate for the |
| calendar year or the Medicare rate used in 2009. The federal government provides 100% of funding for the increased cost |
| related to the increased payment rates. |
| Performance Measures: |
| These increases will bring MA rates closer to Medicare rates and industry payment standards. |
| 8 |
| 0 |
| 8 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 8 |
| 0 |
| 8 |
| 0 |
| 0 |
| 0 |
| ACA: Appeals - New |
| The Governor recommends additional funding to address the increase in appeals activity resulting from increases in |
| Medical Assistance (MA) and New MinnesotaCare enrollment. Implementation of the Affordable Care Act is expected to |
| significantly increase enrollment in MA and MinnesotaCare and expand the scope of eligibility determinations for health |
| care options. This proposal provides the resources to manage costs associated with increased appeals activity related to |
| the increased enrollment in MA and MinnesotaCare. |
| Performance Measures: |
| The timely issuance of decisions will promote consistent application of the law and will ensure that benefits are not paid |
| incorrectly. MA regulations require the continued payment of benefits pending the outcome of appeals. As a result, the |
| issuance of timely decisions also reduces the amount of overpayments for pending appeal matters. DHS expects to |
| schedule all new appeals for a hearing within 30 days of the date the appeal was filed; to issue decisions in 100% of |
| SNAP cases (food support) within 60 days of filing and 100% of all other cases within 90 days of filing; and to prioritize |
| appeals to ensure that determinations having an imminent impact on clients can be heard and decided more quickly and |
| appeals with large financial implications for DHS can be heard and decided expeditiously. |
| 486 |
| 783 |
| 1,269 |
| 759 |
| 759 |
| 1,518 |
| Net Change |
| 486 |
| 783 |
| 1,269 |
| 759 |
| 759 |
| 1,518 |
| Continue Operations of MSHS-Willmar site - New |
| The Governor recommends continuing the operation of the Minnesota Specialty Treatment Services site in Willmar. The |
| Willmar site is a 16-bed mental health Intensive Residential Treatment program operated by State Operated Services. |
| This proposal is funded with a combination of resources from a dedicated State-Operated Services account and facility |
| revenues. |
| Performance Measures: |
| This proposal is expected to reduce the total number of non-acute bed days for psychiatric hospital length of stay |
| (excluding rule 20 stays) at Anoka Metropolitan Regional Treatment Center (AMRTC). DHS AMRTC Continued Stay |
| Criteria reports will be used to monitor this performance. |
| 2,713 |
| 2,713 |
| 5,426 |
| 2,713 |
| 2,713 |
| 5,426 |
| 2,713 |
| 2,713 |
| 5,426 |
| 2,713 |
| 2,713 |
| 5,426 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| ACA: New MinnesotaCare - New |
| The Governor recommends changing eligibility requirements and covered services under the MinnesotaCare program to |
| comply with the requirements for Basic Health Plan (BHP) funding under the ACA. These changes would be effective |
| January 1, 2014. In CY2014, MinnesotaCare will continue under a one-year extension of the state’s current Prepaid |
| Medical Assistance (PMAP) Plus federal waiver and will receive a 50% federal match. Beginning CY2015, Minnesota will |
| receive BHP funding for MinnesotaCare which results in an effective federal match rate of 85%. By FY2017, approximately |
| 195,000 individuals between 138-200% of FPG will be covered under MinnesotaCare under the new BHP requirements |
| and funding. |
| Performance Measures: |
| This proposal will reduce Minnesota's rate of uninsurance for persons above 138% of FPG, as measured by the annual |
| Health Access Survey administered by MDH. |
| (267,495) |
| (61,250) |
| (328,745) |
| (62,960) |
| (101,381) |
| (164,341) |
| 277,522 |
| 45,747 |
| 323,269 |
| (142,890) |
| (101,729) |
| (244,619) |
| Net Change |
| 10,027 |
| (15,503) |
| (5,476) |
| (205,850) |
| (203,110) |
| (408,960) |
| FY 14 |
| FY 15 |
| FY 14-15 |
| Biennium |
| FY 16 |
| FY 17 |
| FY 16-17 |
| Biennium |
| ACA: MinnesotaCare Share of Exchange Funding - New |
| The Governor recommends funding the New MinnesotaCare program’s share of Health Insurance Exchange operating |
| costs. Enrollees will use the Health Insurance Exchange to enroll in the New MinnesotaCare program. This |
| recommendation funds administrative costs to ensure that the new MinnesotaCare program can operate through the |
| infrastructure of the Health Insurance Exchange and leverages federal matching funds to do so. |
| Performance Measures: |
| This proposal will reduce Minnesota’s rate of uninsurance for persons above 138% of FPG, as measured by the annual |
| Health Access Survey administered by MDH. |
| 2,762 |
| 5,868 |
| 8,630 |
| 10,208 |
| 10,448 |
| 20,656 |
| Net Change |
| 2,762 |
| 5,868 |
| 8,630 |
| 10,208 |
| 10,448 |
| 20,656 |
| General Fund Transfer to HCAF in FY 2014 |
| The Governor recommends making a one-time transfer from the general fund to the health care access fund to ensure an |
| adequate fund balance in the health care access fund in FY 2014. |
| Performance Measures: |
| This proposal provides resources to the health care access fund on a one-time basis to maintain the health of the fund in |
| FY 2014. |
| 65,000 |
| 0 |
| 65,000 |
| 0 |
| 0 |
| 0 |
| 65,000 |
| 0 |
| 65,000 |
| 0 |
| 0 |
| 0 |
| Net Change |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| Strengthen Newborn Screening Program |
| The Governor recommends strengthening the state's newborn screening program by adding new tests to the screening |
| program for infants. This program is administered by the Minnesota Department of Health, but will also have an impact on |
| the state's Medical Assistance (MA) program, which is administered by DHS. Only the MA costs are reflected here. The |
| remainder of the change can be found under the Department of Health. |
| Performance Measures: |
| The goal of this proposal is to increase the number of children with a congenital or hereditary disorder that are identified |
| early enough in life to improve medical outcomes. This will be measured by the number of affected children found through |
| the Newborn Screening System. |
| 296 |
| 496 |
| 792 |
| 496 |
| 496 |
| 992 |
| Net Change |
| 296 |
| 496 |
| 792 |
| 496 |
| 496 |
| 992 |
| Net All Change |
| Items |
| 0 |
| 0 |
| 0 |
| 2,000 |
| 4,000 |
| 2,000 |
| (54,801) |
| 223,578 |
| 168,777 |
| 346,378 |
| 695,565 |
| 349,187 |
| 158,971 |
| 25,759 |
| 184,730 |
| (178,007) |
| (392,679) |
| (214,672) |
| Net Change |
| 104,170 |
| 249,337 |
| 353,507 |
| 136,515 |
| 170,371 |
| 306,886 |