Health care appropriations target children’s services

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Besides authorizing Medical Assistance coverage for early intervention treatment of children with autism, a bill re-passed by the House late Friday would require large employers to offer insurance benefits for autism spectrum disorder therapy.

The initiatives are included in HF1233*/ SF1034, the omnibus health and human services finance bill. After adopting the report, the House passed the bill 73-61.

Rep. Thomas Huntley (DFL-Duluth) and Sen. Tony Lourey (DFL-Kerrick) sponsor the bill, which must be re-passed by the Senate before going to the governor.

Under a Reform 20/20 proposal, $12.7 million would be appropriated from the General Fund to create a new MA benefit for children under age 18 with autism, who would receive family-centered, culturally appropriate and individualized treatment.

The Centers for Disease Control and Prevention estimated that one in 88 children was on the autism spectrum in 2012. In 2010, more than 17,000 residents with autism spectrum disorder received Medical Assistance. Depending upon the intensity of the individual’s treatment plan, therapies can cost between $30,000 and $100,000 per year, yet few insurance plans offer coverage.

The bill would mandate insurance coverage for employers with 50 or more employees, a provision sponsored by Rep. Kim Norton (DFL-Rochester). This provision narrowly passed the conference committee after two of the five senators voted against it. Coverage would also be required for state employee group insurance participants beginning in 2016, or before if a collective bargaining agreement or compensation plan includes coverage as an added benefit.

Representatives from Medica and the Minnesota Chamber of Commerce opposed it because it would only apply to a narrow group of insured individuals and would not include children covered under self-insured plans or in Mnsure, the new health insurance marketplace beginning on Jan. 1, 2014.

Norton said her long-term goal would be to include mandated coverage in a list of Minnesota Essential Health Benefits for policies purchased through the health care exchange plans beginning in 2016.

Other care for children

Conferees also adopted the governor’s proposed consolidation of child adoption and foster care rate payment programs, which was not funded in either bill passed earlier by the House and Senate. Current payment rates create disparities and incentivize foster care, rather than adoption. Known as the Northstar Care for Children Act, the bill includes a Senate provision that would grant a 2 percent rate increase to adoptive parents and relatives who have custody of a minor.

The Northstar program would use $3.2 million from the General Fund in the 2014-15 biennium and $16.3 million in the following biennium. Streamlining is expected to result in more children being adopted within two years of entering foster care.

The bill would also allow the Department of Human Services to close some child support cases when payments are overdue three years or more. This would allow staff to work on cases with a higher probability of payment. In the absence of a state law, DHS is required under federal law to continue trying to collect delinquent child support payments, even if there is no reasonable chance of collecting the money.

Rep. Diane Loeffler (DFL-Mpls) said the policy would lead to “more fruitful collections” serving more children.

Other child-related provisions in the bill would:

  • expand MA coverage for children and pregnant women up to 275 percent of the federal poverty guideline;
  • allocate $360,000 for fetal alcohol syndrome grants;
  • modify child care provider regulations regarding children under their care;
  • raise the limit from 10 to 25 days per year that child care providers can be reimbursed when a child enrolled in the Child Care Assistance Program is absent;
  • increase access to quality child care for children with high needs;
  • remove the cap on Minnesota Family Investment Program’s cash benefits when a recipient has another child;
  • provide funding for shelter and treatment of sexually exploited youth and to de-criminalize exploited youth; and
  • fully fund the governor and House proposal to increase School-Linked Mental Health Grants so that mental health providers can serve children in more schools.

The all-day kindergarten proposal contained in the omnibus K-12 education finance bill would result in $1.7 million in savings to the DHS’s MFIP child care assistance program because of reduced child care needs.

Adults and their caregivers

Recent policy changes are driving Minnesota toward keeping aging adults in their homes and in small group settings within their community as an alternative to nursing homes. As more elderly and disabled residents receive care using the home and community-based service model, new policies are needed to protect the safety and rights of health care waiver recipients. Several provisions in the bill would create policies to ensure client safety, to provide more choices and to prevent maltreatment.

Nursing homes, which were due to take a 1.67 percent cut, would instead receive a 5 percent cost-of-living increase, with three-quarters of the increase dedicated to staff wages.

Rep. Joe Schomaker (R-Luverne) said that was not enough. “The funding in this area is still lacking,” he said.

“Joe, Joe, say it isn’t so. You cannot snub your nose at a 5 percent increase,” responded Rep. Patti Fritz (DFL-Faribault), who has been a staunch advocate for increases to nursing homes.

Several Republicans said a 1 percent increase for long-term care facilities for people with disabilities fell short and should have matched nursing home increases.

“I’ve been here 25 years and this is the first time I’ve been accused of not spending enough money,” Huntley said.

Efficiencies and cost savings may result from a revised policy in the bill.

When adults on waivered services go to the doctor, the clinic is only eligible to be reimbursed for providing one covered service, per day. However, some clients may require or prefer to receive multiple services, such as mental health therapy or dental services in addition to a doctor’s appointment. A Senate provision would enable payment to multiple providers for services at the same clinic on the same day. By combining visits, the state could also see savings for the cost of providing non-emergency medical transportation to the client.

Hospitals feared when the bill left the House and Senate the first time that a proposed increase in surcharges would create financial hardship for many hospitals. However, conferees replaced the higher surcharges with an accelerated payment schedule that would raise about $40 million.

Similarly, Health Maintenance Organization surcharges and caps on HMO reserves were proposed, but were replaced with a plan to collect $40 million in lump sum annual premium payments or accelerated payment schedules, depending upon the type of premium.

“I was happy to see the hospital one go away,” Huntley said.

Omitted by conferees

Several House and Senate provisions that went into the conference committee did not come out.

Rep. Mary Franson (R-Alexandria) told conferees that it is too soon to adopt a Senate provision that would base child care assistance payment rates on a quality rating system of providers. The Parent Aware program is too soon to implement in Greater Minnesota, where there are fewer child care choices, she said. Also, recipients needing child care assistance may work nights and weekends, which limits rural choices even further.

Sen. Carla Nelson (R-Rochester) defended the Senate position, saying that quality child care is important to a child’s later success in school. “This is the right thing to do morally, it’s the right thing to do educationally and I think it’s the right thing to do by the taxpayer,” she said.

There were not the required three votes by each of the House and Senate conferees and the measure failed.

Two provisions were dead on arrival. The House floor amendment to require drug testing of legislators was Liebling’s “tongue-in-cheek” response to an amendment from Rep. Steve Drazkowski (R-Mazeppa) to drug test MFIP recipients.

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