HF4632

Purpose

To reorganize Minnesota’s disability and elder care waiver system into a new structure (Phase II) that uses a budget and service model based on each person’s assessed needs, rather than where they live, and to expand how and where services can be provided.

Key Provisions and what the bill aims to do

• Waiver structure and authority

  • Create a two-home and community-based services waiver program structure under section 1915(c) of the federal Social Security Act for people who require levels of care similar to those in nursing homes, hospitals, neurobehavioral hospitals, or intermediate care facilities for persons with developmental disabilities.
  • Implement an individualized budget methodology under 1915(c) to set budgets based on assessed needs, not residence or location.
  • Allow access to a waiver service menu and budgets that support living in a person’s own home, a family home, or any home and community-based setting of the person’s choice.

• Budgeting and eligibility rules

  • Do not determine budgets based on where a person lives; budgets must be based solely on assessed needs.
  • Develop an exception process to support access to self-directed home care nursing services (budget exception).
  • Eligible participants for the budget exception must meet all of these: (1) need level of care delivered in a hospital setting (supported by DHS form 7096 or equivalent medical documentation), (2) qualify for a support range budget of E or H, and (3) do not receive certain other community-based services (no community residential, family residential, integrated community supports, or customized living services).
  • Home care nursing services funded by the budget exception must be ordered by a physician, physician assistant, or advanced practice registered nurse; services must be provided by an RN or LPN within their licensed scope of practice.
  • If annual reassessment shows requirements for the budget exception are no longer met, the commissioner must terminate the budget exception.

• Access, safety, and continuity

  • The commissioner must seek any federal authority needed to implement these changes.
  • Ensure the new waiver menu and individual budgets allow people to live in the home of their choice and do not cause unintended service disruptions within available resources and applicable laws/regulations.

• Planning tools and stakeholder input

  • By no later than July 1, 2026, develop and implement an online support planning and tracking tool that provides information in an accessible format to help people make informed choices. The tool should show:
  • total budget available to a person,
  • the services for which they are eligible,
  • and the services they have chosen and used.
  • Explore options for real-time tracking of a person’s remaining budget throughout the service year.
  • Seek input from people with disabilities about the online planning tool before it is implemented.

• Implementation timing

  • The new two-home waiver and budget framework takes effect January 1, 2027, or upon federal approval, whichever is later.

Significant changes to existing law

• Replaces or modifies the prior Waiver Reimagine framework (Phase I) by codifying Waiver Reimagine Phase II with a formal two-home and community-based services waiver and an individualized budget methodology under federal authority (section 1915(c)).
• Shifts from budget decisions based on residence to decisions based on assessed needs, introducing a formal budget exception for self-directed home care nursing and a new online planning/tracking tool.
• Expands allowable living settings to include a person’s own home, a family home, or any home and community-based setting, subject to resources and regulations.

Implementation and oversight notes

• Lead agencies must submit budget exception requests to the commissioner using a method identified by the commissioner.
• The commissioner may seek federal authority as needed to implement these changes.
• The online tool and real-time budget tracking are subject to accessibility and accurate data requirements, with stakeholder input prior to launch.

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Relevant Terms - waiver - waiver program structure - two-home and community-based services waiver - 1915(c) of the federal Social Security Act - individualized budget methodology - levels of care - nursing home - hospital - neurobehavioral hospital - intermediate care facility for persons with developmental disabilities (ICF/dd) - self-directed home care nursing services - budget exception - support range budget (E or H) - home care nursing services - physician, physician assistant, advanced practice registered nurse (APRN) - registered nurse (RN) - licensed practical nurse (LPN) - DHS form 7096 - annual reassessment - federal authority - online support planning and tracking tool - real-time budget tracking - accessible information - service menu - community-based setting - lead agencies