Purpose

• Direct the commissioner of human services to seek federal approval to allow indirect billing for certain individualized home supports under the home and community-based services (HCBS) waiver. The goal is to enable providers of individualized home supports (with training, without training, and with family training) to bill for services provided without direct contact, under specific conditions, to help maintain access to other necessary services for the recipient.

What would be billed indirectly (Main Provisions)

• The commissioner must submit amendments to the HCBS waiver plans to allow indirect billing for at least the following supports: 1) Researching, coordinating, and arranging transportation, necessary equipment, and all support and training needed for safe community access. 2) Arranging and coordinating access to health care, including scheduling medical appointments, communicating with health professionals, benefits data gathering, review and analysis, and related support and training for health and wellbeing. 3) Coordinating and advocating to ensure needed legal support, crisis prevention, positive support strategies, and related training to maintain the recipient’s preferences. 4) Collaborating with employers to maintain the recipient’s employment. 5) Arranging and coordinating access to resources for basic needs (shelter, food, telephone, Internet). 6) Coordinating to help the recipient live independently in their own home, including collaboration with property management, coordinating with other home- and community-based service providers, meeting with the recipient’s interdisciplinary team, and ensuring access to equipment/technology and all training needed to maintain preferences. 7) Coordinating with other service providers and natural supports as needed for status changes and crisis management.

Conditions for indirect services

• Indirect provision of services means providing services without direct contact and not through remote support, as defined in the waiver plan and statutes.
• Indirect billing may be used only if:
  • The indirect services are necessary to ensure continuity of other required services and supports for the recipient, and
  • Reasonable attempts have been made to directly involve the recipient, or the recipient cannot be directly involved due to illness, injury, or other factors, or
  • The recipient has made an informed choice to allow services to be provided without direct contact.

Definitions and scope

• Indirect provision is defined as services delivered without direct person-to-person contact (and not via remote support) as described in Minnesota law and the applicable waiver plan.

Timeline and implementation

• The commissioner must submit the waiver amendments to CMS by December 1, 2025.
• The amendments must seek federal approval to permit indirect billing for the listed supports, enabling these services to be billed under the HCBS waivers when the stated conditions are met.

Impacts and scope of change

• This bill would expand billing to cover certain support activities that previously required direct contact, potentially increasing the reach of services funded under HCBS waivers.
• The change hinges on federal approval and precise definitions within the waiver plans to ensure proper use and oversight.

Relevant terms - indirect billing - individualized home supports - home and community-based services waiver (HCBS waiver) - indirect provision of services - direct contact (as defined in statute) - remote support - Centers for Medicare and Medicaid Services (CMS) - waiver plan amendments - health care coordination - transportation coordination - employment collaboration - crisis prevention - legal support advocacy - basic needs (shelter, food, phone, Internet) - independent living - interdisciplinary team - natural supports - informed choice - continuity of services

Relevant Terms - indirect billing - individualized home supports - HCBS waiver - indirect provision of services - direct contact - remote support - CMS - waiver plan amendments - transportation - health care coordination - employment - basic needs - independent living - crisis management - legal support - interdisciplinary team