Purpose

• Delay the implementation of Waiver Reimagine Phase II by about one year and set a new implementation path for a two-home and community-based services waiver program under federal rules (SSA section 1915c). The effective start is January 1, 2027 (or 2028), or when federal approval is obtained, whichever is later.

What the bill would do (Main Provisions)

• Create Waiver Reimagine Phase II under two-home and community-based services, using the 1915(c) waiver framework, to serve people who need levels of care similar to nursing homes, hospitals, neurobehavioral hospitals, or intermediate care facilities for persons with developmental disabilities.
• Require an individualized budget methodology under the 1915(c) waiver, to determine funding for the same high-care individuals.
• Establish an individualized budget exception to support access to self-directed home care nursing services.
• Lead agencies must submit budget exception requests to the commissioner using a process defined by the commissioner.

Eligibility and rules for the budget exception

• Eligibility criteria for the budget exception (must meet all three): 1) The person is assessed as needing hospital-level care, evidenced by DHS Form 7096 and related medical monitoring/treatment documentation. 2) The person is assessed to receive a “support range” budget in category E or H. 3) The person does not receive other specific waiver services such as community residential, family residential, integrated community supports, or customized living services.
• Home care nursing services funded through a budget exception must be ordered by a physician, physician assistant, or advanced practice registered nurse.
• If the participant chooses home care nursing, the services must be performed by a registered nurse (RN) or licensed practical nurse (LPN) within their scope of practice.
• If, after annual reassessment, the person no longer meets the requirements, the commissioner must terminate the budget exception.

Other important provisions

• The commissioner may seek any federal authority needed to implement these changes.
• The new waiver service menu and individual budgets must allow people to live in their own home, a family home, or any home and community-based setting of their choice.
• The changes must be implemented in a way that does not cause unintended service disruptions and must be feasible within available resources.
• By no later than July 1, 2026 (or 2027), the commissioner must develop and implement an online support planning and tracking tool. Features include:
  • Accessible format to help people using disability waiver services make informed choices.
  • Display of the total budget available, the services for which a person is eligible, and the services they have chosen and used.
  • Exploration of real-time tracking options to show a person’s remaining budget throughout the service year.
  • Seek input from people with disabilities about the online tool before it is implemented.

Terminology and scope notes

• The bill centers on “Waiver Reimagine Phase II,” a federal-structure waiver under “section 1915(c) of the Social Security Act.”
• It uses terms like “two-home and community-based services waiver,” “individualized budget methodology,” “budget exception,” “support range budget E or H,” and references to care settings such as “nursing home,” “hospital,” “neurobehavioral hospital,” and “intermediate care facility for persons with developmental disabilities (ICF/DD).”
• It also references “home care nursing services,” and providers authorized to deliver them (RNs and LPNs within scope of practice).

Implementation and oversight

• Effective date set as described above (2027/2028 or upon federal approval, whichever is later).
• Online tool development and real-time budget tracking are to be completed by the stated July 1 date (2026 or 2027, depending on final version).
• The commissioner must ensure that the program operates with appropriate oversight and stakeholder input, especially from people with disabilities.

Summary of intended impact

• The bill aims to restructure high-need disability services so people can receive needed care at home or in community settings with transparent budgeting.
• It introduces a formal mechanism to allow self-directed home care nursing when eligible and ensures budgeting aligns with services used and available resources.
• It emphasizes accessibility, informed choice, and real-time awareness of budget status to support people in managing their disability waiver services.

Changes to existing law

• Amends Laws from prior sessions to implement Waiver Reimagine Phase II with the new waiver structure, budget methodologies, and online planning/tracking tools.
• Creates specific eligibility criteria and process for budget exceptions that did not exist in the same form before.

Relevant Terms - Waiver Reimagine Phase II - two-home and community-based services waiver - section 1915(c) of the Social Security Act - individualized budget methodology - budget exception - support range budget E or H - hospital-level care - nursing home - neurobehavioral hospital - ICF/DD (intermediate care facility for persons with developmental disabilities) - home care nursing services - registered nurse (RN) - licensed practical nurse (LPN) - DHS Form 7096 - online support planning and tracking tool - accessible format - real-time budget tracking - lead agencies - federal authority - annual reassessment