Purpose

This bill aims to change how some home-based services are paid for under Minnesota’s Medicaid waivers. It would allow certain providers to bill for indirect, non-face-to-face services (not remote support) when the service recipient cannot be involved directly, with the recipient’s informed consent. The goal is to keep needed services available and prevent gaps in care.

Main Provisions

• Indirect billing authorization:

  • By December 1, 2025, the commissioner of human services must submit amendments to the federal HCBS waiver plans to permit indirect billing for individualized home supports (IHS) provided by providers with training, without training, or with family training.
  • These indirect services are for situations where direct contact with the recipient is not possible or is limited, but the services are necessary to maintain other needed services.

• Conditions for indirect services:

  • There must be a reasonable attempt to involve the service recipient directly.
  • The recipient must be unable to participate directly due to illness, injury, or other factors, or the recipient must have given an informed choice to allow services without direct contact.
  • Indirect services must be provided without direct contact (not defined as remote support).

• What can be billed indirectly (at least these areas must be covered in waiver plan amendments): 1) Researching, coordinating, and arranging transportation, equipment, and training needed for safe community access. 2) Arranging and coordinating access to health care, including scheduling medical appointments, communicating with health professionals, benefits gathering, review/analysis, and related health and wellbeing training. 3) Coordinating and advocating for legal support, crisis prevention, positive support strategies, and maintaining the recipient’s preferences. 4) Collaborating with employers to maintain the recipient’s employment. 5) Arranging and coordinating access to basic needs (shelter, food, phone, Internet). 6) Coordinating to help the recipient continue living independently in their own home (including work with property management). 7) Coordinating with other service providers and natural supports for status changes and crisis management, including working with the recipient’s interdisciplinary team and ensuring access to equipment and technology and related training to maintain preferences.

• Definitions:

  • Indirect provision of services means services provided without direct contact, as defined in Minnesota law, and not through remote support as defined in the waiver plan.

Significance and Changes to Law

• Expands how services under HCBS waivers can be funded by allowing indirect, non-face-to-face service delivery to be billed to Medicaid when direct contact isn’t possible.
• Requires federal (CMS) approval of the waiver amendments to authorize this indirect billing for multiple types of IHSS services.
• Shifts some support responsibilities toward coordination, case management-like tasks, and back-office activities that support a recipient’s health, safety, independence, and community participation.

Implementation Considerations

• Dependency on federal approval from CMS for the changes to take effect.
• Need clear safeguards to ensure informed recipient consent, ongoing oversight of billing for indirect services, and appropriate documentation of indirect activities.
• Will require providers to adapt billing practices to reflect indirect services and verify that direct-contact requirements are appropriately limited by the recipient’s situation.

Definitions and Key Terms (for clarity)

• Indirect billing / indirect provision of services
• Individualized home supports (IHS) with training, without training, with family training
• Home and Community-Based Services (HCBS) waiver plans
• Centers for Medicare and Medicaid Services (CMS)
• Direct contact vs. indirect services vs. remote support
• Interdisciplinary team
• Service recipient

Affected Parties

• Service recipients under Minnesota HCBS waivers
• Providers of individualized home supports (IHS)
• Minnesota Department of Human Services
• Federal CMS (for waiver approvals)

Potential Impacts

• Increased flexibility to maintain access to essential services during illnesses or other barriers to direct contact.
• Potential improvements in continuity of care and community integration for recipients.
• Need for careful monitoring to prevent misbilling and to protect recipient rights and consent.

Relevant Terms indirect billing, indirect provision of services, individualized home supports, IHSS, home and community-based services waiver, HCBS waiver, Centers for Medicare and Medicaid Services, CMS, direct contact, remote support, waiver plan amendments, interdisciplinary team, health care coordination, transportation coordination, health and wellbeing, crisis prevention, independent living, basic needs, employment, legal support, advocacy, consent.