1. Purpose

2. This bill focuses on reforming how home and community-based services (HCBS) case management is delivered for people receiving waivers and basic services under Minnesota’s Medicaid waivers. It aims to improve planning, coordination, monitoring, and accountability; expand the use of qualified vendors; strengthen oversight and cultural responsiveness; and establish processes for reporting and ongoing improvement through a waiver case management quality framework.

3. Main Provisions

4.1 Case management requirements for HCBS waivers - Each HCBS waiver recipient must receive case management from qualified vendors as described in the federally approved waiver plan. - Case management activities include: - Developing a person-centered support plan. - Informing the person or their guardian/parent about all service options available under the waiver plan. - Consulting with relevant medical experts or service providers. - Helping the person find potential service providers, including providers in non-disability-specific settings, employment service providers, and providers of financial management services. - Assisting in accessing services and in appeals. - Coordinating services if another provider isn’t coordinating them. - Evaluating and monitoring services, with at least one annual face-to-face visit. - Reviewing support plans and recommending service authorizations based on identified needs. - Assisting and cooperating with facilities licensed under chapter 144G and meeting licensee obligations.

4.2 Delivery, oversight, and cultural responsiveness - If a county agency contracts for case management, it must provide contact information for filing grievances about the contracted services. - A competitive procurement process must be used for contracted case management at least every two years, with contract oversight to ensure high-quality services. - The competitive process must include criteria to ensure the county maintains a culturally responsive program, defined as delivering equitable, comprehensive, respectful, and high-quality care that accounts for language, culture, health literacy, and other needs of specific populations.

4.3 Timing for new contracts - Beginning July 1, 2029, counties may not enter into new contracts or renew existing county-level case management contracts.

4.4 Provider qualifications and conflict of interest - Case management must be provided by a public or private agency enrolled as a medical assistance (MA) provider and meeting requirements in the approved federal waiver plans. - A private agency may not provide case management if it has a financial interest in other services included in the recipient’s plan. - The term “private agency” is defined as any agency that is not identified as a lead agency under section 256B.0911 subdivision 10.

4.5 Case manager duties and collaboration - Case managers are responsible for the services listed above and must collaborate with the person receiving services, their family, legal representatives, and relevant medical experts and providers in developing and annually reviewing the person-centered support plan and the habilitation plan. - For individuals needing a positive support transition plan under chapter 245D, the case manager must participate in its development and ongoing evaluation with an expanded support team.

4.6 Expanded support team and ongoing evaluation - At least quarterly, the case manager, with the expanded support team, must evaluate the plan’s effectiveness using progress data from the licensed provider. - The evaluation must identify whether the plan is: - Phasing out prohibited procedures, - Building skills to eliminate those procedures, - Meeting timelines and achieving outcomes. - If progress is not adequate, the case manager must work with the expanded support team to identify modifications and determine if extra professional support is needed.

4.7 Training and education for case managers - The Department of Human Services (DHS) must offer ongoing education in case management. - Case managers must receive at least 20 hours of case-management and disability-related training each year, covering topics such as service authorization, person-centered planning, informed choice, informed decision making, cultural competency, employment planning, community living planning, self-direction options, and use of technology supports. - Case managers must annually complete an informed-choice curriculum and pass a competency evaluation on informed decision-making standards. - By August 1, 2024, all case managers must complete an employment support training course identified by the DHS commissioner. - For case managers hired after August 1, 2024, this training must be completed within the first six months of providing case management services. - Case managers must document training completion in a system identified by the commissioner.

4.8 Definitions and interpretation - For the purposes of the section, “person-centered planning” has the meaning given in section 256B.0911 subdivision 10. - Case managers must document completion of training in the designated DHS system.

4.9 Reporting and quality framework (implied) - The bill’s title and provisions indicate the creation of a waiver case management quality framework (and required reports), which would entail ongoing oversight, evaluation, and reporting to improve the quality and accountability of waiver case management services.

1. Significant Changes to Existing Law

• Mandates that HCBS waiver case management be delivered by qualified vendors and integrated into the federally approved waiver plans.
• Expands and formalizes the list of case management activities, including a formal annual face-to-face visit and enhanced involvement in service planning and provider selection.
• Introduces stricter procurement and oversight requirements for county-contracted case management, including a guaranteed grievance mechanism and a mandated culturally responsive program.
• Establishes a firm timeline restricting new or renewed county case management contracts after July 1, 2029.
• Tightens provider eligibility rules by prohibiting private agencies with conflicting financial interests in other services covered by a recipient’s plan.
• Strengthens the role and responsibilities of case managers, including collaboration with expanded support teams and quarterly plan evaluations focused on eliminating prohibited procedures and achieving outcomes.
• Elevates workforce training and credentialing requirements for case managers, including a minimum annual training load, an required informed-choice competency, and a mandatory employment support course for new hires (with a defined rollout timeline).
• Introduces or expands mechanisms for reporting, quality assurance, and likely a statewide quality working group to oversee waiver case management (as indicated by the bill’s title).

1. Implementation and Impact Considerations

• Recipients and families: Potentially more coordinated and person-centered planning, with clearer access to information about service options and a stronger role for case managers in monitoring progress and ensuring plan goals are met.
• Providers and counties: New requirements for qualifications, procurement cycles every two years, grants for grievance processes, and a push toward culturally responsive practices. A transition plan is implied for moving away from new contracts after 2029.
• State oversight: Increased DHS responsibilities for training, quality assurance, and reporting to ensure compliance and continuous improvement in waiver case management.

Relevant Terms - home and community-based services (HCBS) - case management - waiver - person-centered support plan - qualified vendors - medical assistance (MA) provider - competitive proposal process - culturally responsive program - county agency - lead agency - private agency - 144G facilities (licensed facilities) - positive support transition plan - expanded support team - prohibited procedures - progress evaluation data - informed choice - informed decision making - employment planning - community living planning - self-direction - technology supports - employment support training - grievance process - federal waiver plan - 256B.0911 subdivision 10 - 256B.092 subdivision 1a - 256B.49 subdivision 13.1.7 - 245D (positive behavioral supports)