The conference committee on SF4476, comprised of Senators John Hoffman, Omar Fateh, Melissa Wiklund,
and Jim Abeler, and Representatives Joe Schomacker, Dawn Gillman, Mohamud Noor,
and Heather Keeler, completed their work over the weekend. The bill contains
many provisions from HF3379 (Hoffman/Wiklund) Program Integrity bill.
SF4476 passed the Senate on Sunday
night on a vote of 35-31; the House followed suit on a vote of 108-26. The bill was presented to Governor
Walz on May 20 as chapter 121.
SF4476
Spreadsheet; May 17, 2026
Department of Human Services:
- Line
49: DHS Total Appropriations ($149,241M) (FY26-27); ($157,029M) (FY28-29)
- Line
146: Establish Continuity of Care Team: $3,597M (FY26-27); $7,852M
(FY28-29)
- Line
157: Transforming the Human Services System: $4,463M (FY26-27); $11,175M
(FY28-29)
- Line
165: MnCHOICES Workgroup and Report: $450,000 (FY26-27); $750,000
(FY28-29)
- Line
167: MnCHOICES Assessments: $11,773M (FY28-29)
- Line
179: State Administered Eligibility Processing Assessment: $2,000M
(FY26-27)
- Line
197: Waiver Case Management Work Group and Rates Study: $374,000
(FY26-27); $374,000 (FY28-29)
- Line
203: Billing and Payment Oversight for Disability, Older Adult, BH
Services: ($8,315M) (FY26-27); ($242,658M) (FY28-29)
- Line
304: Market and Receipt-Based Rate Modification for Disability and Older
Adults Services: ($504,000) (FY26-27); ($4,536M) (FY28-29)
- Line
313: Modernizing Program and Payment Integrity Safeguards: ($85,672M)
(FY26-27); $8,879M (FY28-29)
- Line
335: Enhancing Program Integrity in MA: $3,930M (FY26-27); $46,632M
(FY28-29)
- Line
372: Program Integrity in Integrated Community Supports Services: $2,140M
(FY26-27); ($4,236M) (FY28-29)
- Line
437: Appeal of Temporary Payment Withhold: $4,015M (FY26-27); $9,290M
(FY28-29)
- Line
455: Administrative Funding for IT Modernization: $1,301M (FY28-29)
- Line
486: Interpretive Guidelines for Disability Waiver Regulations: $652,000
(FY28-29)
- Line
491: CFSS Shared Services Requirements Modification: $399,000 (FY26-27);
$936,000 (FY28-29)
- Line
511: Disability Waiver Annual Vehicle and Home Limit Modifications:
($114,000) (FY26-27); ($5,195M) (FY28-29)
- Line
521: Federal Compliance: Medicaid Access Rule: $1,400M (FY26-27); $2,268M
(FY28-29)
- Line
592: Earlier Effective Date for Improving Housing Options: ($9,163M)
(FY26-27); ($1,784M) (FY28-29)
- Line
597: Federal Compliance: Access to Services for Incarcerated Individuals:
$178,000 (FY26-27); $3,023M (FY28-29)
- Line
627: Human Services Grant
Reductions and Underspent: ($85,985M)
(FY26-27); ($11,382M) (FY28-29) (SEE LINES 627-661 FOR INDIVIDUAL GRANT
LIST)
- Line 634: LTSS Loan Program
Balance: ($65,234M) (FY26-27);
($5,620M) (FY28-29)
- Line 636: LTSS Loan Program
Appropriation: ($822,000) in
FY2627
Department of Children Youth and
Families:
- Line
869: Human Services Redesign (Transforming the Human Services System):
$2,247M (FY26-27); $1,296M (FY28-29)
- Line
875: Program Integrity in CCAP: $2,189M (FY26-27); $5,876M (FY28-29)
SF4476
Language:
Article 1: Continuity Of Care:
- Section
1: Continuity Of Care (adds 256B.045):
Requires the commissioner to establish a continuity of care team at DHS to
preplan, coordinate, and oversee the continuity of care of all clients of
a residential waiver service provider who is subject to a payment withhold
initiated by the commissioner, and provides for direct intervention by
the continuity of care team if the lead agency is unable to adequately
establish continuity of care.
- Subdivision 3. Lead Agency Duties. (a) When a provider is subject to an
administrative action or serious operational event, the lead agency
must:
(1) inform the appropriate
ombudsperson's office for each recipient currently receiving services, if
applicable, that the recipient's service provider is subject to an
administrative action or is experiencing a serious operational event; and(2) directly notify each recipient who
receives services from the provider that the recipient's service provider is
subject to an administrative action or is experiencing a serious operational
event.
(b) When a service provider provides
notice under subdivision 2 that it is unable to continue to provide services to
a recipient due to an administrative action or serious operational event, the
lead agency must assist the provider in developing a continuity of care plan to
facilitate the recipient's transition to another provider of the recipient's
choice. The continuity of care plan must be developed through a
person-centered process and include alternative service options, settings, and
service providers with known service capacity. The lead agency must complete
and receive approval from the recipient of the continuity of care plan no later
than 14 days following the notification under subdivision 2.
(c) When a lead agency identifies a
recipient's transition as a complex transition under section 256B.046, the lead
agency must develop a complex transition plan and
cooperate with and provide information to the commissioner as requested so that
the commissioner can ensure each recipient receives continuity of medically
necessary services and supports through a safe and orderly transition to an
appropriate alternative service provider.
(d) Nothing in this section prohibits
the lead agency from contacting the commissioner or continuity of care team
established in subdivision 4 to request support in ensuring continuity of care.
- Section
2: Complex Transitions
(256B.046):
- Subdivision
1. Complex Transition Identification: The lead agency must work with
the provider and commissioner to identify each recipient whose
transition is a complex transition
- Subdivision
2. Complex Transition Plan. (a) The commissioner must develop guidance on
effective complex transition planning and make a complex transition plan
template available to providers and lead agencies.
- Subdivision
3. Complex Transition Planning. (a) A lead agency that receives notice
from a provider of a serious operational event must assist a recipient
with an identified complex transition to develop a complex transition
plan through a person-centered process.
- Subdivision 4. No Alternative Services
Notification/Lead Agency Responsibilities
- Subd
5. Publishing Data on Continuity of Care Planning and Complex
Transitions/DHS Website
- Section
4: MCO/CBP duties when a provider is no longer able to provide services (section 256B.69, adds subdivision 38).
- Section
6: Housing Support Capacity-Building Grants. DHS must establish
capacity-building grants for housing support providers assisting
recipients of MA home and community-based services, including but not
limited to integrated community supports, to prevent homelessness and
institutionalization. The commissioner must award at least one grant to a
qualified grant recipient located outside of the seven-county metropolitan
area.
- Section
7: Direction to Commissioner; Continuity Of Care Policies And Procedures: DHS
must develop policies and procedures lead agencies must follow when
developing, implementing, monitoring, and closing a complex transition
plan under Minnesota Statutes, section 256B.046.
Article 3: Health Care:
- Section
3: Case Management Contract/In-Person by Interactive Video or Telephone
(section 245.462. adding subdivision 2a).
- Section
4: Coordination between case manager and community support services/adults
(section 245.4711, subdivision 5): The case manager must have at least one
contact each month; telephone contact is limited to no more than two
consecutive months.
- Section
5: Coordination between case manager and community support
services/children (section 245.4881, subdivision 5): The case manager must
have at least one contact each month.
- Section
9: DHS Home and Community-Based Services Early and Often Licensor and
Compliance Team (section 245A.042, adds subdivision 7).
- Section
13: DHS Home and Community-Based Services Provider Support and Technical
Assistance Team (section 256.01, adds subdivision 46).
- Sections
27, 28, 62: NEMT (section 256B.0625, subdivisions 17 and 18i):
- removes July 1, 2026, effective date for
state takeover of administration.
- requires the commissioner DHS to provide
six-months notice to counties, managed care organizations, and
county-based purchasing organizations before implementing the
administrator required under this subdivision.
- requires the commissioner must notify
the revisor of statutes when the administrator under this subdivision is
implemented. EFFECTIVE DATE. This section is effective the day following
final enactment.
- Section
29: Mental Health Case Management/MA Reimbursement (section 256B.0625,
subdivision 20): Counties may receive payment for up to 12 15-minute units
for use at case initiation and case closing to facilitate the recipient's
needs assessments, individualized plan development, referrals, or case
documentation without needing to meet the contact requirements specified
under sections 245.4711, 245.4881, 256B.0924, 256B.094, and 256F.10.
- Section
49: County-Provided Fee-for-Service Rate Setting and
Reconciliation/Targeted Case Management (section 256B.076, adds
subdivision 5): Counties must submit all claims for targeted case
management services described in this section using a 15-minute unit.
- Section
50: Testing and Implementation/SSIS (section 256B.076, adds subdivision
6).
- Section
51: Managed Care/County Based Purchasing Plan Units and Rates for Mental
Health Targeted Case Management (section 256B.076, adds subdivision 7).
- Section
52: Targeted Case Management Gap Funding (section 256B.076, adds
subdivision 8):
- a)
For purposes of this subdivision, "unacceptable loss" means
when a county's finalized amount of targeted case management federal
reimbursement following the commissioner's reconciliation for a calendar
year for targeted case management under subdivision 5 is less than 90
percent of the average federal reimbursement received by that county
during the base calendar years determined in paragraph (c).
- (b)
The commissioner must pay targeted case management gap funding in the
amount and time frame specified in paragraph (c) to an individual county
for calendar years in which the county experiences an unacceptable loss.
- Section
55: Coordination and Provision of Services/MCO or County-Based Purchasing
Plan (section 256B.094, subdivision 3): Child welfare targeted case
management is carved out of Minnesota health care programs managed care
contracts. The case management provider must assist the recipient to
ensure access to all medically necessary services listed in section
256B.0625, whether delivered on a fee-for-service basis or by a MCO or CBP
plan.
- Section
56: MA Reimbursement of Case Management Services (section 256B.094,
subdivision 6):
Article 5: Background Studies:
- Section
36: New Background Studies For Individuals not In NETstudy 2.0: By March 1, 2027, DHS and counties
must conduct new background studies for all individuals specified under
Minnesota Statutes, section 245C.03, subdivision 1, paragraph (a), clauses
(2) to (6), and affiliated with a child foster family setting license
holder, adult foster care or family adult day services and with a family
child care license holder, or a legal nonlicensed child care provider
authorized under Minnesota Statutes, chapter 142E. The commissioner and
counties must follow the requirements in Minnesota Statutes, section
245C.04, subdivision 1, paragraphs (e) and (f), when conducting the
background studies under this section. The new background studies must be
submitted through NETStudy 2.0. Effective: September 1, 2026.
Article 6: Behavioral Health:
- Section
1: Direct Payment/AMHI
(section 245.4661, adds subdivision 1a).
- Section
2: DHS Authority and Rulemaking (section
245.4661, adds subdivision 3a). By January 1, 2027, the
commissioner must submit a report to the chairs and ranking minority
members of the legislative committees with jurisdiction over human
services finance and policy that includes, at a minimum, the commissioner's
plan for determining direct payment eligibility criteria, allowable uses
of direct payments, documentation standards, and reporting requirements
for recipients of direct payments.
- Section
3: Programs and Eligible Services (section 245.4661, subdivision 9):
(a) The following three distinct grant
programs are funded may receive direct payments under this section:
(1) mental health crisis services;
(2) housing with supports for adults
with serious mental illness; and
(3) projects for assistance in transitioning from homelessness (PATH program).
(b) In addition, The following services are eligible for grant funds funding as
direct
payments under this section as the payor of last resort (SEE PAGE 159, LINES
3-4).
- Section
5: Oversight of Direct Payments
(section 245.4661, adds Subdivision 12) The commissioner shall develop and
maintain monitoring, financial review, and accountability procedures for
all direct payments issued under this section.
- Section
12: MA Costs for Certain Inmates
(section 256B.04, subdivision 23) Effective January 1, 2028, or
upon federal approval, whichever is later, the commissioner shall execute
an interagency agreement with the commissioner of corrections to recover
the state cost attributable to MA eligibility for inmates of public
institutions admitted to a medical institution on an inpatient basis.
- Section
13: Coverage For Detained Individuals
(256B.0618): An inmate of a correctional facility who is conditionally
released under section 241.26, 244.065, or 631.425 is eligible for MA for
under certain circumstances (halfway house, house arrest, etc.). Effective
January 1, 2028.
- Section
14: Carceral Targeted Case Management Services (256B.0619): Effective January 1, 2028,
or upon federal approval, whichever is later, MA covers carceral
targeted case management services in accordance with section 256B.0761
and United States Code, title 42, sections 1396a(a)(84); 1396d(a)(32);
1397bb(d); and 1397jj(b)(2) and (7). For individuals eligible for services
under subdivision 3, clause (1) or (2), carceral targeted case
management care coordination is available for 30 days before release and
up to 180 days post release.
Article 9: Aging And Disability
Services:
- Section
3: Meeting fire and safety codes
(245A.04, subdivision 2a), by authorizing DHS to delegate to a
local government the commissioner’s authority to perform specified
inspections of existing residential programs provided inspections do
not occur more frequently than once a year and once more annually as a
reinspection following a violation; requiring the commissioner to cover
the local government’s cost for conducting the delegated inspections;
prohibiting a local government from charging the subject of the inspection
a fee; requiring DHS to provide ongoing oversight of the local governments
to which the commissioner has delegated inspection authority; and
requiring the licensing inspections and the delegated inspections to be
coordinated.
- Section
11: Interpretive guidelines for
disability waiver regulation (256B.04, subdivision 28) requires DHS to
publish timely interpretive guidelines of changing statutes, rules,
regulations, and case law related to providing and billing for home and
community-based services.
- Section
12: Use of MnCHOICES certified
assessors required (256B.04, subdivision 29): Requires the commissioner to
employ a team of certified MnCHOICES assessors that the commissioner
may deploy at the commissioner’s discretion to perform assessments on a
lead agency’s behalf.
- MnCHOICES:
- Section 17: MnCHOICES Assessment and
support planning; supplemental information (section 256B.0911,
subdivision 30); strikes attestation language (SEE PAGE 271, LINES 10 AND
11).
- Section 18: MnCHOICES Administrative
activity (section 256B.0911, subdivision 32): Effective July 1, 2028,
grants limited role-based access to a person's support plan in the
MnCHOICES system to home and community-based service providers who
have been designated as a provider for that person by a lead agency for
the purpose of signing the person's support plan electronically and
demonstrating that the provider has reviewed, understood, and agrees to
deliver services as outlined in the plan.
- Section
19: Billing Limits/Essential Community Supports (section 256B.0922, adds subdivision 3).
- Section
20: Billing Limits/EIDBI (section
256B.0949).
- Section
21: Billing Limits/Home and Community-Based Waivers (section 256B.4912, adds
subdivision 17).
- Section
22: Prohibition of Use of MA Money for Room and Board payments/Home and
Community-Based Waivers (section
256B.4912. adds subdivision 18).
- Section
24: Base wage index; calculations/Home and Community-Based Waivers (section 256B.4914,
subdivision 5a). The base wage index must be calculated as follows:
- (20)
effective October 1, 2027, or upon federal approval, whichever is
later, for integrated community
support staff, the sum of:
- 15
percent of the subtotal of 50 percent of the median wage for home health
and personal care aide (SOC code 31-1120); 30 percent of the median wage
for nursing assistant (SOC code 31-1131); and 20 percent of the median
wage for social and human services aide (SOC code 21-1093); and
- 85
percent of the subtotal of 40 percent of the median wage for home health
and personal care aide (SOC code 31-1120); 20 percent of the median wage
for nursing assistant (SOC code 31-1131); 20 percent of the median wage
for psychiatric technician (SOC code 29-2053); and 20 percent of the
median wage for social and human services aide (SOC code 21-1093).
- Section
25: Residential Support Services/Home and Community-Based Waivers (256B.4914, subdivision 6) Effective
October 1, 2027, or upon federal approval, whichever is later, for
purposes of this section, residential support services includes 24-hour
customized living services, community residential services, customized
living services, and integrated community supports access services.
- Section
28: Payment for Customized Living/Home
and Community-Based Waivers (256B.4914, subdivision 6d):
Effective January 1, 2027, or upon federal approval, whichever is later,
customized living monthly service rate limits must equal the monthly
service rate limits determined under section 256S.202, subdivisions 1 and
2, multiplied by 126.36 percent.
- Section
30: Day Support Services; Component Values and Calculation of Payment
Rates/Home and Community-Based Waivers
(section 256B.4914, subdivision 7b): Effective January 1, 2027, or upon
federal approval, whichever is later, the billing limit for day support
services is equal to a maximum of eight hours per day per recipient.
- Section
34: Respite services; Component Values and Calculation of Payment
Rates/Home and Community-Based Waivers
(section 256B.4914, subdivision 9a): Effective January 1, 2027, or upon
federal approval, whichever is later, the billing limit for in-home
respite services is equal to a maximum of 30 consecutive days per
respite occurrence.
- Section
36: Transportation/Home and Community-Based Waivers (section 256B.4914, subdivision 13):
Effective January 1, 2027, or upon federal approval, whichever is later,
the billing limit for waiver transportation is equal to a maximum of 28
one-way trips per week per participant.
- Section
38: Administrative Fees Charged by Providers and Vendors/Home and
Community-Based (section
256B.4914. adds subdivision 22):Effective July 1, 2027, or upon
federal approval, whichever is later, the commissioner must limit
administrative fees charged by enrolled providers and vendors approved by
lead agencies to no more than six percent of the total cost of the
service or purchased goods. This limit applies to the following services
and other new market rate services as determined by the commissioner:
(1) chore services billed daily;
(2) transitional services; and
(3) transportation.
- Section
48: Billing limits/Elderly Waiver
(section 256S.15, adds subdivision 3): Effective January 1, 2027
- Section
51: Waiver Reimagine Phase II (Laws
2021, First Special Session chapter 7, Article 13, section 73): Effective
January 1, 2027, The commissioner must establish a phased approach
to implementing the two-waiver program structure. The commissioner
must consult with the Olmstead Implementation Office prior to seeking
federal approval to ensure the phased approach promotes community
integration and continuity of care
- Section
52: Licensing Moratorium Exceptions for BI and CADI (Laws 2026, chapter 95, Article 4,
section 2).
- Section
53: Waiver Case Management Advisory Working Group: Report due September 1, 2027.
- Subdivision 2. Membership. The commissioner shall appoint members
representing diverse geographic regions of the state, including
metropolitan and greater Minnesota areas, with at least 30 percent of the
members living or working outside the seven-county metropolitan area and
including:
(1) representatives of the DHS;
(2) lead agencies, as defined in
Minnesota Statutes, section 256B.0911, subdivision 10;
(3) contracted waiver case management
providers;
(4) waiver case managers with current
direct service responsibilities;
(5) individuals receiving waiver
services or their family members or advocates;
(6) representatives of disability
advocacy organizations;
(7) representatives of the Minnesota
Disability Law Center;
(8) representatives of culturally
specific or Tribal communities; and
(9) workforce representatives with
experience in human services.
- Section
54: Direction to Commissioner;
HCBS Waiver Case Management Evaluation and Report: DHS must evaluate
reimbursement rates and lead agency duties associated with home and
community-based services (HCBS) case management under Minnesota Statutes,
sections 256B.092 and 256B.49, and chapter 256S. Report due December 15,
2028.
- Section
55: Integrated Community Supports Reform Study: DHS must review the MA integrated
community supports (ICS) service provided under the home and
community-based waivers authorized under Minnesota Statutes, sections
256B.092 and 256B.49, and evaluate the need for statutory, regulatory, and
programmatic reforms. Initial report due March 1, 2027; final report due
January 1, 2028.
- Section
56: DHS Market Rate Study: Report
due February 15, 2027.
- Section
57: MnCHOICES Redesign Working Group:
Members include one metro and two outside of metro county
representatives. Report due
September 1, 207.
- Section
58: Direction to Commissioner; Environmental Accessibility Adaptations For
Homes: Replace the existing $40,000
annual limit for home modifications with a $40,000 three-year limit.
- Section
59: Direction to Commissioner; Environmental Accessibility Adaptations For
Vehicles: Replace the existing $40,000
annual limit for vehicle modifications with a $40,000 five-year limit.
Article 10: Electronic Visit
Verification:
- Section
1: NEMT (section 256B.0625, subdivision
17): (e) Effective January 1, 2027, or upon federal approval, whichever is
later, MA covers NEMT provided by NEMT providers enrolled in the Minnesota
health care programs. All NEMT providers must comply with the operating standards
for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually
enrolled with the commissioner and reported on the claim as the individual
who provided the service. All NEMT providers must bill for NEMT services
in accordance with Minnesota health care programs criteria and comply
with the requirements under section 256B.073. Publicly operated transit
systems, volunteers, and not-for-hire vehicles are exempt from the
requirements in this paragraph.
Article 11: Miscellaneous:
- Section
1: Training Required for Payments/CCAP (section 142E.16, adds Subdivision
1a)
- Section
3: Direction To Commissioner; Assessment Of Administrative Roles. DHS and
DCYF, in consultation with Minnesota's Tribal Nations and counties, must
conduct a study to assess and recommend improvements to the roles and
responsibilities of the DHS and DCYF, the counties, and Minnesota's Tribal
Nations in administering human services programs.
- Section
4: Direction to Commissioner; Transfer Assessment: DHS must procure a
contract with a vendor to assess the current status of administration of
MA and plan for a transfer of administration of MA to the commissioner by
January 1, 2033. The commissioner must submit the assessment and plan to
the chairs and ranking minority members of the legislative committees with
jurisdiction over human services and health care policy and finance by
October 1, 2028. The commissioner must consult with Minnesota's Tribal
Nations, the Association of Minnesota Counties, and the Minnesota
Association of County Social Service Administrators on the final
deliverables included in the assessment.
- Section
5: Direction to Commissioner of Human Services; Evaluation of DHS
Structure and Processes. DHS must contract with an external consultant to
make recommendations to improve the Departments performance as the state's Medicaid agency. The
external consultant must evaluate the department's structure and processes
and assess the adequacy of the department's current policies, procedures,
systems, organizational structure, staffing levels, and funding to
effectively increase program integrity, minimize fraud, and more
effectively serve as the state's Medicaid agency.
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