Gillette Children’s 2024 State Legislative Wrap Up
This year the Minnesota Legislature passed new laws that will positively impact children with brain, bone and movement conditions and their families. These include expanded coverage for orthotic and prosthetic devices, improvements to the consumer-directed community supports (CDCS) waiver program, increased access to vital health care services, and more. Thank you to the Gillette staff, patients and families who met with legislators, testified in committees and advocated for these needed policy changes. We are so grateful for the Gillette community!
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A Few of Gillette’s 2024 Priority Policies Passed into Law:
We partnered with the Minnesota Society of Orthotists, Prosthetists, & Pedorthists and Wiggle Your Toes to support the So Minnesotans Can Move legislation. This bill requires Minnesota’s state regulated health plans, including Medical Assistance (Minnesota’s Medicaid program) to provide coverage for orthotic and prosthetic devices, supplies, and services, including repair and replacement, at least equal to the coverage provided under federal law. Health plans must also cover orthoses and protheses determined by the enrollee’s provider to be the most appropriate model that meets the medical needs of the enrollee for purposes of performing physical activities, including but not limited to running, biking, swimming, and bathing/showering. This bill also states health plans cannot deny a prosthetic or orthotic benefit for an individual with limb loss or absence that would otherwise be covered for a nondisabled person seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity. Effective January 1, 2025.
New prior authorization reforms include:
Effective January 1, 2026, for all state-regulated health plans, including Medical Assistance, once approved, a prior authorization received for treatment of a chronic health condition does not expire unless the standard of treatment for that health condition changes.
A chronic health condition is defined as a condition that is expected to last one year or more and:
(1) requires ongoing medical attention to effectively manage the condition or prevent an adverse health event; OR
(2) limits one or more activities of daily living.
CDCS is Minnesota’s self-directed Medical Assistance waiver option and is used by thousands of people with disabilities across the state. CDCS participants can designate waiver funding in ways they see fit to enhance their quality of life and increase community integration. New CDCS reforms include:
- Policies governing the CDCS program must be created solely by the Department of Human Services (DHS), and counties cannot create or implement any policies that are in addition to or inconsistent with policies created by DHS;
- Participants must be provided with an explanation of how their CDCS budget was calculated, including a detailed explanation of the variables used in the budget formula;
- Clarification that allowable goods and services for a CDCS participant do not need to be for the sole benefit of the participant, and that goods and services may benefit others if there is also a direct benefit to the participant based on the participant's assessed needs;
- Clarification that goods or services that support the participant's assessed needs for community integration and inclusion are allowable under the consumer-directed community supports program;
- Clarification that the rate authorized for services approved under the consumer-directed community supports personal assistance category may exceed the reasonable range of similar services in the participant's community if the participant has an assessed need for an enhanced rate; and
- Clarification that a participant's spouse or a parent of a minor participant, as defined in the waiver plans, may be paid for consumer-directed community support services at a rate that exceeds that which would otherwise be paid to a provider of a similar service or that exceeds what is allowed by DHS for the payment of personal care assistance services if the participant has an assessed need for an enhanced rate.
DHS will need to receive federal approval for some of the above changes before they become effective.
Legislation passed this year allowing direct support professionals to be paid for providing certain services to individuals enrolled in Minnesota’s Medical Assistance disability waiver plans during acute care hospital stays. This is effective January 1, 2025, or upon federal approval, whichever is later. Unfortunately, this new law does not include reimbursement of direct support professionals under the new Community First Services and Supports (CFSS) program that will be replacing both the current PCA program and the Consumer Support Grant starting October 1, 2024, or of home care services. To address this, legislation was also passed directing DHS to draft a plan that would include CFSS and home care services. This plan must be presented to legislative members by January 1, 2025.
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A History of Advocacy
Gillette Children’s was founded because of the advocacy of Dr. Arthur Gillette and Jessie Haskins. And 125 years later, we continue to build on this legacy, as we know that decisions made by policymakers can have a real-life impact on our patients and their families. That is why our team works every day to make a meaningful difference in the lives of our patients. We do this through advocacy to influence public policy and through active community engagement. We work closely with organizations and policymakers on the local, state, national, and international level to advocate for patients with brain, bone, and movement disorders.