March 27, 2026 · Human Services · 25,175 words · 19 speakers · 747 segments
The quorum is present. The quorum was present before I got here. I was just expected like Utke would have, like, yeah, we are the Quorum. Well, there are members in and out all day. We have multiple hearings going on back and forth. And so just as we begin today, we're going to mark up our omnibus policy bill, right. We have all the work that we had done and the great bill. It's a great bill. And then we also have then yesterday Senate file that will do a markup on 4222. That's Senator Abler's bill. We had Senator Wicklin. We moved it. That's going to be our moving place with all of the work that we're doing in integrity. Right. And that's. So it's going to be right. Is that correct? Did I get that right? And so let's do that. And then there's a whole, I have a whole list of amendments. There's testifiers today too. So we want to keep that. You know, get to your point. I'm going to put you on a two minute clock and then we're going to move on. But let's start if members are okay, Senate File 476. There's an A2 delete all delete everything amendment. So if I want to do that, I want to move adoption of the A2 delete everything amendment to put the omnibus in the proper shape. And I already said that I love it. He just reminded me of quorum as president. I was just like, you know, we got all members say aye. Aye. Opposed, same sign that is there. Next we're going to hear public testimony on the omnibus bill. So testifiers, Matthew Bergeron and Eric Larson, will you work your way up here and if you would, you're here testifying the specific, if you want to testify in specific amendments because we have a list of those. Can you wait until the amendment is moved and then we'll bring you back up to speak. Is that work or so Eric stopped. Dr. Larson stopped. For the record, Matthew Bergeron and Dr. Eric Larson for the record, Mr. Bergeron, go ahead and tell us who you are.
Thank you, Mr. Chair. Committee members, my name is Matthew Bergeron. I'm a health care and government relations attorney with the law firm of Larkin Hoffman here representing the Residential Providers association of Minnesota. Just wanted to provide a couple of quick comments for the committee. We have had over the last couple of weeks concerns with some of the language in the bill regarding restrictions on congregate care settings. We've been working on the amendment before you. Really happy that those conversations are continuing to progress. There are a number of pieces in the bill regarding new regulations for assisted living facilities, requirements regarding AEDs, and some of the documentation requirements for like response times. We're having conversations with advocates on that as it relates to the impacts on small settings for five bed assisted living facilities versus larger settings and kind of how those things might be scalable or implementable for small settings, particularly folks serving individuals on disability waivers versus older Minnesotans or folks on the elderly waiver. But we do want to note there's some really fantastic stuff as well, some of the language that would create some additional flexibility for small assisted living facilities to relocate. We think that's a big part of the the solution to some of the concentration is that as other opportunities become available that those settings are able to move. And lastly, the continuity of care changes in Article 1 are a really important part. As we've been working through issues in trying to make sure that folks are safe even as providers come under instances where there's concerns about payments or program integrity. Making sure that the resident is centered in those conversations is super important. So thank you, Mr. Chair and members.
Thank you, Mr. Bergeron. You're here all day and all evening,
right with us at your beck and call, sir.
Dr. Larson and Sumaca, my old intern is here. This is great. You want to start making your way up to the desk. Dr. Larson, welcome back.
Thank you, Mr. Chair. It's a pleasure to be able to speak to you. I took a little stutter step because I wasn't sure if you meant a new amendment being introduced today, but I'm speaking on the amendments that are on the bill already. I'm Dr. Eric Larson. I'm the chair of the Autism Treatment association of Minnesota. We fully support the efforts to defeat fraud in Minnesota's EIDBI program. Yet the current efforts are being rushed into statute and some of the ADSA policy provisions may impede the ability of our providers to deliver sound and ethical services to the needy children of Minnesota if drafted wrongly. So of my three points, one, we applaud the improved definition of clinical supervision to full identify the auditable billing codes for this service. This is an important and valuable service that should be required to be delivered by the qsp. But two, we also applaud the Senate amendment for the minimum requirement for observation and direction to be able to be delivered by both QSPs and Level 1 providers. This is a key provision because the current workforce shortage prevents agencies from hiring sufficient QSPs to do the meaningful work that it entails. Fortunately, the original drafters of the IDBI statute in 2013 recognized the significant workforce shortage and therefore incorporated the generally accepted national standard for the tiered model of ABA as published by the Behavior Analyst Certification Board and the Council of Autism Service Providers. The tiered model was explicitly designed to address the workforce shortage while requiring that the QSP still take professional responsibility for appropriately delegating services as they are licensed to do by the Minnesota Board of Psychology. Hence, the minimum observation and direction requirement still allows providers to further extend necessary supervision through the Level one and the Level two providers. If that workforce shortage were not taken into account, the resulting loss of access to EIDBI services would have devastating health effects to children with autism. The legislature should consider the massive financial impact on local families and schools if we providers were to be limited by the requirements. Finally, 3 we also express serious concerns over the 90 day financial solvency and surety bond language which imposes an additional cost on the providers who have already suffered one payment cycle being withheld by DHS and also now face high fees to be paid to DHS for the revalidation and for the provisional licenses this year. We fear that this financial requirement will very likely lead to some small nonprofit providers being forced to sell out to large for profit and equity based companies. In order to prevent the resulting loss of access. We suggest including an exception for existing preferred providers, lower amounts for compliance and a two year delay to give time for providers to prepare financially and recruit the bonds. When ethical providers have the financial ability to deliver effective services, the families will be less susceptible to being recruited by fraudulent providers. Thank you
Senator Adler.
So Dr. Larson do you know where that on the sheet that Level 1 and QSP languages Mr. Monahan do you know what page that is?
I can I thought we took that piece out.
No I I think it's in that the Senate has you can have a choice of two providers correct So I just want to make sure that we understand that we have to keep that the the other body only has QSP correct which is problematic and the intention of our work in that little private secret room that anyway that we worked in last year was to have that and then the legal counsel from the crack council it was not private not follow our intent and then do what they thought the word said so we but it's important that stays and I think the 90 day thing is in the house other body and just so you know what that means is that as close to $600 million of requirement on these little you know, so it's really problematic. So thank you.
Thank you, and thank you for that clarification. And yeah, Dr. Larson, just watch that as we get. You know, hopefully we go and do a conference committee, which is our. The way this body, this committee's always done, conference committees has been wide open to the public, so we can do that. So all good. Anybody else for Dr. Larsen? Senator Gruenhagen. Oh, thank you, Mr.
Chair.
Dr. Larson. So you're associated with the autism industry?
Yes, I provide services to young families with autism.
Yeah.
And I have a nephew who was on the spectrum too. So I definitely want to help autistic children. I think all of us do. But last I read, there was only six new autism centers that got licensed. Has that changed at all?
Well, the application for all of the centers is due by the end of May, and it's an extremely laborious process that takes about all day to fill out the application. And we just learned this week that the save for later button on the website doesn't work. So if you spent several hours and then wanted to save for later, you lose all your work.
It all just disappears.
So the. So people are applying. There's a lot of documents to upload.
Senator Abel, Chair.
Is that the min save feature that we have? Everything that admin doesn't work? Seems like, Mr.
Chair.
The.
The language of all the two providers is 50. 50.30.
Thank you, Senator Gruenhagen.
You have to be sure you hold that.
We got it. I love it. Senator Gruenhagen. Oh, don't save it later, Glenn.
Thank you, Mr.
Chair.
Yeah. So what from your perspective, you've been involved with this. Why do you think we had so much fraud? I think it went over a number of years. Went from 15 or 20 centers up to over 500. I mean, why do you think that happened without some type of red flag going up?
Doctor, Senator, the chair, the.
I.
This.
The program itself was passed in 2013, and it took five years to build out the regulations to actually enable the program to be used. So it really wasn't started until 2018. Nobody was doing it then, and providers were using other funding sources and eagerly embraced this program because it's so much better designed for autism. So it's still. Because the workforce shortage, then it gradually built up over that past five year time. And if you had asked me five years ago, is there fraud in this program, I would say no, it's way too highly regulated. It shocked me to hear that there was fraud in our program even when we were hearing about Feeding our future, I was thinking, well, it won't be in this program because it's too highly regulated. So I'm still curious, who's counterfeiting what and how does it slip through the system? Because I can't even imagine how I could have pulled it off.
Thank you, Dr. Larsen. Thanks, Glenn. Thank you, Dr. Sumaca. Tara Kanambi, did you get your PhD yet? No. Close. Welcome. Welcome back, man. Good to see you. Are you here on behalf of the Council?
Yes.
All right. Thank you, Sumaca.
Yes, I can get started. Chair Hoffman and members of the committee, thank you so much for the opportunity to testify today. My name is Sumuka Tarakanambi and I'm a public policy consultant with the Minnesota Council on Disability. I'm here today to speak on behalf of MCD in support of SF476, the Human Services Policy Omnibus, particularly its focus on continuity of care during fraud investigations. In addition to my professional capacity, I'm also here as a person with a disability who relies on Caddy waiver services to live independently in the community. Therefore, I know firsthand how important these services are and how any disruptions to services can cause significant harm to people with disabilities. MCD serves as a liaison between Minnesotans with disabilities and the Legislature. In recent months, we have heard consistently from community members who have experienced significant service disruptions as a result of the state's response to fraud. While we support strong fraud prevention, many of these actions have been implemented without sufficient safeguards to ensure continuity of care for individuals who rely on these services to live independently. The result has been uncertainty, instability, and in some cases, immediate risk to health and housing. These concerns were reflected in our Legislative Priority Survey and legislative forum where individuals and families share the real world consequences of service interruptions. Given this urgency, we strongly appreciate that Article 1 is dedicated to continuity of care protections. The bill establishes a continuity of care team within the Department of Human Services that is responsible for identifying individuals at risk of service disruption due to payment withholds, providing timely notification to impacted individuals, lead agencies, ombudsman offices, and case managers coordinating contingency plans to maintain services. Importantly, the bill prohibits payment withholds until continuity protections are in place and includes a good cause exception when alternate providers are not available. These provisions represent a meaningful step forward, meaningful step toward person centered fraud prevention, and we urge the Committee to retain this language as the bill moves forward. We also support several additional provisions that improve access to services and strengthen protections for people with disabilities, including increased flexibility for unit based services such as in home Support with training, a monthly versus a daily limit, greater flexibility for shared services within CFSs, budget and agency models, stronger maltreatment reporting and clarified lead agency responsibilities. The Housing Stabilization Services redesign, prohibiting facilities from requiring a guardian or conservator as a condition of admission. And finally, policies addressing the concentration of group homes and increased transparency in corporate ownership of nursing homes. While we largely support the bill, we do have one concern. The licensing moratorium on community residential services. Adult foster care may further limit already constrained service options. We are encouraged by the inclusion of exceptions and urge the Committee to ensure that any exception process is clear, timely and accessible. Overall, we appreciate the Committee's work to prioritize continuity of care choice and safety for Minnesotans with disabilities, and we look forward to continued collaboration. Thank you so much for your time and I'm happy to answer any questions.
Summa Ka thank you, Senator Abelor.
Thank you, Sima Kai, I appreciate that.
If you could.
And just so you know, I don't know, you have these kind of a qualitative commentary, but if you could give us the. Give me the sections or us the sections that you really want to make sure we keep. Because this is going to go into a, you know, page four, you know, line 19 kind of stuff. So just, if you could, not now, but just get those to us. You have plenty of time. There's more than a week. So thank you.
Yes, I can do that.
So, Summa Kai, just so you know, Senator Avery, remember the work we did on Connect 700, the fix? He's the one who fixed it. So thank you. Sumacott, good to see you. Yeah, good to see you too.
Thank you.
Before we go to member amendments, there's a few amendments that we need to pass. I want to move the A23 members. This is the technical revisions that Mr. Monahan did and the other nonpartisan staff to get our 476 in order. So Mr. Monahan can answer any questions, if there are any. Senator asmerson, thank you.
Mr. Chair. I was wondering if Mr. Monahan could walk through the amendment while we take a look at it.
This would be the A23, which is the technical revisions. It's being passed out. You will see all those listed on there. So Senator rasinson has asked Mr. Monahan to run through the technical revisions. Mr. Monahan.
Mr.
Chair.
Members, beginning on page one, line three through line 37 is a reviser's instruction related to the recodification in the first three sections of Article 2, where
we're
recodifying Section 245A 03 Subdivision 7. That is the existing Foster care moratorium language that has been rewritten. Rewritten at the beginning of article two. The instructions between line 38 and 41 are just changing the article headers. Line 42 is a request from the Department of Administration related to certain duties at Direct Care and Treatment that the bill include the word delegate instead of designee at the top of page one. Sorry. Page two is another change to the article header. Lines three through 14 are all requests from the Department of Health related to clearing up an ambiguity between the use of the use of the mere word emergency, which in their world means a natural disaster or similar, and making sure that each instance of the new language include the word medical to distinguish it from other types of emergencies. This is mostly related to the,
I
believe what Senator Ablor refers to as the fall language and having a response to other medical emergencies in assisted living facilities. And then finally there's just technical amendment at the bottom amending the title at the bottom bill.
Senator Asperson, Senator Aber.
Well, thanks. And I, I just on this fall language probably a good shorthand for it. There's still discussions going. There will be another amendment coming I suppose on the floor reflecting the agreements that they're I think very collegially working on. And this is the Department of Health PA I think and what's here.
So thanks. Thank you. And members, as different the amendments that people are offering, they're, they're not most of them aren't in your packet. They'll be handed out as folks do that. So all those in favor of the A23 sign? Aye. Aye. Oppose. Same sign. Thank you. So let's move then, the A22amendment. I moved the 822amendment that removes provisions. Remember our history here is if something gets flagged as a fiscal cost, we either get it pulled out in finance or we take care of it here where we're trying to take care of it all here. So the A22 is the amendment removes those provisions that we flagged as fiscal costs and they're more appropriate for a finance bill. So if you want, Mr. Raymond can walk to talk us through those provisions that were being removed if people want. So Mr. Raymond, Mr.
Chair members, I'll walk through each line of the amendment. So starting I'll start with first lines 1.3 and 1.5. So these relate to Senate file 3898 which relates to home and community based services. Right. Regulation modification. So it deletes section 13 and 38. Which the Department of Human Services identified as having a cost. Moving next to line 1.4. So this relates to Senate file. It's a portion of Senate File 3657 relating to billing limit changes for individual individualized home supports. So the lines that are being removed have a cost to medical assistance and are removed in the amendment. So next I'll move to line 1.6. So this is a portion of Senate file. The first engrossment of Senate File 4279 relating to congregate care changes. So this removes one section of that and I believe there's another Amendment posted the A18amendment that removes the remainder of the bill. So the Department of Health identified multiple costs related to that language and is being removed as such. Moving next to line 1.7. So these changes remove the entirety of Senate file 2972 relating to the regulation and notice requirements related to the purchase of nonprofit nurses, nursing homes and assisted living facilities by for profit entities. So both the Department of Health and the Department of Human Services identified multiple costs related to that bill. So the entirety of the bill is removed. And that concludes my remarks.
Sarah rasmussen thank you Mr.
Chair.
And for the bill on proximity that I know we debated. So it's my understanding that this amendment is pulling out part of that or all of it or Mr.
Chair, members, this the there's another amendment where that piece is being pulled out that should be the A18 that should not be listed in this amendment unless I'm thinking of proximity on what should have been a 245D provision but was 144G provision from 2018. Are you talking about that proximity or the proximity of what Mr. Raymond was just alluding to? Mr. Monahan thank you Mr.
Chair. Senator Rasmussen, line six of the amendment removes the portion of that bill to which you were referring that was related to the Vulnerable Adults act and the reporting requirements. So it's actually a drafting error on my part. This should have been in the other amendment but rather than redraft them, we just left it there.
See where my brain was. I was like, sorry, I was on the wrong amendment. I thought you were skipping on me, man. It was good. Senator Abel, I have one more question.
Mr. Chair, I'm not going to ask to go through.
Sorry I missed Senator Rasa that he was done. He has a follow up. Sorry about that.
Totally fine to wait.
Thank you Mr.
Chair.
Question Mr. Raymond, could you explain again what we're doing on line 1.4 of the amendment?
Mr. Chair, Senator Rasmussen so on line four. So these are, this is a portion of the Senate file 3657. So this modifies individualized home, supports billing limit changes. I don't have the language in front of me, but my understanding is there was an exception that was made in certain circumstances in that language. So that change has a rather substantial cost to medical assistance. So it specifically removes the exception language.
Senator Asmoson, a follow up or you're good. All right. Senator Abor.
Yeah. And we can haggle later with the department about what should cost and what shouldn't cost.
No, let's get them up right now.
No, I don't want to waste the time. But like even that, like reporting stuff on page 25, section 13. I don't know why, if you make a provider maintain records that the department has to pay for that. But it's, it's fine. We'll, I just think that would be like a good thing. And then they're going to find fraud and actually save money. But I'm done. Mr. Chair, we'll just, we'll take these up on the finance bill.
I have that on record. Senator ever said he's done for the day. So there.
I'm done for this amendment.
Oh, this okay. Yeah. All those in favor of the A22amendment, say aye. I oppose. Same side. All right, so there's an A18amendment and Mr. Raymond alluded. You asked the question, Senator, so I guess if you want we can but otherwise the A18 addresses what you just brought up. So if any questions on the A18, it's being handed out. Yeah, just what it does is it removes. We can have Mr. Mr. Monahan describe that. Glenn. But it removes, it removes some sections related to Senate File 4279, a work in progress. So if you look. Yeah. Though this is nothing. Ten years ago there was a, there was a pile of, there was a pile of amendments. They ended up getting through them. It was, it's just welcome to Human Services. Right. Be flexible and stuff is a moving figure.
Mr. Chair, I do have one question on the A18.
Senator Rasmussen.
Thank you, Mr. Chair. And either for you or for nonpartisan. If, if the A18 is adopted, what remains of Senate File 4279 and the underlying bill.
Mr. Monahan, Mr.
Chair, Senator Rasmussen. Nothing.
And also all that it gets addressed in the A21, correct? Yes. That is a compromise,
Mr.
Chair.
Compromise between.
So you had members of the community. There's a compromise between the municipalities and providers and the Advocacy groups. So they all did their work to get this point. If there's still work need to be done. This committee has got a history of saying people get into a room and you know, and do it out. But I think this compromises between the municipalities, the providers and the advocacy groups and folks who are working on this. So I'm happy the fact that people were working on this and that I'm not happy with one of the outcomes on it. But then again, that's part of the compromise. Folks. Folks did their work and we got to applaud them for that.
So this was your bill?
Yes.
Mr.
Chair. Mr.
Senator, the city of Coon Rapids that you just represent a tiny sliver of likes to compromise.
They do, yeah.
So, I mean, yeah, Matt called up and said that they didn't work.
Matt's okay with it. Really?
Yeah.
What about Glencoe? Did you get a call from Glencoe?
They're happy? I don't know. Maybe. I don't know. I don't know.
Did you get a call, Glenn, from Glencoe? Are they happy? I doubt if they're happy. All those in favor of the 18th Amendment say aye. Aye. Opposed? Same sign. Thank you. All right, that's putting us. We're getting there. And everybody. They're working the. We have reached a place of agreement between those stakeholders. Like we just talked about. That compromise language is represented in the A21, which has been identified. There is a fiscal cost. For that reason, I will not be. Some of that stuff in the 820 will not be brought forward because of the fact somebody flagged it as a fiscal cost. My intention, though, is to include the language of the A23. The A21. It says A23 here. Did you say A23? A21. When we put together our budget bill. So that's that. We are going to still work on that. We put our budget bill. Does that make sense? Senators. Senators got a thumbs up. So with that, I'm.
Were you going to review the elements of the compromise so we can know there's no. There's no distance in there. I understand, but.
Correct.
There's quality of sighting of resident.
Yeah, there was. There was a compromise getting the cities to get. So, Mr. Monahan, if you could. Do you have that up in front of you? That would be great. If not.
Jim, I can walk through it one minute.
Little piece. Absolutely. If not, I'll get Berger on up here and you can.
Mr.
Chair, Senator Abeler and members, my understanding of the compromise is just to get to the Core of it to remove the 650 foot proximity limitation and instead leverage a current policy used by DHS with respect to authorizing services or licensing HCBS providers who have service settings that have adjoining or adjacent properties and expanding that current regime to apply to all small assisted living facilities and all group homes rather than the current limit which is the same provider can't have two settings adjacent to one another.
Senator Ambler then Senator Gruenhagen.
Thanks.
Good.
Senator Gruenhagen Rapids today.
Yep. Senator Gruenhagen.
Oh, thank you, Mr.
Chair.
Yeah. So does this policy apply statewide?
Senator Gruenhagen, the answer is yes. That's. But we got the issue remember you brought up was that the distance piece and they got rid of that. And I think I won the argument from this committee 10 years ago when I suggested that Department of Human Services should have more say called 245D. Do you remember this, Senator? And so in this case the co location of certain home and community based residential settings it now gives a clear. We know who's in charge of making those determinations. And I guess I'm happy with that. But we still have a problem.
Yeah, the thing is that I just. I know we're going to handle this later but the thing is I just don't. I have the reservations about one size fits all all across the state. I mean there's small communities that might
need a little flexibility on this.
So I think maybe for the metro area or something like that, remember start with that rather than go one size fits all. That's just my input.
No, it's good. And maybe we'll, we'll. We can explain it. Senator Abbott could explain it to you. I can explain it to you too. And the co location of certain home communities, residential settings. This should not, this should not have any bearing on the fact of what you were talking about in New Auburn and that area. So Senator Ablor.
So it may actually increase the quality and then therefore reduce fraud.
So another anti fraud to that point. I think the compromise on here gets that point because now the point point place because we had a problem with who's in charge of this. Is it mdh? Is it dhs? Is this elite agency. And now guess what Glenn. It's dhs. Okay. So I think that's. To me that's a good piece. That makes sense. Yep.
All right.
So I don't think I need to do anything. We already moved the A18. We're not going to move the A21 and that's it. Correct. So now Senator Abler, I think think you want to do your A5 or am I moving on? You got Brian Zerbes and Tammy Roth coming up for your A5. I think it's the A5, Jim. Mr.
Chair, I'll move the A5 and maybe Mr. Zerbes can talk about it while it's being passed out.
Senator Aylor has moved the A5. You want us to vote on that first, Senator Abel, or you want to just have the discussion first? I love it. Brian Zervis, Welcome.
Thank you, Mr. Chair and Committee members. My name is Brian Zervis. I'm the Executive director of March, a statewide trade association for substance user programs and professionals. I'm going to be speaking on the withdrawal management component of the amendment. Withdrawal Management services are a medical version of Detox. These programs provide emergency access for people that are intoxicated or in withdrawal. The language would exempt authorizations from the first five days of treatment for when someone gets admitted to one of these, a withdrawal management program. And the language would enhance a program's ability to be paid for the services rendered. That concludes my testimony. Thank you.
Wow. Senator asmussen.
Thank you, Mr. Chair. Question on the amendment is, have you received any feedback from the Department of Human Services on this amendment? Do they have any concerns?
Mr.
Chair, Senator Rasmussen, we did work with the Department over the November, December and January. The five day window that was identified was actually technical assistance that they advised, which we incorporated.
Mr.
Chair, Senator Asmrson.
Thank you, Mr. Chair. And on the A5. So you're saying the excluding weekends and holidays has been reviewed by dhs. What about the withdrawal management services? Do they have any feedback on that language?
Mr. Zerbus.
Mr.
Chair, Senator Rasmussen, Both provisions in the amendment were included in our package of policy proposals that we reviewed with the Department a few months ago. I do not recall them providing technical assistance on the discharge summary timeline or raising concerns a couple months ago. But on the withdrawal management component, they did want to have a day window identified, so we settled on the five day exclusion window.
Senator Rasmussen, follow up. Good.
Thank you, Mr.
Chair.
I just wonder if we could get anyone from dhs, do they have any concerns with this amendment or. And the reason I'm asking, Mr. Chair, is, you know, when we're talking about utilization reviews, you know, again, we've unfortunately had issues within the SUD industry on making sure that their clients are getting the appropriate services that the state's paying for. And so I just wanted to make sure that with this amendment that we're not creating any Potential issues there?
No, actually, that's a great question. Ms. Grom, welcome.
Mr.
Chair. Christy Grom with the Department of Human Services. Senator Rasmussen, I know our program areas have worked with March and Mr. Zerbus on this language. I'm not familiar with the specifics. I know we've provided the technical assistance described here. I do want to go back to our licensing team just to relook at that language and statute and 245G to make sure that we're okay with it. But we have a great relationship with. With the providers, and I think we share many of the same goals. And we'll be sure to work this out for the committee and keep you apprised of our status.
You good? Senator Asperson's good with that. Thank you. We also have Tammy Roth, Lakes Counseling Center. She's on Zoom.
Hello? Can you hear me? Okay?
I can hear you. Okay.
Wonderful. My name is Tammy Roth. I have worked in the addiction field for almost 14 years, and I've been a licensed alcohol and drug counselor for the last five and a half. I'm here speaking on the A5amendment on the discharge summary piece. Addiction counseling staff are frequently stretched thin due to workforce shortages, excessive documentation requirements, and a desire to provide high quality client care. When a program determines that a client is eligible for discharge, the primary counselor currently has five calendar days to complete a summary of termination of services, also known as a discharge summary. If their schedule for the week is full between group and individual sessions, care coordination with others involved in the client's treatment, and paperwork and billing timelines, it can be very difficult to find time to add this task. As a result, counselors often work beyond their scheduled hours or outside a facility operating hours to maintain agency compliance. This proposal is simple to change the timeline in statute 245G06, subdivision 4A from five days to five business days, so that weekends and holidays can be excluded from the time requirements for completing discharge summaries. I respectfully request your support for these changes to ease the pressure on addiction counseling staff. Thank you for your time.
Thank you, Ms. Roth. Senator Aber, thumbs up. Senator Aber has the A5amendment. We heard from everybody. Questions asked, questions answered. All those in favor of the A5amendment, say I. I oppose. Same sign. Thank you. A5 is now being put in the markup. A6amendment. Senator Abler, is that you want to do that or.
I have the A4 I can talk about if you want.
You want? Yeah. You want to do the A4?
If I have that in Front of me. I can talk about that.
That's fine. Yeah.
MA EPD kind of a sequential thing. Mr.
Chair, is your mic on?
Is it working?
Yeah. Oh, it is.
Can you hear me now?
It was weird. I couldn't hear it.
Must be the Verizon commercial. We should have sponsors for our hearings like and then they could like pay money to have their name mentioned a few times and we could actually put that money into the budget and help people to like be kept in their homes longer. And how's that?
I love it because after like last week when I brought up the corn, you know, do you put corn in your hot dish and everybody was. It would be like. It should have been a, you know, a great.
Well, there are. Yes corn people and there are absolutely not corn people.
That's correct.
Maybe we should testify.
Had some kind of pale on there.
They're pro or anti corn. So. Mr. Chair, I move the A4.
A4 is in front of folks from
Mr. Wudlik and I don't see him here today.
You got anybody here?
But anyway, this is a, it's a new bill and so maybe the department wants to come up and just help us. This is a way to not kick people out the back door and in the epd just due to some things that happen if they don't online 2.9 it says for good cause they don't get renewed.
Renewed.
They have a little time not to get kicked out and it's that idea. And they have to be given due notice to do the renewal. And so that's. That's the bill. And Rob just brought this to me.
No, I love that. This. Who brought it to you? Rob? Oh, yeah, no, this is good. If there's a fiscal. I think there's. We've reached out to the department regarding. If there's a fiscal. So let's. We're not here and haven't heard it on and they'll kick it off. Yeah, yeah, yeah. This will be the, this will be the prime example of going to finance.
Well, I'm not going to finance but we're going to go to the floor.
We'll go to the floor. We'll take it off if we need to. If it does, Senator Rasmussen, we'll put
it in their bill.
Yep, I hear you.
Thank you.
Mr.
Chair and Senator Abel are. Would you mind just kind of walking through the amendment and make. I just want to make sure I understand what it does.
Mr. Chair, there's, I'm just looking. There's the. I don't know who SC is, but I know who LM is. So maybe Mr. Monahan could guide us through the aspects of it.
Mr. Monahan.
Mr. Chair, Senator Rasmussen, the language in the bill is related to, as I understand it, concerns from those employed persons with, with disabilities who qualify for MA who need to have their income eligibility redetermined every six months. My understanding is that often their income is quite variable and sometimes meeting the required submission deadlines to be redetermined are difficult for them to achieve or comply with. So the language here gives greater flexibility or sort of a grace period for them to complete their eligibility redetermination based on their income. And it requires the department to send them certain paperwork in a timely fashion so that they're on notice of their requirement to redetermine their eligibility.
Senator ASPERSON thank you, Mr. Chair, and thank you, Mr. Monahan, for the description. Is this language from another bill, Senator Abelor or Mr. Monahan? I'm just wondering.
It's a bill that just got dropped.
Okay.
Thank you, Mr.
Chair.
Thank you, Senator Abler. I mean my thinking is that I understand what the policy is doing now, which I appreciate, I understand the rationale for why you'd want some more flexibility. But my just kind of basic thinking would be if this is going to allow more people to access a benefit, it's going to have a cost. And so that would just be my concern is that it's, you know, could be quite likely to have a cost, maybe not maybe if there's some information that I'm missing. But that would just be my concern is, you know, having a fiscal item on the policy bill.
Yeah, I think with that if we find out we did put a request in for if there is a cost, Senator Rasmussen and if there is, then I think we just pull it off the floor. That's what we've done in the past, either finance or floor but this one we would go policy. We're not, we don't know. There's some assumptions it might but this is maepd. I just, I, I'm going half and half on that.
Senator Abel so I, yeah, and so just know, I mean I think that's a pretty well known program but the people on MAAPD aren't sitting around just getting rich. They're trying to keep working and we even have trouble if they make too much. They have to stop making money to stay on it. I got it and like they're capped and we've tried in since I've been here. I remember Representative Paymar back in the day was working on this. And once they get in, you want to let them try to stay so they can be rewarded for working. And I think, you know, if it costs anything, I would have to. We don't do dynamic scoring except when it comes to fraud. Mr. Chair. And the governor's budget. But if that's not actually even funny, it's, like, amazing.
No, no.
But preserving the services for individuals and opportunity to stay on this program will keep them more whole and keep them out of some other bad place that they might land in and help them not lose their jobs and all that. So I hope that as we talk to the department, they can come chat with me and happy to work with them to.
Absolutely. I think we put this on and this is what gets me, is people that came to see us ma epd and their services were cut. And they're. They are people. Medical assistants, employed people with disabilities. I get this. I like this. Senator Zainab, Senator Zainab Mohammad, ladies and gentlemen.
Thank you. Mr.
Chair.
You're welcome.
For paragraph B, second page of the amendment.
Yeah.
The second line, it says for a person enrolled in medical assistance under. Under section 245B. 245, 256B, who is who, due to a good cause, is unable to respond within the required time frame. What is good cost defined as.
Senator Abler. Is that. Senator. The good cause clause. Do you know Senate. Mr. Monahan, can you. Can you.
Sure.
Exactly. It's.
It's a cause that's good. Like, it's a good reason. Like, tell me why you didn't do your report. The dog ate it. That's not a good cause. Mr. Chair. But, like, these are individuals. Maybe they couldn't get a PCH. Mr.
Chair.
Mr. Chair. Maybe they were. Maybe their. Their provider was on a payment hold and they didn't have the services they needed to actually get out of bed or they were in the hospital for some medical condition. And I think that the department has. I think they will be very careful at the department not to just, you know, it just didn't feel like it is not a good cause. That's what I think. So just. That's the best. I know. And there may be a definition that.
Mr. Monahan, there is a. There is a legal definition and statute on that. Mr. Monahan, do you want to. Is there a definition anywhere we can use that that refers to good cause?
Mr.
Chair,
I am. I would have to look into that. There are definitions of good cause, but not one that I'm aware of that refers to this particular set of circumstances.
Thank you, Senator Zaynab.
Mr. Chair, I think we should define that before putting it into law. I don't know if that's right now, but we should figure out what a good definition for that is.
Mr. Chair, Senator Abelor, I'll work on that one, too.
Thank you. I think that and Rob, I know Rob said this amendment should only help the people in the program. So it stays. It's, you know, clarify that up. It should, you know. I know that. Senator makequaid.
Thank you, Mr. Chair. I, I support the amendment, Senator Abelor, and the reason I'm asking this question is from experience, not from opposition. But I remember I tried to change the stricken language in 2324, Mr. Chair, to the eligibility determination. Happened every year and found out later that that eligibility determination is not in statute because of Minnesota lawmakers. It's because of the federal law. And so I just want to make sure are we still within the confines of the law with this change and that same question.
Thank you, Senator Makequaid. That same question will pop up if this is within the guidelines. So you might have to have some part of that stricken out or not depending upon that the answer to that question. I hear you. And Mr.
Chair, I'm not sure if Senator McQuade was talking about this, but Mr. Wadlak has popped up his head and it says this amendment should only help the people in the program. It's not to expand inclusion, just keeps them from getting kicked out.
Yep.
That's all. Just so people know and we'll sit down with the department and I know that the department and I mean this. We want to make sure these individuals
can oh, when Elise Bailey's head is shaking. Yes, that means she will be more than happy to sit down and help us. Senator asmussen. We're good.
Mr.
Chair.
I just think this is going to have a cost. So I think there's going to be a cost associated with it. So I would.
You got the over at the under on that.
I think there'll be a cost on this and I just, I would rather have it be discussed in a, in a finance bill. But I, I understand the, the intent of what, what's trying to happen here.
Right. Okay. Thank you. There is.
Yeah.
The discretionary of the lead agency.
Right.
Isn't it good. Cause did you, you want to. There is or not. All those is it the A4amendment, folks? All those in favor of the A4 members say aye. Aye. Oppose. Same sign it does. It passes so Senator Wickland is not Jim, do you have another one?
I have the A6.
That's the one. I'm looking at the A6. You want to pass that out?
This is the Senator Kupak. In lieu of being here. I'm being him today. I can predict it's going to be a nice weekend. Sunday should be a particularly good day to get out with your family and go to the parks. I think mid-60s chance of SPF need. So that's just from him. So there you go. This is the technical. I'll move the A6. It's technical. Back in the day. I don't remember what year. Mr. Monahan will know. We decided to handle border state nursing home rates and they came up with the. They were using North Dakota. I believe it was used the PA1 method. North Dakota being the whimsy place they are, they got rid of that. And so trying to be cooperative with our neighbors, we use their terminology and their terminology is now obsolete, which we would say just about North Dakota at all. Mr. Chair, if we've merged Minnesota with North Dakota, you know what we call it? Minnesota. Anyway, thank you. So that's the deal. I think it's technical and I don't think it has any cost. I think it just keeps things going the way we want. There is a need for retroactivity and so that's what I know. I don't know if it's going to cost anything, but maybe the department can tell us and maybe they're using this method. Anyway, thank you.
Thank you. Any further follow up on the Senator Abel or a six? Senator Aspen.
Thank you, Mr. Chair. I was wondering if nonpartisan could explain so what would this do to rates in these two communities?
Mr. Monahan?
Mr. Chair, Senator Rasmussen, My understanding is the changes in the bill would do nothing to their rates. But it is technical. The problem is the reference to case mix classification PA1. That classification no longer exists. So instead they're putting generic language under the new classification system to refer to the lowest classification, whatever its code.
Huh. I love that. All those in favor of the A6amendment say aye. Aye. Opposed. Same sign. There it is. Senator Wicklin is not with us right now, is she? Senator Mae Quaid. You don't want to do the 8:15, is that correct? All right, I'm X in that out. Senator Abler, we got to come back to when Wicklin comes, will you guys make sure the A8 gets front of us? Because I might have to be in judiciary. But Senator Aber you got the A10.
Remember who brought this to me? Was this Ms. Simons or was that somebody else?
People handing out the A10?
Whoever gave me this, you want to come up and talk about it?
I don't see anybody coming up.
Mr. Lm can explain it to us.
Mr. Monahan, would you help the good senator from Anoka?
Mr.
Chair.
Senator Abler, the original. I'll just first point out.
Yeah, sorry, go ahead.
The original version of this request on page one, line 12, the date was August 31, 2025, which would have resulted in a retroactive effect for this language. So at Senator Abeler's request, I changed it to August 31, 2026. Essentially, what it's trying to do is not have the ratio of waiver recipients versus other residents of a facility altered by the unfortunate absence on September 1st of a given year of a resident from the facility. A facility qualifies for this rate. Add on based on the ratio of waiver received recipients to other residents on September 1st. So if someone is absent on September 1st, they're not counted. So this allows for somebody to be temporarily absent. If that is their permanent residence and they intend to return, they would be counted in that computation of the ratio.
So.
Thanks, Mr.
I'm sorry, I just.
Now you get it. Now you know who brought it to you.
Had a human service moment there. So the deal was this disproportionate share program is actually rewarding assisted livings who actually have the ethic and the commitment to actually serve. And I'm only sorry that the threshold is so high. I think at 82 or 83%. But they're hardly. The people that are in the 70s
are hardly even open.
And many of the assisted livings have like two people, like a very nice place in Ramsey, city of Ramsey, which is where I got like a dog on a bone on this topic. The people could stay there and they could join, although they waiver when they spend down, based on space available, which was two. I won't tell you their name, but. So this was a deal where the resident was in the hospital.
Yes, I remember this. Yep.
And I do not understand
the.
Almost used a curse word, Mr. Chair. I do not understand the antipathy. That's a better word, of whoever in the department does not like this program. I believe the governor of the great state of Minnesota has cancelled this program in his budget. And I don't get it. So here's people who are, Mr. Chair, who are economically challenged and they spent down and now they have nowhere to go. And as a way to encourage them, they would go to these places, but they're stringent with their work. There was even another case, which I don't know if I. Maybe this will help them in the future, but there was an error in the paperwork which the department had a part in or the county did, maybe combined. And so they were within a half a person. And then that person that just didn't count due to error, even though they were about to come in or whatever, then they were denied their little bonus. And we should be doing all we can to open our arms and embrace this. So, Mr. Monahan, if this is without cost, at least we can fix this for the future. And it'd be nice if there's a way to talk about the past. But I think at least going forward, maybe if you put on there a little something phrase saying, would you please help these people who are so committed to the welfare of mankind and making no profits. They're the opposite of private equity.
Mr.
Chair, would you please help them do it? That would be, I think, be consistent with the mission and direction of the Walz administration. And I think, Mr. Chair, every administration. So I think that's it. Mr. Chair, thank you.
No, that makes sense. And I remember that missed it by a day and ended up losing all that. No, this is good. Senator Zainab. Muhammad, did you hit your hand up? Senator Zana, all those in favor of the A10amendment, say aye. Aye. Opposed? Same sign. Thank you, Senator Abler, Senator Wicklin, welcome back. We just going from one committee to another. You ready to go on your A8 or do you want to go to the A14 on Abler and. And Parachi Rodina, come on up. Senator Wickland, the A8's being handed out. Go for, You know, you think as much money that they spent on this system, they could have given us some, like, bumper. Not bumper music, but in this case, transitional music, you know, would have been great. Yeah, I want some. Anybody get me. Get some connection music there.
Mr.
Chair.
Senator Wicklin, thank you.
I just.
I wanted. I want to offer the A8. Senate Council has some technical assistance on it, and I'd like to have Mr. Monahan go over that technical assistance.
Mr. Monahan, from a Cantian perspective, please.
Mr. Chair, there's a drafting error in the AA on line three. The reference should be to line 13, not line three.
Members. All good with that? Do I need to make a motion on top of the motion? Senator Attie shaking his head yes. You want to just incorporate that into your amendment. Yeah, that works. Okay. Did you want. Go ahead, Mr.
Chair. So this amendment came about. I have some bill language and in Article 5, and I don't have the bill number, but it was a Department of Health bill that I presented in this committee. And my understanding was that the Department of Health has been working with the long term care imperative. And I was given language that they had come to agreement on to insert in the section 29. And so I'm bringing it forward. I have also heard just recently that maybe there are concerns about the language. And so while I would like to adopt it today, I do want to continue to have discussions with the advocates because I didn't realize that till today, so.
Mr. Mr. Chair.
Senator Abel.
Well, I want to thank Senator Wickman for bringing this up. This bed. This restraint has been a problem since Fran Bradley, since I got here, the talking about it. And they would let people fall out of bed rather than be restrained and get injured. Some random. Very few people have had come to trouble because of restraints, the whole bed rail question and all that. So, so. But I think it just makes all the sense in the world the way you're going. If it's voluntary and the people are informed, then they would choose that. I have a constituent and it's an old guy and he's falling out of his wheelchair. Luckily, he's not in assisted living, Mr.
Chair.
They leave him there, but. So he's at their house and this guy tends to slide out of his chair. And so his wife put a belt around him. The worker came out and said, you're breaking the law in their own house, like, anyway. So this is very important and I. Senator Wickman, I'm happy to support this on the floor and however long it takes to get this. So the people have the voluntary choice. Thank you.
Yeah, you want to go to Ms. Redina?
Thank you, Chair. Thank you, Committee. Thank you, Senator Wickland. We're thrilled that we're getting close to finally having language clarifying the use of restraints in 144g license settings. When assisted living licensure was passed in 2019. This was always a gap that we knew we were going to have to come back and address, similar to what we already have in 245D license settings. The restraints language in the bill gives everyone rules of the road when it comes to prohibiting or allowing certain types of restraints. The A8 is well intentioned to help ensure informed choice, but as written, it's not clear enough. We're worried about a situation where Family member one comes and talks to mom and signs up for bed rails or puts in a bed rail. And then Family Member 2 reads about bed rail risks and wants to take them off. MDH and providers need a better process in statute to help mediate and avoid this dispute. We're talking with both MDH and provider organizations and hope to find agreed upon language that works for everyone.
Thank you.
Thank you. Ms. Regina, follow up questions. All those in favor of the A8. What? Yeah, I don't think we got. You want to. Senator wickland. Anything else, Mr.
Chair? Senator Abeler, I was given information that I can. We can amend it today and then I will continue to. We'll continue to work on it.
I'm in.
I'm happy I was. I thought you were going to pull it.
So. Yes.
Now the best thing is to have languages moving. Then people have to talk to you
See I was ready to make the motion to move the A8amended as amended right as the oral Amendment. And then I get. You know. So. I'm kidding. All those in favor of Senator Wickham's A8amendment as amendment say I the same sign and passes. Thank you for your work on that. And. And it really. This is bringing back some 2019. I wonder who was the chair back then. Senator, you want Senator Rasmussen, you got one for us. You want to go to Senator Abelor's A14? What are you thinking? Go to Jim. Senator Abler, you want to do your A14? If you don't have it, we can do. Let's do Jordan's A11.
Thank you, Mr. Chair. I'd like to move the A11.
Awesome. Do you want to hesitate to pass it out? Jordan, you want to tell us what this is and where you just give us a little.
Thank you, Mr.
Chair.
Fits.
And members, this is language that this committee has voted on before. This would add in prohibition from Optum using private data that was obtained through their work on behalf of the state in evaluating program integrity vulnerabilities and making policy recommendations.
Oh, I see what you did. You just took out that little section of that just says. Optim Inc. Must not sell, share or disseminate any private data as individuals under incidentals their contract. Senator Wickland, I'm. This is Mr. Chair. We already passed it once, so. Yeah. Oh yeah, yeah.
I don't remember what we included Mr. Chair, but is it just it seemed. Yeah. I thought we already. Didn't we already have a discussion about this?
Yep. We passed it.
Okay.
We could remember we took all that you two were thumbs up because he came over and was talking to you.
I guess my question would be why would we add this?
Senator Ablor might have that.
So this can be the most mentioned item in this committee in the year. I think we're within a couple mentions of it to actually have the most record of all time mentioned. So it's purely about statistics and bragging rights.
I think we should do. Senator rasmussen.
Thank you, Mr.
Chair.
And Senator Wickland brings up a good question. The reason I'd ask members to add this to this bill today is just to have this continue to be a part of the conversation on the DHS policy bill. And Mr. Chair, I'm not certain what will be coming to the, the floor, what omnibus bills will be happening or not happening or standalone bills. And so this will just serve as a marker that this is work that this committee would like to continue on.
Senator Wickland, Mr.
Chair, Senator Asmon, I guess the only thing I'd add is that it's still language that needs to be heard in Judiciary and we're working that.
So,
Mr. Chair, does this get sent to Judiciary if we add this amendment? Because I know my, when we added it to my bill, it got sent to.
I think we need advice because you're adding it to your stuff too.
Mr. Chair, the, sorry, the full meal deal got sent to Judiciary. We decided in our committee.
This is not, this doesn't go, this is the section.
They can't sell their. What they learned. That's, that's what I understand because we did add it on to something that went not to Judiciary.
The health people at the end are thinking, no, do we have opinions? What are you guys thinking?
Mr.
Chair, Senator Asselson.
Thank you.
Mr.
Chair.
The reason that we specifically stuck to this language was to, was based off of advice that the other language would necessitate a stop at the Judiciary Committee. You know, Senator Latz can always, you know, ask for whatever bills he wants. But this was, this is the same language that was adopted on an earlier
bill that didn't go to Judiciary. This is the stuff that doesn't go to Judiciary.
That was our aim with this amendment, was to carve out the items that would trigger a hearing in Judiciary. So that was the intent here with this language.
I remember. Yeah, no, I remember that we recessed and then Sam went over to Senator Wicklin and to Senator Rutke and explained everything and that. And I remember this. If we pull this out, that stops it from going to Judiciary. So I'M okay with that. We're good. Oh, but then they're talking. Letter dispute discussed. So there's. Last week when we had this, the full bill that he was doing, we recessed and this. This part of it because the part of that in the bill language would have caused it to go to Judiciary. And so we pulled out this section at the advice of people smarter than us. This would not have to go to Judiciary. And that's what they're having discussion right now at the end of the table. And if we accept it, we put this on, and it doesn't need to go to Judiciary. It stays with our policy bill. Yeah, cool. Did I explain it? They are health. The health people are mingling. You want to let them mingle? Senator Abely, you want to go join the health people? The health people are mingling down there. We're waiting on them. This is where I want music. You wait till the A19 comes up. I'm looking for that. Steely Dan. How did he get that a 19? We're good. You guys okay? The health. The health people have said we're good. So all those in favor the A11 say aye. Aye. Opposed? Same sign. Thank you. We are. That's done. Jordan's A11. Done. Senator Abler, did your A14. 14? Yeah. You got it now, do you have the A12? Yeah.
Oh, do a Glenn one. He's got the A12. Consequential here.
Well, Glenn, you didn't tell us you had the A12. Now you get. You want to go first? Ladies and gentlemen, Senator gruenhagen with the A12amendment. Yeah.
The reason I brought this amendment in the bill, there's a provision that prohibits nursing homes and assisted living. It prohibits residents from requiring. It prohibits them from requiring a guardian or conservatory for the resident. These are very difficult situations, and we need to ensure the proper protections of those residing in their facilities. This takes away any flexibility for providers when emergencies arise or to plan ahead in case of emergencies. Now, through my insurance agency and even my own family, I've been involved with some of these situations with memory care and other things like this. Unless I'm missing something, I don't understand why the state would take away completely take away the ability for a nursing home or assisted facility to require a guarding or conservatory because, you know, many of these people have severe health problems or memory problems. And I, you know, to me, it's a local control. And unless I'm missing something, what this amendment would do, it would remove this provision from the bill.
Do you remember Senator, thank you. Do you remember the provisions that you're removing in there? Do you remember whose original bills or bill that was?
I think it was yours.
No,
no, I think it was Senator Mann, if I remember right.
Okay.
Senator Abrams, you know, this has been a discussion for a long time and some places it's kind of back, this is the nursing home side. But like, you know, there's just some practices that have not been good about some requirements and in fact, as opposed to control now it's a requirement, some places have a requirement and then it takes away the ability of the industry to have some choice if that's the rule. And I just remember that we had testimony about that. So I remember, I thought that was something that they shouldn't be required to do. I think if we've had testimony in our committee on this topic over the last several years and I would just speak against the amendment personally. So thank you.
Thank you, Senator Abler, I would too. I would, yeah, I agree. I would speak against that piece of that part of the amendment. Glenn. So Senator Aramay Quaid. Well, thank you, Mr.
Chair.
And you know, Senator Abel said it very nicely. I think, you know, we veered from something that could be a conversation or something that could be, you know, part of an individual's entrance into an assisted living facility or nursing home. But now as a requirement, I mean, I'm thinking about what if it's the closest one to your home or to your family's home and it's now a requirement and you don't need this at all in any way, shape or form. No one thinks you need it. Right. It's just a requirement to have some assisted living support. And so I just, I think we should leave this in, I think there's still the ability for assistance that live in facilities and nursing homes to have conversations with families. But we can't, we can't force people into guardians or conservatorships in order to have, you know, a little bit more support to make sure that someone's there if they fall. Like that's taking away a lot of agency.
And this also, this argument, just some of it stems. I wish we would have a, I wish we would have started the session in January so we could have like ample, ample conversation. Because this conversation, Senator Gruenhagen, it also stem, it goes to hospitals getting, you know, somebody going to a long term care facility, not having that go to person. There's a bigger, there's a, you're, you're dipping on a bigger umbrella here that we need to really, I think, get under. So Senator, Senator Zainab Mohammed and then to Senator.
Mr. Chair, I think we passed protections for HCBS last year, so why can't we also just apply it to this?
Yeah. Senator Gruenhagen, then Senator Utcie, unless you want to let Senator Ecke go first. Senator Gruenheim. Yeah, go ahead, Senator Ecke, Go ahead.
Thank you, Mr. Chair. And I guess I would encourage the fellow members to support this amendment because we got division. Honestly, when you go through this process, when people get to the time of needing assisted living in nursing homes, they typically need help. That's why they're going to those facilities. And to prohibit a guardian or family member. I would think that the place would really want it because I can't imagine I've gone through it with, you know, my parents and other elderly people that when they get to the time of the nursing home, they're going there because they need help. I think that this should be removed and we shouldn't be part of it. I mean, it's an individual by individual type thing. When you get to that age, everybody's different. But just telling nursing homes they're prohibited from this and assisted living, I think is wrong.
So, so can we. I got Senator GRUENHAGEN, Senator Wicklin, Ms. Redina, do you guys want to hear from our state? Probably forgets more today than any of us will ever know regarding this argument. So. Ms. Rudina, you want to clarify the room, will you?
Thank you, Chair Hoffman. Thank you, committee members. And I do just want to start by saying we are in discussion with provider organizations on this language as well.
We.
We haven't reached agreement yet, but I think we are continuing to discuss and appreciate that openness and willingness to ongoing conversation to, I hope, address your concerns. Senator Gruenhagen, I think it's worth recognizing that this language is not a blanket prohibition on guardianship and conservatorship. It's simply saying we don't want to have somebody languishing in the hospital who could go to a nursing home or an assisted living facility and that the person can go and we can have supported decision making or in cases where guardianship or conservatorship is appropriate, that can be pursued as well. So it does not stop that possibility from happening. And.
No, you're good.
I had one of those moments.
Thank you.
Do you want to go to her first? Because you're the author of this amendment, Senator Wicklin?
Yeah, I think I would just. I'm just would reinforce what she's saying. It's not saying that a person can't have or can't have a guardianship or have a conservator, but the nursing home can't make it a condition of their coming there, that they have that. I don't think they should be able to prohibit someone from coming
to a
nursing home or assisted living because they don't have a conservator or a guardian. I would oppose removing the sections.
Senator Gruenhagen. Yeah.
I appreciate the discussion on this, and evidently, from her testimony, it is a little bit of a bone of contention. And you are working on language, right? Yeah, I just. I guess I wouldn't want to cut out from the discussion completely the nursing
homes and the assisted living.
I mean, some of these people have worked with residents a number of years.
They also have experience in this area.
They should have some type of an
input versus just a family member. You know, I was told one time, as an elected official, we have the power to convene, and that's it. So it sounds like you're interested in this conversation. It sounds like Ms. Regina. I mean, is. I don't know when we would get to the floor. Right. We got there. Sounds like. It feels like there's plenty of time, you know, to convene some folks and if so, bring an amendment to the floor. She's shaking her head yes. You're shaking your head yes.
Otherwise, we could add the amendment, and then it creates a couple conversation.
I heard that one in class. I think you got a split. I love this committee. We're split right now. This is fun. Yeah. I'm with wickland, Abler, Hoffman.
Mr.
Chair, if we take it out, there will be no conversation.
But I still think. Glenn, no matter what happens here, please, this is of interest to you in Ms. Rudina's office. I think y' all should get together with whoever else is interested, you know, Know, maybe you could finally get Shawn Burke to, you know, do something. And he's wearing a tie, by the way. Did you see that Sean Burke is actually wearing a tie?
No, I'd like to work with her.
You would? Awesome. Yeah. All right. Any other. So should we. Should I just withdraw it or. Yeah, yeah. You want a position? No, Glenn, I. Yeah, if you want, just withdraw it. But with the condition that y' all gonna have something conversation and you're gonna follow up, keep us in the loop, and we could sit still. Added on the floor. So 100%. Okay. Thank you. Senator Gruenhagen withdraws the A12 senator. All right, I'm confused. Glenn, you're the A4. Did we do the A14? All right, is there an A13?
That's bad box.
Okay, we're going. No, A13 is an A4.
Fourteen.
Senator Ablor.
Thank you, Mr. Chair.
This is.
I didn't even know the acronym. This is belts. This is the board of something or other that runs long term care. The administrators. And so this is just a rehash of. It's just a technical cleaning up their language about their fees and so nobody. There's no money in and out, but it's neutral. But I don't know if it belongs on this bill or the next one. So I was just going through my little inventory. Oh, look at this one here. So if the staff thinks this belongs in the finance.
If it stays. If it.
Okay, so I don't care where it goes. I mean, this is the kind of amendment that if we discussed this very long, we'd have no people viewing online.
Does it stay here or go to finance? Yeah, that'd be great. Go ahead, Rick. Kyle. Mr. Raymond. Mr. Raymond. Does it stay here or does it go on to finance? Should we get Elise Bailey to come up too? And you know I'm kidding. Go ahead.
What?
What are you thinking?
So, Mr. Chair, I think the question at hand would be whether the changes in subdivision two would change any revenue for the board of executives for long term. Ltss. So this is. This executive board is defined as a health related board under chapter 214. So as such, any change in revenue wouldn't automatically be spent. So therefore it wouldn't have a zero net effect. So if these changes result in any increase or decrease in the amount of revenue they receive, then therefore there would be a fiscal effect. I'll also note that the base funding for this board is actually under the health and Human services budget.
Senator Wicklin.
Mr.
Chair.
It appears that way, but that was only because last year in the other body it was in their health committee. And so it got brought into our bill at the end. But it would be within this committee's. The board is within this committee's jurisdiction.
Huh? I love it. So we got the health kit. Health folks.
So, Mr.
Chair, where do you want it? We can wait. I just didn't want to lose.
Don't lose it.
I mean, worth having a hearing about, you know that. Boring.
You want to withdraw it and pull it out or you want to stick it in here?
What do you want?
I don't know. At least. Bailey, what is this? Is there A fiscal on this.
This isn't her department.
It's not her. It's not you.
She's come all this way. I think it's all technical. But, Mr. Chair, if you're the least bit worried, we can stick it in the other one. So I'll just withdraw it.
Jim, Senator Abeley has withdrawn the A14 members. The A14 is withdrawn. We got anything else? Jeez, somebody starts singing that song. Hey, 19 by Senator Fate.
Thank you so much, Mr. Chair. I'd like to offer that.
Can you name the drummer in the Steely dad band, by the way?
I have no clue.
Senator Fate. Go ahead.
I'd like to offer the 819Amendment and I can call up Matthew Bergeron if there's any technical questions or if it causes any indigestion.
Only if he's wearing a tie because this is the Senate and he did his, you know, his due diligence down there. Senator Berger, Mr. Bergeron, you want to come on up?
Yep.
And while I'm explaining. So ics. So this connects directly to the continuity of care that you're talking about this session. ICS settings. So when ICS settings close or providers exit. Can I do it while I talk?
Yes. We are now whole because we heard from the A19 of Sealy Dan. So this is the continuity care argument.
Correct.
Connection. Tell me where this ICS conversation so
establishes transparency in two areas. Actually, let me bump up a little bit. So when ICS settings either close or providers leave, individuals can lose both their care and their services at the same time. And it's difficult to manage because there isn't any transparent or up to date data on occupancy or available capacity, which makes it challenging for counties to identify like appropriate placements. And so the two ways that helps is, number one, it requires DHS to publish quarterly data on ICS capacity, which includes occupancy available beds and the number of operating and closed settings, applications under review and then timelines. And the second requires DHS to publish standardized setting review criteria, application templates and documentation requirements so providers and lead agencies have clear and consistent directions. So I think it helps and I
can perhaps I like where he's going with the county side of it. Does it? Because Luella, does that make sense to you? Is that. That she should look at this? You don't even need to talk because I already like it. I like the. But go ahead, Mr. Bergeron, if you want to add to what the good senator from Minneapolis was saying. Mr.
Chair, Senators Matthew Bergeron, Larkin Hoffman on behalf of the Residential Providers association of Minnesota, we've had conversations about uncertainties and confusion with the ICS program going back a couple of years. And Senator Fonte had a bill in front of the committee last year that was talking about codifying this program in a way to create some certainty. This is a small step in that direction and would just require some of these standards and the capacities to be published with a regular basis.
Thank you, Mr. Bergeron. So I'm being told there's an assumption that there would there could possibly, maybe, sorta don't know, be an administrative cost on this. So what are your, what are your thoughts on that? What do you want to do? We don't know because we don't have. But I got. Oh, I just see Elise Bailey shaking her head. She's never wrong. You guys know that Senator.
She is just no fun sometimes. You guys, these responsible parties that come to these meetings.
Oh, ask the question.
I'm sorry, I didn't give. Senator. Senator Ecke should be asking that question. Is there a cost there? Senator Atke. Elise, could you. Is there. Would this make sense? Do you have an idea how much your department of administration. Of course, you probably have to run that through, you know, human resources, which is controlled not by DHS but by mmb. Did you guys know that if there's
a cost, we can just take out a.
They can just do another break time
per diem if we want.
What do you ever get?
What are you thinking?
Chair Halfman, members of the committee. This likely would have a system and a staffing cost. We just don't have capacity to absorb additional reports or work. So we would need staffing to do.
Senator rasmussen.
Thank you, Mr. Chair. And I would also see this as adding additional work on the Department of Human Services. And I would just say, especially in a time when I think all of us are asking DHS to focus on program integrity and focus on continuity, care and those issues. I just don't know if now is the moment we want to be giving them some more additional work, so. Especially if it would require more resources.
Well, that's the thing that I. Go ahead. Senator Fatah.
No, when we talk about continuity of care, and I think that's been the theme this session, I think this is critical in identifying the areas of needs if you want people to get placed in services, I think this is the right way to do it.
Can you get a no cost? I mean, there's a. To the contextual argument that's there because that's all that's all this committee. We talk about continuity care. Right? We are, because it's the. Yeah, go do this. But you're forgetting about the people. We have four, four people dead because of somebody's inability to do continuity of care. Is there a way you go and look at decreasing that fiscal cost side of it? I mean, what's the.
I could refer to, I mean Senator Bergeron.
Matthew Bergeron. It's worth the conversation. I mean I think there's a thematic argument here that I like. When he said that I went God, I like this. And then all sudden I get the oops, there might be an administrative cost to this. And then it's like now what do you guys want? What do you do want to do as a, as a committee? Right.
So I would say. Chair Hoffman. Oh, sorry. I would say that, you know, there's a cost because it's a function that you want the administration to do to, to assist people. And where we're at as an agency is we have a budget of 2% for admin and you know, we could do better on Continental Continuity of care, but we don't have the resources to do it. So it, that's just my personal opinion. If you value that, you know, put it in your budget bill and you know, up the game on continuity of care, including something like a report. But it requires people to do it
correct without you got to have accurate data. Senator Abler.
Well, thank you Mr.
Chair.
And I'm willing to posit that might cost them something at the home office. But I think that this is something especially this niche which is like, I don't know, number two on the hit parade for things that people are worried about, you know, inappropriate services, fraud, that I think that we need to find a way to do this information. And so maybe I'm asking question but like we're asking them to publish. Publish the data. It doesn't. We don't make them develop in the standards, we just say publish them. So it's obvious. I mean that's something you probably already know. You know, just some. I've got a 14 year old grandson who could help you put this on your website if you need a little help. But he's in Colorado so maybe he's busy. But some of this stuff open beds and, and so on is a way to understand and I mean I'm not trying to talk you into free, but I think at some point the department wants to know this in particular. While there's literally probably tens of thousands of people whose care is being Interrupted because of the efforts to constrain fraud and the group and the just not even knowing like Lydia. They didn't know and they're trying to help Lydia, who was displaced in New Year's Eve and has received no services to date and her mom quit her job. And so it'd be nice to know if some of these beds are available for various people with various needs. So like a capacity update. So if the department has a safe transformation or safe something that they're trying to do where they place 77 people or something so far. I just think it's. I think we should find a way to pay for it and even expand on that a little bit. So. And I think that'll help. Otherwise, I don't think Elise could take the pay cut to absorb this. That would be wrong. Let's pay her full pay. So I'm in favor of that too.
Thank you, Mr.
Chair.
Thank you. You two are sitting over here working on something because I can hear the conversation. What do you find? What are you doing? What are you thinking?
You were scheming, but it didn't work out.
It didn't work out. What do you guys want to do? Have them work on it. No, we can't. I'm getting it all, so. All right. Do you want to.
Do you want to budget bill coming in a month or something?
Yeah. You want to withdraw and work? Can you guys work on this and then, I mean.
Yeah, we could work for the budget piece.
And then after all, there is some money that has been underfunded that's sitting in the general fund. Maybe we could do a little, I don't know, forecast grab and try to find some way to pay for some things. We would never. This committee would never do that. That would never even be an effort.
Seen you do that.
I got the two health people laughing down there. Well, you made us pay for something three times. Do you remember that?
Chair Hoffman, for the record, we finally got it done. So you're not fixing that this year.
All right. Senator Fato with motion and he promises Bergeron do not go away. You're gonna be working on this with him. So appreciate your help and help on that. So that's all I got. Utke you got a couple or is that in the next bill?
Mr. Chair, I don't have any amendments, but I do have some things I want to talk about when we get to that point.
I think, you know, I think we're at third reading on this one. You have another amendment for this one or for the next One, no, the next one you have it for. Because then what we'll do is after we decide what to do with this bill, then we'll take a 15 minute recess so we can go grab lunch. But we won't be going to certain places where other people have gone and they've made the news. Stay out of those certain places. Senator ecke.
Thank you, Mr.
Chair. The table's yours.
Thank you. And you know, I've got a question that is going to involve the Department of Human Services. So if whoever wants to come up here, it relates to, it's going to start on page 7, line 10, Department of Human Services under the Continuity of Care. And so it's a funding issue. So I just. That's where my question is going to go.
I see that subdivision two, you're looking at subdivision, subdivision two. Yep. Got you.
And it talks about page seven. Starting on page seven, line 14, we get within existing resources, a commissioner must ensure the continuity of care team always has sufficient staff capacity and resources for timely, complex compliance with the requirements, etc. It goes down through. But then when you get to page eight and we start to talk about some of this extra stuff and then going to line 20, continuity of care team and lead agency shared duties. And this subdivision applies to all lead agencies regardless of whether the lead agency provides case management directly or under contract. And then you get down starting line 829. If the lead agency fails to develop and implement a person centered contingency plan, then you get dropped down a little bit more. The continuity of care team must directly intervene and provide case management directly to the client at the lead agency's expense. And that's my challenge right there. I want to know, will any of these costs be passed on to our counties and what can and should they expect? Because that's the concern that's out there.
I love that question. I love the fact that he brought that up because this was the stuff they're already doing. And Louella, this is stuff I'm looking at. LUELLA Hannibaguai this is stuff that, remember we codified this because a lot of this was stuff they're already doing. But yeah, when you see lead agency to that point, Senator Utke, is there going to be some expanded cost to the lead agency or is this just the fact is the lead agency's in charge anyway? Right. We're just assuring that they're in charge. Does that make sense?
Yeah.
Chair Hoffman, Senator Uckey. Yeah. Looking at the language which I admit is the first time I'm looking at does seem to say that in the event that the DHS has to step in, that it would be at the lead agency's expense. I think we would need a fiscal note for this to. In order for us to kind of think about how we would operationalize that and how it would actually work, how the funding would flow. But you know, my initial reading of it, and I see Luella is up here to provide her feedback. My initial reading of it is that in the event that we have to step in, there would be some sort of financing transaction related to that.
Ms. Louella, thanks.
Chair Hoffman, members of the committee, Luella Coffer, senior department administrator with Hennepin county, and I'm also involved with maxa. The particular provision that I wonder about, not extra, but where there might be an expense to the county to pay the state for services. So, Chair Huffman, I hear you when you're saying much of this is about what we're already expected to do. What the case manager would do is planning to have a contingency plan, look for alternative services, do the work that county or a contracted case manager would be doing. But on line 831 and 832, it specifically says that if that plan doesn't happen in time. So let's assume this is the case where folks have been working on a plan and the alternative services weren't able to be in place in time for the transition, then the Continuity of Care team must directly intervene and provide case management to the client at the lead agency's expense. That particular line where it sounds like they get involved and then we need to pay them for the services they're providing. So that would be my concern.
That's a could. Yeah, I see that that could. And this also what this helps the thing that I asked for all session when I came back, somebody needs to take the lead. Right. And remember where I live, there was a certain cluster of homes and everybody was pointing their finger who was in charge. Right. And I remember Representative Newer from the other body was saying the county lead agency must be the ones that. I mean, we just. So this is the intent was to get to. It's codified. If that piece of it. Senator Abler, you want to address that. This is something that was talked about.
Oh, this is really important. And I'm glad you got this in there. I don't know why we have to say at the lead agency's expense, we already pay for case management.
Yeah.
So I think that going forward, I think we should word Smith, this. That they would then be responsible for case management to do the service, and then they would be able to bill and pay their staff.
So. And that was the intent. I think that's the whole conversation was about that. You're spot on.
So I don't know if you want to take it out right now, but I think that. I think you want to just take that out on the floor and clean it up. And Mr. Monahan can think through about how it would be written, and you can work with the counties, because there's no reason. The case management is not a finite amount of money. It's pretty much what you need for whoever is doing it. That's my advice.
And they're already the ones. To your point, they're already the ones that are being. That's the funding for case management is through that lead agency.
Well, it's out there. If you want to do it, you'll
get paid by the county, correct? So, Senator, I mean.
No, by the state. The state will pay you.
Yeah, correct.
Via the county.
Yeah, via the county. The county is the lead agency in this case.
So, Mr.
Chair.
And that's exactly what the I. The feedback I got from the county is.
They.
They want clarity so that they know what this really means. Right now, there seems to be a little gray area to it, and they need to know what the rules are. And, you know, when it comes to finances, they're used to the state dumping a lot of stuff on their plate, and this caught their attention. So we gotta make sure we.
I believe this committee last year actually protected the taxpayers of counties. And do you remember that? We could call ourselves the. What. What do we. What were we called?
We were amazing.
We all just got our property tax statements, I believe, this week, and we see what gets put on their plate, and we get to pay for it. So that's why they're concerned and want to make sure there's clarity.
So. So two things in front of us. Senator Atke, we can either fix it now, or we can have you and Mr. Monahan and I suppose Louella and somebody from the department get that clarifying language, and we put it on the floor without losing the contextual. The contextual arguments there. But if that little thing needs to
be right, I didn't have any amendment or anything in mind at this point. So, yes, we can work on it between now and the floor. I just wanted to bring it up because.
I'm glad you did.
Counties want clarity on it, and the conversation is good. And now we can work on Something for the floor.
It was a good discovery.
Thank you.
He should be a lawyer.
I think that there could not be a better team on that than it was be going to.
To do that.
And so I just want to remind us all again, I'm told there's 540 providers sitting in the AG's docket with 16 investigators. If they each have 20 people, that's 10,000 clients. And it may well be more than that. So this is not an if they have to figure this out. It's when.
When.
And these people are being shut down today. And the departments, somebody thought they should provide services for 60 days with money they do not have, which is impossible. And so getting our arms around this is not just suddenly a random thing. It's a real thing. And so these are real people. We don't want any more people to come to harm. So thank you, Chair Hoffman.
Thanks.
Yeah, I would say realistically we need more people at the department to adequately get at that demand that you're speaking of. I know you brought that up within available resources. We're trying our best, but the reality is we don't have enough human beings.
It's interesting she brings that up team because we, we had given folks, we had given money to hire folks. And then I'm finding out that, that they can't even. The Human Resources department can't even get not job classes. What's it called, not job description with job classifications done. And that it's not the department that controls human resources, it's mmb. If that's a true statement, then all the work that we've done is getting held up in another bureaucracy instead of the one that's in charge of doing what they're doing now. I make that assumption because of what I had heard and I absolutely believe who I heard it from and why I heard that is absolutely factual. So, for example, there isn't job classifications for individuals that are working in certain departments within the Department of Human Services because they're waiting for Human Resources to do it. And HR is run by MMB in that department. Go figure that one. I'd rather listen to Steely dan than that.
Mr.
Chair. Mr.
Senator, what if we, you know, DHS would hire their own case managers? We already have a budget for that. So then they can.
Good.
All right. So Senator, thank you. Thank you. Senator Atke. You have this committee's commitment that you will work and we got a little bit of time on this, so thank you. Any other comments about our work? I am just absolutely proud to be a part of this committee and the work that we do collaboratively and that there isn't any mediators or posturing or. You know, Glenn threw a pen at me one time.
So
that works.
Senator Abler, Mr. Wedlik has been very busy at home, so. Good cause that he found some definitions and I won't read the whole thing, but. So if we need to put this together. There's already some statutes that talk about it, but he referenced good cause it's a verifiable circumstance if you. Prevents a recipient from completing the renewal process, et cetera, including acute illness or hospitalization, administrative delay, pending documentation, notice, non compliance. And so we could easily stick that in there somewhere or reference, wherever the heck it is. So I'm just. That's easy to fix.
Do you want to direct Liam to do that before? Like we could direct to. For that to happen?
What if he just feels like doing it? We don't have to tell him to do it. Would that be okay?
I don't think he can do that. And he knew that. He knew the answer to that. You know that. It's just like we all know the answer to that. So if. If that would be suitable, this committee, when we do our amendment, would. Would have Mr. Monahan clean up the. The. No. Not going to do it. Got to do it on the floor. All right. Got it. No, not now. No, no, no. On the floor. We'll do it for the floor. Okay. Senate File 476 as amended. On the amended on amendment should be passed and recommendedly sent to general orders. All those in favor say aye. Aye. All oppose. Same sign. It passes. Thank you for your work. Let's take a little 15 minute recess so we can flip to get to C file 4222. And everybody got their stuff ready to go. So. Sa. Sa. Sam. Sa. Sa. Sa. Sa. Sam. Sa. Sa. It. Sa. Sa. Sam. Sa. Sa. Sa. Thank you. We're back.
Mr. Chair.
Senator Atke.
Does your watch have batteries in it? I was gonna suggest you get them checked.
Yeah. Thank you. I'm sorry. Sure. The guy who would ask about. Yes, I. Thank you. I appreciate. You always have. I'm sorry, I just. God, I was on. I was on Senate time. Since everybody wants to make fun of Senate time, right, Senator? Like, where's my batteries? I'm looking at my. Like I got. Yeah, you got me. Senate file 4222. We're going to hear the markup of this bill. This was Senator Abel bill that we had into Senator Wicklin's. Committee and then but what we did is bringing it back to us. I'll end up taking it over as chief author. And then the our intent is that this becomes the vehicle bill for integrity legislation. So really what we're doing here is we're going to add member amendments to it. This gives us time, Senator, at key and team to really spend the next, I think couple of weeks working on this. Right. So it really, like Senator Bach used to say, guarantee, I'll guarantee you this, Senator Gruenhagen, this bill will look different than it does going out of here today because everybody will be working on this. Right. And so Senator Wickland and I would like this to be really a start of a collaborative between on program integrity conversations between our two committees. Isn't that kind of a cool concept? When we return from the break, our plan is to put together in here this package between both of our committees and then take that work product and amend it all the work product, and we'll amend that into Senate file 4222 in Finance. So it's a, it's a hope that we move this bill into Finance, which it does have to go to finance and then we can go from there. So. Questions? Comments, Senator rasmussen Thank you, Mr.
Chair. My preference would be, you know, that there's a lot of new language that's especially been posted in the 810 and I don't know if that's going to be moved to be adopted. But there's a lot of new language in here, a lot of language that hasn't been heard in this committee. And I don't, you know, just given the timing that this was posted this morning.
Yep.
I don't know if members of this committee I can speak for myself. I have been able to review parts of it and there are parts of it that I like, parts of it that I have concerns with. But I don't feel comfortable moving a bill out of committee until this committee has done the work. And I think on an issue like this that's especially going to have finance pieces. I think this is something that we could wait, we could work on overbreak after break, have a fuller markup in this committee on this bill and then move something out. But I just today I don't know if it's the right approach to be be kind of throwing in a lot of new language, a lot of new ideas that we haven't gotten that we haven't gotten testimony on and then, you know, hoping it gets fixed later on
so I'm glad you brought that up, because here's the intent that we are going to hear the A10 Senator Abel's bring in the A10 delete everything amendment. But this. What we want is we want to send this as a placeholder, right, Senator Wickland. And I want this to be the start of that collaborative between, specifically on integrity, conversations between our two committees. And my desire, Senator Asmrson, was to have everything into this bill then. Right? Because we're sending it, it's going to be marked to go someplace. Then we are working on it by the time we get to that place where it needs to be, because it's going to end up coming back to us after that goes to that one place. Or it might go to Senator Wicklin's committee. We don't know. We just know we want to not have. We want to avoid. I do not want to go to rules and hold this up. And that stops us from having the work that we're having. So I hear you. I think our timelines are the same, just the process on doing. I think you and I probably disagree on that in this one, which is great. I mean, that's what this committee does. We agree or disagree. There's a song about that too, isn't there? Oh, yeah, it was like Senator rasmussen. Thank you, Mr.
Chair.
I would also just note that this bill is going to be a late bill at 5pm today, regardless of what this committee does. And that's because the House companion's not moving. And so I think that shows that we do have time to work on this and to make sure we get it right. I think there's a lot of really important work for this committee to do on the topic of program integrity and on the topic of due process. And I just think we should, especially since there are some bills in here that have been heard and acted on favorably. But there's also a lot of new language that hasn't been heard by this committee yet. And we also know there's going to be a financial element to this as well, which I think would put us out to the third deadline.
Okay, well, that's why we're going to finance with this one. That was the intent. So no to those points. Those are good. So Senator Wicklin, Senator Abeler, Senator Utke. Senator. Yeah, we're gonna. We can go if we can just start getting into the discussion of it. If you guys don't have anything to add to the conceptual process. Senator Utke does.
Thank you, Mr. Chair. And just following up on that. I know that, you know, we have members that want this to go through, but the thing that I'm always concerned with, and we've seen it so many times in the past, is we'll just push something through because we're going to fix it later. Well, it never makes it back to the shop to get fixed. And we have time. We've got three more of our meetings that we can have before we actually hit their deadline. I think we got time to put this in its proper place and not slow up or anything. I mean, we can add the amendments to it today or whatever, but I think we should still keep so that we can really make sure it's what we want. Because, you know, when I hear concerns about some of the things in it, and I know that Senator Hibler's brought everything forward in good faith, it's what he believes in. And I like, I appreciate that. But then I have others that have concerns with it, and I think we need to work those issues out around this table before we send it to someone else.
Interesting thoughts? No, no, your thoughts are good. I think we're on the same process, thought pattern, just how we're doing it. I saw this as a time for us to just put everything. You know, it's that ideation moment where you put everything against the wall, then you sit back and you got time to do. It's kind of like there's a certain senator on this committee that decided to Rule 21, one of our bills in this committee. And I was like, I was smiling and. And he said to me, you're not upset? I go, are you kidding me? You just bought me another week of time to work on something. So it's like, I think regardless, you know, the work on it is everything. So I think what we'll do is. Senator Abler, when you're ready. That's the only. Are there any other amendments that I see people adding to this? I think the answer is yes, you got one. Glenn's going to have one. And key, I think you have only one. I thought you had two. You got just one. Just one. I think Zainab, Senator Muhammad has one. Rasmussen, you got a couple. So, Senator abler, after your A10, then we can go to the other.
Well, thank you, Mr.
Chair.
I'd like to move the A10, and I do have an oral amendment to offer, and Mr. Monahan is going to help me offer. It just adds one more person to a stakeholder group.
Mr. Monahan, when you're ready. Nice to see Dominic Spazzetto come out of retirement and hang out in our committee today. Look at this.
See here?
It's right there. Whoa. Where's the Mortadel man? You're supposed to, you know. Wow. Mr. Monahan, when you're ready, Mr.
Chair.
Members, Senator Abler moves oral amendment. Page 16 of the A10amendment to Senate File 4222. Page 16, line 29, delete 7
and
insert 8, Page 17, line 3, delete.
And
page 17, line 4, delete the period and insert semicolon.
And
page 17, after line 4, insert 6, at least one member who is an individual currently receiving services, period.
Thank you, Mr. Chair. That's my motion and you can vote on it or I'll incorporate it, whatever you're more comfortable with, Mr. Chair. Yeah, sure.
Thank you for getting.
Yeah, that's Mr. Berg's work. So, Mr. Chair to comment. And I think if I can have Mr. Bergeron come up and fill in the blanks about what's new since we last saw the A4. It's not a massive amount. And so we heard the A4. We've had hearings on this in both committees. There were, I don't remember the bill numbers, but Senator Muhammad had a bill. I had a bill with due process. There was a good. No bill. There was your bill, Mr.
Chair.
The OIG had their policy bill.
Yep.
And there was one other one.
Yeah, we had.
There's one more that I forgot. Anyway, so this is a very equal handed, without a lot of judgment stuff stuck together. And with the exception of the Senator Mohammad bill with EVV and the numbers, there's openness to that. If there's a way to make it work. And the testimony was that what was there wasn't workable. But if there's a place to add EVV in where it makes sense, I think that's certainly beneficial. And with the numbers as well. The question about numbers that, like nursing homes or somewhere where there's just people working all day, kind of a daily rate or something was problematic. So there's a way to actually make sure we're tracking the right people. But except for that, with that single exception, with that two exceptions, everybody's stuff is put in their compliance training. And even so there's quite a bit here. And it's in all those bills, there was a lot of really solid ways to do program integrity and minimize fraud. And what's been lacking has been the chance to have some due process. And in working with the department. And Senator Rasmussen has An amendment that even allows for a third party to look the thing over after within a period of time. Because what's been going on before is that there's been dis. Languishing of these individuals pending the Attorney General and so on. And so I don't think even much of this bill is splitting much of the difference. It's very inclusive and with the, you know, with the. Even the first comment by the department. And I'm happy to accept that, which we think it helps. And I think the committee has to decide are we going to have. Are we going to be in charge of this as ourselves or are we going to fall into some big lump of finance bills that are going to go forward or maybe one bill. And I think on behalf of the public, I think they want to know what we're doing. I think part of what the error in this process has been, has been the lack of transparency. The prepayment review popped out and that was a surprise to people. And, you know, some of the rules around the credible allegations of fraud, what standards make sense. And I, for one, am very interested to sit down with Mr. Clark and the department and the providers and find a way to make this work. The providers actually provide a wealth of information about how. How to keep it good. And so by bringing in good provider practices with that view, then we can find the ones that are not good. And so that's the point of this. And so that's just my opening thoughts. And I think we're well on our way to a really, really good bill. I think we're far ahead of the House, the other body on this and the work that we've done with the integration of all the people on all the different interests.
So thank you for. For taking that on because this was a conversation that was, you know, we had all these different moving pieces out there. And yeah, I appreciate you on this committee. You went and collaborated it to get us having the conversation. And so that's appreciative of that. So thank you, Senator Abel, for doing that. That's committee work.
Oh, yeah. Thank you. I asked Mr. Bergeron if you could walk through the new additions that came out of those two memos and that were posted somewhere along the line.
But.
And some of these reference federal standards, which I think are healthy. And so if you don't. If that's okay, Mr. Chair, I think that would be productive.
Senator Aaron mayquaid.
Thank you, Mr. Chair. Just so. I'm sorry, I was also next door in Saint Local Gov. This is just a new Bill and we're about to walk through it. Am I caught up?
Yep. Senator Makeway, what we had done is we've taken all the integrity conversations and we attaching it in here. Senator. She's not here. Senator Wickland, we want to do a collaborative the Wicklin Utke world and our world over here. We're going to then work together to have an integrity bill. And, and the desire I just is to get this to go to finance. That gives us now time then to clean up. So whatever's in there now, I mean this is just a baseline. We're going to work on this. I mean we are going to work
on this Senator, just for Senator McQuade's benefit. So the A4amendment was pretty well transmitted around so people kind of know that one pretty well. But so Mr. Bergeron and there were, there's some additions to that that we were working on as refinements and so he's just going to talk about those the additions.
Thank you Senator Zainab. Mohammed, you're good answered. Way to go. Mr. Bergeron, I'm so glad to see you're wearing a tie in the Senate. This is so wonderful to see you in front of this committee. The mic's yours.
Thank you, Mr.
Chair.
Good morning Senators. My name is Matthew Bergeron with the law firm of Larkin Hoffman. I'm here speaking on this today as a practicing healthcare attorney in this space who represents a variety of different types of Medicaid providers providing services subject to the Department of Human Services program integrity, oversight, licensing and provider enrollment standards. In reviewing the various proposals that that Senator Hoffman referenced that had been kind of compiled into this package before, there have been a number of things that we've tried to offer a little bit of feedback or notes. Some of them have been incorporated into the A10 here. Some of them I think are conversations that are still ongoing. With respect to a lot of the pieces on provider enrollment, there's a lot of really valuable authorities I think as far as ensuring enrollment standards and race thresholds for providing services in here. The primary note that provided in that sense there's language regarding moratoriums and on classifying services as high risk. Kind of my recommendation to Senator Ablor and to the committee is that in those instances, the legislature require that those changes, those policy decisions, follow the Administrative Procedures act and be done through some form of rulemaking. This is how you ensure that they're valid. Under our separation of powers, the legislature makes the law. The executive branch enforces it. Unless the legislature delegates that authority to make rules to the state agency. And then we have a process under chapter 14 where that's done. And I think one of the things that we've seen in recent months, but over years as well, is that authority that's not executed through that administrative process can become confusing. Can does not necessarily receive the public input that the administrative law process sets up and also is subject to legal challenge where, if done otherwise, it wouldn't necessarily need to be as it relates specifically to the program integrity. And I want to note that the Department of Human Services has provided some significant feedback to some of the language in here. And I think a lot of that is actually in an amendment that the committee might be considering the A11 at some point in this. And so I kind of want to speak a little bit more about what that looks like, because I think there's some recognition. One of the historic situations has been that when the agency issues a temporary payment withhold for a credible allegation of fraud, because that is a temporary payment withhold, it's not deemed a permanent adverse action. And the courts have held that there is no due process rights, there's no appeal rights. But there's also been nothing in law that has ever established what temporary means. And so I've represented clients over the years that have gotten a temporary payment withhold, and it has gone on years with no subsequent investigation, sanction, criminal case, or anything like that. And so that means that that business, particularly if it's a service provider that's just delivering Medicaid services, is long since out of business. I've had clients that I represented, one agency that got one temporary payment withhold. Eleven months later, they got a letter saying, we've completed our investigation, you're okay. Well, that agency was long gone. There was an instance just this last October, where after two years, an agency sued. And roughly 10 days after they brought their suit in district court, they got a letter that says, the investigation is complete, no fraud, you can resume. And so one of the things that the language in the A10 would seek to do is ensure that there's some mechanism whereby somebody outside of the Department of Human Services looks at a situation and determines whether that allegation of fraud is in fact, credible, and then tries to put some parameters on the timeline definition of what temporary means. In hearing the feedback from the Department of Human Services, they expressed concern because as the. As the bill was originally written and as the A10 was or is, that would be a contested case hearing, just like a licensing violation or a tape take Back and in that you've got a process called discovery whereby the parties have to exchange documents in order to be able to argue the case. And the department has not to speak for them, but has raised concerns that if they're investigating somebody for fraud that would allow, that would require them to share information perhaps too early in the process with a potential criminal defendant. The feedback we've received and that we are happy, you know, the, the provider community that I'm generally working with thinks makes sense as a good middle ground is what is called an in camera review where something is submitted to a judge to review but the parties don't necessarily get to see it.
Right.
It's submitted under seal. And so again the idea there being is that there would have to be some outside third party. In this instance it would be an administrative law judge at the Office of Administrative Hearings just like might be handling a licensing appeal, just might like be handling an overpayment take back or a fine appeal or something like that, who would look at the department submissions, would look at whatever was submitted by the provider and determine whether the allegation of fraud was in fact credible such that the withhold should be sustained. The provider wouldn't get to see what the department had in their process there. And so I think it tries to get at that. But that that review or appeal is kind of like the first step is making sure that there's some outside third party because under current law the agency can submit information and say hey, we think you've got it wrong, but there's no one to look at it. The department is the sole arbiter as to whether their allegation is credible. The other piece in this that is worth noting that is new is some parameters on how long temporary is because at some point it becomes a permanent removal from the Medicaid program, which otherwise under law would be subject to an appeal. The language in the A10 would establish a 60 day window that could again by an administrative law judge under seal be extended up to two more times, up to six months, 180 days days if there remained a credible allegation and an investigation was ongoing. Those timelines are a starting point for the conversation.
But the big part of it is
that if a payment withhold is imposed, services are interrupted. Workers have to change agencies, individuals have to seek services elsewhere. The ball needs to keep rolling and ideally that within that six month window of time, even if the criminal case was still in development, development, the department would be able to identify something, whether it was a licensing violation or other conditions of participation that would allow them to move to either revoke the license or terminate their Medicaid enrollment while still doing, you know, that wouldn't forestall a future criminal fraud prosecution by the Attorney General's office. And so that language in here creates some kind of timeline as to how long a temporary payment withhold can exist. Because while I fully appreciate, you know, the inspector General's comments recently about the workload and capacities of both the attorney General's office and the inspector General's office in the current moment in time, historically we have seen these go on for years and never be resolved. And so that's one of the other issues we're trying to address at the moment. So I think those are the high level differences based on some of the, the broader provider feedback and some of the pieces that you'll see in here. But like I said, I do want to note that there's a potential second amendment that has has been shared that I think would move towards the department's preferred language on a in camera review. And I think that's something that the providers understand and are happy to kind of move and work on.
Mr.
Chair, Mr. Senator.
Well, thank you and I appreciate that. I appreciate the work that's there and I want to just note the people that have put some effort into this and the work. Senator Hoffman, you have a couple of bills here. Senator Muhammad has a bill and she's done a lot of work in the meantime. And I think that the process we've been using all along, Mr. Chair, in this committee where we've included, you know, everybody's work, this is not my bill, most content here is not mine. I just tried to collate it, collate it together. And as you know, Mr. Chair, then it's now your bill. And I thought it would be in the best interest of the work that you chair it and then in consultation with Senator, with everybody on the committee and I think that everybody wants to work on a fraud. But I think the people on this committee, along with Senator well, she's on that committee too, with Senator Whitman, are the best suited anybody in the Senate to create a really good Senate position.
Absolutely. And this makes sense because you start a baseline, you're exciting, you're bringing it together, we are going to have time to work on this. That was the intent when we were talking about with Senator Wicklin. How do we have something that that is going to look, you know, like it's like in the work on it and so on.
I forgot to mention Senator Fateh and Rasmussen, I mean we're all going to have a piece of this. There's more amendments coming and this is,
there's a bunch of amendments going to get added to this. So right now we're just going to start with the A10. So all those in favor of the A10 state.
Mr.
Chair to the A10. Yeah.
Mr. Chair, I again and I guess this would be a question for Mr. Bergeron, Mr. Bergeron, on the language that you've spoken to. Has that been introduced in a bill?
Mr. Bergeron, Mr.
Chair, Senator Rasmussen, the idea of an appeal as it relates to a contested case hearing or the in camera review.
If I look at like Article 1, Section 10, Article 1, Section 11, a lot of the language that you've been working on, has that been introduced in a bill that's been heard in this committee?
Mr. Bergeron, Mr.
Chair and Senator, a number of those pieces come from a package that Senator Abore had in committee last week. I think it would have been a couple of pieces related to that 60 day kind of continuation that definition that is new here and that was feedback that was offered in reaction to that bill's hearing I think a week ago Wednesday.
Yep, sounds good. So the answer is yes, Senator rasmussen.
Thank you, Mr.
Chair.
And I, I just, I don't feel comfortable adopting the 810. I think there's a lot of good stuff in there but I think it, it needs more work. I think we need to so have it.
My question to you is this. You're, and I, I'm just, I'm getting a little, get a little triggered because it's late in the day. Right. Our committee has always moved stuff process through, through. I don't know what the holdup is on this. The A10 gets us in the process through. So I didn't mean to cut you off, Jordan, but I just am like trying to, if, if you, if the A10 isn't adopted for us to start the work with Senator Wickland, then what's, what's your proposal then? You know, so do you have another amendment you want to add that would strip the, I mean it's just I, I don't care what's in the, in the bill right now because the real work's going to start from us once we get moving toward finance. I don't want this committee to go to rules. That's the only thing that was my whole desire and dream. So I didn't mean to cut you out, Jordan. I just, but I was just like
I'm, you know, thank you, Mr. Chair.
No, I appreciate you.
I respect the work of this committee and that's why I think we should do this hard and important work here. And in terms of avoiding rules, sending this bill out of the committee today does not solve that problem for you because the House companion bill is not moving. It was heard and laid over. This Senate file isn't going to become law. And so the even language that we work on that goes into this is going to have to become a part of a different Senate file, which means that we do have time, that we do have time to get it right in this committee when we can hear from testimony, when we have, frankly, when we have time to read through the entire Amendment. The A10, I think was posted this morning was finished last night. And I know there's lots of similarities between that and the A4, but that's been my big thing is even trying to map it and understand what is in front of us and what would be some of the things we'd want to change.
I get it. Your approach is different than my approach. It's just because we're having the same conversation. But the approaches, it was kind of like when Ramstead was asked about, you know, is it, is it Bush or is it Edwards? And he said, well, they're both going to balance the budget. Just their approach to doing it is going to look different in this case. Your end game. I think the end game, what we're trying to get to is more efficient through this way of getting it and then working on it. That's just my style of doing it right where your style is. You want to sit here and do this and then start adding little pieces. And I don't know if we have enough time to do that. Jordan. I mean, I think us getting people working on it after it's all together makes more sense to me. But I'm okay, I hear you. And then we'll go to Senator Zeynep
and actually I would point out something that Mr. Bergeron said, which is we do have, you know, there's this A11amendment where they're actually has been some back and forth and I think some agreement on how we could incorporate due process. But the challenge is that there's so much going on in this a 10 that to try to synchronize everything today, I don't know if that's possible. And so that's why I think this committee should continue to do that work.
And that's my intent, was to throw everything into this Bucket. Then we go to work on it. Then we have it ready to go. Go. Right. It was to give us a baseline to start working from. And that was. That was the intent. You would do it differently than I do.
Yeah.
I get it.
I think we understand each other.
We do. I completely understand. And so. I get it.
I just want to say that I don't. Don't think we should be adopting.
I get it. I get it. Now I. Now that you've explained that, I thought, was he trying to just kill this bill for the sake. You know, that's what I was actually sitting there thinking. But no, you're. You. You want the end product to be the same as our end. You know what I see the end product. Just the process is going. There's two different ways. I love it. Thank you for talking me through that. Senator Zainab. Mohammad.
Mr.
Chair, maybe this is for Matt. Maybe it's for counsel. Can we just go through the parts of the bill that have not seen a committee yet in the Senate?
Mr. Bergeron, do you have an answer to that? Senator Mohamed once would like to know which parts of this A10 were not heard in this committee.
Mr.
Chair, Senator, I'm more than happy to point out a couple of the more substantive pieces that I had made recommendations or had suggested that. That I have seen in here just tie together. Yeah. And I just don't know that I'm in a position to guarantee comprehensive nature of that because I didn't draft it. So I would defer to Mr. Monahan on that. But the two things I can point you to that are in the 8, 10 that I know were not a part of Senator Ablor's previous iteration on some of these program integrity pieces are. Section 13, starting on page 12, the time limit, payment withhold. That is a new concept. And that is. Was not in front of the committee in last week. And that is the. The 60 days extendable up to 180. That is new. And then section 14, the good cause language that is new in a bill form in front of you in this conversation, that is almost exactly the federal regulation dropped in. So it's not new law. There's one kind of minor fleshing out of a concept on page 13, line 15. Yes, line 15. But otherwise the rest of that section is existing federal law. The language on page 13, line 15 just kind of clarifies that. You know, if you look at page 13, line 9, where it says beneficiary access to items or services would be jeopardized by a Payment suspension. And then it lists out some of the examples of that. And those are all federal law. This would add an individual or entity operates a provider controlled residential setting for which individuals are reliant on the entity or on the individual entity for services. So it kind of flows fleshes out a little bit there, getting at some of the continuity of care conversations we've had in the past. But otherwise the rest of that subdivision 2G is the federal regulations. So it's existing law, but it's new to the committee in form of a state statutory proposal here. Those are the two major ones that are additions or fleshings out of some of the materials that Senator Abore had. But I would of course defer to Senate Council for a number of the other smaller pieces. But those are the two major topics.
Mr. Bern, do you know how you arrived at 60 days for page 12, line 12.18?
I'm sorry, Mr.
Chair, how? I think the new language states 60 days. How we are arrived at that number versus other suggestions.
Mr. Chair, committee members. That was a right 60 days. That could be extended twice up to 180 days. Six months was, was something we put out there that, that there wasn't necessarily a, anything other than that was a starting point for the concept of what defining temporary might look like.
Thank you, Senator Mohammad.
Thank you, Mr. Chair. Mr. Bergeron, on page nine, 9.5, it looks like we're redefining the definition of fraud. Has that been heard in committee, Mr. Bergeron?
I'm sorry, Mr. Chair, Senator, could you point me to the line again?
9.5, starting in 9.5.
Yes.
On page 9.5.
On page 9.
Yes. I believe that that language clarifying what is a credible allegation was included in Senator Abore's bill from last Wednesday.
Mr. Chair, Senator Mohammed, was that hurting committee, Mr. Bergeron?
Mr. Chair.
Senator.
Yeah. A week ago Wednesday.
Senator Mohammed, in this committee.
Mr. Bergeron?
I don't remember, so I'm just asking.
Yep. Senator Abel presented a bill in committee a week ago last Wednesday that had a number of these changes. I believe that language was included in that.
Senator Muhammad.
Okay, I don't remember that. I appreciate that.
Senator Rasmussen, Any other questions from members? Senator utke?
Thank you, Mr.
Chair.
And I don't know where this came from. So who would be the one to get the answer? But going to page 39, line 6, when it talks about the surety bonds, how was that number determined? Determined? Anybody know?
Mr. Chair?
Senator.
That was the proposal that Senator Abler and Representative Hicks introduced. I was not involved in that.
Senator otkin.
Thank you, Mr. Chair. And that was the thing when we're missing members around here that played a part in this. I was expecting that I might not get the answer. So we can wait till they get back or something.
We'll do that.
Senator.
Rocky, thank you. With that, we'll take a brief recess.
Sa. Sam. Sa. Sa. Senator abler withdraws his A10 as amendment that leads us to the underlying bill. Underlying bill.
Mr. Chair, I have a suggestion.
Yes, Mr. Abler.
Senator, I think that Senator Rasmussen has an oral amendment and there's some other amendments we can adopt. And then through the wonders of modern AI, which is the Deleum AI then we'll move the amendments and they'll be placed to purpose.
We.
And then we'll be done.
So make sure. Senator, we appreciate that. Make sure you. We haven't. When we move this bill to finance that we have the language in there that is appropriate to give our Mr. Liam the ability to what, place the language and it's in gross form or something like that. You got that language?
Yeah, I think. I think he might even tell me what I want to say.
I love it. All right, Members. Senator Aylor, we're going to Senator muhammad now.
Oh, Mr. Chair, can we have somebody walk through the bill first?
Walk through the bill we already passed out of this committee. This is a. Jeez. Senator Rasmussen, you have an Amendment?
Thank you, Mr. Chair. Yes. On Senate file 4222, the first engrossment.
Yes.
I would move to delete section 15 and section 19.
Okay,
Just. Was there one more Jordan 19's on page 15 maybe.
And I'm just clarifying the article, Mr. Chair, so just give me a minute.
No, you're good. You got a minute.
Thank you, Mr.
Chair.
So I would move that we remove Article 1, Section 15 and Article 1, Section 19 and Article 1 Section 20 from the bill.
Members, it was an oral amendment to remove Article 1, Section 15, Article 1, Section 19 in Article 1, Section 20 to the underlying first engrossment of Senate File 4222. Does everybody understand what just happened? I'm going to send. Get on the microphone when you ask that last thing. All those in favor say aye. Aye. All those opposed? Same sign. Thank you, Senator Rasmussen. You got another one or you're done?
Thank you, Mr. Chair. I would also like to offer the. Let me just make sure I have the right the A11 members.
Senator Rasmussen, you want to hand out the A11 or was that already online. We're going to get it handed out. Oh that's written to his. Never mind. Senator Asserson, you want to withdraw withdraw the A11. Thank you.
And Mr. Chair, you would just yeah. Look to guidance in terms of how we're going to look at adopting additional amendments because I think most of the amendments were drafted to the DE.
Senator Abel.
Thanks Mr.
Chair.
Senator Rasmussen we're going to adopt them all with the following advice to the Mr. Monahan that he will find a way to fit them into the draft in an appropriate way. Otherwise we'll have to take a recess while we figure that out. That seems like an agreeable way and then when you see the new engrossment they'll all be very carefully placed in a thoughtful manner.
Thank you.
The other amendments that are standalones are up for are very appropriate for today
and as long as we give instructions. Senators, Mr. Monahan can explain that.
Mr. Chair, members. Well first for the record this is a very unusual situation. Secondly, I am comfortable taking instruction to find the proper place place to engross amendments if what is being added are essentially standalone sections new proposals. I am not willing to use my discretion to integrate a page and line amendment into language to which it was not drafted.
Make sense to everybody what he just said. So Mr. Monahan, can you repeat that now that everybody's like going what is he willing to do? And yes Mr. Monahan,
Mr. Chair, members, I'm willing to take construction to find the property location to engross an amendment that contains only new language, preferably in a new section. I am not willing to use any discretion to redraft a page in line amendment to a bill to which the amendment was not originally drafted.
Crystal clear. So we will give him the instruction at the end as well just to make it very clear. You guys okay with that? All right with that, who's got amendments? Senator Zainab Mohamed.
Mr. Chair, it's an oral amendment and I want to remove page 9 starting line 9.3 that paragraph.
Liam.
A redefine.
Page nine members. Santa file 4222 first engrossment beginning at line 9.3, correct?
That's correct.
And what are you doing with that 9.3 to 9. No, 9.3 to what line you're deleting 9 point.
Yeah, I want to keep it as the existing standard of what the definition is and remove this new lingua.
So removing 9394-959697-98999, 10, 911 and 912, you're removing those.
That's correct, Mr. Chair.
Oops.
Mr. Monahan, just a new definition to be clear.
Mr. Chair members, Senator Muhammad keeps referring to a new definition. Is she referring to paragraph C or to clause 2 higher up on the page?
Senator Zaynab, can you answer that?
Paragraph C where we're defining it and then also the clause that go with it.
Mr.
Chair, Senator Abel, I think the issue
is in daisha and compared to preponderance. And so I think just for the sake of today, if Mr. Monahan can give us advice about hoback, go back to the original definition using the word indisha and just instead of taking it out. I think you need this, don't we? Because it isn't recodified.
Mr. Money,
Maybe Liam can tell us if it's recodifying or if it's a new definition.
Does what she's trying to do make sense? What do you think,
Mr. Chair members. Deleting paragraph C is. Makes sense.
Okay.
Because that is new language.
Bingo.
Not.
Hang on, I'm not done. Changing clause 3. I need time to compare it to existing law. Because. Because clause two was originally a recodification of existing language that somewhere along the way was modified slightly. So if you're going to start to amend this section, I need time to make sure that you make a conforming change to clause two that will have the result of maintaining current law.
Senator Muhammad,
I think my goal was to just go back to existing language. So I understand what you're saying.
Existing.
Existing law.
Existing law, exactly. Yes, I can do that, but I need.
That's right.
Five minutes to do it.
Nope, take your time.
One Mr. Chair, Senator, current law is stricken elsewhere as part of a kind of a recodification. And so the difference that I inserted here, which is my language, if you go back to pretty much use the word indisha of something or other instead of preponderance, then you're good.
Yeah.
So I think that for the sake of time and just was it I have to actually go to work pretty soon.
So Senator Fatah then Senator Rasmussen, just
to be clear, is sections section C9 3 to 9913 to 91 6, is that creating a new definition? Is that what you're saying? If so, what's the old definition? What's the difference?
She's saying go back to the old. He's go back to the old definition is what that is definition there? Yeah, that is new definition you're looking at. They're saying strike that. To go back to the old definition and Mr.
Chair, I noticed this because it was also a part of the 8 10amendment.
Yeah, yeah, yeah. Senator Rat.
Thank you.
Thank you. Mr. Chair. I think what. What we're both kind of struggling with is that within Article 1 there, there is some language that has kind of been in the A4, it's been in the A10 that we have some concerns with. And so one idea that I could propose would be just taking out Article 1 and having Article 2 in. And again, if this is designed to continue conversations that could be. It's my understanding that Article 2 provisions aren't controversial as far as I know. But so that's just food for thought for us to consider versus to go through section by section.
Mr. Chuck, Senator Abelitt first Senator Muhammad's concern on line 9.5. If the language is on pain line 4.27 to 4.32 in that area on line 4.29, all we have to do is take out the. We have to insert indictment of reliability. And so to reinstate state that language. That was what was originally in the bill that came from the department. And I thought that was just too low of a standard as a federal standard. We need to really define indisham. And so maybe we should. If you look at 4.29, you'll see that phrase and the same paragraph that you probably want to preserve.
Mr. Chair, maybe we should ask DHS.
Well then we're receiving. We are in recess.
If you look at 4.27.
Sam. Sa. Sa. Sa. Motion or yours? It was a motion. So Senator Rasmussen motion. Give us your motion. We will vote on your motion.
Thank you, Mr. Chair.
I have to roll call it. Mr. Chair.
Thank you. We will roll call has been asked for it. Shelby. Senator Rasmussen, I would move to remove
Article 1 of the bill.
Senator Rasmussen moves to remove Article 1. There's been a roll call requested. A roll call Will disperse when you're ready. Chair Hoffman? No. Vice Chair Fattay?
No.
Lee Rasmussen.
Yes.
Senator Ablor. Senator Gruenhagen?
Yes.
Senator McQuade?
Senator Muhammad. Senator Utke. Yes.
Senator Wickland.
Senator Muhammad.
All members that voted that voted. We have four no and three yeses. The amendment does not get added on to that. We have another amendment. Senator. Senator ecke.
Thank you, Mr.
Chair.
I have the A12.
The A12amendment members you have in front of you. It's got to get passed out. Senator Atki, do you want to tell us about the A12?
Yeah. Thank you, Mr. Chair. This follows along the theme of program integrity Those that are on the health committee heard this last week also. This just takes. And it affects the Department of Children, Youth and Families and the Department of Human Services. And you'll notice that we referenced chapter or statute 16B981, subdivision 2 numerous times. So it addresses the financial information required and a determination of ability to perform. And so that's what it's all about. It goes into whether they're a non profit and asking for 990s or A for profit at audited statements, et cetera. But it's just to further ensure whether it's a renewal of a license, licensure grants, that we're dealing with reputable people and organizations.
Nice work on this. Questions for the good Senator? Seeing none. All those in favor of the 812Amendment say aye. Aye. Opposed? Same sign, Senator Atke? No, you only had one, Senator Gruenhagen.
Oh, I have the 813.
813 members. Should I describe it? Yeah, go ahead, Senator. Yeah.
Prior to 2018, the Department of Human Services internal office of Inspector General published an annual report on their licensing, background study and fraud prevention measures. The last of these reports was submitted to the legislature covering the 2017 calendar year. Since then we have seen rampant fraud far worse than any other state. Again, DHS was doing this on a voluntary basis. They weren't required to, but they were reporting to the legislature so we could have oversight as far as the fraud's concerned. Once this stopped in 2018, fraud exploded. The bill will legislate legislatively mandate that what has already been done prior to 2018, it restores transparency that the public has been begging for. Within this report, the legislature and the public will have transparency into the OIG's caseload, fraud prevention efforts and ways in which everyone can partner together to stop rampant fraud. Without transparency, we cannot put a stop to fraud. This is another tool, and I believe an important tool in our toolbox to put an end to a fraud and protect the taxpayers money. With that I would urge adoption.
Any questions for the good senator from Glynco on the 8 13? Seeing none. All those in favor of the 813 say aye. Aye. Oppose. Same sign. It passes. 8 13. Any more amendments? Seeing none. I'm going to have the Senate file 4222.
I had an amendment.
I gave you the opportunity when I said so. Now tell me your amendment, please.
Sorry, it's been so many amendments. Add the EVV amendment. I need to figure out which number it is. I'm sorry,
it's the A17 go. Tell us about your A17amendment, please. Senator Zaynab, with the. The A17.
Thank you, Mr. Chair. We heard it in committee a few weeks ago. It was also heard in Human Service or Health and Human Services. It's the EVV language.
Any questions for Senator? We have already heard this bill, the EVV language, Senator Gruenhagen. So it's a verification. Okay. It's a good amendment. All those in favor of the A17 say I. I oppose. Same sign. Thank you. The A17 is now part of the integrity. Senator, we're good. Senate file. Okay. Senate File 42, 4222, as amended, should be re. Recommended to pass incentive finance with the specific instructions that Senate Research or Senate.
Whatever.
Liam Monahan, without. Without. Thank you. We're going to do this one without recommendation. So. So let me rephrase that. I move Senate File 4222, as amended, should be. Not. Should be sent to Finance Committee without recommendation. And, Mr. Monahan, specific instructions to be able to engross the stuff as it does.
Mr. Chair, I think there are many questions from the committee, and my question is, I think Liam was working on an amendment for me. I'm not sure everybody is on the same page on the direction on the bill. I know I'm a new member, but I just want to get some direction here because there was an amendment being drafted for me.
So the motion right now is to pass. To pass this bill and sent without recommendation to Finance Committee, which means when you send something without recommendation, you know there's things that are going to be worked on along the way. This is getting us the ability to work on the stuff that we need to work on, which you could clearly tell because everybody had an opinion in this committee about what something should be done on, right? So guess what? Y' all need to get together and do a. Y' all come like they say in North Carolina, and get together. So with that, I want to make my motion to either pass this bill without recommendation or not pass it. I'm not taking any more amendments. The board is closed.
Mr.
Chair, my motion. I said my motion. All those in favor say I. I oppose. Same sign. Does pass. Thank you very much, everybody. We are adjourn.