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Note: The Senate Information Office has toll-free telephone numbers to enable citizens of Greater Minnesota to obtain general information about the Minnesota Senate. The telephone numbers are: 1-888-234-1112 (voice) and 1-888-234-1216 (TTY).
Update: April 6, 2004 9:30 a.m.
A bill modifying childcare assistance was the first measure heard. S.F. 2496, sponsored by Sen. John Hottinger (DFL-St. Peter), provides a definition of quality child care and alters provisions relating to transition year child care and the sliding fee schedule. Berglin said that although the bill was very good, the fiscal impact was too great for this year. The panel amended the measure to remove the appropriations and returned the bill to the Early Childhood Policy and Budget Division.
A second bill, S.F. 2196, carried by Hottinger, was advanced to the full Finance Committee. The measure extends the sunset date for the supportive housing and manage care pilot project until June 30, 2007. H.F. 1961, sponsored by Sen. Leo Foley (DFL-Coon Rapids), was also advanced to the full Finance Committee. The bill expands the crime of first degree murder to include an offender who causes the death of a minor while committing child abuse, when the perpetrator has engage in a past pattern of child abuse upon any child.
The other bills on the division's agenda were all laid over for possible inclusion in the omnibus proposal. S.F. 2636, sponsored by Sen. Jim Vickerman (DFL-Tracy), changes a nursing facility payment rate for a facility in Jackson County. S.F. 1841, authored by Sen. Steve Dille (R-Dassel), specifies that $5 of the marriage license fee be used to fund a Minnesota Healthy Marriage and Responsible Fatherhood Initiative. The bill further directs the commissioner of human services to create the initiative to develop a community-based collaborative project that will test and evaluate a comprehensive strategy for promoting marriage and responsible fatherhood among unmarried urban parents who are expecting or have recently had a child.
S.F. 1991, carried by Berglin, modifies parental contributions for Medical Assistance, modifies MFIP provisions, modifies Medical Assistance estate recovery provisions and removes liens against life estates and joint tenant interests. S.F. 2513, sponsored by Sen. Paul Koering (R-Fort Ripley), modifies the definition of gross income for farm self-employed families for MinnesotaCare purposes.
S.F. 1760, authored by Berglin, is a comprehensive health care cost containment measure. The bill limits premium growth rates, requires the commissioner of health to establish annual health care expenditure limits, requires state agencies to encourage the adoption of best practices guidelines and participation in best practices measurement activities by health care providers and requires the implementation of an electronic medical record system. S.F. 1966, carried by Sen. Yvonne Prettner Solon (DFL-Duluth), establishes a prescription drug bulk purchasing plan. S.F. 2360, sponsored by Berglin, authorizes a long-term care partnership program and authorizes programs for all-inclusive care for the elderly. S.F. 1875, also carried by Berglin, provides that a decision by a relative not to be a placement resource at the beginning of an out-of-home placement case does not affect whether the relative is considered for placement of the child at a later date.
The corrections appropriations and reductions result in a net increase of $7.73 million, primarily for increased costs associated with changes in the sexual predator provisions and methamphetamine provisions. Funding is also increased for the Board of Public Defenders to make up for the loss of co-pay revenue and to assist with increased sex offender and methamphetamine caseloads.
The proposal also contains Berglin's bill for health cost containment, including limits on the growth of insurance premiums, health care expenditure limits, best practices and quality improvement initiatives and the implementation of an electronic medical records system. The proposal also restores some of the cuts made to health care last year and provides an option to allow small employers to enroll their employees in MinnesotaCare.
Other provisions of the bill modify Minnesota Family Investment Program provisions and make changes in continuing care provisions.
Berglin said the bill also contains a variety of bills heard over the course of the session. One measure, authored by Sen. Sandra Pappas (DFL-St. Paul), modifies outpatient rehabilitation services, another measure, sponsored by Sen. Becky Lourey (DFL-Kerrick), provides for a lead assessment pilot projects and a third provision, carried by Sen. Linda Higgins (DFL-Mpls.), prohibits health care provider kickbacks. Other bills provide a rate increase to a Ramsey County nursing facility, require price reporting by pharmaceutical manufacturers, and modify nursing facility case mix purchasing. The proposal also contains Sen. Yvonne Prettner Solon's (DFL-Duluth) bill to provide for prescription drug bulk purchasing. The measure also includes Sen. Steve Dille's (R-Dassel) bill that establishes the Minnesota Health Marriage and Responsible Fatherhood Initiative and increases marriage license fees.
A number of amendments were offered and discussed. Sen. Paul Koering (R-Fort Ripley) offered an amendment to provide protections for workers dealing with civilly committed sexual predators. Solon offered an amendment to evaluate the new consumer-directed community support option under the home and community-based waiver programs. Another amendment, offered by Solon, requires prioritization for persons whose programs ended Jan. 1, 2004, for the distribution of funds under community support programs. All of the amendments were adopted.
Berglin also offered several amendments. One amendment provides that profits derived from the operation of wood shops at Veterans Homes be used for the benefit of the residents of the homes. Another provision requires pharmacy benefits to be explained to consumers. One amendment requires a study of mental health drugs used in correctional facilities. Another amendment allows an adult foster care provider to become the legal representative of a person for purposes of health care directives. One provision requires the commissioner of corrections to convene a working group to study issues related to reinstating a parole board. All of the amendments were adopted.
Sen. Linda Higgins (DFL-Mpls.) also offered a series of amendments. One amendment provides for a pilot program testing the statewide trauma system plan. Another amendment that made several changes to the Health Powers Act was offered and withdrawn. Instead, Higgins offered an amendment to extend the act for two years. Another amendment requires coverage for ovarian cancer screening. One amendment requires information to be disclosed about ownership of outpatient surgical and imaging centers and requires the centers to provide information to the Dept. of Health. Another amendment extends long term care insurance to local government employees. Finally, one amendment provides for a statewide public health information management system. All of the Higgins amendments were adopted.
Two amendments were offered by Sen. Julie Rosen (R-Fairmont). One amendment specifies that gamma-butyrolactone and 1,4-butanediol are not controlled substances when intended for industrial use or occurring in a natural concentration. The second amendment provides for notification about properties contaminated by a methamphetamine lab.
The measure was approved and advanced to the full Finance Committee.
S.F. 1650, sponsored by Sen. Yvonne Prettner Solon (DFL-Duluth), requires drug manufacturers to report quarterly the average wholesale price, wholesale acquisition cost, average manufacturer price and best price of each drug to the commissioner of human services and the Board of Pharmacy. The measure also authorizes the Attorney General's Office to pursue penalties against any manufacturer who violates the reporting requirement. The bill was laid over for possible inclusion in the omnibus bill. S.F. 1602, carried by Sen. Brian LeClair (R-Woodbury), provides for partial conformity with the federal Medicare Prescription Drug, Improvement and Modernization Act of 2003. The measure was forwarded to the full Finance Committee without recommendation.
S.F. 2786, carried by Sen. Sandra Pappas (DFL-St. Paul), creates an exception to the intermediate care facility for persons with mental retardation and related conditions payment system for a 51 bed facility in Ramsey County until the facility is completely closed. S.F. 1006, also authored by Pappas, establishes a Medical Assistance (MA) rate for rehabilitation services that are 50 percent greater than the maximum otherwise allowed for a facility designated as an essential community provider as of Jan. 1, 2000, and with at least 25 percent of the clients receiving services at the facility or in their homes being MA recipients. Both measures were laid over for possible inclusion in the omnibus bill.
S.F. 1835, authored by Sen. Michelle Fischbach (R-Paynesville), provides for a review of hospital moratorium exceptions. The bill was approved and advanced to the full Finance Committee.
S.F. 1627, sponsored by Sen. Linda Higgins (DFL-Mpls.), prohibits health care provider conflicts of interests and kickbacks. The bill also provides civil and criminal penalties for violations. S.F. 2839, authored by Sen. Steve Kelley (DFL-Hopkins), exempts newly arrived refugees and asylees who meet certain qualifications from participating in the diversionary work program. The measures were laid over for consideration in the omnibus bill.
S.F. 1759, authored by Berglin, provides that the commissioner of health accept an application for designation as an essential community provider from one applicant that is a nonprofit community services agency certified as a MA provider that provides mental health, behavioral health, chemical dependency, employment and health wellness services to the underserved Spanish-speaking Latino families and individuals in Minneapolis and St. Paul. S.F. 1876, carried by Berglin, modifies nursing facility case mix calculations for reimbursement. S.F. 2225, also sponsored by Berglin, directs the commissioner of human services to develop and employment option for persons committed to a sexual psychopathic personality treatment center in order for patients to contribute to their cost of care. The bill specifies that the earning generated be divided between the patient and the center. All three bills were laid over for possible inclusion in the omnibus bill.
Two measures sponsored by Sen. Becky Lourey (DFL-Kerrick) were also heard. S.F. 1206 provides for the prevention of lead poisoning. The bill modifies blood lead level analysis or assessment requirements, requires the commissioner of health to maintain a list of lead safe practices training programs and requires local permitting authorities to distribute fact sheets upon application for permits to remodel, renovate or rehabilitate homes built before 1978. S.F. 2672 requires the commissioner of human services to implement a project that would provide culturally specific pharmaceutical care to American Indian MA recipients over age 55 upon receipt of federal approval. Both measures were laid over for possible inclusion in the omnibus bill.
The division also reviewed the relevant portions of the omnibus crime bill, S.F. 1863. The bill, sponsored by Sen. Leo Foley (DFL-Coon Rapids), increases statutory maximum sentences for sex offenders, provides for indeterminate sentencing with a lifetime maximum for repeat sex offenders, amends predatory offender registration requirements, increases penalties for methamphetamine-related crimes, funds pilot project methamphetamine treatment programs, creates a revolving loan fund for methamphetamine laboratory cleanup and revises other criminal justice laws.
S.F. 982, sponsored by Sen. Gary Kubly (DFL-Granite Falls), provides that the profits derived from wood shops at veterans homes may be used only for the benefit of the homes' residents. S.F. 2351, carried by Sen. Sheila Kiscaden (IP-Rochester), establishes and modifies credentialing requirements for speech-language pathologists, audiologists, occupational therapists, speech-language pathology assistants, physician assistants, registered nurses, advanced practice registered nurses, dentists, dental hygienists, dental assistants, dental aides, podiatrists, alcohol and drug counselors and licensed professional counselors. Sen. Becky Lourey (DFL-Kerrick) authored two bills. S.F. 2124 modifies child care center licensing fees. S.F. 2477 modifies the date of application for General Assistance Medical Care. Division Chair Linda Berglin (DFL-Mpls.) also carried two bills. S.F. 1857 changes provisions in the prescription drug assistance program. S.F. 2426 repeals fees required for the use of public defenders and provides that public defenders have access to government data about witnesses and clients. The fees repealed were struck down by the Minnesota Supreme Court as unconstitutional; the bill includes an appropriation to the Board of Public Defense to replace the fee revenue. No action was taken on any of the bills.
In other action, the division heard from the Dept. of Human Services on its proposal to revise the nursing home system, on its administrative reduction and on increased costs related to changing referral patterns for sex offenders.
S.F. 1863, sponsored by Sen. Leo Foley (DFL-Coon Rapids), increases the statutory maximum sentence for sex offenders, provides for mandatory life sentences for repeat sex offenders, makes a number of changes to methamphetamine laws and makes changes to the driving while impaired, prostitution, identity theft, trespass and interference with privacy laws. The division, chaired by Sen. Linda Berglin (DFL-Mpls.), questioned the bed impact of various provisions on the corrections system and discussed other fiscal aspects of the bill. Members added an amendment incorporating language from S.F. 1727, sponsored by Sen. Mike McGinn (R-Eagan). The bill makes it a crime to falsely report police misconduct. The bill was laid over for further discussion.
In other action, division members heard, but took no action on, five additional bills. S.F. 1600, sponsored by Sen. Charles "Chuck" Wiger (DFL-North St. Paul), permits a Medical Assistance payment rate increase for a Ramsey County nursing facility. S.F. 2923, authored by Sen. Rod Skoe (DFL-Clearbrook), authorizes a planned closure rate adjustment for a nursing facility in Becker County. S.F. 2318, carried by Berglin, modifies the provider tax paid by federally qualified health centers and health centers in Greater Minnesota. Sen. Becky Lourey (DFL-Kerrick) sponsored two measures. S.F. 1969 annually transfers $1.19 million of the appropriation to the commissioner of health for fetal alcohol spectrum (FAS) disorder administration and grants to a statewide organization focusing solely on prevention of and intervention with FAS. S.F. 2124 reduces child care center licensing fees.
The panel considered the recommendations for the Departments of Health, Corrections and Human Services. The full recommendations are available online. The division also heard a report concerning disparities and barriers to utilization among Minnesota health care program enrollees.
The report details a business plan to end long-term homelessness in Minnesota by 2010. The plan includes providing housing with support service opportunities to 4,000 additional households and using cost effective reforms for providing housing and support services. The plan estimates a total approximate cost of $540 million over 7 years from all sources including state bonding, the Minnesota Housing Finance Agency, the Dept. of Human Services, the federal government, local governments and philanthropic and non-profit organizations.
The second half of the hearing was devoted to a detailed discussion of the governor's supplemental budget recommendations for the Dept. of Human Services. Assistant Commissioner of Health Care Brian Osberg, Assistant Commissioner of Continuing Care Loren Colman and Assistant Commissioner of Children and Family Services Maria Gomez all spoke to the panel on specific budget items. The full recommendations are available online.
Scandrett said there is a crisis of affordability and that major change is needed. "Isolated, band-aid approaches will not have a lasting effect," Scandrett said. He said that almost all Minnesotans agree on two fundamental principles: they want a responsive system where everyone gets the health care they need; and they want a privately-based health care system that offers as much choice as possible.
Scandrett said the report recommends putting Minnesotans in the driver's seat by providing more choices and control of their health care treatment with incentives for choosing higher quality, lower cost providers. The report also recommends fully disclosing costs and quality so that Minnesotans can make informed decisions. Scandrett said the report recommends reducing costs through better quality and providing incentives to encourage health. The report also recommends assuring universal participation in the health care system, supporting new models for health care education, and reducing the cost of overhead and administration, Scandrett said.
The full report is available on-line.
In other action, the division, chaired by Sen. Linda Berglin (DFL-Mpls.) also heard several bonding proposals. S.F. 2136, sponsored by Sen. Sheila Kiscaden (IP-Rochester), authorizes grants to assist counties to construct regional adult detention facilities. The measure appropriates $40 million to provide the grants. Under the bill, grants of up to 25 percent of the cost of construction may be made to individual county applicants and grants of up to 75 percent of the cost of construction may be made to multicounty or county or groups of county and tribal government applicants.
S.F. 1795, authored by Sen. Carrie Ruud (R-Breezy Point), appropriates $5 million for a grant to Cass County to construct a regional publicly operated jail. The measure requires a non-state match of a least $6 million and allows adjacent counties to participate in the project.
S.F. 2053, sponsored by Berglin, appropriates $1.4 million for a grant to Hennepin County to renovate and expand the acute psychiatric service at Hennepin County Medical Center. The measure also requires a match of non-state funds. S.F. 2388, also carried by Berglin, appropriates $5 million to remove asbestos and lead contamination from the site of the former Sears store near Chicago and Lake Streets and to construct space within that site for the Health Career Institute. S.F. 1303, sponsored by Sen. Becky Lourey (DFL-Kerrick), appropriates $500,000 for purchasing and placing cemetery grave markers or memorial monuments at cemeteries located at regional treatment centers.
No formal action was taken on the measures, but members did rank bonding priorities to be forwarded to the Capital Investment Committee.
Hauer said Minnesota has five Medicaid waiver programs-mental retardation or related conditions waiver, elderly waiver, community alternatives for disabled individuals waiver, traumatic brain injury waiver and community alternative care waiver. Hauer said the waiver programs provide community alternatives to care in facilities such as nursing homes, hospitals and intermediate care facilities. She said during the past 12 years, total spending on the five programs grew at an average annual rate of 23 percent and that caseload growth was the primary factor driving costs. Hauer said the spending per recipient under the mental retardation or related conditions waiver program has been lower than costs per recipient for institutional care but that the savings are more than offset by increased spending because of caseload growth. She said Minnesota spent about $1 billion in FY 2003 for the waiver programs and that the mental retardation or related conditions waiver program accounted for about $799 million of the total.
Hauer said the report also examined the allocation process for the waiver programs. The method for allocating funds is based on prior-year spending plus adjustments and that amounts for reserve accounts were allocated as part of county budgets, she said. The report found that the allocation method does not allocate resources in proportion to the needs of counties' caseloads, that prudent spenders receive lower allocations and that allocation does not respond to changes in caseload needs.
Hauer said the report concluded that pressure for increased spending will continue, the department should modify its method of allocating mental retardation and related condition waiver funds, the department should set additional controls for appropriate spending and the department should evaluate county compliance with state rules.
The panel also heard the Dept. Human Services response to the report from Shirley York, director, Disability Services Division. York said the agency appreciated the efforts of the Legislative Auditor's Office to really understand the intricacies of the waiver programs. She said that the programs have achieved the major policy goal of maintaining community alternatives speaks well for the programs. She said the challenge is that the waiver programs are very fast-growing, but the department also reviewed the programs to see what administrative changes need to be made. York said the auditor's report and findings are consistent with the department's review and the agency intends to follow the recommendations.
Members also heard a presentation on the provider tax hospital cost benefits study by Lynn Blewett, Ph.D., University of Minnesota School of Public Health.
Assistant Commissioner Brian Osberg and Mary Kennedy, Dept. of Human Services, summarized the changes made to Medicare, including the addition of a prescription drug benefit. Scott Leitz, Dept. of Health, said the changes affect many Minnesotans, since 13 percent of the state's population gets its primary coverage through Medicare. Representatives of HealthPartners, Blue Plus, UCare and Medica discussed the difficulties the law poses to them, including an unequal regulatory structure, barriers to competitiveness and prohibitions to wrapping the "donut hole" gap in the prescription drug benefit.
Assistant Hennepin County Attorney Gail Baez said people living in high drug traffic zones feel their communities are occupied by a hostile force, even when the traffickers are considered to be low-level users and dealers. She said the drug trade relies on the threat of violence to keep neighborhood residents in fear. One reason data on drug convictions show high departure rates for the duration of sentences is that some prosecutors prefer to maintain the degree of a defendant's offense but negotiate less prison time, Baez said. She urged policymakers not to lower sentencing guidelines, because the guidelines are used as a baseline for negotiations between prosecutors and defense attorneys. Lower guidelines will create a new, lower level of actual sentences, Baez said, "and I'm not certain that would be a healthy thing at all."
Division members also heard from two members of the Minneapolis City Council. Don Samuels and Dean Zimmerman live in the Jordan and Phillips neighborhoods, respectively, which are two of the neighborhoods with the highest levels of drug activity. "We have the luxury of saying that dealing is a nonviolent crime because 98 percent of the people who live around drug dealers will remain silent or apathetic," Samuels said. Brad Pass, Phillips Bloomington Avenue Citizens Patrol, said calling drug crimes nonviolent tears apart neighborhoods. There is often little to no penalty for buying drugs, said Jordan resident Dennis Wagner. He said buyers often have a lot more to lose by being designated criminals than neighborhood juveniles. "If a local kid gets arrested, that's a step up on his gang ladder," Wagner said.
The panel also heard a report on drug offender sentencing from the Minnesota Sentencing Guidelines Commission. The report is available online.
Dan Williams, Veterans Home Board member, presented the bonding requests for the Veterans Home Board. He said the needs for the various facilities were identified through both formal studies and discussion with veterans. Williams said the main goals identified by the board are asset preservation, renovation, the development of special care units for Alzheimer's and dementia patients, the development of initiatives and programs for dealing with the growing waiting lists, and leveraging federal funds. The total cost of the bonding needs identified by the board is $30.9 million. The state portion, Williams said, is $18.68 million and the federal portion is $12.253 million. He said the governor has recommended $7.07 million.
Division Chair Linda Berglin (DFL-Mpls.) said the panel needed to keep in mind the operating costs of facilities. She said, "It doesn't work to build new units and not be able to run them."
Members also heard from Mike Tessneer, State Operated Services, Dept. of Human Services. He outlined several proposals for the department. Tessneer said the agency is requesting $6.15 million for upgrading building and facility components to facilitate redevelopment and reuse of surplus Regional Treatment Center properties. In addition, the proposal includes demolition of old, non-functional buildings considered too expensive to redevelop for an alternative reuse. Tessneer outlined a $1.014 million proposal for system-wide roof repairs and replacement and a $5 million proposal for system-wide asset preservation. He said the proposal includes funding to address known safety hazards, health risks and code deficiencies and to maintain and preserve capital investment in state assets.
Tessneer also explained a $3 million agency request for new facilities for the sex offender treatment program. He said the funds are to be used to develop additional secure bed capacity for individuals committed to the Minnesota sex offender program. He said changes to the Dept. of Corrections referral process is expected to increase the number of referrals by 36 per year. Tessneer said that based on the new rate of admissions and the length of treatment, the population is expected to reach 300 by March 2006, 400 by December 2008 and 500 by October 2011.
The division, chaired by Sen. Linda Berglin (DFL-Mpls.), heard first from Kevin Kajer, chief administrator, Public Defense Board. Kajer said the general fund appropriation for FY 2005 is $7.6 million less than the general fund appropriation for FY 2004. He said the Legislature devised a schedule of co-payments for public defenders services to help make up the difference between the appropriations for the two fiscal years, but the collection of co-payments has not made up the shortfall. As a result, Kajer said, the Board of Public Defense is requesting a supplemental budget request of $11.838 million. The supplemental appropriation is to fund the scheduled FY 2005 budget reduction, fund the 40,000 hours that part-time public defenders put in over and above the agency complement for FY 2003 and to fund staff positions vacant in FY 2004.
The board petitioned the Supreme Court for caseload relief in three areas, Kajer said. He said the petition requested relief by establishing a presumption that continuances be granted upon request for out of custody clients, limiting public defender appointments in child protection cases to one public defender and requiring pre-petition screening or alternative response in all child protection cases prior to the court filing. However, the Supreme Court denied the petition, Kajer said.
In addition, last fall, Hennepin County challenged the constitutionality of the public defender co-payment and that case is now before the Supreme Court, Kajer said.
Kajer said the public defenders' workload has increased significantly in recent years and that the trend is for still heavier case loads. He said the board does not take a position on issues before the Legislature such as the .08 blood alcohol limit, but that the financial and workload consequences must be taken into account.
The division then turned their attention to the population increase within the Dept. of Corrections. Dan Storkamp, Dept. of Corrections, said the adult male prison population is expected to increase between 200 and 400 offenders annually, with larger increases in the next few years. Storkamp said the projections are done annually, in consultation with the Sentencing Guidelines Commission, and includes only adult prison beds. He said the projections are based on current laws, policies and practices. In July 2003, the total prison population was 7,579 and the current projections place the total population at 9,940 by July 2011, Storkamp said. He said the increases are a result of court volume increases, felony DWI offenders and increases in drug/meth cases.
Dennis Benson, deputy commissioner, presented the department's bed space plan. He said in FY 2004-05, the department plans on double bunks in St. Cloud and Stillwater and to rent beds. In FY 2006-07, Benson said the department plans to expand the challenge incarceration program, expand Stillwater and rent beds.
Benson also took a few moments to explain educational and treatment programming the department conductions within the correctional facilities. He said programs such as education and chemical dependency treatment are the best and cheapest security in corrections facilities.
Benson outlined the department's 2004 bonding initiatives. The department is requesting $74.9 million for expansion at the Faribault facility, $11 million for asset preservation, $19.2 million for creation of a 150 bed segregation unit at Stillwater and $350,000 for expansion of the challenge incarceration program by 24 beds.
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