Healthcare Update - November 2018

Key Highlights in this topic/WORKGROUP for the PREVIOUS month:

DHS Procurement staff facilitated regional meetings for the 2020 Medical Assistance and MinnesotaCare Managed Care procurement process.  The meetings were held from October 19th through November 16th.  Questions regarding the RFP process may be submitted until December 21st to DHS.PSD.Procurement@state.mn.us.


The METS Program Management (PMT) has finalized the 2019 roadmap.  It will go to the Executive Steering Committee (ESC) for approval on November 27th.  Once approved, it will be available to share.


The METS PMT is finalizing the “Operationally Efficient” list of functionality as directed by the Enterprise Architecture Board (EAB).  It will be presented to the EAB on December 10th


Effective Jan. 1, 2019, the service rate limits for several Elderly Waiver (EW), Alternative Care (AC) and Essential Community Supports (ECS) program services will increase. 


Beginning Jan. 1, 2019, all personal care assistance (PCA) and home care nursing (HCN) services for people under age 65 will be covered under fee-for-service (FFS). Members will continue to be enrolled in the MCO they were enrolled in, but managed care organization (MCO) contracts for Minnesota Health Care Programs (MHCP) members under age 65 will no longer cover PCA and HCN.   Under this contract change, members will continue to be enrolled in the MCO they were enrolled in and the MCO will continue to pay for their other health care services.  The contract change does not apply to the two options for seniors (age 65 and over): Minnesota Senior Health Options (MSHO) or Minnesota Senior Care+ (MSC+). MSHO and MSC+ MCOs will continue to authorize and pay for PCA and HCN services.


Requested Actions needed from MACSSA in the next month:




The report of the Periodic Data Matching (PDM) assessment workgroup has been finalized.  In summary, the workgroup reports that the functionality appears to operate per business requirements, and no current, known system issues were identified that were exacerbated by the process.  This report was given to the METS PMT, and per the governance process, the METS PMT voted on November 20th to recommend to the METS ESC that PDM moves forward and is turned back on statewide.  The ESC will take a vote on this recommendation on November 27th.


Issues/Concerns regarding this topic this month:

Cost Effective Health Insurance (CEHI) continues to be an area of confusion and concern for workers.  The Cost Effective department at DHS is open to providing training to Counties.  If you are interested, contact dhs.cehi@state.mn.us.


Legislative Impacts:


Bulletins, Publications, or supporting materials to be included with this update: 



Kari Ouimette

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