Beginning Jan. 1, 2024, no health plan company may restrict the choice of an enrollee as to where the enrollee receives services from an out-of-network licensed health care provider related to the diagnosis, monitoring and treatment of a rare disease or condition when criteria are met. Cost-sharing requirements and benefit or services limitations for the diagnosis and treatment of a rare disease or condition must not place a greater financial burden on the enrollee or be more restrictive than those requirements for in-network medical treatment. 

The cities of Apple Valley, St. Paul and Fridley now have access to state funding to support the construction of inclusive and accessible playgrounds that accommodate physical disabilities as well as the unique needs of children with intellectual or developmental disabilities. Funding includes fencing, separation from water hazards and physical barriers on busy streets to keep children safe. 

The Minnesota Medicaid Drug Formulary Committee (DFC) manages the state preferred drug list and evaluates whether drugs covered by state public programs should be subject to prior authorization, and what the prior authorization criteria should be.  

Effective immediately, DFC membership must include a physician with experience serving persons with disabilities and physicians specializing in pediatrics and diagnosing and treating rare diseases. The committee will now have two consumer members, both with a personal or professional connection to Medical Assistance; and one member designated by the Minnesota Rare Disease Advisory Council. 

Effective Jan. 1, 2024, anyone enrolled in a state public health care program who uses an enteral tube for feedings or medication administration will have a prior authorization for a liquid medication approved within 24 hours if the drug is being prescribed for a Food and Drug Administration (FDA) approved condition, even if the individual has current or prior claims for pills for that condition. If more than one version of the oral liquid form of a drug is available, the Department of Human Services may select the version. 

A 40-hour weekly household limit on the number of hours a parent of a minor, or a spouse, can be reimbursed for providing disability-related care to their minor child or spouse under consumer-directed community supports (CDCS) or community first services and supports (CFSS) has not taken into consideration the number of parents available to provide care, the number of children who qualify for services, or the type of services the individual receiving care is eligible for.  

Effective July 1, 2023, or upon federal approval (whichever is later), each parent in a two-parent household can be reimbursed for providing up to 40 hours of caregiving per week. A single parent, or one parent in a household where only one parent is providing care, can provide up to 60 hours of caregiving per week, as can a spouse.  

The Tax Equity and Fiscal Responsibility Act (TEFRA) is a federal law that allows Medicaid (called Medical Assistance in Minnesota) eligibility for children with a certified disability in families with incomes too high to qualify for Medical Assistance. All parents with an adjusted gross income beginning at 275 percent of federal poverty guidelines have been required to pay a fee, that can be as high as several thousand dollars per month, for their child to access Medical Assistance through the TEFRA option. This has been financially burdensome for many families and has made the program unaffordable for others. With this new law, parental fees are eliminated under both Medical Assistance TEFRA and Home and Community-Based Services (HCBS) waivers.  

Gillette and other pediatric provider across Minnesota advocated for policies to keep our kids safe from gun violence. New laws will help keep guns away from people who are at extreme risk to themselves or others and will expand background checks for gun sales and transfers. 

Effective Jan. 1, 2024, or upon federal approval and completion of state implementation requirements (whichever is later), a child under 19 years of age eligible for Medical Assistance must remain eligible for 12 months. Effective Jan. 1, 2025, 12-month continuous eligibility will be extended to include children under age 21, and children under age six will remain eligible for Medical Assistance without interruption from the time they are first determined eligible up until the month they reach six years of age. Continuous eligibility ensures that children who are already enrolled in Medical Assistance do not lose their coverage due to administrative hurdles or minor fluctuations in their family’s income. 

Effective Jan. 1, 2024, Medical Assistance will cover an FDA approved monitoring device, including technology that provides ongoing patient monitoring and alert services that detect seizure activity and transmit notification of the seizure activity to a caregiver for appropriate medical response, or collects data of the seizure activity that can be used by a health care provider to diagnose or appropriately treat a health care condition that causes the seizure activity.