Transcription

Minnesota Prepaid Medical Assistance Project Plus (PMAP )§1115 Waiver No. 11-W-0039/5Demonstration Year 24Annual ReportJuly 1, 2018 through June 30, 2019Submitted to:U.S. Department of Health & Human ServicesCenters for Medicare & Medicaid ServicesCenter for Medicaid and CHIP ServicesSubmitted by:Minnesota Department of Human Services540 Cedar StreetSt. Paul, Minnesota 55164-0983

State of MinnesotaDepartment of Human ServicesThis document may be reproduced without permission.

Table of ContentsINTRODUCTION . 1Background . 1PMAP Waiver Renewal . 1ENROLLMENT INFORMATION . 2OUTREACH AND MARKETING . 2Education and Enrollment. 2PMAP PURCHASING . 2Additional Information Regarding Managed Care Plans the State Contracts With . 3PMAP Purchasing for American Indian Recipients . 4OPERATIONAL AND POLICY DEVELOPMENTS . 5BUDGET NEUTRALITY DEVELOPMENTS . 5MEMBER MONTH REPORTING . 5CONSUMER ISSUES . 5County Advocates . 5Grievance System . 5POST AWARD PUBLIC FORUM ON PMAP WAIVER . 5QUALITY ASSURANCE AND MONITORING. 6Quality Strategy . 6MCO Internal Quality Improvement System . 6External Review Process. 6Consumer Satisfaction . 7i

Update on Comprehensive Quality Strategy. 7DEMONSTRATION EVALUATION . 7STATE CONTACT . 7ATTACHMENTSABCDEFPMAP Enrollment InformationHealth Plan Financial SummaryTribal Health Director Meeting AgendasUpdated Budget Neutrality SpreadsheetMember Month ReportState Fair Hearing Summaryii

FORWARDAs required by the terms and conditions approving §1115(a) waiver No. 11 -W-00039/5, entitled"Minnesota Prepaid Medical Assistance Project Plus (PMAP )," this document is submitted tothe Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health andHuman Services as the annual report for the period of July 1, 2018 through June 30, 2019. Thisdocument provides an update on the status of the implementation of the PMAP Program.iii

IntroductionBackgroundThe PMAP Section 1115 Waiver has been in place for over 30 years, primarily as the federalauthority for the MinnesotaCare program, which provided comprehensive health care coveragethrough Medicaid funding for people with incomes in excess of the standards in the MedicalAssistance program. On January 1, 2015, MinnesotaCare was converted to a basic health plan,under section 1331 of the Affordable Care Act. As a basic health plan, MinnesotaCare is nolonger funded through Medicaid. Instead, the state receives federal payments based on thepremium tax credits and cost-sharing subsidies that would have been available through the healthinsurance exchange.The PMAP waiver also provided the State with longstanding federal authority to enroll certainpopulations eligible for Medical Assistance into managed care who otherwise would have beenexempt from managed care under the Social Security Act. In December of 2014, CMS notifiedthe Department of Human Services (DHS) that it would need to transition this portion of itsPMAP waiver authority to a section 1915(b) waiver. Therefore, on October 30, 2015, DHSsubmitted a request to transfer this authority to its Minnesota Senior Care Plus section 1915(b)waiver.During this process, DHS determined that continued waiver authority was unnecessary for all ofthe groups historically included under the PMAP waiver. Because of the state’s updatedeligibility and enrollment processes for Medical Assistance, some of these populations are nolonger mandatorily enrolled into managed care. Instead, they can enroll in managed care on avoluntary or an optional basis.Therefore, the amendment to the MSC 1915(b) waiver only sought to continue federal waiverauthority to require the following groups to enroll in managed care: American Indians, as defined in 25 U.S.C. 1603(c), who otherwise would not bemandatorily enrolled in managed care; Children under age 21 who are in state-subsidized foster care or other out-of-homeplacement; and Children under age 21 who are receiving foster care under Title IV-E.CMS approved the amendment to the MSC waiver on December 22, 2015 with an effectivedate of January 1, 2016.PMAP Waiver RenewalThe PMAP waiver continues to be necessary to continue certain elements of Minnesota’sMedical Assistance program. On February 11, 2016, CMS approved DHS’s request to renew thePMAP waiver for the period of January 1, 2016 through December 31, 2020.1

The current waiver provides continued federal authority to: Cover children as “infants” under Medical Assistance who are 12 to 23 months old withincome eligibility above 275 percent and at or below 283 percent of the federal povertylevel (FPL) (referred to herein as “MA One Year Olds”);Waive the federal requirement to redetermine the basis of Medical Assistance eligibilityfor caretaker adults with incomes at or below 133 percent of the FPL who live withchildren age 18 who are not full-time secondary school students;Provide Medical Assistance benefits to pregnant women during the period of presumptiveeligibility; andFund graduate medical education through the Medical Education Research Costs(MERC) trust fund.Enrollment InformationPlease refer to Attachment A for PMAP enrollment activity for the period July 1, 2018 throughJune 30, 2019.Outreach and MarketingEducation and EnrollmentDHS uses a common streamlined application for Medical Assistance, MinnesotaCare andMNsure coverage. Medical Assistance and MinnesotaCare applicants have the option ofapplying online through the MNsure website or by mail with a paper application.The MNsure website provides information on Minnesota’s health care programs. The site isdesigned to assist individuals with determining their eligibility status for insurance affordabilityprograms in Minnesota. The site provides a description of coverage options through qualifiedhealth plans, Medical Assistance and MinnesotaCare. It also provides information about theapplication, enrollment and appeal processes for these coverage options.In-person assisters and navigators are also available to assist individuals with the eligibility andenrollment process through the MNsure website. MNsure has a navigator grantee outreachprogram that does statewide activities to help individuals with enrollment.Applicants and enrollees who receive Medical Assistance through fee for service can call theDHS Member Help Desk for assistance with questions about eligibility, information on coverageoptions, status of claims, spenddowns, prior authorizations, reporting changes that may affectprogram eligibility, and other health care program information.PMAP PurchasingCoverage for a large portion of enrollees in Medical Assistance is purchased on a prepaidcapitated basis. The remaining recipients receive services from enrolled providers who are paid2

on a fee-for-service basis. Most of the fee-for-service recipients are individuals with disabilities.DHS contracts with MCOs in each of Minnesota’s 87 counties.Additional Information Regarding Managed Care Plans the State Contracts WithThe following information regarding the managed care plans the State contracts with to providePMAP services is provided in accordance with item 28 of the special terms and conditions forthe PMAP §1115 waiver.28(a)(i) A description of the process for managed care capitation rate setting.Minnesota uses both state-set rates and competitive bidding to arrive at appropriate rate rangesfor the Families and Children contract. Rates continue to reflect the influence of both previousyears bidding results and subsequent adjustments. For all areas, the actuaries consider factorsincluding but not limited to health care inflationary trends, morbidity (changing age/illness of thepopulation), and changes in benefits. The State then sets the rates using emerging MCOencounter, financial and other information at a level that meets budget projections and isexpected to produce appropriate access and quality of care. The PMAP capitation rates are riskadjusted. The methodology for developing rate ranges was provided to all MCOs. MCOs hadopportunity to review and respond to the methodology.28(a)(ii) The number of contract submissions, the names of the plans, and a summary ofthe financial information, including detailed information on administrative expenses,premium revenues, provider payments and reimbursement rates, contributions to reserves,service costs and utilization, and capitation rate-setting and risk adjustments methodssubmitted by each bidder.A graphic representation of the MCO service areas and information about the number of plansunder contract in each county for PMAP and Minnesota Care can be found at Health PlanService Areas.28(a)(iii) Annual managed care plan financial audit report summary.Attachment B contains a summary of the MCO audited financial statements for 2018, by publicprogram product (PMAP, MinnesotaCare), including a comparison of medical and administrativeexpenses to premium revenue.28(a)(iv) A description of any corrective action plans required of the managed care plans.The Annual Technical Report (ATR) is an evaluation of MCO compliance with federal and statequality, timeliness and access to care requirements. The report is published on the DHS site atManaged Care Reporting. The report summarizes the results of the independent external qualityreview of Minnesota’s publicly funded managed care programs. Chapter 3 of the ATR presentsMCO-specific performance, including strengths, opportunities for improvement andrecommendations identified during the external quality review process. Chapter 4 of the ATRpresents improvement recommendations from the previous year’s external quality review andincludes a discussion on how effectively each MCO addressed the recommendations. The3

Minnesota Department of Health’s managed care licensing examination and the on-site triennialcompliance assessment is used by the external quality review organization along withinformation from other sources to generate the ATR. The most recent results from the managedcare licensing examinations and the triennial compliance assessment can be found on theMinnesota Department of Health web site at Quality Assurance and Performance Measurement.PMAP Purchasing for American Indian RecipientsThe Minnesota Legislature enacted a number of provisions, subsequently authorized by CMS, toaddress issues related to tribal sovereignty that prevent Indian Health Service (IHS) facilitiesfrom entering into contracts with MCOs, and other provisions that have posed obstacles toenrolling American Indian recipients who live on reservations into PMAP. The legislation allowsAmerican Indian beneficiaries who are enrolled in managed care to receive covered servicesunder Medical Assistance through an IHS or other tribal provider (commonly referred to as“638s”) whether or not these providers are in the MCO’s network.Contracts with MCOs include provisions designed to facilitate access to providers for AmericanIndian recipients, including direct access to IHS and 638 providers. IHS and 638 providers mayrefer recipients to MCO-network specialists without requiring the recipient to first see a primarycare provider. DHS has implemented the PMAP out-of-network purchasing model forAmerican Indian recipients of Medical Assistance who are not residents of reservations.Summary Data. The following is a summary of the number of people identified as AmericanIndians who were enrolled in Medical Assistance during calendar year 2018.Medical Assistance Enrollees who are American IndianCalendar Year 2018Families and Children38,390Disabled4,662Elderly1,421Adults with no Children13,350Total57,823Tribal Health Workgroup. The quarterly Tribal Health Workgroup was formed to address theneed for a regular forum for formal consultation between tribes and state employees. Theworkgroup meets on a quarterly basis and is regularly attended by Tribal Health Directors, TribalHuman Services Directors, and representatives from the Indian Health Service, the MinnesotaDepartment of Health and the Minnesota Department of Human Services. During the period ofJuly 1, 2018 through June 30, 2019 (PMAP demonstration year 24) the work group met onSeptember 6, 2018, November 15, 2018, March 21, 2019 and May 23, 2019. The agendas foreach of these meetings are provided at Attachment C.4

Operational and Policy DevelopmentsThere were no significant program developments or operational issues for populations coveredunder this waiver during the demonstration year ending June 30, 2019.Budget Neutrality DevelopmentsDemonstration expenditures are reported quarterly using Form CMS-64, 64.9 and 64.10. Pleasesee Attachment D for an updated budget neutrality spreadsheet.Member Month ReportingMember months for “MA One-Year Olds” and Medicaid Caretaker Adults” for the periodJuly 1, 2018 through June 30, 2019 are provided at Attachment E.Consumer IssuesCounty AdvocatesUnder Minnesota law, county advocates are required to assist managed care enrollees in eachcounty. The advocates assist enrollees with resolving issues related to their MCO. When unableto resolve issues informally, the county advocates educate enrollees about their rights under thegrievance system. County advocates provide assistance in filing grievances through both formaland informal processes, and are available to assist in the appeal or state fair hearingprocess. State ombudsmen and county advocates meet regularly to identify issues that arise andto cooperate in resolving problematic cases.Grievance SystemThe grievance system is available to managed care enrollees who have problems accessingnecessary care, billing issues or quality of care issues. Enrollees may file a grievance or anappeal with the MCO and may file a state fair hearing through DHS. A county advocate or astate managed care ombudsman may assist managed care enrollees with grievances, appeals, andstate fair hearings. The provider or health plan must respond directly to county advocates and thestate ombudsman regarding service delivery and must be accountable to the state regardingcontracts with Medical Assistance funds.Please refer to Attachment F for a summary of state fair hearings closed in quarters one throughfour of PMAP demonstration year 24.Post Award Public Forum on PMAP WaiverIn accordance with the PMAP Special Terms and Conditions (STCs), paragraph 16, DHS holdspublic forums to provide the public with an opportunity to comment on the progress of thePMAP Demonstration.DHS held a post award public forum on June 27, 2019 to provide the public with an opportunityto comment on the progress of the PMAP demonstration. A notice was published on the DHSPublic Participation web site on May 28, 2019 informing the public of the date, time and location5

of the forum. There were no members of the public in attendance at this forum. The next publicforum is planned for the summer of 2020.Quality Assurance and MonitoringTo ensure that the level of care provided by each MCO meets acceptable standards, the statemonitors the quality of care provided by each MCO through an ongoing review of each MCO’squality improvement system, grievance procedures, service delivery plan, and summary of healthutilization information.Quality StrategyIn accordance with 42 C.F.R. §438.202(a), the state’s quality strategy was developed to monitorand oversee the quality of PMAP and other publicly funded managed care programs inMinnesota.This quality strategy assesses the quality and appropriateness of care and services provided byMCOs for all enrollees in managed care. It incorporates elements of current MCO contractrequirements, state health maintenance organization (HMO) licensing requirements (MinnesotaStatutes, Chapters 62D, 62M, 62Q), and federal Medicaid managed care regulations (42 C.F.R.§438). The combination of these requirements (contract and licensing) and standards (qualityassurance and performance improvement) are at the core of DHS’s quality strategy. DHSassesses the quality and appropriateness of health care services, monitors and evaluates theMCO’s compliance with managed care requirements and, when necessary, imposes correctiveactions and appropriate sanctions if MCOs are not in compliance with these requirements andstandards. The outcomes of these quality improvement activities are included in the AnnualTechnical Report (ATR).MCO Internal Quality Improvement SystemMCOs are required to have an internal quality improvement system that meets state and federalstandards set forth in the contract between the MCO and DHS. These standards are consistentwith those required under state HMO licensure requirements. The Minnesota Department ofHealth conducts triennial audits of the HMO licensing requirements.External Review ProcessEach year, as the state Medicaid agency, DHS must conduct an external quality review ofmanaged care services. The purpose of the external quality review is to produce the AnnualTechnical Report (ATR) that includes:1) Determination of compliance with federal and state requirements,2) Validation of performance measures, and performance improvement projects, and3) An assessment of the quality, access, and timeliness of health care services providedunder managed care.Where there is a finding that a requirement is not met, the MCO is expected to take correctiveaction to come into compliance with the requirement. The external quality review organization6

(EQRO) conducts an overall review of Minnesota’s managed care system. The charge of thereview organization is to identify areas of strength and weakness and to make recommendationsfor change. Where the technical report describes areas of weakness or makes recommendations,the MCO is expected to consider the information, determine how the issue applies to its situationand respond appropriately. The review organization follows up on the MCO’s response to theareas identified in the past year’s ATR. The technical report is published on the DHS website atManaged Care Reporting.DHS also conducts annual surveys of enrollees who switch between MCOs during the calendaryear. Survey results are summarized and sent to CMS in accordance with the physician incentiveplan (PIP) regulation. The survey results are published annually and are available on the DHSwebsite at Managed Care Reporting.Consumer SatisfactionDHS sponsors an annual satisfaction survey of public program managed care enrollees using theConsumer Assessment of Health Plans Survey (CAHPS ) instrument and methodology to assessand compare the satisfaction of enrollees with services and care provided by MCOs. DHScontracts with a certified CAHPS vendor to administer and analyze the survey. Survey resultsare published on the DHS website at Managed Care Reporting.Comprehensive Quality StrategyMinnesota’s Comprehensive Quality Strategy is an overarching and dynamic continuous qualityimprovement strategy integrating processes across Minnesota’s Medicaid program. Measuresand processes related to the programs affected by the PMAP waiver are included in theComprehensive Quality Strategy. An updated Comprehensive Quality Strategy was submitted toCMS on May 25, 2018 and posted on the DHS Quality Improvement web site.Demonstration EvaluationThe evaluation plan for the PMAP waiver period from January 1, 2015 throughDecember 31, 2018 was initially submitted with Minnesota’s PMAP waiver extension requestin December of 2014. In May of 2016 the evaluation plan was revised to reflect the approvedterms of our waiver with an end date of 2020 instead of the previous draft timeline which endedin 2018. The evaluation plan was updated in November 2016, and again in June 2017, to addressCMS comments. In August 2017, CMS approved the PMAP evaluation plan. The PMAP STCs were updated to incorporate the approved evaluation plan as Attachment B of the STCs.State ContactThe state contact person for this waiver is Jan Kooistra. She can be reached by telephone at(651) 431-2118, or email at [email protected]

Attachment APMAP §1115 Waiver Demonstration Year 24Enrollment Data by Eligibility GroupJuly 1, 2018 through September 30, 2018Demonstration Populations (as hard codedin the CMS 64)Population 1: MA One Year Olds withincomes above 275% FPL and at or below283% FPLPopulation 2: Medicaid Caretaker Adultswith incomes at or below 133% FPL livingwith a child age 18Enrollees at close ofquarterCurrentEnrolleesDisenrolled in currentquarter (July 1, 2018 through(September 30, 2018)(November 5, 2018)September 30, 2018)4541372,8632,7591,025Enrollees at close ofquarterCurrentEnrolleesDisenrolled in currentquarter (October 1, 2018(December 31, 2018)(February 4, 2019)through December 31, 2018)4539412,8202,7341,188Enrollees at close ofquarterCurrentEnrolleesDisenrolled in currentquarter (January 1, 2019(March 31, 2019)(May 3, 2019)through March 31, 2019)4446282,6832,6811,002Enrollees at close ofquarterCurrentEnrolleesDisenrolled in currentquarter (April 1, 2019(June 30, 2019)(August 5, 2019)through June 30, 2019)5957472,6492,6481,004October 1, 2018 through December 31, 2018Demonstration Populations (as hard codedin the CMS 64)Population 1: MA One Year Olds withincomes above 275% FPL and at or below283% FPLPopulation 2: Medicaid Caretaker Adultswith incomes at or below 133% FPL livingwith a child age 18January 1, 2019 through March 31, 2019Demonstration Populations (as hard codedin the CMS 64)Population 1: MA One Year Olds withincomes above 275% FPL and at or below283% FPLPopulation 2: Medicaid Caretaker Adultswith incomes at or below 133% FPL livingwith a child age 18April 1, 2019 through June 30, 2019Demonstration Populations (as hard codedin the CMS 64)Population 1: MA One Year Olds withincomes above 275% FPL and at or below283% FPLPopulation 2: Medicaid Caretaker Adultswith incomes at or below 133% FPL livingwith a child age 18

Pregnant Women in a Hospital Presumptive Eligibility PeriodJuly 1, 2017 through June 30, 2018Eligibility uaryFebruaryMarchAprilMayJuneEligibility 18Unique Enrollees486061403438273046495344

2018 Health Plan Financial Summaryby Product (in thousands )Minnesota Public Programs OnlyBluePlusHPItascaMedicaAttachment BMetropolit.PrimeWestSouth C.UcareAll PlansPMAPPremium Revenues (line 8)Medical/Hospital Expenses (line 18)Administrative Expenses (lines 20-21)Member MonthsPMPM - revPMPM - clmsPMPM - admin 1,704,881 1,507,756 154,5033,848,599 739,091 685,889 52,9851,601,965 42,982 38,578 3,46987,253( 833)( 1,782)( 76)(547) 186,899 161,696 23,120284,092 178,418 173,721 12,866414,140 164,983 162,269 15,195389,484 1,185,727 1,085,567 85,8472,650,337 4,202,148 3,813,692 347,9109,275,323 442.99 391.77 40.15 461.37 428.15 33.08 492.61 442.14 39.76 1,522.80 3,257.52 138.69 657.88 569.17 81.38 430.82 419.47 31.07 423.59 416.63 39.01 447.39 409.60 32.39 453.05 411.17 37.51 159,218 141,795 13,369362,179 103,170 100,306 8,278240,761 3,574 3,279 28787,253( 105) 371( 6)- 8,886 7,565 1,31421,397 16,892 16,844 1,46236,490 17,909 17,584 1,59337,912 136,258 138,657 9,769302,304 445,803 426,402 36,0661,088,296 439.61 391.51 36.91 428.51 416.62 34.38 40.96 37.58 3.29 415.31 353.53 61.41 462.92 461.62 40.07 472.39 463.81 42.01 450.73 458.67 32.32 409.63 391.81 33.14 317,274 284,722 13,834 15,552 15,487 1,2415,542 428,666 390,013 14,623132,171 0 0 0104,456 133,409 113,858 9,28139,171 62,745 59,545 2,52523,376 60,758 55,196 4,28122,287 468,693 432,193 32,856150,106 1,487,097 1,351,014 78,642477,109 3,037.40 2,725.76 132.44 3,405.82 2,906.70 236.94 2,806.25 2,794.39 223.99 3,243.27 2,950.82 110.64 2,684.17 2,547.25 108.03 2,726.17 2,476.60 192.11 3,122.41 2,879.25 218.89 3,116.89 2,831.67 164.83MinnesotaCarePremium Revenues (line 8)Medical/Hospital Expenses (line 18)Administrative Expenses (lines 20-21)Member MonthsPMPM - revPMPM - clmsPMPM - adminMSHOPremium Revenues (line 8)Medical/Hospital Expenses (line 18)Administrative Expenses (lines 20-21)Member MonthsPMPM - revPMPM - clmsPMPM - adminSNBCPremium Revenues (line 8)Medical/Hospital Expenses (line 18)Administrative Expenses (lines 20-21)Member MonthsPMPM - revPMPM - clmsPMPM - admin#DIV/0!#DIV/0!#DIV/0!- 83,534 88,685 6,76566,877 215,658 191,125 19,864159,293 39,204 31,698 4,08924,573 31,394 30,621 2,30927,324 43,530 41,832 3,20235,795 481,534 441,027 35,370353,078 894,855 824,988 71,599666,940 1,249.07 1,326.09 101.15 1,353.84 1,199.83 124.70 1,595.41 1,289.94 166.39 1,148.96 1,120.67 84.49 1,216.09 1,168.66 89.46 1,363.82 1,249.09 100.18 1,341.73 1,236.97 107.35Admin does not include chmentB

Attachment CTribal Health Directors MeetingSMSC – The Link Conference Center2200 Trail of DreamsPrior Lake, MN 55372Thursday, September 6, 20189:00 am to 3:00 pmUPDATED AGENDA9:00 – 9:15 a.m.Welcome/Opening Prayer/Moment of Silence and Introductions9:15 – 10:15 a.m.Tribal and Urban Health Directors ONLY meetingHot topics affecting American Indians on and off reservations bothnationally and locally10:15 – 10:30 a.m.BreakReturn from breakIntroductions repeated (if needed)10:30 – 10:45 a.m.MDH Update from AC Paul Allwood on behalf of Commissioner Malcolm10:45 – 11:30MDH Health Protection BureauAssistant Commissioner Paul Allwood and Division Directors11:30 – 12:00 p.m.MDH Oral Health ProgramGenelle Lamont and IHS Dr. Nathan Mork12:00 – 12:30 p.m.: Lunch/AnnouncementsInput on meeting space and meeting dates for 2018Discussion on November 15th meeting12:30 – 1:00 p.m.MDH Cancer Control and Prevention/ Sage Programs SectionMelanie Peterson-Hickey and staff

Attachment C1:00 – 1:45 p.m.DHS Healthcare AdministrationAssistant Commissioner Nathan MoraccoSamantha MillsTribal Health Care Financing WorkgroupState Plan Amendments and Waivers1:45 – 2:00 p.m.DHS SNBC American Indian Statement feedbackPam Olson2:00 – 2:15 p.m.DHS/MBA Indian Elder Coordinator/LiaisonLeonard Geshick2:15 – 2:30 p.m.March of DimesExecutive Director Angie DeeganTribal Health Directors 2018 Confirmed Meeting Dates:Thursday, November 15th from 9am to 3pmAgenda items for next meetingAdjourn3:15 – 4:45 p.m.Tribal Health Care Financing Workgroup Follow-up(in the same room) Samantha Mills and workgroup members

Attachment CTribal Health Directors MeetingSMSC – The Link Conference Center2200 Trail of DreamsPrior Lake, MN 55372Thursday, November 15, 20189:00 am to 3:00 pmFINAL AGENDA9:00 – 11:00 a.m.Welcome/Opening PrayerAppreciation Breakfast11:00 – 12:30 p.m.Tribal Health Directors only12:30 – 12:45 p.m.Break12:45 – 1:45 p.m.MDH OSHII Tribal SHIP/Tobacco Grants – Report on accomplishment of the pastfive years and input into next five-year grant application (June 2019 to May 2024)and NDSU evaluation process1:45 – 2:45 p.m.DHS Updates: Behavioral Health: OpioidsDHS State Plan AmendmentsDHS Tribal Healthcare Finance Workgroup Updates2:45 – 3:00 p.m.ClearwayTribal Health Directors 2019 Proposed Meeting Dates:Thursday, February 21Thursday, May 16Thursday, August 22Thursday, November 21Agenda items for next meetingAdjourn

Attachment CTribal and Urban Indian Health Directors MeetingSMSC – The Link Conference Center2200 Trail of DreamsPrior Lake, MN 55372RESCHEDULED MEETINGThursday, March 21, 20199:00 am to 3:00 pmFINAL AGENDA9:00 – 9:30 a.m.Opening Prayer/Invocation/Moment of SilenceWelcome and Introductions9:30 – 10:50 a.m.Tribal Health Directors only10:50 – 11:00Break to bring in Commissioners, state staff and guests11:00 – 12:00 p.m.DHS Commissioner Tony Lourey and MDH Commissioner Jan Malcolm and DHSand MDH Executive Office staff meet and greet - confirmed12:00 – 1:00 p.m.Lunch Break – pay your own; everyone is welcome to st

Jul 01, 2018 · "Minnesota Prepaid Medical Assistance Project Plus (PMAP )," this document is submitted to the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health an