Video & Transcript Research : 'elderly care'
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WA
Washington 2025-2026 Regular Session
House Early Learning & Human Services Jan 23rd, 2026 at 08:00 am
Early Learning & Human Services
Transcript Highlights:
- underlying bill here modifies some licensure requirements for receiving children for supervision or care
- and lawyers to be licensed, allowing the termination of licenses for inactivity, exempting kinship care
- and lawyers to be licensed, allowing the termination of licenses for inactivity, exempting kinship care
- And our child care providers are stretched.
- Just briefly, this gives some flexibility to our small child care providers. Please vote yes.
Keywords:
child welfare, risk assessment, investigation, child abuse, neglect, military families, early childhood education, access, assistance program, education equity, homelessness, youth programs, advisory committee, prevention, protection, HB 2219, child care licensing, early learning, DCYF, Department of Children Youth and Families
Summary:
The House Early Learning and Human Services Committee took up possible executive session on nine bills, first briefing amendments and proposed substitutes before voting. House Bill 2099, expanding eCAP access and prioritization for children of military families, was amended to include NOAA and Public Health Service commissioned corps members and broader deployment criteria, then passed unanimously. House Bill 2185, which strengthens the advisory committee for homeless youth services, also passed unanimously without amendments. House Bill 2219, addressing mixed-ratio time in child care centers and waiving repeat pre-service orientation in limited cases, adopted an amendment adding conditions for the waiver and then passed unanimously.
House Bill 2253, a broad licensure and regulatory bill affecting child care and residential programs, saw several amendments considered; one report amendment was rejected, and an amendment restoring state monitoring and health/safety reviews at the Washington School for the Deaf was adopted. The committee then passed the amended bill unanimously. House Bills 2317 and 2318, both expanding flexibility for ECEAP and Head Start providers, passed without amendments and with unanimous support. House Bill 2319, renaming residential habilitation centers in statute, adopted a technical correction amendment and passed unanimously. House Bill 2350, requiring notice when a residential habilitation center is out of compliance with CMS requirements, was amended to emphasize posted notices, email options, preferred-language notices, and plain-language summaries, then passed unanimously.
The committee then returned to House Bill 1544, which directs DCYF to study and improve its risk, strengths, and needs assessment tool and certify its validation. Four amendments were considered: one requiring domestic violence to be included in the study was adopted; amendments on defining “safe,” auditing missing data on near-fatalities and safety-plan failures, and prohibiting use of an unvalidated tool to screen out referrals were rejected. The amended second substitute bill passed on a 9-0 vote, with Representatives Burnett and Penner voting “no without recommendation.” The committee adjourned after reporting all nine bills out of committee, most with do pass recommendations and several with adopted amendments.
TX
Transcript Highlights:
- I understand the concerns about ensuring a fair trial, and we care deeply about that.
- Elderly and disabled Texans often face serious challenges when it comes to participating in courtroom
- But we often are so worried about our community that we don't take care of ourselves.
- The second thing is, I've been a critical care nurse for.
- I take care of open hearts, the sickest of the sick. I hold someone's life in my hands.
Keywords:
animal cruelty, nonlivestock, prosecution, veterinary defense, animal welfare, aggravated assault, penal code, public servant, deadly weapon, mass shooting, Penal Code, penalties, felony, Texas Penal Code, felony enhancement, first-degree felony, second-degree felony, violent crime, assault punishment, serious bodily injury
MN
Minnesota 2025-2026 Regular Session
State Committee Meeting - 2025-04-03
State Government Finance and Policy
Transcript Highlights:
- And State Poisoner, our team is happy to find a solution to get this thing taken care of.
- use care provided by families, friends, and neighbors.
- And you may have noticed the elderly volunteers at our polling places.
- We take care of each other and our neighbors. We read to children in schools.
- Transportation was the number one issue discussed, with health care and housing as two and three.
MN
Minnesota 2025-2026 Regular Session
House State Government Finance and Policy Committee 4/3/25
State Government Finance and Policy
Transcript Highlights:
- Chair Nash said he was happy to find a solution to get this thing taken care of.
- : 46% use care provided by families, friends, and neighbors.
- We take care of each other and our neighbors. We read to children in schools.
- </c><00:38:57.560><c> volunteers</c> may have noticed the elderly volunteers may have noticed the elderly
- of each other and our neighbors we care of each other and our neighbors we read<00:39:07.040><c> to<
MN
Minnesota 2025-2026 Regular Session
Children and Families Finance and Policy Committee 3/25/26
Children and Families Finance and Policy
Transcript Highlights:
- </c><00:19:00.840><c> system</c> we witnessed in our child care system we witnessed in our child care
- </c> the executive director for a child care the executive director for a child care program<00:19:56.560
- </c> Sanford with the Minnesota Child Care Sanford with the Minnesota Child Care Association,<00:26:43.040
- Limiting the county-by-county care.
- </c> exiting out of foster care exiting out of foster care are<01:51:28.920><c> protected</c><01:51:29.640
Keywords:
youth intervention, grants, community support, early intervention services, nonprofit, Minnesota human services, forecast adjustment, budget forecast, appropriations, Medical Assistance, MinnesotaCare, Health Care Access Fund, general fund, behavioral health, housing support, General Assistance, Minnesota Supplemental Aid, MFIP, DWP, child care assistance
WA
Washington 2025-2026 Regular Session
Senate Health & Long-Term Care Jan 20th, 2026 at 10:30 am
Health & Long-Term Care
Transcript Highlights:
- As you know, we are seeing a lot of volatility in health care right now.
- So Samaritan and Moses Lake has an affiliation with multi-care.
- When I read what the bill does, that health care, Medicaid managed care organizations and others may
- Senate Bill 5916 directly addresses. ...care, not fewer.
- Association of Washington, and Fresenius Medical Care.
Keywords:
health insurance, health carrier, insurance carrier, prompt pay, timely payment, claims processing, clean claim, remittance advice, provider reimbursement, hospital billing, medical billing, prior authorization, claims denial, interest on late claims, administrative penalty, Washington insurance commissioner, RCW 48, public employees benefits board, school employees benefits board, Medicaid managed care
Summary:
The committee heard public testimony on several health care bills. SB 6159 would create a public hospital infrastructure account funded by a new coverage assessment on insurers and other premium-tax payers, to help public hospital districts and other public health entities finance major construction and modernization projects and allow more cooperative agreements among public hospitals. The sponsor and supporters said it would help public hospitals remain competitive and better serve rural and underserved patients, while opponents argued the assessment would raise health care costs, could sweep in property and casualty insurers and mutual companies, and might create legal and affordability problems. Testimony also raised concerns that the bill’s cooperation language could unintentionally narrow existing affiliations with nonpublic entities. The hearing closed with 5 signed in pro, 74 con, and 2 other.
The committee then heard SB 5845, which would replace the current 95% timely-payment standard with a requirement that all clean claims be paid or denied within 30 days, with notice requirements for incomplete claims and interest or penalties for late payment. Hospitals, physicians, and health systems strongly supported the bill, saying delayed and unpredictable payments create major cash-flow and administrative burdens and that some large claims can remain unpaid for months or longer even when care was approved. Health plans opposed the bill, saying they already meet current standards, that the bill could limit their ability to investigate fraud, waste, and abuse or review high-dollar claims, and that it should include more balanced timelines and exceptions. The hearing closed with 69 signed in pro, 4 con, and 2 other.
The committee also heard SB 5916, which would prohibit health plans, Medicaid managed care organizations, and public employee plans from disadvantaging non-opioid pain treatments relative to opioids through formulary placement or utilization management, and would require a Department of Health educational pamphlet on non-opioid options. Patients, recovery advocates, and rare disease advocates supported the bill as a way to improve access to safer pain care and reduce barriers like prior authorization and step therapy. The Health Care Authority and an insurers’ representative said they support access to non-opioids but were concerned the bill could require preferred status for all non-opioids whenever any opioid is preferred, increasing costs and limiting formulary management. The hearing closed with 8 signed in pro, 1 con, and 2 other.
Later, the committee heard SB 6102, a technical bill to align the ambulance transport quality assurance fee with federal rules after changes in federal law limited new provider taxes. The ambulance association supported the bill, saying the existing fee has significantly improved wages and benefits for EMS workers and that the change is needed to preserve the program. The hearing closed with 50 signed in pro, 1 con, and 0 other. The committee also heard SB 6103, which would make Medicaid payments for rural emergency hospitals subject to appropriation and create a state framework for a rural hospital conversion model. Supporters from East Adams Rural Health Care and the Washington State Hospital Association said the bill would help keep rural emergency services viable, especially for communities along the I-90 corridor. The hearing closed with 58 signed in pro, 1 con, and 0 other. Finally, the committee heard SB 6071, which would shorten the time limit for insurers to seek overpayment recoveries from providers from two years to six months, or nine months for coordination-of-benefits cases, extending a standard already enacted for mental health and substance use disorder services. Providers from acupuncture, massage, podiatry, and other small practices supported the bill, saying long clawback periods create financial instability and administrative burden, while the remaining testimony was still being taken when the transcript ended.
TX
Transcript Highlights:
- , CBC model of care.
- Uh, these are people who deserve to be taken care of, and taking care of them, doing criminal history
- They know they're taking care of the elderly and frail population.
- It is the ethical and moral responsibility to provide that care.
- So we need to be caring for their part.
Bills:
HB 660, HB 4845, HB 3902, HB 5396, HB 4615, HB 1825, HB 1403, HB 4336, HB 4585, HB 4371, HB 863, SB 1589, HB 5223, HB 3195, HB 2734
Keywords:
child protective services, adult protective services, caseload limits, call processing goals, child-care licensing, employee workload, reporting requirements, employee caseload limits, protective services, workload management, accountability, Department of Family and Protective Services, employee goals, call processing, child care, human resources, government accountability, Medicaid, provider enrollment, revalidation
TX
Transcript Highlights:
- A complex care aide in home health is a trained caregiver who provides specialized care.
- (CBC) model of care.
- We appreciate the careful approach adopted by House Bill 3195.
- They know they are taking care of the elderly and frail population. It is their duty.
- So we need to be caring for that part.
Bills:
HB660, HB4845, HB3902, HB5396, HB4615, HB1825, HB1403, HB4336, HB4585, HB4371, HB863, SB1589, HB5223, HB3195, HB2734
Keywords:
child protective services, adult protective services, caseload limits, call processing goals, child-care licensing, employee workload, reporting requirements, employee caseload limits, protective services, workload management, accountability, Department of Family and Protective Services, employee goals, call processing, child care, human resources, government accountability, Medicaid, provider enrollment, revalidation
TX
Transcript Highlights:
- In the process, nursing facilities must continue to care for patients and fund that care without Medicaid
- care ombudsman.
- and increase quality of care.
- So you have the patient care expense, which would include direct care, dietary, and indirect care.
- We want to make sure the elderly and the frail population of Texas are taken care of.
Bills:
HB660, HB4845, HB3902, HB5396, HB4615, HB1825, HB1403, HB4336, HB4585, HB4371, HB863, SB1589, HB5223, HB3195, HB2734
Keywords:
child protective services, adult protective services, caseload limits, call processing goals, child-care licensing, employee workload, reporting requirements, employee caseload limits, protective services, workload management, accountability, Department of Family and Protective Services, employee goals, call processing, child care, human resources, government accountability, Medicaid, provider enrollment, revalidation
WA
Washington 2025-2026 Regular Session
House Health Care & Wellness Jan 28th, 2026 at 01:30 pm
Health Care & Wellness
Transcript Highlights:
- Health care provider.
- In many ways, Coordinated Care is the Affordable Care Act success story.
- care services.
- That's the promise of future care when people's long-term care and other health care needs escalate.
- That's the promise of future care when people's long-term care and other health care needs escalate.
Keywords:
healthcare, insurance, certification, state regulation, health plan, therapy, psychotherapy, mental health, regulation, professional standards, behavioral health, mental health crisis, crisis response, co-response, co-responder, first responder, EMS, emergency medical services, paramedic, EMT
Summary:
The House Health Care & Wellness Committee held public hearings on House Bill 2564, concerning the health benefit exchange, and House Bill 2599, concerning the use of AI in therapy services. HB 2564 would let the exchange adopt annual market-factor certification criteria to address access and affordability issues, including requiring more meaningful plan differences, broader county participation, and availability of lower-premium options. Supporters, including the exchange, former Sen. Karen Kaiser, consumer advocates, rural and tribal representatives, and some brokers, said the bill could help prevent bare counties, improve affordability, and reduce confusing plan duplication. Opponents, including carrier groups, insurers, the hospital association, and insurance producers, warned it could reduce carrier participation, create uncertainty, overlap with OIC authority, and raise provider costs. HB 2599 would restrict licensed therapy providers from using AI to make independent therapeutic decisions, directly interact with clients, generate treatment plans without review, or advertise AI as therapy; supporters said it was needed to prevent deceptive or dangerous chatbot therapy, while several professional groups and Teladoc supported the intent but asked for narrower definitions and clearer carveouts for routine clinician-supervised tools. The committee also heard testimony on the bills’ details and possible amendments, but took no public-hearing votes on either bill.
In executive session, the committee considered five bills. HB 1784, on certified medical assistants entering and activating orders, passed with a proposed substitute that added standing written protocols, annual review requirements, and a 24-hour countersignature deadline; it was reported out 18-0. HB 2242, on preventive services and immunization recommendations, had three amendments considered: two were rejected and one JLARC study amendment was adopted, after which the substitute bill passed 11-7. HB 2384, on actuarial reviews for continuing care retirement communities, passed as a substitute after technical changes and was reported out 16-2. HB 2505, creating an exemption from adult family home licensure for certain foster family situations, adopted an amendment adding disqualifying conditions and then passed 18-0. The committee deferred action on HB 1809 and HB 2261, and adjourned after completing its work.
WA
Washington 2025-2026 Regular Session
House Health Care & Wellness Jan 21st, 2026 at 01:30 pm
Health Care & Wellness
Transcript Highlights:
- a health care provider must also state the provider's name, type of credential, and any health care-related
- care credential during patient care encounters.
- Two, it ensures that all health care advertisements that name a health care professional identify the
- when the vast majority of our health care dollars... ...towards medical care.
- Additionally, providers of community-based care and in-home care, ...from liability.
Keywords:
healthcare, transparency, patient communication, credentials, professional standards, medical loss ratio, insurance, health plans, cost management, nursing delegation, registered nurse, RN, home care aide, nursing assistant, certified nursing assistant, CNA, medical assistant, home health, hospice, community-based care
Summary:
The House Health Care and Wellness Committee held public hearings on House Bills 2261, 2283, and 2425, then took executive action on House Bills 2110, 2113, 2122, and 2152. HB 2261 would require health care providers to wear badges showing name, credential, and degree initials, require similar disclosures in advertising, and restrict use of the title “physician surgeon”; supporters framed it as a patient transparency measure, while many providers and associations opposed it as burdensome, confusing, and harmful to access, especially for adult family homes and solo practices. HB 2283 would raise the medical loss ratio for fully insured plans to 90%; supporters said it would direct more premium dollars to care and lower costs, while insurers warned it could destabilize markets and reduce flexibility for administrative services. HB 2425 would modernize nurse delegation rules, expand what tasks can be delegated, and broaden liability protections; supporters said it would reduce barriers and help address workforce shortages, while opponents raised patient safety and accountability concerns.
During executive session, the committee advanced all four bills. HB 2110, allowing certain nurses without EMT certification to provide care on inter-facility specialty care transport, was amended and reported out with a due pass recommendation. HB 2113, which addresses radiological technicians performing IV contrast procedures under certain supervision arrangements, was reported out without amendment. HB 2122, requiring hospitals to offer flu vaccines under specified conditions, was amended three times and then reported out. HB 2152, requiring certain facilities to allow medical cannabis use by qualifying patients with terminal conditions, was amended to include exemptions and policy details, including naming it Ryan’s Law, and was then reported out as amended. The committee adjourned after these votes.
TX
Transcript Highlights:
- can improve access to family child care for military families.
- and managed care plans.
- Foster care like me, those safety nets don't often exist.
- I aged out of care at 18, I didn't know what to do.
- So what happens to these children that do not receive care, receive delayed care?
Bills:
HB2646, HB3941, HB5153, HB5155, HB5394, HB 1106, HB426, HB4529, HB3984, HB4273, HB 1097, HB3940, HB1941, HB4377, HB3153
Keywords:
child care, task force, high-quality care, affordability, prekindergarten partnerships, foster care, transitional living, Medicaid reform, youth assistance, independent living, services for youth, employment training, educational support, mental health services, health care, public health, child health program, reimbursement, local health entities, maternal health
TX
Transcript Highlights:
- As a result, newborns are experiencing delays and missing vital early care, including early checkups
- I have you as Alec Mendoza from Texans Care for Children.
- We know that early checkup screenings and medical care are vital for a baby's healthy start.
- Any delays in medical care can cause significant health issues for children.
- Can you please all of you share what you're seeing when a child ages out of foster care?
Bills:
HB2646, HB3941, HB5153, HB5155, HB5394, HB 1106, HB426, HB4529, HB3984, HB4273, HB 1097, HB3940, HB1941, HB4377, HB3153
Keywords:
child care, task force, high-quality care, affordability, prekindergarten partnerships, foster care, transitional living, Medicaid reform, youth assistance, independent living, services for youth, employment training, educational support, mental health services, health care, public health, child health program, reimbursement, local health entities, maternal health
FL
Florida 2026 Regular Session
Appropriations Committee on Health and Human Services Feb 4th, 2026
Appropriations Committee on Health and Human Services
Transcript Highlights:
- since the announcement about a month ago of changes that will throw about 16,000 people out of medical care
- reducing their eligibility criteria, which is going to limit the pool of clients who could access care
- , ...that special relationship you have with your physician as a woman, in HIV care, you build a very
- And it creates greater barriers to care for someone. And so there are concerns with it.
- And finally, it requires AHCA to adopt rules for minimum standards for pediatric care.
Keywords:
pediatric care, emergency departments, hospital regulations, patient safety, health care standards, veterans, dental care, healthcare, grant program, income assistance, human trafficking, nurse licensure, registered nurse, RN, licensed practical nurse, LPN, Florida Board of Nursing, Department of Health, licensure by examination, nursing education
Summary:
The Appropriations Committee on Health and Human Services heard public comment first on the AIDS Drug Assistance Program and the iBudget waiver. Testimony on the HIV program warned that proposed Department of Health changes could disrupt care for thousands of clients, create confusion, and force people off life-saving medications; a senator suggested affected clients explore medically needy and FQHC/340B options. Testimony on iBudget urged support for a roughly 7% rate adjustment for direct support professionals, citing rising costs and the need to sustain the developmental disabilities workforce.
The committee then considered several bills. SB 428 expanded Florida’s swim lesson voucher program from children ages 0-4 to ages 1-7 and was reported favorably. SB 68 required hospitals with emergency departments to adopt pediatric emergency care policies, training, equipment standards, and readiness assessments; an amendment aligning reporting dates with the House was adopted, and the bill was reported favorably. SB 1718 lengthened the time an adult may stay in an out-of-home placement before being treated as a visitor, reduced background screening burdens for foster families, made the Step Into Success program permanent, and created a best-practices program; it was also reported favorably.
The committee next approved SB 606, which adds drowning-prevention and safe-bathing education to postpartum materials and requires related compliance records, and SB 96, which expands the Veterans Dental Care Grant Program to veterans up to 400% of the federal poverty level; an amendment removed the bill’s specific $500,000 appropriation so funding can be handled in the budget process. SB 340 required nursing education to include a two-hour human trafficking course before licensure, and SB 1480 created a grandfathering process for certain area-of-critical-need health care providers if federal designations change, both of which were reported favorably. The committee adjourned after all bills passed their roll calls.
MN
Minnesota 2025-2026 Regular Session
House Children and Families Finance and Policy Committee 3/11/26
Children and Families Finance and Policy
Transcript Highlights:
- </c> children's care. children's care.
- > for</c><00:49:40.400><c> their</c> can care provide free care for their can care provide free care
- </c> their care. their care.
- </c> entered foster care. entered foster care.
- </c> foster care. foster care.
Keywords:
public authorities, dissolution cases, court system, child protection, legal notice, foster care, child welfare, enrollment priority, education programs, child care assistance, foster youth, extended foster care, bill of rights, out-of-home placement, Minnesota Statutes chapter 260C, social services agency, caseworker, permanency team, sibling visitation, relative contact
ND
North Dakota 2025-2026 Regular Session
Senate Appropriations - Human Resources Division Apr 15th, 2025 at 09:00 am
Appropriations - Human Resources Division
Transcript Highlights:
- is 2399, and that's related to PRTFs and how they're billing and how that's reimbursed for direct care
- How they're billing and how that's reimbursed for direct care.
Bills:
HB1012
Keywords:
health and human services, DHHS, appropriations, biennial budget, behavioral health, substance use disorder, opioid settlement, medical assistance expansion, Medicaid, basic care, long-term care, child care assistance, early childhood care, child care provider payments, guardianship, conservatorship, housing loan fund, disability services, extraordinary medical needs, community health trust fund
Summary:
The Senate Appropriations Human Services Division met to consider House Bill 1012, the Department of Human Services budget, and reviewed three previously made amendments: correcting a reference to $30 million underfunding, changing “human service centers” to “behavioral health clinics,” and revising section 31 language so the department would review medical assistance services and report findings and recommendations rather than directly implement adjustments. The committee also discussed whether to include funding related to two other bills with fiscal impacts, House Bill 1485 (personal needs allowance) and House Bill 2399 (PRTF reimbursement), noting those measures may go to conference committee and that appropriations could be added there instead of in HB 1012. The committee agreed to proceed with HB 1012 and members noted provider inflation questions would be raised later in full committee.
The division then approved a due pass recommendation on the amendments to HB 1012 and, after a roll call vote, approved HB 1012 as amended on a 4-1 vote, with Senator Mathern voting no. Senator Davison was named as carrier. Members also discussed House Bill 1577, involving wastewater project financing and possible amendments related to a line of credit from the Bank of North Dakota for specific projects, and House Bill 1619, for which additional amendments were expected before full committee action. The meeting ended with general thanks and adjournment.
MN
Minnesota 2025-2026 Regular Session
House Workforce, Labor, and Economic Development Finance and Policy Committee 3/18/25
Workforce, Labor, and Economic Development Finance and Policy
Transcript Highlights:
- I am a server and a cashier at Serenity Care Center.
- We don't care if they're union or non-union; we don't care.
- We don't care if they're union or non-union; we don't care.
- We don't care if they're union or non-union; we don't care.
- If you grow up in health care, you might be in health care.
Keywords:
HF339, Nursing Home Workforce Standards Board, nursing homes, long-term care, elder care, workforce standards, certified worker organizations, labor funding, general fund appropriation, worker grants, Minnesota labor law, nursing home staffing, caregiver workforce, section 181.214, HF1272, nursing home, boarding care home, nursing home workers, labor standards, Medicaid-certified facility
AL
Transcript Highlights:
- Untreated postpartum depression increases long-term health care costs due to emergency interventions
- Is there a funding mechanism for ADPH to take care of the cost?
- Because, as I see it, now the medical schools are teaching more short-term patient care.
- My grandson just finished getting his MD this summer, and it's just that part of caring and nurturing
Keywords:
lead ban, plumbing codes, lead-free, public health, environmental management, respiratory therapy, interstate compact, licensing, military service members, healthcare access, regulation, postpartum depression, postnatal care, maternal mental health, perinatal depression, postpartum screening, new mother, birth mother, newborn discharge, hospital discharge materials
NM
Transcript Highlights:
- I sort of care, but not really much about that.
- At the same time, the compact finally expands access to health care.
- for our communities, caring for my family, caring for your families, and everyone's in this room and
- We need more expanded access to care.
- Sixteen bills in the state Senate; fourteen were related to health care.
Keywords:
interstate medical licensure compact, physician licensure, medical license reciprocity, expedited licensure, medical practice act, New Mexico medical board, compact commission, physician mobility, telemedicine, license portability, background check, disciplinary action, joint investigation, reproductive health care, gender-affirming care, scope of practice, medical board transparency, multistate compact, licensure renewal, health care workforce
MN
Minnesota 2025-2026 Regular Session
House Human Services Finance and Policy Committee 3/24/26
Human Services Finance and Policy
Transcript Highlights:
- They use us as their voice and the care residents that take care of them.
- </c> care we provide in our own homes. care we provide in our own homes.
- </c> part of a family foster care. part of a family foster care.
- </c> and the care that I have provided. and the care that I have provided.
- </c> care providers that do. care providers that do.
Keywords:
Medical Assistance, Medicaid, prepayment review, claims review, fee-for-service, provider integrity, high-risk provider, high-risk service, fraud prevention, program integrity, Department of Human Services, CMS, Centers for Medicare and Medicaid Services, health care billing, medical claims, provider enrollment, Indian Health Service, Minnesota Statutes chapter 256B, human services, medical assistance