HF 2159

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; requiring certain medical assistance enrollees who
are children with high-cost medical conditions to receive integrated health care
coordination and social support services through the U special kids program;
appropriating money; proposing coding for new law in Minnesota Statutes,
chapter 256B.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [256B.0751] CARE COORDINATION FOR CHILDREN WITH
HIGH-COST MEDICAL CONDITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Care coordination required. new text end

new text begin (a) The commissioner of human
services shall contract with the U special kids program to provide care coordination,
beginning October 1, 2007, for medical assistance enrollees who are children with
high-cost medical conditions, and to perform the other duties specified in this section.
new text end

new text begin (b) For purposes of this section, "care coordination" means collaboration with
primary care physicians and specialists to manage care, development of medical
management plans for recurrent acute illnesses, oversight and coordination of all aspects
of care in partnership with families, organization of medical information into a summary
of critical information, coordination and appropriate sequencing of tests and multiple
appointments, information and assistance with accessing resources, and telephone triage
for acute illnesses or problems.
new text end

new text begin Subd. 2. new text end

new text begin Referrals. new text end

new text begin The commissioner shall develop a mechanism to refer
children to the U special kids program for care coordination. Beginning October 1, 2007,
and subject to the limits on total program enrollment specified in subdivision 3, the
commissioner shall refer to the U special kids program children who:
new text end

new text begin (1) incur medical expenses that exceed the qualifying level specified in subdivision 3;
new text end

new text begin (2) have medical conditions that involve four or more major systems; require
multiple specialists; use of technology such as G-tube, trach, central line, or oxygen; and
multiple medications; and
new text end

new text begin (3) do not have a medical case manager for cancer, organ transplantation, epilepsy,
or bone marrow replacement.
new text end

new text begin Subd. 3. new text end

new text begin Qualifying level of medical expenses. new text end

new text begin (a) For the period October 1, 2007,
through September 30, 2008, the commissioner shall refer children for care coordination
under this section if they incurred medical expenses of $500,000 or more during the
fiscal year ending June 30, 2007.
new text end

new text begin (b) For the period October 1, 2008, through September 30, 2009, the commissioner
shall refer children for care coordination under this section if they incurred medical
expenses of $400,000 or more during the fiscal year ending June 30, 2008.
new text end

new text begin (c) For the period October 1, 2009, through September 30, 2010, the commissioner
shall refer children for care coordination under this section if they incurred medical
expenses of $300,000 or more during the fiscal year ending June 30, 2009.
new text end

new text begin (d) Beginning October 1, 2010, the commissioner shall refer children for care
coordination under this section if they incurred medical expenses of $250,000 or more
during the previous fiscal year.
new text end

new text begin (e) The commissioner shall limit referrals to the extent necessary to ensure that
total enrollment in the U special kids program does not exceed 100 children for the
period October 1, 2007, through September 30, 2008, and does not exceed 150 children
beginning October 1, 2008.
new text end

new text begin Subd. 4. new text end

new text begin Case management. new text end

new text begin Beginning October 1, 2007, the U special kids
program shall coordinate all nonmedical case management services provided to children
who are required to receive care coordination under this section. The program may
require all nonmedical case managers, including, but not limited to, county case managers
and case managers for children served under a home and community-based waiver,
to submit care plans for approval, and to document client compliance with the care
plans. The U special kids program, beginning October 1, 2008, may employ or contract
with nonmedical case managers to provide all nonmedical case management services to
children required to receive care coordination under this section. The commissioner shall
reimburse the U special kids program for case management services through the medical
assistance program.
new text end

new text begin Subd. 5. new text end

new text begin Statewide availability of care coordination. new text end

new text begin The U special kids program
may contract with other entities to provide care coordination services as defined in
subdivision 1, in order to ensure the availability of these services in all regions of the state.
new text end

new text begin Subd. 6. new text end

new text begin Advance practice nurse telephone triage system. new text end

new text begin The U special kids
program shall establish and operate an advance practice nurse telephone triage system that
is available statewide, 24 hours a day, seven days per week. The system must provide
advance practice nurses with access to a Web-based information system to appropriately
triage medical problems, manage care, and reduce unnecessary hospitalizations.
new text end

new text begin Subd. 7. new text end

new text begin Web-accessible database. new text end

new text begin The commissioner shall contract with an
appropriate vendor to design, develop, and maintain an information management
application and system that is secure and Web accessible for critical information
summaries of children served by the U special kids program, to:
new text end

new text begin (1) allow effective communication and treatment integration between health care
providers, patients and their families, case managers, advance practice nurses providing
telephone triage services, and other persons or entities serving children enrolled in the U
special kids program; and
new text end

new text begin (2) allow more effective program administration, financial management, and billing.
new text end

new text begin Ownership of the information management application and system shall reside with the
Department of Human Services. Data entry shall remain the responsibility of U special
kids program case managers.
new text end

new text begin Subd. 8. new text end

new text begin Monitoring and evaluation. new text end

new text begin The commissioner shall monitor program
outcomes and evaluate the extent to which referrals to the U special kids program have
improved the quality and coordination of care and provided financial savings to the
medical assistance program. The U special kids program shall submit to the commissioner,
in the form and manner specified by the commissioner, all data and information necessary
to monitor program outcomes and evaluate the program. The commissioner shall present
a preliminary evaluation to chairs of house and senate human services committees by
January 15, 2008, and a final evaluation to chairs of house and senate human services
committees by January 15, 2010.
new text end

Sec. 2. new text begin APPROPRIATION.
new text end

new text begin (a) $1,500,000 in fiscal year 2008 and $1,500,000 in fiscal year 2009 are
appropriated from the general fund to the commissioner of human services for contracting
for care coordination with the U special kids program under Minnesota Statutes, section
256B.0751.
new text end

new text begin (b) $500,000 in fiscal year 2008 and $500,000 in fiscal year 2009 are appropriated
from the general fund to the commissioner of human services for the U special kids
program to establish and administer an advance practice nurse telephone triage system
under Minnesota Statutes, section 256B.0751, subdivision 6.
new text end

new text begin (c) $500,000 in fiscal year 2008 is appropriated from the general fund to the
commissioner of human services to establish a Web-accessible database under Minnesota
Statutes, section 256B.0751, subdivision 7.
new text end

new text begin (d) $500,000 in fiscal year 2008 and $750,000 in fiscal year 2009 are appropriated
from the general fund to the commissioner of human services to reimburse the U special
kids program for complementary alternative medicine treatment not covered under
medical assistance.
new text end