HF 2693

as introduced - 90th Legislature (2017 - 2018) Posted on 05/18/2017 09:38am

A bill for an act
relating to human services; requiring the commissioner of human services to design
a state Medicare demonstration project; requiring a report to the legislature.

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

Section 1. STATE MEDICARE DEMONSTRATION PROJECT.

Subdivision 1.

Project design.

The commissioner of human services shall develop a
design and implementation timeline for a demonstration project under which persons age
55 and over, who would otherwise be covered through the individual market, would be able
to receive coverage under an expanded Medicare program. The demonstration project design
and proposed implementation by the commissioner must meet the criteria specified in this
section.

Subd. 2.

Eligibility.

(a) In order to be eligible for coverage under the demonstration
project, an individual must:

(1) be age 55 or older;

(2) have a household income that exceeds 200 percent of the federal poverty guidelines;

(3) not be eligible for coverage under medical assistance, MinnesotaCare, or the federal
Medicare program;

(4) not be eligible for employer-subsidized insurance; and

(5) be a lawful resident of Minnesota.

(b) An individual eligible to receive advanced premium tax credits and cost-sharing
subsidies through MNsure may choose to obtain coverage under the demonstration project,
but must allow the value of the advanced premium tax credits and cost-sharing subsidies
to accrue to the state.

Subd. 3.

Covered services.

The demonstration project must cover at least those services
covered under Medicare. The commissioner may expand covered services to include
additional preventive services, and other services appropriate for the population to be served
by the demonstration project.

Subd. 4.

Service delivery; provider contracting.

(a) The commissioner shall directly
contract with health care providers to deliver services to demonstration project enrollees.
The commissioner may contract with providers using competitive bidding on a regional
basis.

(b) The commissioner shall require all providers to deliver services under a value-based
purchasing arrangement that includes payment benchmarks for total cost of care, risk-gain
sharing, and incentives for care coordination. In designing the delivery system, the
commissioner shall incorporate relevant features of health care delivery systems operating
under Minnesota Statutes, section 256B.0755, the county pilot program operating under
Minnesota Statutes, section 256B.0756, and health care homes operating under Minnesota
Statutes, sections 256B.0751 and 256B.0757, and may incorporate features of other
innovative payment methods.

(c) The commissioner shall evaluate providers on quality and outcome measures, and
shall consider provider scores on these measures when determining provider payment rates.
The commissioner shall adjust quality and outcome scores to reflect enrollee socioeconomic
characteristics, health disparities, and language, cultural, and other barriers to care.

Subd. 5.

Premiums and cost-sharing.

(a) The commissioner shall develop a sliding
premium scale for demonstration project enrollees.

(b) The commissioner shall base enrollee cost-sharing on the cost-sharing requirements
of the Medicare program, but may modify these cost-sharing requirements as needed to
ensure affordable access to care.

Subd. 6.

Coordination.

The demonstration project shall be designed and operated in a
manner that facilitates the transition of demonstration project enrollees to the federally
operated Medicare program, once demonstration project enrollees become eligible for that
program.

Subd. 7.

Report to legislature.

The commissioner, by January 15, 2018, shall present
a report on the demonstration project to the legislative committees with jurisdiction over
health and human services policy and spending, commerce, and health. The report must:

(1) include a design for the demonstration project that is consistent with and includes
recommendations related to the criteria specified in this section;

(2) list the federal waivers, approvals, and law changes necessary to implement the
demonstration project, and recommend a strategy and timeline by which the state and its
congressional delegation can seek the waivers, approvals, and law changes;

(3) provide recommendations on funding sources for the demonstration project, that
include a consideration of the use of funds that would otherwise be provided to an enrollee
in the form of advanced premium tax credit and cost-sharing reductions, and use of an
expanded Medicare payroll tax; and

(4) include an implementation plan and timeline for the demonstration project, and
recommendations for necessary changes in state law.