HF 2826

as introduced - 88th Legislature (2013 - 2014) Posted on 03/06/2014 01:57pm

A bill for an act
relating to health; defining county roles and options in the purchasing of health
care for people enrolled in Minnesota health care programs; amending Minnesota
Statutes 2012, sections 256B.69, subdivisions 3a, 3b; 256B.692, subdivision 1;
Minnesota Statutes 2013 Supplement, section 256B.0756.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 256B.0756, is amended to read:

256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.

(a) The commissioner, upon federal approval of a new waiver request or amendment
of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
County, or both, to test alternative and innovative integrated health care delivery networks.

(b) Individuals eligible for the pilot program shall be individuals who are eligible
for medical assistance under section 256B.055 and who reside in Hennepin County
or Ramsey County. The commissioner may identify individuals to be enrolled in the
Hennepin County pilot program based on zip code in Hennepin County or whether the
individuals would benefit from an integrated health care delivery network.

(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
health care delivery network in their county of residence. The integrated health care
delivery network in Hennepin County shall be a network, such as an accountable care
organization or a community-based collaborative care network, created by or including
Hennepin County Medical Center. The integrated health care delivery network in Ramsey
County shall be a network, such as an accountable care organization or community-based
collaborative care network, created by or including Regions Hospital.

(d) In developing a payment system for the pilot programs, the commissioner shall
establish a total cost of care for the recipients enrolled in the pilot programs that equals
the cost of care that would otherwise be spent for these enrollees in the prepaid medical
assistance program.

(e) The commissioner shall apply to the federal government for, or as appropriate,
cooperate with counties, providers, or other entities that are applying for any applicable
grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
111-152, that would further the purposes of or assist in the creation of an integrated health
care delivery network for the purposes of this subdivision, including, but not limited to, a
global payment demonstration or the community-based collaborative care network grants.

new text begin (f) Effective July 1, 2014, the commissioner may expand the pilot program under
this section to be available to any other county or group of counties for any categories of
persons enrolled in Minnesota health care programs, if the county or group of counties
meets the applicable requirements for a pilot project under this section.
new text end

Sec. 2.

Minnesota Statutes 2012, section 256B.69, subdivision 3a, is amended to read:

Subd. 3a.

County authority.

(a) The commissioner, when implementing the
medical assistance prepayment program new text begin or an accountable care program new text end within a county,
must include the county board in the process of development, approval, and issuance of
the request for proposals to provide services to eligible individuals within the proposed
county. County boards must be given reasonable opportunity to make recommendations
regarding the development, issuance, review of responses, and changes needed in the
request for proposals. The commissioner must provide county boards the opportunity to
review each proposal based on the identification of community needs under chapters
145A and 256E and county advocacy activities. If a county board finds that a proposal
does not address certain community needs, the county board and commissioner shall
continue efforts for improving the proposal and network prior to the approval of the
contract. The county board shall make recommendations regarding the approval of local
networks and their operations to ensure adequate availability and access to covered
services. The deleted text begin provider or deleted text end health plan new text begin or accountable entity new text end must respond directly to
county advocates and the state prepaid medical assistance ombudsperson regarding
service delivery and must be accountable to the state regarding contracts with medical
assistance funds. The county board may recommend a maximum number of participating
health plans new text begin and accountable entities new text end after considering the size of the enrolling population;
ensuring adequate access and capacity; considering the client and county administrative
complexity; and considering the need to promote the viability of locally developed health
plans. The county board or a single entity representing a group of county boards and the
commissioner shall mutually select health plans new text begin or accountable entities new text end for participation
at the time of initial implementation of the prepaid medical assistance program new text begin or
accountable care program new text end in that county or group of counties and at the time of contract
renewal. The commissioner shall also seek input for contract requirements from the
county or single entity representing a group of county boards at each contract renewal and
incorporate those recommendations into the contract negotiation process.

(b) At the option of the county board, the board may develop contract requirements
related to the achievement of local public health goals to meet the health needs of medical
assistance enrollees. These requirements must be reasonably related to the performance of
health plan new text begin or accountable entity new text end functions and within the scope of the medical assistance
benefit set. If the county board and the commissioner mutually agree to such requirements,
the department shall include such requirements in all health plan new text begin or accountable entity
new text end contracts deleted text begin governing the prepaid medical assistance program deleted text end in that county at initial
implementation of the program in that county and at the time of contract renewal. The
county board may participate in the enforcement of the contract provisions related to
local public health goals.

(c) For counties in which a prepaid medical assistance program new text begin or accountable care
program new text end has not been established, the commissioner shall not implement that program
new text begin in that county new text end if a county board new text begin or group of counties new text end submits an acceptable and timely
deleted text begin preliminary and final deleted text end proposal under section 256B.692, new text begin or to become an accountable entity
operating another type of accountable care program new text end until county-based purchasing new text begin or the
other accountable care program new text end is no longer operational in that county. For counties in
which a prepaid medical assistance program new text begin or accountable care program new text end is in existence
on or after September 1, 1997, the commissioner must terminate contracts with health
plans according to section 256B.692, subdivision 5, new text begin or with other accountable entities new text end if
the county board submits and the commissioner accepts a preliminary and final proposal
deleted text begin according to that subdivision deleted text end . The commissioner is not required to terminate contracts that
begin on or after September 1, 1997, according to section 256B.692 until two years have
elapsed from the date of initial enrollment.

(d) In the event that a county board or a single entity representing a group of county
boards and the commissioner cannot reach agreement regarding: (i) the selection of
participating health plans new text begin or accountable entities new text end in that county; (ii) contract requirements;
or (iii) implementation and enforcement of county requirements including provisions
regarding local public health goals, the commissioner shall resolve all disputes after taking
into account the recommendations of a three-person mediation panel. The panel shall be
composed of one designee of the president of the association of Minnesota counties, one
designee of the commissioner of human services, and one person selected jointly by the
designee of the commissioner of human services and the designee of the Association of
Minnesota Counties. Within a reasonable period of time before the hearing, the panelists
must be provided all documents and information relevant to the mediation. The parties to
the mediation must be given 30 days' notice of a hearing before the mediation panel.

(e) If a county which elects to implement county-based purchasing new text begin or other
accountable care program new text end ceases to implement deleted text begin county-based purchasing deleted text end new text begin the program new text end ,
it is prohibited from assuming the responsibility of county-based purchasing new text begin or other
accountable entity new text end for a period of five years from the date it discontinues purchasing.

(f) The commissioner shall not require that contractual disputes between
county-based purchasing entities and the commissioner be mediated by a panel that
includes a representative of the Minnesota Council of Health Plans.

(g) At the request of a county-purchasing entity, the commissioner shall adopt a
contract reprocurement or renewal schedule under which all counties included in the
entity's service area are reprocured or renewed at the same time.

(h) The commissioner shall provide a written report under section 3.195 to the chairs
of the legislative committees having jurisdiction over human services in the senate and the
house of representatives describing in detail the activities undertaken by the commissioner
to ensure full compliance with this section. The report must also provide an explanation
for any decisions of the commissioner not to accept the recommendations of a county or
group of counties required to be consulted under this section. The report must be provided
at least 30 days prior to the effective date of a new or renewed prepaid or managed care
contract in a county.

new text begin (i) For purposes of this subdivision and subdivision 3b, the following terms have
the meanings given:
new text end

new text begin (1) "accountable care program" means a health care delivery systems demonstration
project under section 256B.0755, a county-integrated care delivery network under section
256B.0756, an accountable community for health project authorized by the Center for
Medicare and Medicaid Services Innovation Center under a state innovation model grant,
or a county-based purchasing plan under section 256B.692; and
new text end

new text begin (2) "accountable entity" means the health care delivery system, provider, network,
government entity, or other entity that is proposing or operating an accountable care
program.
new text end

Sec. 3.

Minnesota Statutes 2012, section 256B.69, subdivision 3b, is amended to read:

Subd. 3b.

Provision of data to county boards.

The commissioner, in consultation
with representatives of county boards of commissioners new text begin , new text end shall identify program
information and data necessary on an ongoing basis for county boards to: (1) make
recommendations to the commissioner related to state purchasing under the prepaid
medical assistance program new text begin or an accountable care program new text end ; and (2) effectively new text begin develop
or new text end administer county-based purchasing new text begin or other form of accountable care program new text end . This
information and data must include, but is not limited to, county-specific, individual-level
fee-for-service and prepaid health plan claims information.

Sec. 4.

Minnesota Statutes 2012, section 256B.692, subdivision 1, is amended to read:

Subdivision 1.

In general.

new text begin (a) new text end County boards or groups of county boards may elect
to purchase or provide health care services on behalf of persons eligible for medical
assistance who would otherwise be required to or may elect to participate in the prepaid
medical assistance program according to section 256B.69. Counties that elect to purchase
or provide health care under this section must provide all services included in prepaid
managed care programs according to section 256B.69, subdivisions 1 to 22. County-based
purchasing under this section is governed by section 256B.69, unless otherwise provided
for under this section. new text begin County-based purchasing programs integrate medical care with
public health and social services, create provider incentives based on total cost of care,
facilitate information exchange for care coordination, and contribute to other health care
reform goals. The state shall recognize and work with county-based purchasing programs
as local government agents and partners when developing and implementing health care
reforms and changes that directly affect the enrolled recipients for whom the programs
are accountable.
new text end

new text begin (b) County boards or groups of county boards may elect to establish a health care
delivery system demonstration project under section 256B.0755, or a county health care
delivery network under section 256B.0756. Projects established under this paragraph are
governed by the requirements established by the commissioner under section 256B.0755
or 256B.0756, respectively, and are not subject to the requirements of this section.
new text end

new text begin (c) County boards or groups of county boards may elect to establish accountable
communities for health as authorized under the state innovation model demonstration
project established with the Center for Medicare and Medicaid Services Innovation Center.
Projects established under this paragraph are governed by the requirements established
by the commissioner for accountable communities for health and are not subject to the
other requirements of this section.
new text end

new text begin (d) The commissioner and the commissioner of health shall implement this section
in a manner appropriate to a state-county relationship as distinguished from a state
contract with a private vendor, and shall take into consideration the higher level of public
transparency and accountability inherent in a governmental organization that is governed
by elected officials. To the extent possible, the commissioner shall waive or modify
regulations, requirements, and mandated reports that are inappropriate, duplicative, or
unnecessary as applied to counties or groups of counties due to the existence of other laws
and regulations governing accountability, solvency, reporting, availability of information,
and other matters for governmental entities.
new text end