HF 3380

2nd Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; revising requirements for county-based purchasing
for state health care programs; amending Minnesota Statutes 2007 Supplement,
section 256B.69, subdivision 4; Laws 2005, First Special Session chapter 4,
article 8, section 84, as amended.

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

Section 1.

Minnesota Statutes 2007 Supplement, section 256B.69, subdivision 4, is
amended to read:

Subd. 4.

Limitation of choice.

(a) The commissioner shall develop criteria to
determine when limitation of choice may be implemented in the experimental counties.
The criteria shall ensure that all eligible individuals in the county have continuing access
to the full range of medical assistance services as specified in subdivision 6.

(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:

(1) persons eligible for medical assistance according to section 256B.055,
subdivision 1;

(2) persons eligible for medical assistance due to blindness or disability as
determined by the Social Security Administration or the state medical review team, unless:

(i) they are 65 years of age or older; or

(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
Security Act;

(3) recipients who currently have private coverage through a health maintenance
organization;

(4) recipients who are eligible for medical assistance by spending down excess
income for medical expenses other than the nursing facility per diem expense;

(5) recipients who receive benefits under the Refugee Assistance Program,
established under United States Code, title 8, section 1522(e);

(6) children who are both determined to be severely emotionally disturbed and
receiving case management services according to section 256B.0625, subdivision 20,
except children who are eligible for and who decline enrollment in an approved preferred
integrated network under section 245.4682;

(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;

(8) persons eligible for medical assistance according to section 256B.057,
subdivision 10; and

(9) persons with access to cost-effective employer-sponsored private health
insurance or persons enrolled in a non-Medicare individual health plan determined to be
cost-effective according to section 256B.0625, subdivision 15.

Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an
elective basis. The commissioner may enroll recipients in the prepaid medical assistance
program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by
spending down excess income.

(c) The commissioner may allow persons with a one-month spenddown who are
otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay
their monthly spenddown to the state.

(d) The commissioner may require those individuals to enroll in the prepaid medical
assistance program who otherwise would have been excluded under paragraph (b), clauses
(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.

(e) Before limitation of choice is implemented, eligible individuals shall be notified
and after notification, shall be allowed to choose only among demonstration providers.
The commissioner may assign an individual with private coverage through a health
maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider,
the recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.

(f) An infant born to a woman who is eligible for and receiving medical assistance
and who is enrolled in the prepaid medical assistance program shall be retroactively
enrolled to the month of birth in the same managed care plan as the mother once the
child is enrolled in medical assistance unless the child is determined to be excluded from
enrollment in a prepaid plan under this section.

new text begin (g) The commissioner shall assign an eligible individual, in the absence of a specific
managed care plan choice by the individual, to the county-based purchasing health plan in
Olmsted, Winona, Houston, Fillmore, and Mower Counties.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
new text end

Sec. 2.

Laws 2005, First Special Session chapter 4, article 8, section 84, as amended by
Laws 2006, chapter 264, section 15, is amended to read:

Sec. 84. SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
CONTRACT.

new text begin (a) new text end Notwithstanding Minnesota Statutes, section 256B.692, subdivision 6, clause
(1), paragraph (c), the commissioner of human services shall approve a county-based
purchasing health plan proposal, submitted on behalf of Cass, Crow Wing, Morrison,
Todd, and Wadena Counties, that requires county-based purchasing on a single-plan basis
contract if the implementation of the single-plan purchasing proposal does not limit an
enrollee's provider choice or access to services and all other requirements applicable to
health plan purchasing are satisfied. The commissioner shall continue new text begin , until December 31,
2010, new text end single health plan purchasing arrangements with county-based purchasing entities
in the service areas in existence on May 1, 2006, including arrangements for which a
proposal was submitted by May 1, 2006, on behalf of Cass, Crow Wing, Morrison, Todd,
and Wadena Counties, in response to a request for proposals issued by the commissioner.

new text begin (b) Notwithstanding Minnesota Statutes, section 256B.692, subdivision 6, clause
(1)(c), the commissioner of human services shall approve a county-based purchasing
health plan proposal submitted on behalf of Winona, Houston, Fillmore, and Mower
Counties for medical assistance, MinnesotaCare, general assistance medical care, and
other prepaid health care programs administered by the commissioner of human services
if the implementation of the proposal does not limit an enrollee's provider choice or access
to services, and all other requirements applicable to health plan purchasing are satisfied.
new text end

new text begin (c) The commissioner shall develop a plan to reopen all counties for competitive
reprocurement every five years, beginning in 2011.
new text end

new text begin (d) new text end The commissioner shall consider, and may approve, contracting on a
single-health plan basis with county-based purchasing plans, or with other qualified health
plans that have coordination arrangements with counties, to serve persons with a disability
who voluntarily enroll, in order to promote better coordination or integration of health
care services, social services and other community-based services, provided that all
requirements applicable to health plan purchasing, including those in Minnesota Statutes,
section 256B.69, subdivision 23, are satisfied. deleted text begin By January 15, 2007, the commissioner
shall report to the chairs of the appropriate legislative committees in the house and senate
an analysis of the advantages and disadvantages of using single-health plan purchasing
to serve persons with a disability who are eligible for health care programs. The report
shall include consideration of the impact of federal health care programs and policies for
persons who are eligible for both federal and state health care programs and shall consider
strategies to improve coordination between federal and state health care programs for
those persons.
deleted text end