SF 3241

as introduced - 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 2006, sections
256B.69, subdivision 3a; 256B.692, subdivisions 1, 2, 5, 7; Minnesota Statutes
2007 Supplement, section 256B.69, subdivision 4; Laws 2005, First Special
Session chapter 4, article 8, section 84, as amended; repealing Minnesota Statutes
2006, section 256B.692, subdivision 10.

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

Section 1.

Minnesota Statutes 2006, section 256B.69, subdivision 3a, is amended to
read:

Subd. 3a.

County authority.

(a) The commissioner, when implementing the general
assistance medical care, or medical assistance prepayment program new text begin and other prepaid
health care programs administered by the commissioner of human services 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
provider or health plan 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 and general assistance medical care
funds. The county board may recommend a maximum number of participating health
plans 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 for participation at the time of initial implementation of the
new text begin state new text end prepaid deleted text begin medical assistance program deleted text end new text begin health care programs 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. deleted text begin The commissioner, in conjunction with the county board, shall
actively seek to develop a mutually agreeable timetable prior to the development of the
request for proposal, but counties must agree to initial enrollment beginning on or before
January 1, 1999, in either the prepaid medical assistance and general assistance medical
care programs or county-based purchasing under section 256B.692. At least 90 days
before enrollment in the medical assistance and general assistance medical care prepaid
programs begins in a county in which the prepaid programs have not been established, the
commissioner shall provide a report to the chairs of senate and house committees having
jurisdiction over state health care programs which verifies that the commissioner complied
with the requirements for county involvement that are specified in this subdivision.
deleted text end

(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 deleted text begin medical
assistance and general assistance medical care deleted text end enrollees new text begin in state prepaid health care
programs new text end . These requirements must be reasonably related to the performance of health
plan functions and within the scope of the deleted text begin medical assistance and general assistance
medical care deleted text end new text begin programs' new text end benefit sets. If the county board and the commissioner mutually
agree to such requirements, the department shall include such requirements in all health
plan contracts governing the prepaid deleted text begin medical assistance and general assistance medical
care deleted text end programs 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) deleted text begin For counties in which prepaid medical assistance and general assistance medical
care programs have not been established, the commissioner shall not implement those
programs if a county board submits acceptable and timely preliminary and final proposals
under section 256B.692, until county-based purchasing is no longer operational in that
county. deleted text end For counties in which prepaid deleted text begin medical assistance and general assistance medical
care deleted text end programs are in existence on or after September 1, 1997, the commissioner must
terminate contracts with health plans according to section 256B.692, subdivision 5, if
the county board submits and the commissioner accepts preliminary and final proposals
according to that subdivision. 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 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 deleted text begin designee of the commissioner of health deleted text end new text begin person
selected jointly by the designee of the commissioner of human services and the designee
of the Association of Minnesota Counties. The parties to the mediation must be given 30
days' notice of a hearing before the mediation panel meets new text end .

(e) If a county which elects to implement county-based purchasing ceases to
implement county-based purchasing, it is prohibited from assuming the responsibility of
county-based purchasing for a period of five years from the date it discontinues purchasing.

deleted text begin (f) Notwithstanding the requirement in this subdivision that a county must agree to
initial enrollment on or before January 1, 1999, the commissioner shall grant a delay in
the implementation of the county-based purchasing authorized in section 256B.692 until
federal waiver authority and approval has been granted, if the county or group of counties
has submitted a preliminary proposal for county-based purchasing by September 1, 1997,
has not already implemented the prepaid medical assistance program before January 1,
1998, and has submitted a written request for the delay to the commissioner by July
1, 1998. In order for the delay to be continued, the county or group of counties must
also submit to the commissioner the following information by December 1, 1998. The
information must:
deleted text end

deleted text begin (1) identify the proposed date of implementation, as determined under section
256B.692, subdivision 5;
deleted text end

deleted text begin (2) include copies of the county board resolutions which demonstrate the continued
commitment to the implementation of county-based purchasing by the proposed date.
County board authorization may remain contingent on the submission of a final proposal
which meets the requirements of section 256B.692, subdivision 5, paragraph (b);
deleted text end

deleted text begin (3) demonstrate actions taken for the establishment of a governance structure
between the participating counties and describe how the fiduciary responsibilities of
county-based purchasing will be allocated between the counties, if more than one county
is involved in the proposal;
deleted text end

deleted text begin (4) describe how the risk of a deficit will be managed in the event expenditures are
greater than total capitation payments. This description must identify how any of the
following strategies will be used:
deleted text end

deleted text begin (i) risk contracts with licensed health plans;
deleted text end

deleted text begin (ii) risk arrangements with providers who are not licensed health plans;
deleted text end

deleted text begin (iii) risk arrangements with other licensed insurance entities; and
deleted text end

deleted text begin (iv) funding from other county resources;
deleted text end

deleted text begin (5) include, if county-based purchasing will not contract with licensed health plans
or provider networks, letters of interest from local providers in at least the categories of
hospital, physician, mental health, and pharmacy which express interest in contracting
for services. These letters must recognize any risk transfer identified in clause (4), item
(ii); and
deleted text end

deleted text begin (6) describe the options being considered to obtain the administrative services
required in section 256B.692, subdivision 3, clauses (3) and (5).
deleted text end

deleted text begin (g) For counties which receive a delay under this subdivision, the final proposals
required under section 256B.692, subdivision 5, paragraph (b), must be submitted at
least six months prior to the requested implementation date. Authority to implement
county-based purchasing remains contingent on approval of the final proposal as required
under section 256B.692.
deleted text end

deleted text begin (h) If the commissioner is unable to provide county-specific, individual-level
fee-for-service claims to counties by June 4, 1998, the commissioner shall grant a delay
under paragraph (f) of up to 12 months in the implementation of county-based purchasing,
and shall require implementation not later than January 1, 2000. In order to receive an
extension of the proposed date of implementation under this paragraph, a county or group
of counties must submit a written request for the extension to the commissioner by August
1, 1998, must submit the information required under paragraph (f) by December 1, 1998,
and must submit a final proposal as provided under paragraph (g).
deleted text end

deleted text begin (i) Notwithstanding other requirements of this subdivision, the commissioner
shall not require the implementation of the county-based purchasing authorized in
section 256B.692 until six months after federal waiver approval has been obtained for
county-based purchasing, if the county or counties have submitted the final plan as
required in section 256B.692, subdivision 5. The commissioner shall allow the county or
counties which submitted information under section 256B.692, subdivision 5, to submit
supplemental or additional information which was not possible to submit by April 1, 1999.
A county or counties shall continue to submit the required information and substantive
detail necessary to obtain a prompt response and waiver approval. If amendments to
the final plan are necessary due to the terms and conditions of the waiver approval, the
commissioner shall allow the county or group of counties 60 days to make the necessary
amendments to the final plan and shall not require implementation of the county-based
purchasing until six months after the revised final plan has been submitted.
deleted text end

Sec. 2.

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
counties having an approved county-based purchasing health plan.
new text end

Sec. 3.

Minnesota Statutes 2006, section 256B.692, subdivision 1, is amended to read:

Subdivision 1.

In general.

County boards or groups of county boards may elect
to purchase or provide health care services on behalf of persons eligible for medical
assistance deleted text begin and deleted text end new text begin , MinnesotaCare, new text end general assistance medical care new text begin , and other prepaid health
care programs administered by the commissioner of human services new text end who would otherwise
be required to or may elect to participate in the prepaid medical assistance or prepaid
general assistance medical care programs according to sections 256B.69 and 256D.03.
Counties that elect to purchase or provide health care under this section must provide all
services included in prepaid managed care programs according to sections 256B.69,
subdivisions 1 to 22, and 256D.03. County-based purchasing under this section is
governed by section 256B.69, unless otherwise provided for under this section.

Sec. 4.

Minnesota Statutes 2006, section 256B.692, subdivision 2, is amended to read:

Subd. 2.

Duties of commissioner of health.

(a) Notwithstanding chapters 62D and
62N, a county that elects to purchase new text begin health care services for persons eligible for new text end medical
assistance deleted text begin and deleted text end new text begin , MinnesotaCare, new text end general assistance medical care new text begin , and other prepaid health
care programs administered by the commissioner of human services new text end in return for a fixed
sum without regard to the frequency or extent of services furnished to any particular
enrollee is not required to obtain a certificate of authority under chapter 62D or 62N.
The county board of commissioners is the governing body of a county-based purchasing
program. In a multicounty arrangement, the governing body is a joint powers board
established under section 471.59.

(b) A county that elects to purchase deleted text begin medical assistance and general assistance
medical deleted text end new text begin health new text end care services under this section must deleted text begin satisfy deleted text end new text begin assure new text end the commissioner of
health that the requirements for assurance of consumer protection, provider protection,
and fiscal solvency of chapter 62D, applicable to health maintenance organizations, or
chapter 62N, applicable to community integrated service networks, will be met.

(c) A county must also assure the commissioner of health that the requirements of
sections 62J.041; 62J.48; 62J.71 to 62J.73; 62M.01 to 62M.16; all applicable provisions
of chapter 62Q, including sections 62Q.075; 62Q.1055; 62Q.106; 62Q.12; 62Q.135;
62Q.14; 62Q.145; 62Q.19; 62Q.23, paragraph (c); 62Q.43; 62Q.47; 62Q.50; 62Q.52 to
62Q.56; 62Q.58; 62Q.68 to 62Q.72; and 72A.201 will be met.

(d) All enforcement and rulemaking powers available under chapters 62D, 62J,
62M, 62N, and 62Q are hereby granted to the commissioner of health with respect to
counties that purchase deleted text begin medical assistance and general assistance medical deleted text end new text begin health new text end care
services under this section.

(e) The commissioner, in consultation with county government, shall develop
administrative and financial reporting requirements for county-based purchasing programs
relating to sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 62N.31,
and other sections as necessary, that are specific to county administrative, accounting, and
reporting systems and consistent with other statutory requirements of counties.

Sec. 5.

Minnesota Statutes 2006, section 256B.692, subdivision 5, is amended to read:

Subd. 5.

County proposals.

(a) deleted text begin On or before September 1, 1997, deleted text end A county
board that wishes to purchase or provide health care under this section must submit a
preliminary proposal that substantially demonstrates the county's ability to meet all the
requirements of this section deleted text begin in response to criteria for proposals issued by the department
on or before July 1, 1997 deleted text end . Counties submitting preliminary proposals must establish a
local planning process that involves input from medical assistance deleted text begin and deleted text end new text begin , new text end general assistance
medical care deleted text begin recipients deleted text end new text begin , and MinnesotaCare enrollees new text end , recipient advocates, providers and
representatives of local school districts, labor, and tribal government to advise on the
development of a final proposal and its implementation.

(b) The county board must submit a final proposal deleted text begin on or before July 1, 1998, deleted text end that
demonstrates the ability to meet all the requirements of this section deleted text begin , including beginning
enrollment on January 1, 1999, unless a delay has been granted under section 256B.69,
subdivision 3a, paragraph (g) deleted text end .

(c) deleted text begin After January 1, 1999, deleted text end For a county in which the prepaid medical assistance
program is in existence, the county board must submit a preliminary proposal at least 15
months prior to termination of health plan contracts in that county and a final proposal
six months prior to the health plan contract termination date in order to begin enrollment
after the termination. Nothing in this section shall impede or delay implementation
or continuation of the prepaid medical assistance and general assistance medical care
programs in counties for which the board does not submit a proposal, or submits a
proposal that is not in compliance with this section.

(d) The commissioner is not required to terminate contracts for the prepaid medical
assistance and prepaid general assistance medical care programs that begin on or after
September 1, 1997, in a county for which a county board has submitted a proposal under
this paragraph, until two years have elapsed from the date of initial enrollment in the
prepaid medical assistance and prepaid general assistance medical care programs.

Sec. 6.

Minnesota Statutes 2006, section 256B.692, subdivision 7, is amended to read:

Subd. 7.

Dispute resolution.

In the event the commissioner rejects a proposal
under subdivision 6, the county board may request the recommendation of a three-person
mediation panel. The commissioner shall resolve all disputes after taking into account
the recommendations of the 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 deleted text begin designee of the commissioner of health deleted text end new text begin person
selected jointly by the designee of the commissioner of human services and the designee
of the Association of Minnesota Counties. The commissioner shall provide background
materials, including all submitted proposals, to panel members and affected counties at
least 30 days before the panel is first convened new text end .

Sec. 7.

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. deleted text begin SOLE-SOURCE OR deleted text end SINGLE-PLAN MANAGED CARE
CONTRACT.

Notwithstanding Minnesota Statutes, section 256B.692, subdivision 6, clause
(1), deleted text begin paragraph (c), deleted text end the commissioner of human services shall approve a county-based
purchasing health plan proposal deleted text begin , 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 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. deleted text end new text begin for any Minnesota county
or counties, establishing the county-based purchasing entity as a single-plan contract for
all counties that are eligible under federal law, and no more than two plans, including the
county-based purchasing plan for those counties not federally eligible for single-plan
status, and where 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 request
federal approval, if necessary, to permit a single-plan purchasing option even if choice is
available in the area, or for no more than two plans in areas that are not federally eligible
for single-plan status. The commissioner shall continue single health plan purchasing
arrangements with county-based purchasing entities for all government-funded programs
approved by Minnesota Statutes, section 256B.692. The commissioner shall approve
contracting on a single health plan basis, or with no more than two plans, including the
county-based purchasing plan for those counties not federally eligible for single-plan
status that have coordination arrangements with counties to serve persons 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. The requirement to continue to use single-plan purchasing arrangements in
these counties applies to all managed care or prepaid programs administered by the
commissioner and applies to new programs and reprocurement or renewal of existing
arrangements, provided the county-based purchasing entity continues to meet the
commissioner's contracting requirements on the same basis as other managed care or
prepaid plans in other regions. new text end

deleted text begin 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. 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

Sec. 8. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall codify section 7 as a new subdivision of Minnesota
Statutes, section 256B.692.
new text end

Sec. 9. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256B.692, subdivision 10, new text end new text begin is repealed.
new text end