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HF 2916

as introduced - 88th Legislature (2013 - 2014) Posted on 03/10/2014 01:18pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 03/10/2014

Current Version - as introduced

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A bill for an act
relating to human services; modifying provisions related to human services
operations and health care; modifying bond requirements for medical suppliers;
repealing certain reports and obsolete rules; authorizing rulemaking; requiring
the commissioner to seek federal authority to amend the state Medicaid
plan; making technical changes; amending Minnesota Statutes 2012, sections
256B.5016, subdivision 1; 256B.69, subdivision 16; 393.01, subdivisions 2, 7;
Minnesota Statutes 2013 Supplement, section 256B.04, subdivision 21; Laws
2011, First Special Session chapter 9, article 9, section 17; repealing Minnesota
Statutes 2012, section 256.01, subdivision 32; Minnesota Rules, parts 9500.1126;
9500.1450, subpart 3; 9500.1452, subpart 3; 9500.1456; 9505.5300; 9505.5305;
9505.5310; 9505.5315; 9505.5325; 9525.1580.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 256B.04, subdivision 21,
is amended to read:


Subd. 21.

Provider enrollment.

(a) If the commissioner or the Centers for
Medicare and Medicaid Services determines that a provider is designated "high-risk," the
commissioner may withhold payment from providers within that category upon initial
enrollment for a 90-day period. The withholding for each provider must begin on the date
of the first submission of a claim.

(b) An enrolled provider that is also licensed by the commissioner under chapter
245A must designate an individual as the entity's compliance officer. The compliance
officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws
and regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of
the provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws
and regulations;

(5) promptly report to the commissioner any identified violations of medical
assistance laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance
reimbursement overpayment, report the overpayment to the commissioner and make
arrangements with the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

(c) The commissioner may revoke the enrollment of an ordering or rendering
provider for a period of not more than one year, if the provider fails to maintain and, upon
request from the commissioner, provide access to documentation relating to written orders
or requests for payment for durable medical equipment, certifications for home health
services, or referrals for other items or services written or ordered by such provider, when
the commissioner has identified a pattern of a lack of documentation. A pattern means a
failure to maintain documentation or provide access to documentation on more than one
occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
provider under the provisions of section 256B.064.

(d) The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or
under the Medicaid program or Children's Health Insurance Program of any other state.

(e) As a condition of enrollment in medical assistance, the commissioner shall
require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
and Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

(f) As a condition of enrollment in medical assistance, the commissioner shall
require that a high-risk provider, or a person with a direct or indirect ownership interest in
the provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is
designated high-risk for fraud, waste, or abuse.

(g)(1) Upon initial enrollment, reenrollment, and new text begin notification of new text end revalidation, all
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner.new text begin A medical
supplier subject to the surety bond requirement in this clause is limited to a provider
enrolled or eligible for enrollment as provider type 76. For purposes of this clause, the
following providers are not medical suppliers and are not required to obtain a surety bond:
a federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.
new text end

(2) At the time of initial enrollment or reenrollment, deleted text begin the provider agencydeleted text end new text begin all medical
suppliers enrolled as provider type 76
new text end must purchase a performance bond of $50,000. If
a revalidating provider's Medicaid revenue in the previous calendar year is up to and
including $300,000, the provider agency must purchase a performance bond of $50,000. If
a revalidating provider's Medicaid revenue in the previous calendar year is over $300,000,
the provider agency must purchase a performance bond of $100,000. The performance
bond must allow for recovery of costs and fees in pursuing a claim on the bond.

new text begin (3) For purposes of clauses (1) and (2), "provider type 76" means a medical supplier
that can purchase medical equipment or supplies for sale or rental to the general public
and is able to perform or arrange for necessary repairs to and maintenance of equipment
offered for sale or rental.
new text end

(h) The Department of Human Services may require a provider to purchase a
performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
department determines there is significant evidence of or potential for fraud and abuse by
the provider, or (3) the provider or category of providers is designated high-risk pursuant
to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450. The
performance bond must be in an amount of $100,000 or ten percent of the provider's
payments from Medicaid during the immediately preceding 12 months, whichever is
greater. The performance bond must name the Department of Human Services as an
obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.

Sec. 2.

Minnesota Statutes 2012, section 256B.5016, subdivision 1, is amended to read:


Subdivision 1.

Managed care pilot.

The commissioner may initiate a capitated
risk-based managed care option for services in an intermediate care facility for persons
with developmental disabilities according to the terms and conditions of the federal
agreement governing the managed care pilot. The commissioner may grant a variance
to any of the provisions in sections 256B.501 to 256B.5015 and Minnesota Rules, parts
9525.1200 to 9525.1330 deleted text begin and 9525.1580deleted text end .

Sec. 3.

Minnesota Statutes 2012, section 256B.69, subdivision 16, is amended to read:


Subd. 16.

Project extension.

Minnesota Rules, parts 9500.1450; 9500.1451;
9500.1452; 9500.1453; 9500.1454; 9500.1455; deleted text begin 9500.1456;deleted text end 9500.1457; 9500.1458;
9500.1459; 9500.1460; 9500.1461; 9500.1462; 9500.1463; and 9500.1464 are extended.

Sec. 4.

Minnesota Statutes 2012, section 393.01, subdivision 2, is amended to read:


Subd. 2.

Selection of members, terms, vacancies.

Except in counties which
contain a city of the first class and counties having a poor and hospital commission, the
local social services agency shall consist of seven members, including the board of county
commissioners, to be selected as herein provided; two members, one of whom shall be
a woman, shall be appointed by the deleted text begin commissioner of human servicesdeleted text end new text begin board of county
commissioners
new text end , one each year for a full term of two years, from a list of residentsdeleted text begin , submitted
by the board of county commissioners
deleted text end . As each term expires or a vacancy occurs by reason
of death or resignationnew text begin ,new text end a successor shall be appointed by the deleted text begin commissioner of human
services
deleted text end new text begin board of county commissionersnew text end for the full term of two years or the balance of any
unexpired term from a list of one or more, not to exceed three residents deleted text begin submitted by the
board of county commissioners
deleted text end . The board of county commissioners may, by resolution
adopted by a majority of the board, determine that only three of their members shall be
members of the local social services agency, in which event the local social services agency
shall consist of five members instead of seven. When a vacancy occurs on the local social
services agency by reason of the death, resignation, or expiration of the term of office of a
member of the board of county commissioners, the unexpired term of such member shall
be filled by appointment by the county commissioners. Except to fill a vacancy the term
of office of each member of the local social services agency shall commence on the first
Thursday after the first Monday in July, and continue until the expiration of the term
for which such member was appointed or until a successor is appointed and qualifies.
deleted text begin If the board of county commissioners shall refuse, fail, omit, or neglect to submit one
or more nominees to the commissioner of human services for appointment to the local
social services agency by the commissioner of human services, as herein provided, or to
appoint the three members to the local social services agency, as herein provided, by the
time when the terms of such members commence, or, in the event of vacancies, for a
period of 30 days thereafter, the commissioner of human services is hereby empowered
to and shall forthwith appoint residents of the county to the local social services agency.
The commissioner of human services, on refusing to appoint a nominee from the list of
nominees submitted by the board of county commissioners, shall notify the county board
of such refusal. The county board shall thereupon nominate additional nominees. Before
the commissioner of human services shall fill any vacancy hereunder resulting from the
failure or refusal of the board of county commissioners of any county to act, as required
herein, the commissioner of human services shall mail 15 days' written notice to the board
of county commissioners of its intention to fill such vacancy or vacancies unless the board
of county commissioners shall act before the expiration of the 15-day period.
deleted text end

Sec. 5.

Minnesota Statutes 2012, section 393.01, subdivision 7, is amended to read:


Subd. 7.

Joint exercise of powers.

Notwithstanding the provisions of subdivision 1
two or more counties may by resolution of their respective boards of county commissioners,
agree to combine the functions of their separate local social services agency into one local
social services agency to serve the two or more counties that enter into the agreement.
Such agreement may be for a definite term or until terminated in accordance with its terms.
When two or more counties have agreed to combine the functions of their separate local
social services agency, a single local social services agency in lieu of existing individual
local social services agency shall be established to direct the activities of the combined
agency. This agency shall have the same powers, duties and functions as an individual local
social services agency. The single local social services agency shall have representation
from each of the participating counties with selection of the members to be as follows:

(a) Each board of county commissioners entering into the agreement shall on an
annual basis select one or two of its members to serve on the single local social services
agency.

(b) Each board of county commissioners entering into the agreement shall deleted text begin in
accordance with procedures established by the commissioner of human services, submit a
list of names of three county residents, who shall not be county commissioners, to the
commissioner of human services. The commissioner shall
deleted text end select one deleted text begin person from each
county list
deleted text end new text begin county resident who is not a county commissionernew text end to serve as a local social
services agency member.

(c) The composition of the agency may be determined by the boards of county
commissioners entering into the agreement providing that no less than one-third of the
members are appointed as provided in clause (b).

Sec. 6.

Laws 2011, First Special Session chapter 9, article 9, section 17, is amended to
read:


Sec. 17. SIMPLIFICATION OF ELIGIBILITY AND ENROLLMENT
PROCESS.

(a) The commissioner of human services shall issue a request for information for an
integrated service delivery system for health care programs, food support, cash assistance,
and child care. The commissioner shall determine, in consultation with partners in
paragraph (c), if the products meet departments' and counties' functions. The request for
information may incorporate a performance-based vendor financing option in which the
vendor shares the risk of the project's success. The health care system must be developed
in phases with the capacity to integrate food support, cash assistance, and child care
programs as funds are available. The request for information must require that the system:

(1) streamline eligibility determinations and case processing to support statewide
eligibility processing;

(2) enable interested persons to determine eligibility for each program, and to apply
for programs online in a manner that the applicant will be asked only those questions
relevant to the programs for which the person is applying;

(3) leverage technology that has been operational in other state environments with
similar requirements; and

(4) include Web-based application, worker application processing support, and the
opportunity for expansion.

(b) The commissioner shall issue a final report, including the implementation plan,
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services no later than January 31, 2012.

(c) The commissioner shall partner with counties, a service delivery authority
established under Minnesota Statutes, chapter 402A, the Office of Enterprise Technology,
other state agencies, and service partners to develop an integrated service delivery
framework, which will simplify and streamline human services eligibility and enrollment
processes. The primary objectives for the simplification effort include significantly
improved eligibility processing productivity resulting in reduced time for eligibility
determination and enrollment, increased customer service for applicants and recipients of
services, increased program integrity, and greater administrative flexibility.

(d) deleted text begin The commissioner, along with a county representative appointed by the
Association of Minnesota Counties, shall report specific implementation progress to the
legislature annually beginning May 15, 2012.
deleted text end

deleted text begin (e)deleted text end The commissioner shall work with the Minnesota Association of County Social
Service Administrators and the Office of Enterprise Technology to develop collaborative
task forces, as necessary, to support implementation of the service delivery components
under this paragraph. The commissioner must evaluate, develop, and include as part
of the integrated eligibility and enrollment service delivery framework, the following
minimum components:

(1) screening tools for applicants to determine potential eligibility as part of an
online application process;

(2) the capacity to use databases to electronically verify application and renewal
data as required by law;

(3) online accounts accessible by applicants and enrollees;

(4) an interactive voice response system, available statewide, that provides case
information for applicants, enrollees, and authorized third parties;

(5) an electronic document management system that provides electronic transfer of
all documents required for eligibility and enrollment processes; and

(6) a centralized customer contact center that applicants, enrollees, and authorized
third parties can use statewide to receive program information, application assistance,
and case information, report changes, make cost-sharing payments, and conduct other
eligibility and enrollment transactions.

deleted text begin (f)deleted text end new text begin (e)new text end Subject to a legislative appropriation, the commissioner of human services
shall issue a request for proposal for the appropriate phase of an integrated service delivery
system for health care programs, food support, cash assistance, and child care.

Sec. 7. new text begin RULEMAKING; REDUNDANT PROVISION REGARDING
TRANSITION LENSES.
new text end

new text begin The commissioner of human services shall amend Minnesota Rules, part 9505.0277,
subpart 3, to remove transition lenses from the list of eyeglass services not eligible for
payment under the medical assistance program. The commissioner may use the good
cause exemption in Minnesota Statutes, section 14.388, subdivision 1, clause (4), to adopt
rules under this section. Minnesota Statutes, section 14.386, does not apply except as
provided in Minnesota Statutes, section 14.388.
new text end

Sec. 8. new text begin FEDERAL APPROVAL.
new text end

new text begin By October 1, 2015, the commissioner of human services shall seek federal authority
to operate the program in Minnesota Statutes, section 256B.78, under the state Medicaid
plan, in accordance with United States Code, title 42, section 1396a(a)(10)(A)(ii)(XXI).
To be eligible, an individual must have family income at or below 200 percent of the
federal poverty guidelines, except that for an individual under age 21, only the income of
the individual must be considered in determining eligibility. Services under this program
must be available on a presumptive eligibility basis.
new text end

Sec. 9. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall remove cross-references to the sections and parts
repealed in section 10, paragraphs (a) and (b), wherever they appear in Minnesota Rules
and shall make changes necessary to correct the punctuation, grammar, or structure of the
remaining text and preserve its meaning.
new text end

Sec. 10. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, section 256.01, subdivision 32, new text end new text begin is repealed.
new text end

new text begin (b) new text end new text begin Minnesota Rules, parts 9500.1126; 9500.1450, subpart 3; 9500.1452, subpart 3;
9500.1456; and 9525.1580,
new text end new text begin are repealed.
new text end

new text begin (c) new text end new text begin Minnesota Rules, parts 9505.5300; 9505.5305; 9505.5310; 9505.5315; and
9505.5325,
new text end new text begin are repealed contingent upon federal approval of the state Medicaid plan
amendment under section 8. The commissioner of human services shall notify the revisor
of statutes when this occurs.
new text end