HF 820

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 03/13/2013 08:18pm

A bill for an act
relating to human services; modifying provisions related to health care and
medical assistance; amending Minnesota Statutes 2012, sections 62J.495,
subdivision 15; 256.01, subdivision 34; 256.962, subdivision 8; 256B.0625,
subdivisions 8, 8a, 8b, 17, 18f, 25; 256B.0755, subdivision 7; repealing
Minnesota Rules, part 9505.0315, subpart 7, item D.

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

Section 1.

Minnesota Statutes 2012, section 62J.495, subdivision 15, is amended to read:

Subd. 15.

Appeals review process.

(a) Upon receipt of an appeal notice
satisfying subdivision 14, the commissioner shall review the appeal and issue a written
appeal determination on each appealed item with 90 days. Upon mutual agreement, the
commissioner and the provider may extend the time for issuing a determination for a
specified period. The commissioner shall notify the provider deleted text begin by first class mail deleted text end of the
appeal determination. The appeal determination takes effect upon the date of issuance
specified in the determination.

(b) In reviewing the appeal, the commissioner may request additional written or oral
information from the provider.

(c) The provider has the right to present information by telephone, in writing, or
in person concerning the appeal to the commissioner prior to the issuance of the appeal
determination within 30 days of the date the appeal was received by the commissioner.
The provider must request an in-person conference in writing, separate from the appeal
letter. Statements made during the review process are not admissible in a contested case
hearing absent an express stipulation by the parties to the contested case.

(d) For an appeal item on which the provider disagrees with the appeal determination,
the provider may file with the commissioner a written demand for a contested case
hearing to determine the proper resolution of specified appeal items. The demand must
be postmarked or received by the commissioner within 30 days of the date of issuance
specified in the determination. A contested case demand for an appeal item nullifies
the written appeal determination issued by the commissioner for that appeal item. The
commissioner shall refer any contested case demand to the Office of the Attorney General.

(e) A contested case hearing must be heard by an administrative law judge according
to sections 14.48 to 14.56. In any proceeding under this section, the appealing party must
demonstrate by a preponderance of the evidence that the Minnesota electronic health
record incentives program eligibility determination is incorrect.

(f) Regardless of any appeal, the Minnesota electronic health record incentives
program eligibility determination must remain in effect until final resolution of the appeal.

(g) The commissioner has discretion to issue to the provider a proposed resolution
for specified appeal items upon a request from the provider filed separately from the
notice of appeal. The proposed resolution is final upon written acceptance by the provider
within 30 days of the date the proposed resolution was mailed to or personally received by
the provider, whichever is earlier.

Sec. 2.

Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:

Subd. 34.

Federal administrative reimbursement dedicated.

Federal
administrative reimbursement resulting from the following activities is appropriated to the
commissioner for the designated purposes:

(1) reimbursement for the Minnesota senior health options project; and

(2) reimbursement related to prior authorization new text begin , review of medical necessity, new text end and
inpatient admission certification by a professional review organization. A portion of
these funds must be used for activities to decrease unnecessary pharmaceutical costs in
medical assistance.

Sec. 3.

Minnesota Statutes 2012, section 256.962, subdivision 8, is amended to read:

Subd. 8.

Eligibility deleted text begin end deleted text end new text begin review new text end dates.

The commissioner shall develop and
implement a process by January 1, 2013, to provide eligibility deleted text begin end deleted text end new text begin review new text end dates upon
request from the managed care and county-based purchasing plans for medical assistance
and MinnesotaCare enrollees.

Sec. 4.

Minnesota Statutes 2012, section 256B.0625, subdivision 8, is amended to read:

Subd. 8.

Physical therapy.

(a) Medical assistance covers physical therapy and
related services. Specialized maintenance therapy is covered for recipients age 20 and
under.

(b) deleted text begin Authorization by the commissioner is required to provide medically necessary
services to a recipient. deleted text end Services provided by a physical therapy assistant shall be
reimbursed at the same rate as services performed by a physical therapist when the
services of the physical therapy assistant are provided under the direction of a physical
therapist who is on the premises. Services provided by a physical therapy assistant that
are provided under the direction of a physical therapist who is not on the premises shall
be reimbursed at 65 percent of the physical therapist rate.

Sec. 5.

Minnesota Statutes 2012, section 256B.0625, subdivision 8a, is amended to read:

Subd. 8a.

Occupational therapy.

(a) Medical assistance covers occupational
therapy and related services. Specialized maintenance therapy is covered for recipients
age 20 and under.

(b) deleted text begin Authorization by the commissioner is required to provide medically necessary
services to a recipient. deleted text end Services provided by an occupational therapy assistant shall be
reimbursed at the same rate as services performed by an occupational therapist when the
services of the occupational therapy assistant are provided under the direction of the
occupational therapist who is on the premises. Services provided by an occupational
therapy assistant that are provided under the direction of an occupational therapist who is
not on the premises shall be reimbursed at 65 percent of the occupational therapist rate.

Sec. 6.

Minnesota Statutes 2012, section 256B.0625, subdivision 8b, is amended to read:

Subd. 8b.

Speech-language pathology and audiology services.

(a) Medical
assistance covers speech-language pathology and related services. Specialized
maintenance therapy is covered for recipients age 20 and under.

(b) deleted text begin Authorization by the commissioner is required to provide medically necessary
speech-language pathology services to a recipient.
deleted text end

deleted text begin (c) deleted text end Medical assistance covers audiology services and related services. Services
provided by a person who has been issued a temporary registration under section 148.5161
shall be reimbursed at the same rate as services performed by a speech-language pathologist
or audiologist as long as the requirements of section 148.5161, subdivision 3, are met.

Sec. 7.

Minnesota Statutes 2012, section 256B.0625, subdivision 17, is amended to read:

Subd. 17.

Transportation costs.

(a) Medical assistance covers medical
transportation costs incurred solely for obtaining emergency medical care or transportation
costs incurred by eligible persons in obtaining emergency or nonemergency medical
care when paid directly to an ambulance company, common carrier, or other recognized
providers of transportation services. Medical transportation must be provided by:

(1) an ambulance, as defined in section 144E.001, subdivision 2;

(2) special transportation; or

(3) common carrier including, but not limited to, bus, taxicab, other commercial
carrier, or private automobile.

(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
transportation, or private automobile.

The commissioner may use an order by the recipient's attending physician to certify that
the recipient requires special transportation services. Special transportation providers shall
perform driver-assisted services for eligible individuals. Driver-assisted service includes
passenger pickup at and return to the individual's residence or place of business, assistance
with admittance of the individual to the medical facility, and assistance in passenger
securement or in securing of wheelchairs or stretchers in the vehicle. Special transportation
providers must obtain written documentation from the health care service provider who
is serving the recipient being transported, identifying the time that the recipient arrived.
Special transportation providers may not bill for separate base rates for the continuation of
a trip beyond the original destination. Special transportation providers must take recipients
to deleted text begin the nearest appropriate deleted text end new text begin their new text end health care provider deleted text begin , deleted text end using the most direct route new text begin , which must
not exceed 30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty
care provider, unless the recipient receives authorization from the local agency new text end . The
minimum medical assistance reimbursement rates for special transportation services are:

(1)(i) $17 for the base rate and $1.35 per mile for special transportation services to
eligible persons who need a wheelchair-accessible van;

(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
eligible persons who do not need a wheelchair-accessible van; and

(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
special transportation services to eligible persons who need a stretcher-accessible vehicle;

(2) the base rates for special transportation services in areas defined under RUCA
to be super rural shall be equal to the reimbursement rate established in clause (1) plus
11.3 percent; and

(3) for special transportation services in areas defined under RUCA to be rural
or super rural areas:

(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
percent of the respective mileage rate in clause (1); and

(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
112.5 percent of the respective mileage rate in clause (1).

(c) For purposes of reimbursement rates for special transportation services under
paragraph (b), the zip code of the recipient's place of residence shall determine whether
the urban, rural, or super rural reimbursement rate applies.

(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
means a census-tract based classification system under which a geographical area is
determined to be urban, rural, or super rural.

(e) Effective for services provided on or after September 1, 2011, nonemergency
transportation rates, including special transportation, taxi, and other commercial carriers,
are reduced 4.5 percent. Payments made to managed care plans and county-based
purchasing plans must be reduced for services provided on or after January 1, 2012,
to reflect this reduction.

Sec. 8.

Minnesota Statutes 2012, section 256B.0625, subdivision 18f, is amended to
read:

Subd. 18f.

Enrollee assessment process.

(a) new text begin The commissioner shall require that
the administrator of nonemergency medical transportation adhere to the assessment
process recommended by the nonemergency medical transportation advisory committee.
new text end The commissioner deleted text begin , in consultation with the Nonemergency Medical Transportation
Advisory Committee, deleted text end shall deleted text begin develop and deleted text end implement, by July 1, deleted text begin 2013 deleted text end new text begin 2014 new text end , deleted text begin a deleted text end new text begin the
new text end comprehensive, statewide, standard assessment process for medical assistance
enrollees seeking nonemergency medical transportation services new text begin recommended by the
nonemergency medical transportation advisory committee new text end . The assessment process must
identify a client's level of needs, abilities, and resources, and match the client with the
mode of transportation in the client's service area that best meets those needs.

(b) The assessment process must:

(1) address mental health diagnoses when determining the most appropriate mode of
transportation;

(2) base decisions on clearly defined criteria that are available to clients, providers,
and counties;

(3) be standardized across the state and be aligned with other similar existing
processes;

(4) allow for extended periods of eligibility for certain types of nonemergency
transportation when a client's condition is unlikely to change; and

(5) increase the use of public transportation when appropriate and cost-effective,
including offering monthly bus passes to clients.

Sec. 9.

Minnesota Statutes 2012, section 256B.0625, subdivision 25, is amended to read:

Subd. 25.

Prior authorization required.

(a) The commissioner shall publish in
the Minnesota health care programs provider manual and on the department's Web site a
list of health services that require prior authorization, deleted text begin as well as deleted text end the criteria and standards
used to select health services on the list new text begin , and the criteria and standards used to determine
whether certain providers must obtain prior authorization for their services new text end . The list new text begin of
services requiring prior authorization new text end and the criteria and standards used to formulate deleted text begin it deleted text end new text begin the
list of services or the selection of providers for whom prior authorization is required new text end are
not subject to the requirements of sections 14.001 to 14.69. The commissioner's decision
whether prior authorization is required for a health service new text begin or is required for a provider new text end is
not subject to administrative appeal. new text begin Use of criteria or standards to select providers for
whom prior authorization is required shall not impede access to the service involved for any
group of individuals with unique or special needs due to disability or functional condition.
new text end

(b) The commissioner shall implement a modernized electronic system for providers
to request prior authorization. The modernized electronic system must include at least the
following functionalities:

(1) authorizations are recipient-centric, not provider-centric;

(2) adequate flexibility to support authorizations for an episode of care, continuous
drug therapy, or for individual onetime services and allows an ordering and a rendering
provider to both submit information into one request;

(3) allows providers to review previous authorization requests and determine where
a submitted request is within the authorization process;

(4) supports automated workflows that allow providers to securely submit medical
information that can be accessed by medical and pharmacy review vendors as well as
department staff; and

(5) supports development of automated clinical algorithms that can verify
information and provide responses in real time.

(c) The system described in paragraph (b) shall be completed by March 1, 2012. All
authorization requests submitted on and after March 1, 2012, or upon completion of the
modernized authorization system, whichever is later, must be submitted electronically by
providers, except requests for drugs dispensed by an outpatient pharmacy, services that
are provided outside of the state and surrounding local trade area, and services included
on a service agreement.

Sec. 10.

Minnesota Statutes 2012, section 256B.0755, subdivision 7, is amended to read:

Subd. 7.

Expansion.

The commissioner shall deleted text begin explore the expansion of deleted text end new text begin expand
new text end the demonstration project to include additional medical assistance and MinnesotaCare
enrollees, and shall seek participation of Medicare in demonstration projects. The
commissioner shall seek to include participation of privately insured persons and Medicare
recipients in the health care delivery demonstration. new text begin As part of the demonstration
expansion, the commissioner may procure the services of the health care delivery systems
authorized under this section by geographic area, to supplement or replace the services
provided by managed care plans operating under section 256B.69.
new text end

Sec. 11. new text begin REPEALER.
new text end

new text begin Minnesota Rules, part 9505.0315, subpart 7, item D, new text end new text begin is repealed.
new text end