HF 1059

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; allowing PACE programs to
be covered under alternative integrated long-term care
services; amending Minnesota Statutes 2004, section
256B.69, subdivision 23.

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

Section 1.

Minnesota Statutes 2004, section 256B.69,
subdivision 23, is amended to read:

Subd. 23.

Alternative integrated long-term care services;
elderly and disabled persons.

(a) The commissioner may
implement demonstration projects to create alternative
integrated delivery systems for acute and long-term care
services to elderly persons and persons with disabilities as
defined in section 256B.77, subdivision 7a, that provide
increased coordination, improve access to quality services, and
mitigate future cost increases. The commissioner may seek
federal authority to combine Medicare and Medicaid capitation
payments for the purpose of such demonstrations. Medicare funds
and services shall be administered according to the terms and
conditions of the federal waiver and demonstration provisions.
For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to
subdivisions 1 to 22. The provisions of Minnesota Rules, parts
9500.1450 to 9500.1464, apply to these demonstrations, with the
exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457,
subpart 1, items B and C, which do not apply to persons
enrolling in demonstrations under this section. An initial open
enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to
Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is
enrolled in a health plan under these demonstrations and the
health plan's participation is subsequently terminated for any
reason, the person shall be provided an opportunity to select a
new health plan and shall have the right to change health plans
within the first 60 days of enrollment in the second health
plan. Persons required to participate in health plans under
this section who fail to make a choice of health plan shall not
be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota
Rules, part 9505.5220, subpart 1, item A, if adopted, for the
purpose of demonstrations under this subdivision, the
commissioner may contract with managed care organizations,
including counties, to serve only elderly persons eligible for
medical assistance, elderly and disabled persons, or disabled
persons only. For persons with primary diagnoses of mental
retardation or a related condition, serious and persistent
mental illness, or serious emotional disturbance, the
commissioner must ensure that the county authority has approved
the demonstration and contracting design. Enrollment in these
projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under
this subdivision for persons with primary diagnoses of mental
retardation or a related condition, serious and persistent
mental illness, or serious emotional disturbance, without
approval of the county board of the county in which the
demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to
252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules,
parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580,
and 9525.1800 to 9525.1930, the commissioner may implement under
this section projects for persons with developmental
disabilities. The commissioner may capitate payments for ICF/MR
services, waivered services for mental retardation or related
conditions, including case management services, day training and
habilitation and alternative active treatment services, and
other services as approved by the state and by the federal
government. Case management and active treatment must be
individualized and developed in accordance with a
person-centered plan. Costs under these projects may not exceed
costs that would have been incurred under fee-for-service.
Beginning July 1, 2003, and until two years after the pilot
project implementation date, subcontractor participation in the
long-term care developmental disability pilot is limited to a
nonprofit long-term care system providing ICF/MR services, home
and community-based waiver services, and in-home services to no
more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall
report to the legislature prior to expansion of the
developmental disability pilot project. This paragraph expires
two years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for
disabled persons, the commissioner must provide information to
appropriate committees of the house of representatives and
senate and must involve representatives of affected disability
groups in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative
reimbursement methodology in section 256B.434 may, in
collaboration with a hospital, clinic, or other health care
entity provide services under paragraph (a). The commissioner
shall amend the state plan and seek any federal waivers
necessary to implement this paragraph.

new text begin (e) The commissioner, in consultation with the
commissioners of commerce and health, may approve and implement
programs for all-inclusive care for the elderly (PACE) according
to federal laws and regulations governing that program and state
laws or rules applicable to participating providers. A PACE
provider is not required to be licensed or certified as a health
plan company as defined in section 62Q.01, subdivision 4.
Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver
or community alternatives for disabled individuals or who are
already eligible for Medicaid but meet level of care criteria
for receipt of waiver services may choose to enroll in the PACE
program. Medicare and Medicaid services will be provided
according to this subdivision and federal Medicare and Medicaid
requirements governing PACE providers and programs. PACE
enrollees will receive Medicaid home and community-based
services through the PACE provider as an alternative to services
for which they would otherwise be eligible through home and
community-based waiver programs. The commissioner shall
establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or
other relevant managed care programs operated by the state.
new text end