HF 1704

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:53am

A bill for an act
relating to human services; creating a withhold to managed care plan payments
for prepaid medical assistance and general assistance medical care; amending
Minnesota Statutes 2008, sections 256B.69, subdivision 5a; 256L.12, subdivision
9.

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

Section 1.

Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to
read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner shall
withhold five percent of managed care plan payments under this section new text begin and county-based
purchasing plan's payment rate under section 256B.692 new text end for the prepaid medical assistance
and general assistance medical care programs pending completion of performance targets.
Each performance target must be quantifiable, objective, measurable, and reasonably
attainable, except in the case of a performance target based on a federal or state law or rule.
Criteria for assessment of each performance target must be outlined in writing prior to the
contract effective date. The managed care plan must demonstrate, to the commissioner's
satisfaction, that the data submitted regarding attainment of the performance target is
accurate. The commissioner shall periodically change the administrative measures used
as performance targets in order to improve plan performance across a broader range of
administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23. deleted text begin A managed care plan or a county-based purchasing plan
under section 256B.692 may include as admitted assets under section 62D.044 any amount
withheld under this paragraph that is reasonably expected to be returned.
deleted text end

(d) deleted text begin (1) deleted text end Effective for services rendered on or after January 1, 2009, the commissioner
shall withhold three percent of managed care plan payments under this section new text begin and
county-based purchasing plan payments under section 256B.692 new text end for the prepaid medical
assistance and general assistance medical care programs. The withheld funds must be
returned no sooner than July 1 and no later than July 31 of the following year. The
commissioner may exclude special demonstration projects under subdivision 23.

deleted text begin (2) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under
this paragraph. deleted text end The return of the withhold under this paragraph is not subject to the
requirements of paragraph (c).

new text begin (e) Effective for services rendered on or after January 1, 2010, the commissioner
shall include as part of the performance targets described in paragraph (a) a reduction in
the health plan's emergency room utilization rate for state health care program enrollees
by a measurable rate of five percent from the plan's utilization rate for state health care
program enrollees for the previous calendar year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for each consecutive
contract period until the health plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the health plan's emergency room utilization
rate for state health care program enrollees for calendar year 2008.
new text end

new text begin (f) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:

Subd. 9.

Rate setting; performance withholds.

(a) Rates will be prospective,
per capita, where possible. The commissioner may allow health plans to arrange for
inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
an independent actuary to determine appropriate rates.

deleted text begin (b) For services rendered on or after January 1, 2003, to December 31, 2003, the
commissioner shall withhold .5 percent of managed care plan payments under this section
pending completion of performance targets. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year if performance targets
in the contract are achieved. A managed care plan may include as admitted assets under
section 62D.044 any amount withheld under this paragraph that is reasonably expected
to be returned.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments new text begin and county-based purchasing
plan payments new text end under this section pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the
contract effective date. The managed care plan must demonstrate, to the commissioner's
satisfaction, that the data submitted regarding attainment of the performance target is
accurate. The commissioner shall periodically change the administrative measures used
as performance targets in order to improve plan performance across a broader range of
administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, such as characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July 1 and no later than July 31 of the
following calendar year if performance targets in the contract are achieved. deleted text begin A managed
care plan or a county-based purchasing plan under section 256B.692 may include as
admitted assets under section 62D.044 any amount withheld under this paragraph that is
reasonably expected to be returned. deleted text end

new text begin (c) Effective for services rendered on or after January 1, 2010, the commissioner
shall include as part of the performance targets described in paragraph (b) a reduction in
the plan's emergency room utilization rate for state health care program enrollees by a
measurable rate of five percent from the plan's utilization rate for the previous calendar
year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for each consecutive
contract period until the health plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the health plan's emergency room utilization
rate for state health care program enrollees for calendar year 2008.
new text end

new text begin (d) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.
new text end