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HF 1961

as introduced - 90th Legislature (2017 - 2018) Posted on 03/02/2017 01:19pm

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

Current Version - as introduced

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A bill for an act
relating to human services; requiring the commissioner of human services to
establish a bundled payment for maternity and newborn care; amending Minnesota
Statutes 2016, section 256B.0755, subdivisions 1, 4.

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

Section 1.

Minnesota Statutes 2016, section 256B.0755, subdivision 1, is amended to read:


Subdivision 1.

Implementation.

(a) The commissioner shall develop and authorize a
demonstration project to test alternative and innovative health care delivery systems,
including accountable care organizations that provide services to a specified patient
population for an agreed-upon total cost of care or risk/gain sharing payment arrangement.
The commissioner shall develop a request for proposals for participation in the demonstration
project in consultation with hospitals, primary care providers, health plans, and other key
stakeholders.

(b) In developing the request for proposals, the commissioner shall:

(1) establish uniform statewide methods of forecasting utilization and cost of care for
the appropriate Minnesota public program populations, to be used by the commissioner for
the health care delivery system projects;

(2) identify key indicators of quality, access, patient satisfaction, and other performance
indicators that will be measured, in addition to indicators for measuring cost savings;

(3) allow maximum flexibility to encourage innovation and variation so that a variety
of provider collaborations are able to become health care delivery systems;

(4) encourage and authorize different levels and types of financial risknew text begin , including financial
risk through the use of bundled payments for care episodes
new text end ;

(5) encourage and authorize projects representing a wide variety of geographic locations,
patient populations, provider relationships, and care coordination models;

(6) encourage projects that involve close partnerships between the health care delivery
system and counties and nonprofit agencies that provide services to patients enrolled with
the health care delivery system, including social services, public health, mental health,
community-based services, and continuing care;

(7) encourage projects established by community hospitals, clinics, and other providers
in rural communities;

(8) identify required covered services for a total cost of care model or services considered
in whole or partially in an analysis of utilization for a risk/gain sharing model;

(9) establish a mechanism to monitor enrollment;

(10) establish quality standards for the delivery system demonstrations; and

(11) encourage participation of privately insured population so as to create sufficient
alignment in demonstration systems.

(c) To be eligible to participate in the demonstration project, a health care delivery system
must:

(1) provide required covered services and care coordination to recipients enrolled in the
health care delivery system;

(2) establish a process to monitor enrollment and ensure the quality of care provided;

(3) in cooperation with counties and community social service agencies, coordinate the
delivery of health care services with existing social services programs;

(4) provide a system for advocacy and consumer protection; and

(5) adopt innovative and cost-effective methods of care delivery and coordination, which
may include the use of allied health professionals, telemedicine, patient educators, care
coordinators, and community health workers.

(d) A health care delivery system demonstration may be formed by the following groups
of providers of services and suppliers if they have established a mechanism for shared
governance:

(1) professionals in group practice arrangements;

(2) networks of individual practices of professionals;

(3) partnerships or joint venture arrangements between hospitals and health care
professionals;

(4) hospitals employing professionals; and

(5) other groups of providers of services and suppliers as the commissioner determines
appropriate.

A managed care plan or county-based purchasing plan may participate in this
demonstration in collaboration with one or more of the entities listed in clauses (1) to (5).

A health care delivery system may contract with a managed care plan or a county-based
purchasing plan to provide administrative services, including the administration of a payment
system using the payment methods established by the commissioner for health care delivery
systems.

(e) The commissioner may require a health care delivery system to enter into additional
third-party contractual relationships for the assessment of risk and purchase of stop loss
insurance or another form of insurance risk management related to the delivery of care
described in paragraph (c).

Sec. 2.

Minnesota Statutes 2016, section 256B.0755, subdivision 4, is amended to read:


Subd. 4.

Payment system.

(a) In developing a payment system for health care delivery
systems, the commissioner shall establish a total cost of care benchmark or a risk/gain
sharing payment model to be paid for services provided to the recipients enrolled in a health
care delivery system.new text begin The commissioner, by January 1, 2018, shall establish a bundled
payment for comprehensive maternity and newborn care episodes, and may establish bundled
payments for other episodes of care.
new text end

(b) The payment system may include incentive payments to health care delivery systems
that meet or exceed annual quality and performance targets realized through the coordination
of care.

(c) An amount equal to the savings realized to the general fund as a result of the
demonstration project shall be transferred each fiscal year to the health care access fund.