HF 2693

as introduced - 90th Legislature (2017 - 2018) Posted on 05/18/2017 09:38am

A bill for an act
relating to human services; requiring the commissioner of human services to design
a state Medicare demonstration project; requiring a report to the legislature.

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

Section 1. new text begin STATE MEDICARE DEMONSTRATION PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Project design. new text end

new text begin The commissioner of human services shall develop a
design and implementation timeline for a demonstration project under which persons age
55 and over, who would otherwise be covered through the individual market, would be able
to receive coverage under an expanded Medicare program. The demonstration project design
and proposed implementation by the commissioner must meet the criteria specified in this
section.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin (a) In order to be eligible for coverage under the demonstration
project, an individual must:
new text end

new text begin (1) be age 55 or older;
new text end

new text begin (2) have a household income that exceeds 200 percent of the federal poverty guidelines;
new text end

new text begin (3) not be eligible for coverage under medical assistance, MinnesotaCare, or the federal
Medicare program;
new text end

new text begin (4) not be eligible for employer-subsidized insurance; and
new text end

new text begin (5) be a lawful resident of Minnesota.
new text end

new text begin (b) An individual eligible to receive advanced premium tax credits and cost-sharing
subsidies through MNsure may choose to obtain coverage under the demonstration project,
but must allow the value of the advanced premium tax credits and cost-sharing subsidies
to accrue to the state.
new text end

new text begin Subd. 3. new text end

new text begin Covered services. new text end

new text begin The demonstration project must cover at least those services
covered under Medicare. The commissioner may expand covered services to include
additional preventive services, and other services appropriate for the population to be served
by the demonstration project.
new text end

new text begin Subd. 4. new text end

new text begin Service delivery; provider contracting. new text end

new text begin (a) The commissioner shall directly
contract with health care providers to deliver services to demonstration project enrollees.
The commissioner may contract with providers using competitive bidding on a regional
basis.
new text end

new text begin (b) The commissioner shall require all providers to deliver services under a value-based
purchasing arrangement that includes payment benchmarks for total cost of care, risk-gain
sharing, and incentives for care coordination. In designing the delivery system, the
commissioner shall incorporate relevant features of health care delivery systems operating
under Minnesota Statutes, section 256B.0755, the county pilot program operating under
Minnesota Statutes, section 256B.0756, and health care homes operating under Minnesota
Statutes, sections 256B.0751 and 256B.0757, and may incorporate features of other
innovative payment methods.
new text end

new text begin (c) The commissioner shall evaluate providers on quality and outcome measures, and
shall consider provider scores on these measures when determining provider payment rates.
The commissioner shall adjust quality and outcome scores to reflect enrollee socioeconomic
characteristics, health disparities, and language, cultural, and other barriers to care.
new text end

new text begin Subd. 5. new text end

new text begin Premiums and cost-sharing. new text end

new text begin (a) The commissioner shall develop a sliding
premium scale for demonstration project enrollees.
new text end

new text begin (b) The commissioner shall base enrollee cost-sharing on the cost-sharing requirements
of the Medicare program, but may modify these cost-sharing requirements as needed to
ensure affordable access to care.
new text end

new text begin Subd. 6. new text end

new text begin Coordination. new text end

new text begin The demonstration project shall be designed and operated in a
manner that facilitates the transition of demonstration project enrollees to the federally
operated Medicare program, once demonstration project enrollees become eligible for that
program.
new text end

new text begin Subd. 7. new text end

new text begin Report to legislature. new text end

new text begin The commissioner, by January 15, 2018, shall present
a report on the demonstration project to the legislative committees with jurisdiction over
health and human services policy and spending, commerce, and health. The report must:
new text end

new text begin (1) include a design for the demonstration project that is consistent with and includes
recommendations related to the criteria specified in this section;
new text end

new text begin (2) list the federal waivers, approvals, and law changes necessary to implement the
demonstration project, and recommend a strategy and timeline by which the state and its
congressional delegation can seek the waivers, approvals, and law changes;
new text end

new text begin (3) provide recommendations on funding sources for the demonstration project, that
include a consideration of the use of funds that would otherwise be provided to an enrollee
in the form of advanced premium tax credit and cost-sharing reductions, and use of an
expanded Medicare payroll tax; and
new text end

new text begin (4) include an implementation plan and timeline for the demonstration project, and
recommendations for necessary changes in state law.
new text end