HF 2941

as introduced - 87th Legislature (2011 - 2012) Posted on 03/20/2012 10:44am

A bill for an act
relating to human services; establishing a coordinated care system for medical
assistance enrollees who are adults without children; proposing coding for new
law in Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.85] COORDINATED CARE FOR ADULTS WITHOUT
CHILDREN.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
apply.
new text end

new text begin (b) "Eligible enrollees" means adults without children eligible for medical assistance
under section 256B.055, subdivision 15, with incomes that do not exceed 75 percent
of the federal poverty guidelines.
new text end

new text begin (c) "Federally qualified health center" has the meaning provided in section 145.9269,
subdivision 1.
new text end

new text begin Subd. 2. new text end

new text begin Suspension. new text end

new text begin The commissioner, effective January 1, 2013, shall suspend
the use of managed care and county-based purchasing plans under sections 256B.69 and
256B.692, to deliver medical assistance services to adults without children eligible under
section 256B.055, subdivision 15. The commissioner shall reinstate service delivery
through managed care and county-based purchasing plans only if authorized by state law.
new text end

new text begin Subd. 3. new text end

new text begin Care coordination through fee-for-service. new text end

new text begin (a) Effective January 1,
2013, and until federal approval is received for a primary care case management system,
the commissioner shall deliver services to eligible enrollees through a fee-for-service
system. The commissioner shall coordinate care delivery under this system through the
use of health care homes certified under section 256B.0751, federally qualified health
centers, and other primary care providers.
new text end

new text begin (b) Effective upon federal approval, but not earlier than January 1, 2013, the
commissioner shall deliver services to eligible enrollees through a fee-for-service
primary care case management system, as authorized under United States Code, title 42,
section 1396u-2. The primary care case management system must incorporate the use of
health care homes, federally qualified health centers, and other primary care providers,
as specified in paragraph (a), and must include case management for human services
and housing, as well as for health care needs. The commissioner shall require eligible
enrollees to select a health care home, federally qualified health center, or other primary
care provider from which to receive covered services, case management, and other care
coordination.
new text end

new text begin Subd. 4. new text end

new text begin Coordinated care system. new text end

new text begin (a) Effective January 1, 2014, or upon federal
approval, whichever is later, the commissioner shall deliver services to eligible enrollees
through a coordinated care system. The coordinated care system must:
new text end

new text begin (1) allow coordinated care providers to enter into risk/gain sharing contracts to
provide and coordinate health care, human services, and housing for eligible enrollees;
new text end

new text begin (2) require eligible enrollees to agree to receive all nonemergency services covered
under the contract from the coordinated care provider or through referral;
new text end

new text begin (3) make payment under risk/gain sharing contracts dependent upon a comparison
of the cost of services provided to eligible enrollees with the coordinated care provider's
per-member, per-month, risk-adjusted, cost of care benchmark, and the extent to which the
coordinated care provider meets quality standards;
new text end

new text begin (4) set limits on provider risk under a contract that are appropriate to the size and
revenues of the provider and other factors; and
new text end

new text begin (5) provide appeal mechanisms for both coordinated care providers and eligible
enrollees.
new text end

new text begin (b) A coordinated care provider may include the following groups of providers and
suppliers, if they have established a mechanism for shared governance:
new text end

new text begin (1) professionals in group practice arrangements;
new text end

new text begin (2) networks of individual practices of professionals;
new text end

new text begin (3) partnerships or joint venture arrangements between hospitals and health care
professionals;
new text end

new text begin (4) hospitals employing professionals;
new text end

new text begin (5) human service and housing providers; and
new text end

new text begin (6) other providers of services and supplies that the commissioner determines are
appropriate and that are coordinated by a primary care provider, federally qualified health
center, health care home, or other coordinated care providers.
new text end

new text begin Subd. 5. new text end

new text begin Plan for coordinated care system; advisory group. new text end

new text begin (a) The commissioner
shall present to the legislature by December 15, 2012, an implementation plan and draft
legislation to deliver care beginning January 1, 2014, to eligible enrollees through
a coordinated care system. In developing this plan, the commissioner shall consider
any available findings and results from the health care delivery demonstration project
authorized under section 256B.0755, and the Hennepin County pilot program authorized
under section 256B.0756, and shall consult with the advisory group established in
paragraph (b).
new text end

new text begin (b) The commissioner shall establish an advisory group comprised of health care
providers, consumer representatives, and human service and housing providers, to assist
the commissioner in developing the plan and draft legislation required by paragraph (a).
new text end