HF 3072

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; amending county-based purchasing law; amending
Minnesota Statutes 2006, section 256B.692, subdivisions 3, 6; Laws 2005, First
Special Session chapter 4, article 8, section 84, as amended.

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

Section 1.

Minnesota Statutes 2006, section 256B.692, subdivision 3, is amended to
read:

Subd. 3.

Requirements of the county board.

A county board that intends to
purchase or provide health care under this section, which may include purchasing all or
part of these services from health plans or individual providers on a fee-for-service basis,
or providing these services directly, must demonstrate the ability to follow and agree to
the following requirements:

(1) purchase all covered services for a fixed payment from the state that does not
exceed the estimated state and federal cost that would have occurred under the prepaid
medical assistance and general assistance medical care programs;

(2) ensure that covered services are accessible to all enrollees and new text begin except for
counties located within a rural area as defined in Code of Federal Regulations, title 42,
section 438.52, paragraph (b), new text end that enrollees have a reasonable choice of providers, health
plans, or networks when possible. new text begin For counties located within an urban area as defined
in Code of Federal Regulations, title 42, section 412.62, paragraph (f), the county may
provide a choice of two different county-based purchasing plans to satisfy the choice of
providers requirement in this section. new text end If the county is also a provider of service, the county
board shall develop a process to ensure that providers employed by the county are not the
sole referral source and are not the sole provider of health care services if other providers,
which meet the same quality and cost requirements are available;

(3) issue payments to participating vendors or networks in a timely manner;

(4) establish a process to ensure and improve the quality of care provided;

(5) provide appropriate quality and other required data in a format required by
the state;

(6) provide a system for advocacy, enrollee protection, and complaints and appeals
that is independent of care providers or other risk bearers and complies with section
256B.69;

(7) ensure that the implementation and operation of the Minnesota senior health
options demonstration project and the Minnesota disability health options demonstration
project, authorized under section 256B.69, subdivision 23, will not be impeded;

(8) ensure that all recipients that are enrolled in the prepaid medical assistance or
general assistance medical care program will be transferred to county-based purchasing
without utilizing the department's fee-for-service claims payment system;

(9) ensure that all recipients who are required to participate in county-based
purchasing are given sufficient information prior to enrollment in order to make informed
decisions; and

(10) ensure that the state and the medical assistance and general assistance medical
care recipients will be held harmless for the payment of obligations incurred by the county
if the county, or a health plan providing services on behalf of the county, or a provider
participating in county-based purchasing becomes insolvent, and the state has made the
payments due to the county under this section.

Sec. 2.

Minnesota Statutes 2006, section 256B.692, subdivision 6, is amended to read:

Subd. 6.

Commissioner's authority.

The commissioner may:

(1) reject any preliminary or final proposal that:

deleted text begin (a) deleted text end new text begin (i) new text end substantially fails to meet the requirements of this section, or

deleted text begin (b) that the commissioner determines would substantially impair the state's ability to
purchase health care services in other areas of the state, or
deleted text end

deleted text begin (c) would substantially impair an enrollee's choice of care systems when reasonable
choice is possible, or
deleted text end

deleted text begin (d) deleted text end new text begin (ii) new text end would substantially impair the implementation and operation of the
Minnesota senior health options demonstration project authorized under section 256B.69,
subdivision 23; and

(2) assume operation of a county's purchasing of health care for enrollees in medical
assistance and general assistance medical care in the event that the contract with the
county is terminated.

Sec. 3.

Laws 2005, First Special Session chapter 4, article 8, section 84, as amended by
Laws 2006, chapter 264, section 15, is amended to read:

Sec. 84. SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
CONTRACT.

Notwithstanding Minnesota Statutes, section 256B.692, subdivision 6 deleted text begin , clause
(1), paragraph (c) deleted text end , the commissioner of human services shall approve a county-based
purchasing health plan proposal, submitted on behalf of Cass, Crow Wing, Morrison,
Todd, and Wadena Counties, that requires county-based purchasing on a single-plan basis
contract if the implementation of the single-plan purchasing proposal does not limit an
enrollee's provider choice or access to services and all other requirements applicable to
health plan purchasing are satisfied. The commissioner shall continue single health plan
purchasing arrangements with county-based purchasing entities in the service areas in
existence on May 1, 2006, including arrangements for which a proposal was submitted by
May 1, 2006, on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena Counties, in
response to a request for proposals issued by the commissioner.

The commissioner shall consider, and may approve, contracting on a single-health
plan basis with county-based purchasing plans, or with other qualified health plans
that have coordination arrangements with counties, to serve persons with a disability
who voluntarily enroll, in order to promote better coordination or integration of health
care services, social services and other community-based services, provided that all
requirements applicable to health plan purchasing, including those in Minnesota Statutes,
section 256B.69, subdivision 23, are satisfied. By January 15, 2007, the commissioner
shall report to the chairs of the appropriate legislative committees in the house and senate
an analysis of the advantages and disadvantages of using single-health plan purchasing
to serve persons with a disability who are eligible for health care programs. The report
shall include consideration of the impact of federal health care programs and policies for
persons who are eligible for both federal and state health care programs and shall consider
strategies to improve coordination between federal and state health care programs for
those persons.