HF 3573

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

A bill for an act
relating to human services; revising requirements for county-based purchasing
for state health care programs; requiring a mandated report; amending Minnesota
Statutes 2006, sections 256B.69, subdivision 3a; 256B.692, subdivisions 1, 2, 7;
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.69, subdivision 3a, is amended to
read:

Subd. 3a.

County authority.

(a) The commissioner, when implementing the general
assistance medical care, new text begin MinnesotaCare, new text end or medical assistance prepayment program new text begin and
other prepaid health care programs administered by the commissioner of human services
new text end within a county, must include the county board in the process of development, approval,
and issuance of the request for proposals to provide services to eligible individuals
within the proposed county. County boards must be given reasonable opportunity to
make recommendations regarding the development, issuance, review of responses, and
changes needed in the request for proposals. The commissioner must provide county
boards the opportunity to review each proposal based on the identification of community
needs under chapters 145A and 256E and county advocacy activities. If a county board
finds that a proposal does not address certain community needs, the county board and
commissioner shall continue efforts for improving the proposal and network prior to the
approval of the contract. The county board shall make recommendations regarding the
approval of local networks and their operations to ensure adequate availability and access
to covered services. The provider or health plan must respond directly to county advocates
and the state prepaid medical assistance ombudsperson regarding service delivery and
must be accountable to the state regarding contracts with medical assistance and general
assistance medical care funds. The county board may recommend a maximum number of
participating health plans after considering the size of the enrolling population; ensuring
adequate access and capacity; considering the client and county administrative complexity;
and considering the need to promote the viability of locally developed health plans. The
county board or a single entity representing a group of county boards and the commissioner
shall mutually select health plans for participation at the time of initial implementation of
the new text begin state new text end prepaid deleted text begin medical assistance program deleted text end new text begin health care programs new text end in that county or group
of counties and at the time of contract renewal. The commissioner shall also seek input
for contract requirements from the county or single entity representing a group of county
boards at each contract renewal and incorporate those recommendations into the contract
negotiation process. deleted text begin The commissioner, in conjunction with the county board, shall
actively seek to develop a mutually agreeable timetable prior to the development of the
request for proposal, but counties must agree to initial enrollment beginning on or before
January 1, 1999, in either the prepaid medical assistance and general assistance medical
care programs or county-based purchasing under section 256B.692. At least 90 days
before enrollment in the medical assistance and general assistance medical care prepaid
programs begins in a county in which the prepaid programs have not been established, the
commissioner shall provide a report to the chairs of senate and house committees having
jurisdiction over state health care programs which verifies that the commissioner complied
with the requirements for county involvement that are specified in this subdivision. deleted text end

(b) At the option of the county board, the board may develop contract requirements
related to the achievement of local public health goals to meet the health needs of deleted text begin medical
assistance and general assistance medical care deleted text end enrollees new text begin in state prepaid health care
programs new text end . These requirements must be reasonably related to the performance of health
plan functions and within the scope of the deleted text begin medical assistance and general assistance
medical care deleted text end new text begin programs' new text end benefit sets. If the county board and the commissioner mutually
agree to such requirements, the department shall include such requirements in all health
plan contracts governing the prepaid deleted text begin medical assistance and general assistance medical
care deleted text end programs in that county at initial implementation of the program in that county and
at the time of contract renewal. The county board may participate in the enforcement of
the contract provisions related to local public health goals.

(c) For counties in which prepaid deleted text begin medical assistance and general assistance medical
care deleted text end programs have not been established, the commissioner shall not implement those
programs if a county board submits acceptable and timely preliminary and final proposals
under section 256B.692, until county-based purchasing is no longer operational in that
county. For counties in which prepaid deleted text begin medical assistance and general assistance medical
care deleted text end programs are in existence on or after September 1, 1997, the commissioner must
terminate contracts with health plans according to section 256B.692, subdivision 5, if
the county board submits and the commissioner accepts preliminary and final proposals
according to that subdivision. The commissioner is not required to terminate contracts that
begin on or after September 1, 1997, according to section 256B.692 until two years have
elapsed from the date of initial enrollment.

(d) In the event that a county board or a single entity representing a group of county
boards and the commissioner cannot reach agreement regarding: (i) the selection of
participating health plans in that county; (ii) contract requirements; or (iii) implementation
and enforcement of county requirements including provisions regarding local public
health goals, the commissioner shall resolve all disputes after taking into account the
recommendations of a three-person mediation panel. The panel shall be composed of one
designee of the president of the association of Minnesota counties, one designee of the
commissioner of human services, and one deleted text begin designee of the commissioner of health deleted text end new text begin person
selected jointly by the designee of the commissioner of human services and the designee
of the Association of Minnesota Counties. The person selected must not be an employee
of either the commissioner of human services or the Association of Minnesota Counties.
Within a reasonable period of time before the hearing the panelists must be provided all
documents and information relevant to the mediation. The parties to the mediation must
be given 30 days' notice of a hearing before the mediation panel new text end .

(e) If a county which elects to implement county-based purchasing ceases to
implement county-based purchasing, it is prohibited from assuming the responsibility of
county-based purchasing for a period of five years from the date it discontinues purchasing.

deleted text begin (f) Notwithstanding the requirement in this subdivision that a county must agree to
initial enrollment on or before January 1, 1999, the commissioner shall grant a delay in
the implementation of the county-based purchasing authorized in section 256B.692 until
federal waiver authority and approval has been granted, if the county or group of counties
has submitted a preliminary proposal for county-based purchasing by September 1, 1997,
has not already implemented the prepaid medical assistance program before January 1,
1998, and has submitted a written request for the delay to the commissioner by July
1, 1998. In order for the delay to be continued, the county or group of counties must
also submit to the commissioner the following information by December 1, 1998. The
information must:
deleted text end

deleted text begin (1) identify the proposed date of implementation, as determined under section
256B.692, subdivision 5;
deleted text end

deleted text begin (2) include copies of the county board resolutions which demonstrate the continued
commitment to the implementation of county-based purchasing by the proposed date.
County board authorization may remain contingent on the submission of a final proposal
which meets the requirements of section 256B.692, subdivision 5, paragraph (b);
deleted text end

deleted text begin (3) demonstrate actions taken for the establishment of a governance structure
between the participating counties and describe how the fiduciary responsibilities of
county-based purchasing will be allocated between the counties, if more than one county
is involved in the proposal;
deleted text end

deleted text begin (4) describe how the risk of a deficit will be managed in the event expenditures are
greater than total capitation payments. This description must identify how any of the
following strategies will be used:
deleted text end

deleted text begin (i) risk contracts with licensed health plans;
deleted text end

deleted text begin (ii) risk arrangements with providers who are not licensed health plans;
deleted text end

deleted text begin (iii) risk arrangements with other licensed insurance entities; and
deleted text end

deleted text begin (iv) funding from other county resources;
deleted text end

deleted text begin (5) include, if county-based purchasing will not contract with licensed health plans
or provider networks, letters of interest from local providers in at least the categories of
hospital, physician, mental health, and pharmacy which express interest in contracting
for services. These letters must recognize any risk transfer identified in clause (4), item
(ii); and
deleted text end

deleted text begin (6) describe the options being considered to obtain the administrative services
required in section 256B.692, subdivision 3, clauses (3) and (5).
deleted text end

deleted text begin (g) For counties which receive a delay under this subdivision, the final proposals
required under section 256B.692, subdivision 5, paragraph (b), must be submitted at
least six months prior to the requested implementation date. Authority to implement
county-based purchasing remains contingent on approval of the final proposal as required
under section 256B.692.
deleted text end

deleted text begin (h) If the commissioner is unable to provide county-specific, individual-level
fee-for-service claims to counties by June 4, 1998, the commissioner shall grant a delay
under paragraph (f) of up to 12 months in the implementation of county-based purchasing,
and shall require implementation not later than January 1, 2000. In order to receive an
extension of the proposed date of implementation under this paragraph, a county or group
of counties must submit a written request for the extension to the commissioner by August
1, 1998, must submit the information required under paragraph (f) by December 1, 1998,
and must submit a final proposal as provided under paragraph (g).
deleted text end

deleted text begin (i) Notwithstanding other requirements of this subdivision, the commissioner
shall not require the implementation of the county-based purchasing authorized in
section 256B.692 until six months after federal waiver approval has been obtained for
county-based purchasing, if the county or counties have submitted the final plan as
required in section 256B.692, subdivision 5. The commissioner shall allow the county or
counties which submitted information under section 256B.692, subdivision 5, to submit
supplemental or additional information which was not possible to submit by April 1, 1999.
A county or counties shall continue to submit the required information and substantive
detail necessary to obtain a prompt response and waiver approval. If amendments to
the final plan are necessary due to the terms and conditions of the waiver approval, the
commissioner shall allow the county or group of counties 60 days to make the necessary
amendments to the final plan and shall not require implementation of the county-based
purchasing until six months after the revised final plan has been submitted.
deleted text end

new text begin (f) The commissioner shall not require that contractual disputes between
county-based purchasing entities and the commissioner be mediated by a panel that
includes a representative of the Minnesota Council of Health Plans.
new text end

new text begin (g) At the request of a county-purchasing entity, the commissioner shall adopt a
contract reprocurement or renewal schedule under which all counties included in the
entity's service area are reprocured or renewed at the same time.
new text end

new text begin (h) The commissioner shall provide a written report under section 3.195 to the chairs
of the legislative committees having jurisdiction over human services in the senate and the
house of representatives describing in detail the activities undertaken by the commissioner
to ensure full compliance with this section. The report must also provide an explanation
for any decisions of the commissioner not to accept the recommendations of a county or
group of counties required to be consulted under this section. The report must be provided
at least 30 days prior to the effective date of a new or renewed prepaid or managed care
contract in a county.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.692, subdivision 1, is amended to read:

Subdivision 1.

In general.

County boards or groups of county boards may elect
to purchase or provide health care services on behalf of persons eligible for medical
assistance deleted text begin and deleted text end new text begin , MinnesotaCare, new text end general assistance medical care new text begin , and other prepaid
health care programs administered by the commissioner of human services new text end who would
otherwise be required to or may elect to participate in the prepaid deleted text begin medical assistance or
prepaid general assistance medical care deleted text end new text begin state health care new text end programs according to sections
256B.69 and 256D.03. Counties that elect to purchase or provide health care under this
section must provide all services included in prepaid managed care programs according to
sections 256B.69, subdivisions 1 to 22, and 256D.03. County-based purchasing under this
section is governed by section 256B.69, unless otherwise provided for under this section.

Sec. 3.

Minnesota Statutes 2006, section 256B.692, subdivision 2, is amended to read:

Subd. 2.

Duties of commissioner of health.

(a) Notwithstanding chapters 62D and
62N, a county that elects to purchase new text begin health care services for persons eligible for new text end medical
assistance deleted text begin and deleted text end new text begin , MinnesotaCare, new text end general assistance medical care new text begin , and other prepaid health
care programs administered by the commissioner of human services new text end in return for a fixed
sum without regard to the frequency or extent of services furnished to any particular
enrollee is not required to obtain a certificate of authority under chapter 62D or 62N.
The county board of commissioners is the governing body of a county-based purchasing
program. In a multicounty arrangement, the governing body is a joint powers board
established under section 471.59.

(b) A county that elects to purchase deleted text begin medical assistance and general assistance
medical deleted text end new text begin health new text end care services under this section must deleted text begin satisfy deleted text end new text begin assure new text end the commissioner of
health that the requirements for assurance of consumer protection, provider protection,
and fiscal solvency of chapter 62D, applicable to health maintenance organizations, or
chapter 62N, applicable to community integrated service networks, will be met.

(c) A county must also assure the commissioner of health that the requirements of
sections 62J.041; 62J.48; 62J.71 to 62J.73; 62M.01 to 62M.16; all applicable provisions
of chapter 62Q, including sections 62Q.075; 62Q.1055; 62Q.106; 62Q.12; 62Q.135;
62Q.14; 62Q.145; 62Q.19; 62Q.23, paragraph (c); 62Q.43; 62Q.47; 62Q.50; 62Q.52 to
62Q.56; 62Q.58; 62Q.68 to 62Q.72; and 72A.201 will be met.

(d) All enforcement and rulemaking powers available under chapters 62D, 62J,
62M, 62N, and 62Q are hereby granted to the commissioner of health with respect to
counties that purchase deleted text begin medical assistance and general assistance medical deleted text end new text begin health new text end care
services under this section.

(e) The commissioner, in consultation with county government, shall develop
administrative and financial reporting requirements for county-based purchasing programs
relating to sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 62N.31,
and other sections as necessary, that are specific to county administrative, accounting, and
reporting systems and consistent with other statutory requirements of counties.

Sec. 4.

Minnesota Statutes 2006, section 256B.692, subdivision 7, is amended to read:

Subd. 7.

Dispute resolution.

In the event the commissioner rejects a proposal
under subdivision 6, the county board may request the recommendation of a three-person
mediation panel. The commissioner shall resolve all disputes after taking into account
the recommendations of the mediation panel. The panel shall be composed of one
designee of the president of the Association of Minnesota Counties, one designee of the
commissioner of human services, and one deleted text begin designee of the commissioner of health deleted text end new text begin person
selected jointly by the designee of the commissioner of human services and the designee
of the Association of Minnesota Counties. The person selected must not be an employee
of either the commissioner of human services or the Association of Minnesota Counties.
Within a reasonable period of time before the hearing the panelists must be provided all
documents and information relevant to the mediation. The parties to the mediation must
be given 30 days' notice of a hearing before the mediation panel new text end .

Sec. 5.

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. deleted text begin SOLE-SOURCE OR deleted text end SINGLE-PLAN MANAGED CARE
CONTRACT.

new text begin (a) new text end Notwithstanding Minnesota Statutes, section 256B.692, subdivision 6, clause
(1), paragraph (c), 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 new text begin to use new text end 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, deleted text begin 2006, on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena Counties, in
response to a request for proposals issued by the commissioner deleted text end new text begin 2008. The requirement
to continue to use single-plan purchasing arrangements in these counties applies to
all managed care or prepaid health care programs administered by the commissioner
and applies to reprocurement or renewal of arrangements, provided the county-based
purchasing entity continues to meet the commissioner's contracting requirements that are
applicable to county-based purchasing arrangements under chapters 256B and 256D new text end .

new text begin (b) new text end The commissioner shall consider, and may approve, contracting on a
single-health plan basis with new text begin other new text end 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. deleted text begin 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 deleted text end new text begin Nothing in this paragraph supersedes or modifies the requirements in
paragraph (a) new text end .

Sec. 6. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall codify section 5 as a new subdivision of Minnesota
Statutes, section 256B.692.
new text end