HF 708

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; modifying an ombudsman for managed care
provision; modifying a MnDHO provision; providing limited medical assistance
coverage for individuals eligible under Medicare Part D; appropriating
money; amending Minnesota Statutes 2006, sections 256B.031, subdivision 6;
256B.0625, by adding a subdivision; 256B.69, subdivision 23.

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

Section 1.

Minnesota Statutes 2006, section 256B.031, subdivision 6, is amended to
read:

Subd. 6.

Ombudsman.

new text begin (a) new text end The commissioner shall designate an ombudsman
to advocate for persons required to enroll in prepaid health plans under this section.
The ombudsman shall advocate for recipients enrolled in prepaid health plans through
complaint and appeal procedures and ensure that necessary medical services are provided
either by the prepaid health plan directly or by referral to appropriate social services. At
the time of enrollment in a prepaid health plan, new text begin and annually thereafter, new text end the local agency
shall inform recipients about the ombudsman program and their right to a resolution of
a complaint by the prepaid health plan if they experience a problem with the plan or
its providers.

new text begin (b) The managed care ombudsman shall report annually to the house and senate
chairs of the committees having jurisdiction over health and human services on the budget
for and activities of the office, by program, age and eligibility type including the number
of persons assisted; the types of problems encountered; actions taken, including appeals;
outcomes for enrollees; and any recommendations for change to contracts, grievance, and
appeal process, or other changes to improve managed care services.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 13i. new text end

new text begin Medicare Part D. new text end

new text begin (a) Notwithstanding subdivision 13, paragraph (d),
for recipients who are enrolled in a Medicare Part D prescription drug plan or Medicare
Advantage special needs plan, medical assistance covers the following:
new text end

new text begin (1) co-payments which the recipient is responsible for under a Medicare Part D
prescription drug plan or Medicare Advantage special needs plan, once the recipient has
paid $12 per month in prescription drug co-payments, and according to the requirements
of the plan; and
new text end

new text begin (2) any prescription drug that is not covered by the Medicare Part D prescription
drug plan or Medicare Advantage special needs plan in which the recipient is enrolled
but only after a determination has been made by the Board on Aging that the recipient is
enrolled in the plan that provides the most comprehensive prescription drug coverage in
terms of the recipient's prescription drug needs.
new text end

new text begin (b) Notwithstanding subdivision 13, paragraph (d), for recipients who are eligible for
Medicare Part D but who are awaiting enrollment into a Medicare Part D prescription drug
plan or Medicare Advantage special needs plan, medical assistance covers prescription
drugs as required under subdivision 13, paragraph (a), for a period of 60 days beginning
the date the Medicare Part D application was submitted.
new text end

new text begin (c) Medical assistance coverage under paragraphs (a) and (b) shall be provided
according to the requirements of subdivisions 13 to 13h.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 3.

Minnesota Statutes 2006, section 256B.69, subdivision 23, is amended to read:

Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations and may contract with
Medicare-approved special needs plans to provide Medicaid services. Medicare funds and
services shall be administered according to the terms and conditions of the federal contract
and demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations,
with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1,
items B and C, which do not apply to persons enrolling in demonstrations under this
section. An initial open enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
the health plan's participation is subsequently terminated for any reason, the person shall
be provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons
required to participate in health plans under this section who fail to make a choice of
health plan shall not be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
the commissioner may contract with managed care organizations, including counties, to
serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
disabled persons only. For persons with a primary diagnosis of developmental disability,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with a primary diagnosis of developmental disabilities, serious and persistent
mental illness, or serious emotional disturbance, without approval of the county board of
the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for developmental
disabilities, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until two years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
two years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas
of the state. Until deleted text begin January 1, 2008 deleted text end new text begin July 1, 2009 new text end , expansion for MnDHO projects that
include home and community-based services is limited to the two projects and service
areas in effect on March 1, 2006. Enrollment in integrated MnDHO programs that
include home and community-based services shall remain voluntary. Costs for home
and community-based services included under MnDHO must not exceed costs that
would have been incurred under the fee-for-service program. In developing program
specifications for expansion of integrated programs, the commissioner shall involve and
consult the state-level stakeholder group established in subdivision 28, paragraph (d),
including consultation on whether and how to include home and community-based waiver
programs. Plans for further expansion of MnDHO projects shall be presented to the chairs
of the house and senate committees with jurisdiction over health and human services
policy and finance by February 1, 2007.

(g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

Sec. 4. new text begin APPROPRIATION; OMBUDSMAN FOR MANAGED CARE.
new text end

new text begin $300,000 is appropriated from the general fund to the commissioner of human
services for the biennium ending June 30, 2009, for the ombudsman for managed care
under Minnesota Statutes, section 256B.031, subdivision 6, to increase staff specifically
trained and experienced to assist persons with disabilities on issues involving health
coverage under Minnesota Statutes, section 256B.69. The federal Medicaid matching
funds available for this function shall be dedicated to the commissioner for this purpose.
new text end