HF 1524

as introduced - 91st Legislature (2019 - 2020) Posted on 02/21/2019 02:06pm

A bill for an act
relating to human services; setting a provider payment floor for health plan
companies and county-based purchasing plans serving medical assistance and
MinnesotaCare enrollees; amending Minnesota Statutes 2018, sections 256B.69,
subdivision 6; 256B.692, subdivision 3; 256L.12, subdivision 7.

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

Section 1.

Minnesota Statutes 2018, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) Each demonstration provider shall be responsible for the
health care coordination for eligible individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services including
but not limited to the full range of services listed in sections 256B.02, subdivision 8, and
256B.0625 in order to ensure appropriate health care is delivered to enrollees.
Notwithstanding section 256B.0621, demonstration providers that provide nursing home
and community-based services under this section shall provide relocation service coordination
to enrolled persons age 65 and over;

(2) shall accept the prospective, per capita payment from the commissioner in return for
the provision of comprehensive and coordinated health care services for eligible individuals
enrolled in the program;

(3) may contract with other health care and social service practitioners to provide services
to enrollees; deleted text begin and
deleted text end

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11 new text begin ;
and
new text end

new text begin (5) shall reimburse health care providers employed by, or under contract with, the
demonstration provider at payment rates that are at least as high as the greater of the medical
assistance or Medicare fee-for-service payment rate for the same service new text end .

(b) Demonstration providers must comply with the standards for claims settlement under
section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health care and
social service practitioners to provide services to enrollees. A demonstration provider must
pay a clean claim, as defined in Code of Federal Regulations, title 42, section 447.45(b),
within 30 business days of the date of acceptance of the claim.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2018, 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 program;

(2) ensure that covered services are accessible to all enrollees and that enrollees have a
reasonable choice of providers, health plans, or networks when possible. 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 new text begin and in
compliance with the requirements of section 256B.69, subdivision 6, paragraph (a), clause
(5) new text end ;

(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 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 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256L.12, subdivision 7, is amended to read:

Subd. 7.

Managed care plan vendor requirements.

The following requirements apply
to all counties or vendors who contract with the Department of Human Services to serve
MinnesotaCare recipients. Managed care plan contractors:

(1) shall authorize and arrange for the provision of the full range of services listed in
section 256L.03 in order to ensure appropriate health care is delivered to enrollees;

(2) shall accept the prospective, per capita payment or other contractually defined payment
from the commissioner in return for the provision and coordination of covered health care
services for eligible individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide services
to enrollees;

(4) shall provide for an enrollee grievance process as required by the commissioner and
set forth in the contract with the department;

(5) shall retain all revenue from enrollee co-payments;

(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status or
previous utilization of health services;

(7) shall demonstrate capacity to accept financial risk according to requirements specified
in the contract with the department. A health maintenance organization licensed under
chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required to
demonstrate financial risk capacity, beyond that which is required to comply with chapters
62C and 62D; deleted text begin and
deleted text end

(8) shall submit information as required by the commissioner, including data required
for assessing enrollee satisfaction, quality of care, cost, and utilization of services new text begin ; and
new text end

new text begin (9) shall reimburse health care providers employed by, or under contract with, the
contractor at payment rates that are at least as high as the greater of the medical assistance
or Medicare fee-for-service payment rate for the same service new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end