1.1 	A bill for an act
1.2 	relating to human services; setting a provider payment floor for health plan 
1.3 	companies and county-based purchasing plans serving medical assistance and 
1.4 	MinnesotaCare enrollees;amending Minnesota Statutes 2018, sections 256B.69, 
1.5 	subdivision 6; 256B.692, subdivision 3; 256L.12, subdivision 7.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2018, section 256B.69, subdivision 6, is amended to read:
1.8 		Subd. 6.Service delivery. (a) Each demonstration provider shall be responsible for the 
1.9 	health care coordination for eligible individuals. Demonstration providers:
1.10 	(1) shall authorize and arrange for the provision of all needed health services including 
1.11 	but not limited to the full range of services listed in sections 256B.02, subdivision 8, and 
1.12 	256B.0625 in order to ensure appropriate health care is delivered to enrollees. 
1.13 	Notwithstanding section 256B.0621, demonstration providers that provide nursing home 
1.14 	and community-based services under this section shall provide relocation service coordination 
1.15 	to enrolled persons age 65 and over;
1.16 	(2) shall accept the prospective, per capita payment from the commissioner in return for 
1.17 	the provision of comprehensive and coordinated health care services for eligible individuals 
1.18 	enrolled in the program;
1.19 	(3) may contract with other health care and social service practitioners to provide services 
1.20 	to enrollees; and
1.21 	(4) shall institute recipient grievance procedures according to the method established 
1.22 	by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved 
2.1 	through this process shall be appealable to the commissioner as provided in subdivision 11; 
2.2 	and
2.3 	(5) shall reimburse health care providers employed by, or under contract with, the 
2.4 	demonstration provider at payment rates that are at least as high as the greater of the medical 
2.5 	assistance or Medicare fee-for-service payment rate for the same service.
2.6 	(b) Demonstration providers must comply with the standards for claims settlement under 
2.7 	section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health care and 
2.8 	social service practitioners to provide services to enrollees. A demonstration provider must 
2.9 	pay a clean claim, as defined in Code of Federal Regulations, title 42, section 447.45(b), 
2.10 	within 30 business days of the date of acceptance of the claim.

2.11 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
2.12 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
2.13 	when federal approval is obtained.

2.14 	Sec. 2. Minnesota Statutes 2018, section 256B.692, subdivision 3, is amended to read:
2.15 		Subd. 3.Requirements of the county board. A county board that intends to purchase 
2.16 	or provide health care under this section, which may include purchasing all or part of these 
2.17 	services from health plans or individual providers on a fee-for-service basis, or providing 
2.18 	these services directly, must demonstrate the ability to follow and agree to the following 
2.19 	requirements:
2.20 	(1) purchase all covered services for a fixed payment from the state that does not exceed 
2.21 	the estimated state and federal cost that would have occurred under the prepaid medical 
2.22 	assistance program;
2.23 	(2) ensure that covered services are accessible to all enrollees and that enrollees have a 
2.24 	reasonable choice of providers, health plans, or networks when possible. If the county is 
2.25 	also a provider of service, the county board shall develop a process to ensure that providers 
2.26 	employed by the county are not the sole referral source and are not the sole provider of 
2.27 	health care services if other providers, which meet the same quality and cost requirements 
2.28 	are available;
2.29 	(3) issue payments to participating vendors or networks in a timely manner and in 
2.30 	compliance with the requirements of section 256B.69, subdivision 6, paragraph (a), clause 
2.31 	(5);
2.32 	(4) establish a process to ensure and improve the quality of care provided;
3.1 	(5) provide appropriate quality and other required data in a format required by the state;
3.2 	(6) provide a system for advocacy, enrollee protection, and complaints and appeals that 
3.3 	is independent of care providers or other risk bearers and complies with section 256B.69;
3.4 	(7) ensure that the implementation and operation of the Minnesota senior health options 
3.5 	demonstration project and the Minnesota disability health options demonstration project, 
3.6 	authorized under section 256B.69, subdivision 23, will not be impeded;
3.7 	(8) ensure that all recipients that are enrolled in the prepaid medical assistance program 
3.8 	will be transferred to county-based purchasing without utilizing the department's 
3.9 	fee-for-service claims payment system;
3.10 	(9) ensure that all recipients who are required to participate in county-based purchasing 
3.11 	are given sufficient information prior to enrollment in order to make informed decisions; 
3.12 	and
3.13 	(10) ensure that the state and the medical assistance recipients will be held harmless for 
3.14 	the payment of obligations incurred by the county if the county, or a health plan providing 
3.15 	services on behalf of the county, or a provider participating in county-based purchasing 
3.16 	becomes insolvent, and the state has made the payments due to the county under this section.

3.17 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
3.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
3.19 	when federal approval is obtained.

3.20 	Sec. 3. Minnesota Statutes 2018, section 256L.12, subdivision 7, is amended to read:
3.21 		Subd. 7.Managed care plan vendor requirements. The following requirements apply 
3.22 	to all counties or vendors who contract with the Department of Human Services to serve 
3.23 	MinnesotaCare recipients. Managed care plan contractors:
3.24 	(1) shall authorize and arrange for the provision of the full range of services listed in 
3.25 	section 256L.03 in order to ensure appropriate health care is delivered to enrollees;
3.26 	(2) shall accept the prospective, per capita payment or other contractually defined payment 
3.27 	from the commissioner in return for the provision and coordination of covered health care 
3.28 	services for eligible individuals enrolled in the program;
3.29 	(3) may contract with other health care and social service practitioners to provide services 
3.30 	to enrollees;
3.31 	(4) shall provide for an enrollee grievance process as required by the commissioner and 
3.32 	set forth in the contract with the department;
4.1 	(5) shall retain all revenue from enrollee co-payments;
4.2 	(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status or 
4.3 	previous utilization of health services;
4.4 	(7) shall demonstrate capacity to accept financial risk according to requirements specified 
4.5 	in the contract with the department. A health maintenance organization licensed under 
4.6 	chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required to 
4.7 	demonstrate financial risk capacity, beyond that which is required to comply with chapters 
4.8 	62C and 62D; and
4.9 	(8) shall submit information as required by the commissioner, including data required 
4.10 	for assessing enrollee satisfaction, quality of care, cost, and utilization of services; and
4.11 	(9) shall reimburse health care providers employed by, or under contract with, the 
4.12 	contractor at payment rates that are at least as high as the greater of the medical assistance 
4.13 	or Medicare fee-for-service payment rate for the same service.

4.14 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
4.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
4.16 	when federal approval is obtained.