HF 1345

as introduced - 88th Legislature (2013 - 2014) Posted on 03/07/2013 02:12pm

A bill for an act
relating to human services; modifying provisions related to health care and
health disparities; requiring reports; appropriating money; amending Minnesota
Statutes 2012, sections 62Q.19, subdivision 3; 62U.02, subdivision 1; 145.928,
by adding a subdivision; 256B.06, subdivision 4; 256B.0625, by adding a
subdivision; 256B.0651, by adding subdivisions; 256B.76, subdivision 4, by
adding a subdivision; 256B.763.

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

Section 1.

Minnesota Statutes 2012, section 62Q.19, subdivision 3, is amended to read:

Subd. 3.

deleted text begin Health plan company deleted text end new text begin Essential community provider new text end affiliation.

A
health plan company new text begin , MinnesotaCare participating entity, or health carrier offering a
qualified health plan through the Minnesota Insurance Marketplace new text end must offer a provider
contract to any designated essential community provider located within the area served
by the health plan company. A health plan company shall not restrict enrollee access to
services designated to be provided by the essential community provider for the population
that the essential community provider is certified to serve. A health plan company may
also make other providers available for these services. A health plan company may require
an essential community provider to meet all data requirements, utilization review, and
quality assurance requirements on the same basis as other health plan providers.

Sec. 2.

Minnesota Statutes 2012, section 62U.02, subdivision 1, is amended to read:

Subdivision 1.

Development.

(a) The commissioner of health shall develop a
standardized set of measures by which to assess the quality of health care services offered
by health care providers, including health care providers certified as health care homes
under section 256B.0751. Quality measures must be based on medical evidence and be
developed through a process in which providers participate. The measures shall be used
for the quality incentive payment system developed in subdivision 2 and must:

(1) include uniform definitions, measures, and forms for submission of data, to the
greatest extent possible;

(2) seek to avoid increasing the administrative burden on health care providers;

(3) be initially based on existing quality indicators for physician and hospital
services, which are measured and reported publicly by quality measurement organizations,
including, but not limited to, Minnesota Community Measurement and specialty societies;

(4) place a priority on measures of health care outcomes, rather than process
measures, wherever possible; deleted text begin and
deleted text end

(5) incorporate measures for primary care, including preventive services, coronary
artery and heart disease, diabetes, asthma, depression, and other measures as determined
by the commissioner new text begin ;
new text end

new text begin (6) ensure that measures are collected and reported by categories of race, ethnicity,
language, and other patient characteristics that are known to be correlated with poorer
health, access, and quality of care for particular groups of patients, so that the data is
useful in identifying and eliminating health disparities; and
new text end

new text begin (7) ensure that measures used for public reporting or payment incentives are
adjusted for patient characteristics that are known to be correlated with poorer health,
access, and quality of care, so that quality reports and payment incentives do not create a
disadvantage for providers who serve high concentrations of patients who experience the
greatest health disparities new text end .

(b) The measures shall be reviewed at least annually by the commissioner.

Sec. 3.

Minnesota Statutes 2012, section 145.928, is amended by adding a subdivision
to read:

new text begin Subd. 15. new text end

new text begin Health disparities. new text end

new text begin The commissioner of health, in consultation with
the commissioner of human services, shall complete an assessment of the methods used
by state agencies and the legislature to obtain advice and input from the public on health
care programs, policies, and legislation to determine the extent to which the methods
used are effective in obtaining advice and input from those patients and populations that
experience the greatest health disparities, compared to other patients and populations. The
commissioner shall submit a report to the legislature by December 15, 2013, that includes
the assessment and comparison of existing public input activities and identifies a range
of options for ways of improving public input and advice from patients and populations
experiencing the greatest health disparities.
new text end

Sec. 4.

Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:

Subd. 4.

Citizenship requirements.

(a) Eligibility for medical assistance is limited
to citizens of the United States, qualified noncitizens as defined in this subdivision, and
other persons residing lawfully in the United States. Citizens or nationals of the United
States must cooperate in obtaining satisfactory documentary evidence of citizenship or
nationality according to the requirements of the federal Deficit Reduction Act of 2005,
Public Law 109-171.

(b) "Qualified noncitizen" means a person who meets one of the following
immigration criteria:

(1) admitted for lawful permanent residence according to United States Code, title 8;

(2) admitted to the United States as a refugee according to United States Code,
title 8, section 1157;

(3) granted asylum according to United States Code, title 8, section 1158;

(4) granted withholding of deportation according to United States Code, title 8,
section 1253(h);

(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);

(6) granted conditional entrant status according to United States Code, title 8,
section 1153(a)(7);

(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;

(8) is a child of a noncitizen determined to be a battered noncitizen by the United
States Attorney General according to the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
Public Law 104-200; or

(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.

(c) All qualified noncitizens who were residing in the United States before August
22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation.

(d) Beginning December 1, 1996, qualified noncitizens who entered the United
States on or after August 22, 1996, and who otherwise meet the eligibility requirements
of this chapter are eligible for medical assistance with federal participation for five years
if they meet one of the following criteria:

(1) refugees admitted to the United States according to United States Code, title 8,
section 1157;

(2) persons granted asylum according to United States Code, title 8, section 1158;

(3) persons granted withholding of deportation according to United States Code,
title 8, section 1253(h);

(4) veterans of the United States armed forces with an honorable discharge for
a reason other than noncitizen status, their spouses and unmarried minor dependent
children; or

(5) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.

Beginning July 1, 2010, children and pregnant women who are noncitizens
described in paragraph (b) or who are lawfully present in the United States as defined
in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
eligibility requirements of this chapter, are eligible for medical assistance with federal
financial participation as provided by the federal Children's Health Insurance Program
Reauthorization Act of 2009, Public Law 111-3.

(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
Code, title 8, section 1101(a)(15).

(f) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of
this chapter, if such care and services are necessary for the treatment of an emergency
medical condition.

(g) For purposes of this subdivision, the term "emergency medical condition" means
a medical condition that meets the requirements of United States Code, title 42, section
1396b(v).

(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
of an emergency medical condition are limited to the following:

(i) services delivered in an emergency room or by an ambulance service licensed
under chapter 144E that are directly related to the treatment of an emergency medical
condition;

(ii) services delivered in an inpatient hospital setting following admission from an
emergency room or clinic for an acute emergency condition; and

(iii) follow-up services deleted text begin that are directly related to the original service provided to
treat the emergency medical condition and are covered by the global payment made to the
provider deleted text end new text begin provided after discharge from an emergency room or inpatient hospital setting
that are necessary to prevent recurrence of a medical emergency new text end .

(2) Services for the treatment of emergency medical conditions do not include:

(i) services delivered in an emergency room or inpatient setting to treat a
nonemergency condition;

(ii) organ transplants, stem cell transplants, and related care;

(iii) services for routine prenatal care;

(iv) continuing care, including long-term care, nursing facility services, home
health care, adult day care, day training, or supportive living services new text begin , except follow-up
services in these categories that are covered if they are provided after discharge from an
emergency room or inpatient hospital setting and are necessary to prevent recurrence
of a medical emergency new text end ;

(v) elective surgery;

(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
part of an emergency room visit;

(vii) preventative health care and family planning services;

(viii) dialysis new text begin , except as medically necessary after discharge from an emergency
room or inpatient hospital setting to prevent recurrence of a medical emergency new text end ;

(ix) chemotherapy or therapeutic radiation services new text begin , except as medically necessary
after discharge from an emergency room or inpatient hospital setting to prevent recurrence
of a medical emergency new text end ;

(x) rehabilitation services;

(xi) physical, occupational, or speech therapy;

(xii) transportation services;

(xiii) case management;

(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;

(xv) dental services new text begin , except as medically necessary after discharge from an
emergency room or inpatient hospital setting to prevent recurrence of a medical emergency new text end ;

(xvi) hospice care;

(xvii) audiology services and hearing aids;

(xviii) podiatry services;

(xix) chiropractic services;

(xx) immunizations;

(xxi) vision services and eyeglasses;

(xxii) waiver services;

(xxiii) individualized education programs; or

(xxiv) chemical dependency treatment.

new text begin (3) Notwithstanding clauses (1) and (2), the commissioner may authorize payment
for alternative services, including, but not limited to, long-term care services, that would
not otherwise be paid for under this section if the commissioner determines that the
alternative services, if provided, would be a lower cost alternative to utilization of
emergency room, inpatient, and other services. The commissioner shall seek a waiver or
federal approval as necessary to implement this clause.
new text end

(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
nonimmigrants, or lawfully present in the United States as defined in Code of Federal
Regulations, title 8, section 103.12, are not covered by a group health plan or health
insurance coverage according to Code of Federal Regulations, title 42, section 457.310,
and who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance through the period of pregnancy, including labor and delivery, and 60
days postpartum, to the extent federal funds are available under title XXI of the Social
Security Act, and the state children's health insurance program.

(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
services from a nonprofit center established to serve victims of torture and are otherwise
ineligible for medical assistance under this chapter are eligible for medical assistance
without federal financial participation. These individuals are eligible only for the period
during which they are receiving services from the center. Individuals eligible under this
paragraph shall not be required to participate in prepaid medical assistance.

Sec. 5.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 61. new text end

new text begin Payment for multiple services provided on the same day. new text end

new text begin The
commissioner shall not prohibit payment, including supplemental payments, for mental
health services or dental services provided to a patient by a clinic or health care
professional solely because the mental health or dental services were provided on the same
day as other covered health services furnished by the same provider.
new text end

Sec. 6.

Minnesota Statutes 2012, section 256B.0651, is amended by adding a
subdivision to read:

new text begin Subd. 18. new text end

new text begin Critical access home care services payment rate. new text end

new text begin Effective for
home care services delivered on or after July 1, 2013, the commissioner shall increase
reimbursements for home care service providers designated by the commissioner to be
critical access home care providers by 30 percent above the reimbursement rate that would
otherwise be paid to the critical access home care provider. The commissioner shall pay
the managed care plans and county-based purchasing plans in an amount sufficient to
reflect increased reimbursement to critical access home care providers as approved by the
commissioner. The commissioner shall designate a home care provider to be a critical
access home care provider if more than 50 percent of the provider's home care patient
encounters per year are with patients who are low-income and uninsured or covered
by medical assistance or MinnesotaCare.
new text end

Sec. 7.

Minnesota Statutes 2012, section 256B.0651, is amended by adding a
subdivision to read:

new text begin Subd. 19. new text end

new text begin Critical access provider payment rates. new text end

new text begin Payments for covered services
provided under the MinnesotaCare program shall include critical access and community
health center payment rates and enhancements and special rate methodologies established
under sections 256B.0625, subdivision 30; 256B.0651, subdivision 18; 256B.76,
subdivision 4; and 256B.763.
new text end

Sec. 8.

Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:

Subd. 4.

Critical access dental providers.

(a) Effective for dental services rendered
on or after January 1, 2002, the commissioner shall increase reimbursements to dentists
and dental clinics deemed by the commissioner to be critical access dental providers.
For dental services rendered on or after July 1, 2007, the commissioner shall increase
reimbursement by deleted text begin 30 deleted text end new text begin 40 new text end percent above the reimbursement rate that would otherwise be
paid to the critical access dental provider. The commissioner shall pay the managed
care plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.

(b) The commissioner shall designate the following dentists and dental clinics as
critical access dental providers:

(1) nonprofit community clinics that:

(i) have nonprofit status in accordance with chapter 317A;

(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);

(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;

(iv) have professional staff familiar with the cultural background of the clinic's
patients;

(v) charge for services on a sliding fee scale designed to provide assistance to
low-income patients based on current poverty income guidelines and family size;

(vi) do not restrict access or services because of a patient's financial limitations
or public assistance status; and

(vii) have free care available as needed;

(2) federally qualified health centers, rural health clinics, and public health clinics;

(3) new text begin city or new text end county owned and operated hospital-based dental clinics;

(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance, general assistance medical
care, or MinnesotaCare; deleted text begin and
deleted text end

(5) a dental clinic owned and operated by the University of Minnesota or the
Minnesota State Colleges and Universities system deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) privately owned dental clinics or practices, if:
new text end

new text begin (i) the clinic or practice is located within a dental professional shortage area under
Code of Federal Regulations, title 42, part 5, and United States Code, title 42, section
254E, and is located outside the seven-county metropolitan area;
new text end

new text begin (ii) more than 50 percent of the clinic or practice's patient encounters per year
are with patients who are low-income and uninsured or covered by medical assistance
or MinnesotaCare;
new text end

new text begin (iii) the clinic or practice does not restrict access or services because of a patient's
financial limitations or public assistance status and offers free or reduced fee care used on
a sliding fee based on federal poverty guidelines and family size and income; and
new text end

new text begin (iv) the level of service provided by the clinic or practice is critical to maintaining
adequate levels of patient access within the service area in which the dentist operates.
new text end

deleted text begin (c) The commissioner may designate a dentist or dental clinic as a critical access
dental provider if the dentist or dental clinic is willing to provide care to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare at a level which
significantly increases access to dental care in the service area.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end A designated critical access clinic shall receive the reimbursement rate
specified in paragraph (a) for dental services provided off site at a private dental office if
the following requirements are met:

(1) the designated critical access dental clinic is located within a health professional
shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
States Code, title 42, section 254E, and is located outside the seven-county metropolitan
area;

(2) the designated critical access dental clinic is not able to provide the service
and refers the patient to the off-site dentist;

(3) the service, if provided at the critical access dental clinic, would be reimbursed
at the critical access reimbursement rate;

(4) the dentist and allied dental professionals providing the services off site are
licensed and in good standing under chapter 150A;

(5) the dentist providing the services is enrolled as a medical assistance provider;

(6) the critical access dental clinic submits the claim for services provided off site
and receives the payment for the services; and

(7) the critical access dental clinic maintains dental records for each claim submitted
under this paragraph, including the name of the dentist, the off-site location, and the
license number of the dentist and allied dental professionals providing the services.

Sec. 9.

Minnesota Statutes 2012, section 256B.76, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Teledentistry and mobile services. new text end

new text begin Covered dental services provided
remotely using telecommunications equipment or provided in settings outside of a dental
clinic using portable or mobile dental equipment shall be reimbursed at the same rate as if
the service were provided in-person or in a dental clinic.
new text end

Sec. 10.

Minnesota Statutes 2012, section 256B.763, is amended to read:

256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.

(a) For services defined in paragraph (b) and rendered on or after July 1, 2007,
payment rates shall be increased by 23.7 percent over the rates in effect on January 1,
2006, for:

(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;

(2) community mental health centers under section 256B.0625, subdivision 5; and

(3) mental health clinics and centers certified under Minnesota Rules, parts
9520.0750 to 9520.0870, or hospital outpatient psychiatric departments that are designated
as essential community providers under section 62Q.19.

(b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient
consultation.

(c) This increase does not apply to rates that are governed by section 256B.0625,
subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are
negotiated with the county, rates that are established by the federal government, or rates
that increased between January 1, 2004, and January 1, 2005.

(d) The commissioner shall adjust rates paid to prepaid health plans under contract
with the commissioner to reflect the rate increases provided in paragraphs (a), (e), and
(f). The prepaid health plan must pass this rate increase to the providers identified in
paragraphs (a), (e), (f), and (g).

(e) Payment rates shall be increased by 23.7 percent over the rates in effect on
December 31, 2007, for:

(1) medication education services provided on or after January 1, 2008, by adult
rehabilitative mental health services providers certified under section 256B.0623; and

(2) mental health behavioral aide services provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.

(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943
and not already included in paragraph (a), payment rates shall be increased by 23.7 percent
over the rates in effect on December 31, 2007.

(g) Payment rates shall be increased by 2.3 percent over the rates in effect on
December 31, 2007, for individual and family skills training provided on or after January
1, 2008, by children's therapeutic services and support providers certified under section
256B.0943.

new text begin (h) In addition to increases provided under paragraphs (a) through (g), payment rates
shall be increased by ten percent for community mental health center services rendered
on or after July 1, 2013, by community mental health centers under section 256B.0625,
subdivision 5.
new text end

Sec. 11. new text begin OUTREACH AND ENROLLMENT ASSISTANCE.
new text end

new text begin For the biennium ending June 30, 2015, the payment for outreach and enrollment
assistance services resulting in a successful enrollment in medical assistance or
MinnesotaCare is $250.
new text end

Sec. 12. new text begin FEDERALLY QUALIFIED HEALTH CENTER SUBSIDY.
new text end

new text begin For the biennium ending June 30, 2015, $5,000,000 per year is appropriated from
the general fund to the commissioner of health for subsidies for federally qualified health
centers under Minnesota Statutes, section 145.9269.
new text end

Sec. 13. new text begin MEDICAL EDUCATION AND RESEARCH COSTS.
new text end

new text begin For the biennium ending June 30, 2015, $....... per year is appropriated from the
general fund to the commissioner of health for distribution under Minnesota Statutes,
section 62J.692, subdivision 4.
new text end

Sec. 14. new text begin HEALTH DISPARITIES PAYMENT ENHANCEMENT.
new text end

new text begin The commissioner of human services shall develop a methodology to pay a higher
payment rate for health care providers and services that takes into consideration the higher
cost, complexity, and resources needed to serve patients and populations who experience
the greatest health disparities in order to achieve the same health and quality outcomes that
are achieved for other patients and populations. The commissioner shall submit a report
and recommendations to the legislature by December 15, 2013, including the proposed
methodology for providing a health disparities payment adjustment.
new text end