1.1                          A bill for an act 
  1.2             relating to human services; expanding definition of 
  1.3             "demonstration provider"; adding provisions for 
  1.4             prepayment demonstration project; amending Minnesota 
  1.5             Statutes 1994, section 256B.69, by adding a 
  1.6             subdivision; Minnesota Statutes 1995 Supplement, 
  1.7             section 256B.69, subdivisions 2 and 6. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 1995 Supplement, section 
  1.10  256B.69, subdivision 2, is amended to read: 
  1.11     Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
  1.12  the following terms have the meanings given.  
  1.13     (a) "Commissioner" means the commissioner of human services.
  1.14  For the remainder of this section, the commissioner's 
  1.15  responsibilities for methods and policies for implementing the 
  1.16  project will be proposed by the project advisory committees and 
  1.17  approved by the commissioner.  
  1.18     (b) "Demonstration provider" means an individual, agency, 
  1.19  organization, or group of these entities that participates in 
  1.20  the demonstration project according to criteria, standards, 
  1.21  methods, and other requirements established for the project and 
  1.22  approved by the commissioner.  Demonstration provider also 
  1.23  includes nursing facilities selected by the commissioner to 
  1.24  participate in the alternative payment demonstration project 
  1.25  specified in section 256B.434. 
  1.26     (c) "Eligible individuals" means those persons eligible for 
  2.1   medical assistance benefits as defined in sections 256B.055, 
  2.2   256B.056, and 256B.06. 
  2.3      (d) "Limitation of choice" means suspending freedom of 
  2.4   choice while allowing eligible individuals to choose among the 
  2.5   demonstration providers.  
  2.6      (e) This paragraph supersedes paragraph (c) as long as the 
  2.7   Minnesota health care reform waiver remains in effect.  When the 
  2.8   waiver expires, this paragraph expires and the commissioner of 
  2.9   human services shall publish a notice in the State Register and 
  2.10  notify the revisor of statutes.  "Eligible individuals" means 
  2.11  those persons eligible for medical assistance benefits as 
  2.12  defined in sections 256B.055, 256B.056, and 256B.06.  
  2.13  Notwithstanding sections 256B.055, 256B.056, and 256B.06, an 
  2.14  individual who becomes ineligible for the program because of 
  2.15  failure to submit income reports or recertification forms in a 
  2.16  timely manner, shall remain enrolled in the prepaid health plan 
  2.17  and shall remain eligible to receive medical assistance coverage 
  2.18  through the last day of the month following the month in which 
  2.19  the enrollee became ineligible for the medical assistance 
  2.20  program. 
  2.21     Sec. 2.  Minnesota Statutes 1995 Supplement, section 
  2.22  256B.69, subdivision 6, is amended to read: 
  2.23     Subd. 6.  [SERVICE DELIVERY.] (a) Each demonstration 
  2.24  provider shall be responsible for the health care coordination 
  2.25  for eligible individuals.  Demonstration providers:  
  2.26     (1) shall authorize and arrange for the provision of all 
  2.27  needed health services including but not limited to the full 
  2.28  range of services listed in sections 256B.02, subdivision 8, and 
  2.29  256B.0625 and for children eligible for medical assistance under 
  2.30  section 256B.055, subdivision 12, home care services and 
  2.31  personal care assistant services in order to ensure appropriate 
  2.32  health care is delivered to enrollees; 
  2.33     (2) shall accept the prospective, per capita payment from 
  2.34  the commissioner in return for the provision of comprehensive 
  2.35  and coordinated health care services for eligible individuals 
  2.36  enrolled in the program; 
  3.1      (3) may contract with other health care and social service 
  3.2   practitioners to provide services to enrollees; and 
  3.3      (4) shall institute recipient grievance procedures 
  3.4   according to the method established by the project, utilizing 
  3.5   applicable requirements of chapter 62D.  Disputes not resolved 
  3.6   through this process shall be appealable to the commissioner as 
  3.7   provided in subdivision 11.  
  3.8      (b) Demonstration providers must comply with the standards 
  3.9   for claims settlement under section 72A.201, subdivisions 4, 5, 
  3.10  7, and 8, when contracting with other health care and social 
  3.11  service practitioners to provide services to enrollees.  A 
  3.12  demonstration provider must pay a clean claim, as defined in 
  3.13  Code of Federal Regulations, title 42, section 447.45(b), within 
  3.14  30 business days of the date of acceptance of the claim.  
  3.15     (c) Nursing facilities selected by the commissioner to 
  3.16  participate in the alternative payment demonstration project 
  3.17  specified in section 256B.434 may be exempted from any of the 
  3.18  responsibilities in paragraphs (a) and (b). 
  3.19     Sec. 3.  Minnesota Statutes 1994, section 256B.69, is 
  3.20  amended by adding a subdivision to read: 
  3.21     Subd. 24.  [LEGISLATIVE APPROVAL REQUIRED.] The 
  3.22  commissioner shall not expand the prepayment demonstration 
  3.23  project to any geographic area beyond the geographic areas 
  3.24  designated on or before February 1, 1996, without specific 
  3.25  legislative approval by the chairs of the health and human 
  3.26  services finance committees.  Legislative approval will be 
  3.27  contingent upon proven cost effectiveness of the prepayment 
  3.28  demonstration project with all enrolled populations.