1.1                          A bill for an act 
  1.2             relating to human services; authorizing a long-term 
  1.3             care partnership program; authorizing programs for 
  1.4             all-inclusive care for the elderly; amending Minnesota 
  1.5             Statutes 2003 Supplement, section 256B.69, subdivision 
  1.6             23; proposing coding for new law in Minnesota 
  1.7             Statutes, chapter 256B. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 
  1.10     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.11  section, the following terms have the meanings given them. 
  1.12     Subd. 2.  [HOME CARE SERVICE.] "Home care service" means 
  1.13  care described in section 144A.43. 
  1.14     Subd. 3.  [LONG-TERM CARE INSURANCE.] "Long-term care 
  1.15  insurance" means a policy described in section 62S.01. 
  1.16     Subd. 4.  [MEDICAL ASSISTANCE.] "Medical assistance" means 
  1.17  the program of medical assistance established under section 
  1.18  256B.01. 
  1.19     Subd. 5.  [NURSING HOME.] "Nursing home" means a nursing 
  1.20  home as described in section 144A.01. 
  1.21     Subd. 6.  [PARTNERSHIP POLICY.] "Partnership policy" means 
  1.22  a long-term care insurance policy that meets the requirements 
  1.23  under subdivision 10. 
  1.24     Subd. 7.  [PARTNERSHIP PROGRAM.] "Partnership program" 
  1.25  means the Minnesota partnership for long-term care program 
  1.26  established under this section. 
  2.1      Subd. 8.  [PROGRAM ESTABLISHED.] (a) The commissioner, in 
  2.2   cooperation with the commissioner of commerce, shall establish 
  2.3   the Minnesota partnership for long-term care program to provide 
  2.4   for the financing of long-term care through a combination of 
  2.5   private insurance and medical assistance. 
  2.6      (b) An individual who meets the requirements in this 
  2.7   paragraph is eligible to participate in the partnership 
  2.8   program.  The individual must: 
  2.9      (1) be a Minnesota resident; 
  2.10     (2) purchase a partnership policy that is delivered, issued 
  2.11  for delivery, or renewed on or after the effective date of this 
  2.12  section, and maintain the partnership policy in effect 
  2.13  throughout the period of participation in the partnership 
  2.14  program; and 
  2.15     (3) exhaust the minimum benefits under the partnership 
  2.16  policy as described in this section.  Benefits received under a 
  2.17  long-term care insurance policy before the effective date of 
  2.18  this section do not count toward the exhaustion of benefits 
  2.19  required in this subdivision. 
  2.20     Subd. 9.  [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 
  2.21  application of an individual who meets the requirements 
  2.22  described in subdivision 8, the commissioner shall determine the 
  2.23  individual's eligibility for medical assistance according to 
  2.24  paragraphs (b) and (c). 
  2.25     (b) After disregarding financial assets exempted under 
  2.26  medical assistance eligibility requirements, the commissioner 
  2.27  shall disregard an additional amount of financial assets equal 
  2.28  to the dollar amount of coverage utilized under the partnership 
  2.29  policy. 
  2.30     (c) The commissioner shall consider the individual's income 
  2.31  according to medical assistance eligibility requirements. 
  2.32     Subd. 10.  [APPROVED POLICIES.] (a) A partnership policy 
  2.33  must meet all of the requirements in paragraphs (b) to (g).  
  2.34     (b) Minimum coverage shall be for a period of not less than 
  2.35  two years and for a dollar amount equal to 24 months of nursing 
  2.36  home care at the minimum daily benefit rate determined and 
  3.1   adjusted under paragraph (c).  The policy shall provide for home 
  3.2   health care benefits to be substituted for nursing home care 
  3.3   benefits on the basis of two home health care days for one 
  3.4   nursing home care day. 
  3.5      (c) Minimum daily benefits shall be $130 for nursing home 
  3.6   care or $65 for home care.  These minimum daily benefit amounts 
  3.7   shall be adjusted by the commissioner on October 1 of each year 
  3.8   by a percentage equal to the inflation protection feature 
  3.9   described in section 62S.23, subdivision 1, clause (1).  
  3.10  Adjusted minimum daily benefit amounts shall be rounded to the 
  3.11  nearest whole dollar.  
  3.12     (d) A third party designated by the insured shall be 
  3.13  entitled to receive notice if the policy is about to lapse for 
  3.14  nonpayment of premium, and an additional 30-day grace period for 
  3.15  payment of premium shall be granted following notification to 
  3.16  that person. 
  3.17     (e) The policy must cover all of the following services: 
  3.18     (1) nursing home stay; 
  3.19     (2) home care service; 
  3.20     (3) care management; and 
  3.21     (4) up to 14 days of nursing care in a hospital while the 
  3.22  individual is waiting for long-term care placement. 
  3.23     (f) Payment for service under paragraph (e), clause (4), 
  3.24  must not exceed the daily benefit amount for nursing home care. 
  3.25     (g) A partnership policy must offer the following options 
  3.26  for an adjusted premium: 
  3.27     (1) an elimination period of not more than 100 days; and 
  3.28     (2) nonforfeiture benefits for applicants between the ages 
  3.29  of 18 and 75. 
  3.30     <b>[EFFECTIVE DATE.]</b> (a) This section is effective July 1, 
  3.31  2004, to the extent permitted by federal law.  If any provision 
  3.32  of this section is prohibited by federal law, the provision 
  3.33  shall become effective when federal law is changed to permit its 
  3.34  application or a waiver is received.  The commissioner of human 
  3.35  services shall notify the revisor of statutes when federal law 
  3.36  is enacted or a waiver or other federal approval is received and 
  4.1   publish a notice in the State Register.  The commissioner must 
  4.2   include the notice in the first State Register published after 
  4.3   the effective date of the federal changes. 
  4.4      (b) If, by July 1, 2004, any provision of this section is 
  4.5   not effective because of prohibitions in federal law, the 
  4.6   commissioner of human services shall apply to the federal 
  4.7   government by August 1, 2004, for a waiver of those prohibitions 
  4.8   or other federal authority, and that provision shall become 
  4.9   effective upon receipt of a federal waiver or other federal 
  4.10  approval, notification to the revisor of statutes, and 
  4.11  publication of a notice in the State Register to that effect. 
  4.12     Sec. 2.  Minnesota Statutes 2003 Supplement, section 
  4.13  256B.69, subdivision 23, is amended to read: 
  4.14     Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
  4.15  ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
  4.16  implement demonstration projects to create alternative 
  4.17  integrated delivery systems for acute and long-term care 
  4.18  services to elderly persons and persons with disabilities as 
  4.19  defined in section 256B.77, subdivision 7a, that provide 
  4.20  increased coordination, improve access to quality services, and 
  4.21  mitigate future cost increases.  The commissioner may seek 
  4.22  federal authority to combine Medicare and Medicaid capitation 
  4.23  payments for the purpose of such demonstrations.  Medicare funds 
  4.24  and services shall be administered according to the terms and 
  4.25  conditions of the federal waiver and demonstration provisions.  
  4.26  For the purpose of administering medical assistance funds, 
  4.27  demonstrations under this subdivision are subject to 
  4.28  subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
  4.29  9500.1450 to 9500.1464, apply to these demonstrations, with the 
  4.30  exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
  4.31  subpart 1, items B and C, which do not apply to persons 
  4.32  enrolling in demonstrations under this section.  An initial open 
  4.33  enrollment period may be provided.  Persons who disenroll from 
  4.34  demonstrations under this subdivision remain subject to 
  4.35  Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
  4.36  enrolled in a health plan under these demonstrations and the 
  5.1   health plan's participation is subsequently terminated for any 
  5.2   reason, the person shall be provided an opportunity to select a 
  5.3   new health plan and shall have the right to change health plans 
  5.4   within the first 60 days of enrollment in the second health 
  5.5   plan.  Persons required to participate in health plans under 
  5.6   this section who fail to make a choice of health plan shall not 
  5.7   be randomly assigned to health plans under these demonstrations. 
  5.8   Notwithstanding section 256L.12, subdivision 5, and Minnesota 
  5.9   Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
  5.10  purpose of demonstrations under this subdivision, the 
  5.11  commissioner may contract with managed care organizations, 
  5.12  including counties, to serve only elderly persons eligible for 
  5.13  medical assistance, elderly and disabled persons, or disabled 
  5.14  persons only.  For persons with primary diagnoses of mental 
  5.15  retardation or a related condition, serious and persistent 
  5.16  mental illness, or serious emotional disturbance, the 
  5.17  commissioner must ensure that the county authority has approved 
  5.18  the demonstration and contracting design.  Enrollment in these 
  5.19  projects for persons with disabilities shall be voluntary.  The 
  5.20  commissioner shall not implement any demonstration project under 
  5.21  this subdivision for persons with primary diagnoses of mental 
  5.22  retardation or a related condition, serious and persistent 
  5.23  mental illness, or serious emotional disturbance, without 
  5.24  approval of the county board of the county in which the 
  5.25  demonstration is being implemented.  
  5.26     (b) Notwithstanding chapter 245B, sections 252.40 to 
  5.27  252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 
  5.28  parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 
  5.29  and 9525.1800 to 9525.1930, the commissioner may implement under 
  5.30  this section projects for persons with developmental 
  5.31  disabilities.  The commissioner may capitate payments for ICF/MR 
  5.32  services, waivered services for mental retardation or related 
  5.33  conditions, including case management services, day training and 
  5.34  habilitation and alternative active treatment services, and 
  5.35  other services as approved by the state and by the federal 
  5.36  government.  Case management and active treatment must be 
  6.1   individualized and developed in accordance with a 
  6.2   person-centered plan.  Costs under these projects may not exceed 
  6.3   costs that would have been incurred under fee-for-service. 
  6.4   Beginning July 1, 2003, and until two years after the pilot 
  6.5   project implementation date, subcontractor participation in the 
  6.6   long-term care developmental disability pilot is limited to a 
  6.7   nonprofit long-term care system providing ICF/MR services, home 
  6.8   and community-based waiver services, and in-home services to no 
  6.9   more than 120 consumers with developmental disabilities in 
  6.10  Carver, Hennepin, and Scott counties.  The commissioner shall 
  6.11  report to the legislature prior to expansion of the 
  6.12  developmental disability pilot project.  This paragraph expires 
  6.13  two years after the implementation date of the pilot project.  
  6.14     (c) Before implementation of a demonstration project for 
  6.15  disabled persons, the commissioner must provide information to 
  6.16  appropriate committees of the house of representatives and 
  6.17  senate and must involve representatives of affected disability 
  6.18  groups in the design of the demonstration projects. 
  6.19     (d) A nursing facility reimbursed under the alternative 
  6.20  reimbursement methodology in section 256B.434 may, in 
  6.21  collaboration with a hospital, clinic, or other health care 
  6.22  entity provide services under paragraph (a).  The commissioner 
  6.23  shall amend the state plan and seek any federal waivers 
  6.24  necessary to implement this paragraph. 
  6.25     (e) The commissioner, in consultation with the 
  6.26  commissioners of commerce and health, may approve and implement 
  6.27  Programs for All-Inclusive Care for the Elderly (PACE) under the 
  6.28  federal laws and regulations governing that program and 
  6.29  participating providers.  A PACE provider shall not be required 
  6.30  to be licensed or certified as a health plan company as defined 
  6.31  in section 62Q.01, subdivision 4.  Persons age 55 or older who 
  6.32  have been screened by the county and found to be eligible for 
  6.33  services under the elderly waiver or community alternatives for 
  6.34  disabled individuals may choose to enroll in the PACE program.  
  6.35  Services shall be provided under this subdivision and federal 
  6.36  Medicare and Medicaid requirements governing PACE providers and 
  7.1   programs.  Program enrollees shall receive medical assistance 
  7.2   home and community-based waiver services as an alternative 
  7.3   through the PACE provider.  The commissioner shall establish 
  7.4   medical assistance rates for program providers that do not 
  7.5   exceed costs that would have been incurred under medical 
  7.6   assistance fee-for-service arrangements.