1.1 	A bill for an act
1.2 	relating to human services; allowing the commissioner of human services 
1.3 	to contract with Medicare-approved special needs plans to provide medical 
1.4 	assistance services to persons with disabilities; creating a stakeholder group; 
1.5 	requiring legislative approval; appropriating money; amending Minnesota 
1.6 	Statutes 2004, section 256B.69, subdivision 9, by adding a subdivision; 
1.7 	Minnesota Statutes 2005 Supplement, section 256B.69, subdivision 23.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2004, section 256B.69, subdivision 9, is amended to read:
1.10 		Subd. 9.Reporting. (a) Each demonstration provider shall submit information as 
1.11 	required by the commissioner, including data required for assessing client satisfaction, 
1.12 	quality of care, cost, and utilization of services for purposes of project evaluation. The 
1.13 	commissioner shall also develop methods of data reporting and collection from county 
1.14 	advocacy activities in order to provide aggregate enrollee information on encounters 
1.15 	and outcomes to determine access and quality assurance. Required information shall be 
1.16 	specified before the commissioner contracts with a demonstration provider.
1.17 	(b) Nonpersonally identifiable health plan encounter data, aggregate spending data, 
1.18 	and criteria for service authorization and service use are public data that the commissioner 
1.19 	shall make available and use in public reports. The commissioner shall require each health 
1.20 	plan and county-based purchasing plan to provide:
1.21 	(1) encounter data for each service provided, using standard codes and unit of 
1.22 	service definitions set by the commissioner, in a form that the commissioner can report 
1.23 	by age, eligibility groups, and health plan;
1.24 	(2) total aggregate medical assistance spending for major categories of service 
1.25 	as reported to the commissioner of commerce under section 62D.08, subdivision 3, 
2.1 	paragraph (a), in a form that the commissioner can report by age, eligibility group, and 
2.2 	health plan; and 
2.3 	(3) criteria, written policies, and procedures required to be disclosed under section 
2.4 	62M.10, subdivision 7, and Code of Federal Regulations, title 42, part 438.210(b)(1), used 
2.5 	for each type of service for which authorization is required.

2.6 	Sec. 2. Minnesota Statutes 2005 Supplement, section 256B.69, subdivision 23, is 
2.7 	amended to read:
2.8 		Subd. 23.Alternative services; elderly and disabled persons. (a) The 
2.9 	commissioner may implement demonstration projects to create alternative integrated 
2.10 	delivery systems for acute and long-term care services to elderly persons and persons 
2.11 	with disabilities as defined in section 256B.77, subdivision 7a, that provide increased 
2.12 	coordination, improve access to quality services, and mitigate future cost increases. 
2.13 	The commissioner may seek federal authority to combine Medicare and Medicaid 
2.14 	capitation payments for the purpose of such demonstrations and may contract with 
2.15 	Medicare-approved special needs plans to provide Medicaid services. Medicare funds and 
2.16 	services shall be administered according to the terms and conditions of the federal waiver 
2.17 	and demonstration provisions. For the purpose of administering medical assistance funds, 
2.18 	demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions 
2.19 	of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, with the 
2.20 	exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, items B and 
2.21 	C, which do not apply to persons enrolling in demonstrations under this section. An initial 
2.22 	open enrollment period may be provided. Persons who disenroll from demonstrations 
2.23 	under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464. 
2.24 	When a person is enrolled in a health plan under these demonstrations and the health 
2.25 	plan's participation is subsequently terminated for any reason, the person shall be provided 
2.26 	an opportunity to select a new health plan and shall have the right to change health plans 
2.27 	within the first 60 days of enrollment in the second health plan. Persons required to 
2.28 	participate in health plans under this section who fail to make a choice of health plan shall 
2.29 	not be randomly assigned to health plans under these demonstrations. Notwithstanding 
2.30 	section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, subpart 1, item A, 
2.31 	if adopted, for the purpose of demonstrations under this subdivision, the commissioner 
2.32 	may contract with managed care organizations, including counties, to serve only elderly 
2.33 	persons eligible for medical assistance, elderly and disabled persons, or disabled persons 
2.34 	only. For persons with primary diagnoses of mental retardation or a related condition, 
2.35 	serious and persistent mental illness, or serious emotional disturbance, the commissioner 
3.1 	must ensure that the county authority has approved the demonstration and contracting 
3.2 	design. Enrollment in these projects for persons with disabilities shall be voluntary. The 
3.3 	commissioner shall not implement any demonstration project under this subdivision for 
3.4 	persons with primary diagnoses of mental retardation or a related condition, serious and 
3.5 	persistent mental illness, or serious emotional disturbance, without approval of the county 
3.6 	board of the county in which the demonstration is being implemented.
3.7 	(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
3.8 	to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to 
3.9 	9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement 
3.10 	under this section projects for persons with developmental disabilities. The commissioner 
3.11 	may capitate payments for ICF/MR services, waivered services for mental retardation or 
3.12 	related conditions, including case management services, day training and habilitation and 
3.13 	alternative active treatment services, and other services as approved by the state and by the 
3.14 	federal government. Case management and active treatment must be individualized and 
3.15 	developed in accordance with a person-centered plan. Costs under these projects may not 
3.16 	exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003, 
3.17 	and until two years after the pilot project implementation date, subcontractor participation 
3.18 	in the long-term care developmental disability pilot is limited to a nonprofit long-term 
3.19 	care system providing ICF/MR services, home and community-based waiver services, 
3.20 	and in-home services to no more than 120 consumers with developmental disabilities in 
3.21 	Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature 
3.22 	prior to expansion of the developmental disability pilot project. This paragraph expires 
3.23 	two years after the implementation date of the pilot project.
3.24 	(c) Before implementation of a demonstration project for disabled persons, the 
3.25 	commissioner must provide information to appropriate committees of the house of 
3.26 	representatives and senate and must involve representatives of affected disability groups 
3.27 	in the design of the demonstration projects.
3.28 	(d) A nursing facility reimbursed under the alternative reimbursement methodology 
3.29 	in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity 
3.30 	provide services under paragraph (a). The commissioner shall amend the state plan and 
3.31 	seek any federal waivers necessary to implement this paragraph.
3.32 	(e) The commissioner, in consultation with the commissioners of commerce and 
3.33 	health, may approve and implement programs for all-inclusive care for the elderly (PACE) 
3.34 	according to federal laws and regulations governing that program and state laws or rules 
3.35 	applicable to participating providers. The process for approval of these programs shall 
3.36 	begin only after the commissioner receives grant money in an amount sufficient to cover 
4.1 	the state share of the administrative and actuarial costs to implement the programs during 
4.2 	state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an 
4.3 	account in the special revenue fund and are appropriated to the commissioner to be used 
4.4 	solely for the purpose of PACE administrative and actuarial costs. A PACE provider is 
4.5 	not required to be licensed or certified as a health plan company as defined in section 
4.6 	62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county 
4.7 	and found to be eligible for services under the elderly waiver or community alternatives 
4.8 	for disabled individuals or who are already eligible for Medicaid but meet level of 
4.9 	care criteria for receipt of waiver services may choose to enroll in the PACE program. 
4.10 	Medicare and Medicaid services will be provided according to this subdivision and 
4.11 	federal Medicare and Medicaid requirements governing PACE providers and programs. 
4.12 	PACE enrollees will receive Medicaid home and community-based services through the 
4.13 	PACE provider as an alternative to services for which they would otherwise be eligible 
4.14 	through home and community-based waiver programs and Medicaid State Plan Services. 
4.15 	The commissioner shall establish Medicaid rates for PACE providers that do not exceed 
4.16 	costs that would have been incurred under fee-for-service or other relevant managed care 
4.17 	programs operated by the state.
4.18 	(f) The commissioner shall seek federal approval to expand the Minnesota disability 
4.19 	health options (MnDHO) program established under this subdivision in stages, first to 
4.20 	regional population centers outside the seven-county metro area and then to all areas 
4.21 	of the state. Until January 1, 2008, expansion for MnDHO projects that include home 
4.22 	and community-based services is limited to the two projects and service areas in effect 
4.23 	on March 1, 2006.  Enrollment in integrated MnDHO programs that include home and 
4.24 	community-based services shall remain voluntary. Costs for home and community-based 
4.25 	services included under MnDHO must not exceed costs that would have been incurred 
4.26 	under the fee-for-service program. In developing program specifications for expansion of 
4.27 	integrated programs, the commissioner shall involve and consult the state-level stakeholder 
4.28 	group established in subdivision 28, paragraph (d), including consultation on whether and 
4.29 	how to include home and community-based waiver programs. Plans for further expansion 
4.30 	of MnDHO projects shall be presented to the chairs of the house and senate committees 
4.31 	with jurisdiction over health and human services policy and finance by February 1, 2007.
4.32 	(g) Notwithstanding section 256B.0261, health plans providing services under this 
4.33 	section are responsible for home care targeted case management and relocation targeted 
4.34 	case management. Services must be provided according to the terms of the waivers and 
4.35 	contracts approved by the federal government.

4.36 	EFFECTIVE DATE. This section is effective the day following final enactment. 

5.1 	Sec. 3. Minnesota Statutes 2004, section 256B.69, is amended by adding a subdivision 
5.2 	to read:
5.3 		Subd. 28.Medicare special needs plans and medical assistance basic health 
5.4 	care for persons with disabilities. (a) The commissioner may contract with qualified 
5.5 	Medicare-approved special needs plans to provide medical assistance basic health care 
5.6 	services to persons with disabilities, including those with developmental disabilities. 
5.7 	Basic health care services include:
5.8 	(1) those services covered by the medical assistance state plan except for ICF/MR 
5.9 	services, home and community-based waiver services, case management for persons with 
5.10 	developmental disabilities under section 256B.0625, subdivision 20a, and personal care 
5.11 	and certain home care services defined by the commissioner in consultation with the 
5.12 	stakeholder group established under paragraph (d);
5.13 	(2) basic health care services may also include risk for up to 100 days of nursing 
5.14 	facility services for persons who reside in a noninstitutional setting and home health 
5.15 	services related to rehabilitation as defined by the commissioner after consultation with 
5.16 	the stakeholder group; and
5.17 	(3) the commissioner may exclude other medical assistance services from the basic 
5.18 	health care benefit set. Enrollees in these plans can access any excluded services on the 
5.19 	same basis as other medical assistance recipients who have not enrolled.
5.20 	Unless a person is otherwise required to enroll in managed care, enrollment in these 
5.21 	plans for Medicaid services must be voluntary. For purposes of this subdivision, automatic 
5.22 	enrollment with an option to opt out is not voluntary enrollment. 
5.23 	(b) Beginning January 1, 2007, the commissioner may contract with qualified 
5.24 	Medicare special needs plans to provide basic health care services under medical assistance 
5.25 	to persons who are dually eligible for both Medicare and Medicaid and those Social 
5.26 	Security beneficiaries eligible for Medicaid but in the waiting period for Medicare. The 
5.27 	commissioner shall consult with the stakeholder group under paragraph (d) in developing 
5.28 	program specifications for these services. The commissioner shall report to the chairs of 
5.29 	the house and senate committees with jurisdiction over health and human services policy 
5.30 	and finance by February 1, 2007, on implementation of these programs and the need for 
5.31 	increased funding for the ombudsman for managed care and other consumer assistance 
5.32 	and protections needed due to enrollment in managed care of persons with disabilities.
5.33 	(c) Beginning January 1, 2008, the commissioner may expand contracting under this 
5.34 	subdivision to all persons with disabilities not otherwise required to enroll in managed 
5.35 	care.
6.1 	(d) The commissioner shall establish a state-level stakeholder group to provide 
6.2 	advice on managed care programs for persons with disabilities, including both MnDHO 
6.3 	and contracts with special needs plans that provide basic health care services as described 
6.4 	in paragraphs (a) and (b). The stakeholder group shall provide advice on program 
6.5 	expansions under this subdivision and subdivision 23, including:
6.6 	(1) implementation efforts; 
6.7 	(2) consumer protections; and 
6.8 	(3) program specifications such as quality assurance measures, data collection and 
6.9 	reporting, and evaluation of costs, quality, and results.
6.10 	(e) Each plan under contract to provide medical assistance basic health care services 
6.11 	shall establish a local or regional stakeholder group, including representatives of the 
6.12 	counties covered by the plan, members, consumer advocates, and providers, for advice on 
6.13 	issues that arise in the local or regional area.

6.14 	Sec. 4. STAKEHOLDER PARTICIPATION.
 6.15 	The commissioner of human services shall establish one or more stakeholder groups 
6.16 	of interested persons, including representatives of recipients, advocacy groups, counties, 
6.17 	providers, and health plans to provide information and advice on the development of any 
6.18 	proposals for changes in the medical assistance program authorized by the federal Deficit 
6.19 	Reduction Act of 2005, Public Law 109-171.

6.20 	EFFECTIVE DATE. This section is effective the day following final enactment.

6.21 	Sec. 5. LEGISLATIVE AUTHORIZATION REQUIRED.
 6.22 	Any changes to the medical assistance program proposed as a result of the 
6.23 	federal Deficit Reduction Act of 2005, Public Law 109-171, which affect cost sharing, 
6.24 	co-payments, premiums, eligibility, covered services, service limitations, or benefit set 
6.25 	changes, must receive legislative approval prior to being implemented or submitted to the 
6.26 	Centers for Medicare and Medicaid Services.

6.27 	EFFECTIVE DATE. This section is effective the day following final enactment.

6.28 	Sec. 6. APPROPRIATION; OMBUDSMAN FOR MANAGED CARE.
 6.29 	$200,000 is appropriated from the general fund to the commissioner of human 
6.30 	services in fiscal year 2007 to increase staff for the development and management of 
6.31 	contract requirements associated with enrolling persons with disabilities in managed 
6.32 	care and for the ombudsman for managed care office in order to assist persons with 
7.1 	disabilities on issues involving health coverage under Minnesota Statutes, section 
7.2 	256B.69, subdivision 28.