SF 3600

Introduction - 84th Legislature (2005 - 2006)

Posted on 12/15/2009 12:00 a.m.

A bill for an act
relating to human services; restricting what qualifies as a trade secret; expanding
managed care to include persons with disabilities; requiring stakeholder
participation; requiring legislative authorization; amending Minnesota Statutes
2004, section 256B.69, subdivision 9, by adding subdivisions; Minnesota
Statutes 2005 Supplement, section 256B.69, subdivision 23.

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

Section 1.

Minnesota Statutes 2004, section 256B.69, subdivision 9, is amended to read:

Subd. 9.

Reporting.

new text begin (a) new text end Each demonstration provider shall submit information as
required deleted text begin by deleted text end new text begin in the contract with new text end the commissioner, including data required for assessing
client satisfaction, quality of care, cost, and utilization of services for purposes of project
evaluation. The commissioner shall also develop methods of data new text begin reporting and new text end collection
from county advocacy activities in order to provide aggregate enrollee information on
encounters and outcomes to determine access and quality assurance. deleted text begin Required information
shall be specified before the deleted text end deleted text begin commissioner contracts with a demonstration provider.
deleted text end

new text begin (b) Health plan encounter data, spending data, and criteria for service authorization
and service use are public data under section 13.02, subdivision 14, and do not qualify
as trade secrets pursuant to section 13.37, subdivision 1, paragraph (b). Effective for
2007 contracts, the commissioner must require from each health plan and county-based
purchasing plan:
new text end

new text begin (1) encounter data for each service provided, using standard codes and unit of
service definitions set by the commissioner, in a form that the commissioner can report
by age, eligibility group, and health plan;
new text end

new text begin (2) the total amount paid to providers for each type of service, in a form that the
commissioner can report by age, eligibility group, and health plan; and
new text end

new text begin (3) the criteria used for each type of service for which authorization is required.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2005 Supplement, section 256B.69, subdivision 23, is
amended to read:

Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations. Medicare funds and services
shall be administered according to the terms and conditions of the federal waiver and
demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, with the
exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, items B and
C, which do not apply to persons enrolling in demonstrations under this section. An initial
open enrollment period may be provided. Persons who disenroll from demonstrations
under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464.
When a person is enrolled in a health plan under these demonstrations and the health
plan's participation is subsequently terminated for any reason, the person shall be provided
an opportunity to select a new health plan and shall have the right to change health plans
within the first 60 days of enrollment in the second health plan. Persons required to
participate in health plans under this section who fail to make a choice of health plan shall
not be randomly assigned to health plans under these demonstrations. Notwithstanding
section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, subpart 1, item A,
if adopted, for the purpose of demonstrations under this subdivision, the commissioner
may contract with managed care organizations, including counties, to serve only elderly
persons eligible for medical assistance, elderly and disabled persons, or disabled persons
only. For persons with primary diagnoses of mental retardation or a related condition,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with primary diagnoses of mental retardation or a related condition, serious and
persistent mental illness, or serious emotional disturbance, without approval of the county
board of the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for mental retardation or
related conditions, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until two years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
two years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas
of the state. new text begin Until July 1, 2007, expansion activities for MnDHO projects beyond
the two operating as of March 1, 2006, shall be limited to planning, negotiation with
interested health plans, and involvement of stakeholders at the state level to examine
and make recommendations on consumer protections, program standards, outcomes,
quality measures, requirements for the inclusion of home and community waiver services
and home-care services, and changes in legislation necessary to include persons with
developmental disabilities. Plans for expansion of MnDHO shall be presented to the chairs
of the house and senate health and human services policy and finance committees by
February 1. Enrollment in new MnDHO projects shall not begin until after July 1, 2007.
new text end

(g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2004, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 28. new text end

new text begin Medicare special needs plans and medical assistance basic health
care for persons with disabilities. new text end

new text begin For persons with disabilities, the commissioner
shall develop a plan and establish requirements and program standards for contracts
with managed care health plans that seek to provide medical assistance basic healthcare
services, excluding home and community-based waiver services, home-care services
under sections 256B.0627, ICF/MR and skilled nursing facilities under section 256B.0625,
subdivision 2, and case management for persons with mental retardation or related
condition under section 256B.0625, subdivision 20, paragraph (a). The commissioner may
exclude other medical assistance services from the basic health care benefit set. Medical
assistance services excluded from the basic health care benefit set under this subdivision
shall continue to be available to recipients on the same basis as before enrollment in a
managed care plan covering basic health services. Enrollment for persons with disabilities
for medical assistance basic health care services with a Medicare special needs plan must
be voluntary, and does not include passive enrollment with an opt-out provision. The plan
shall be presented to the chairs of the house and senate health and human services finance
and policy committees by February 1, 2007. Enrollment of persons with disabilities shall
not begin until after July 1, 2007.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Minnesota Statutes 2004, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 29. new text end

new text begin Managed care disabilities stakeholder group. new text end

new text begin The commissioner
shall establish a stakeholder group to provide advice on all department managed care
programs for persons with disabilities, including expansion efforts, contract matters,
implementation, data collection and reporting requirements, program standards, quality
assurance measures, and evaluation of the cost, quality, and results.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 5. new text begin STAKEHOLDER PARTICIPATION.
new text end

new text begin The commissioner shall establish one or more stakeholder groups of interested
persons, including representatives of recipients, advocacy groups, counties, providers, and
health plans to provide information and advice on the development of any proposals for
changes in the medical assistance program authorized by the federal Deficit Reduction
Act of 2005, Public Law 109-171.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6. new text begin LEGISLATIVE AUTHORIZATION REQUIRED.
new text end

new text begin Any changes to the medical assistance program proposed as a result of the federal
Deficit Reduction Act of 2005, Public Law 109-171, must receive legislative approval prior
to being implemented or submitted to the Centers for Medicare and Medicaid services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end