<a id="pl.1.3"></a><var>1.3</var>cooperative; revising requirements for county-based purchasing for state health <br/>
<a id="pl.1.4"></a><var>1.4</var>care programs; appropriating money;amending Minnesota Statutes 2007 <br/>
<a id="pl.1.5"></a><var>1.5</var>Supplement, section 256B.69, subdivision 4; proposing coding for new law <br/>
<a id="pl.1.6"></a><var>1.6</var>in Minnesota Statutes, chapter 62R.<br/>
<a id="pl.1.7"></a><var>1.7</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.0.1.0"></a><a id="pl.1.8"></a><var>1.8</var>    Section 1. <b>[62R.09] RURAL HEALTH COOPERATIVE CONTRACT </b><br/>
<a id="pl.1.9"></a><var>1.9</var><b>OVERSIGHT.</b><br/>
<a id="pl.1.10"></a><var>1.10</var>    Subdivision 1. <b>Review and approval; monitoring.</b> (a) The commissioner shall <br/>
<a id="pl.1.11"></a><var>1.11</var>establish criteria and procedures to review and authorize contracts and business or <br/>
<a id="pl.1.12"></a><var>1.12</var>financial arrangements under section 62R.06, subdivision 1. All contracts and business <br/>
<a id="pl.1.13"></a><var>1.13</var>or financial arrangements must be submitted on an application for approval to the <br/>
<a id="pl.1.14"></a><var>1.14</var>commissioner. The commissioner shall not deny any application unless the commissioner <br/>
<a id="pl.1.15"></a><var>1.15</var>determines that the proposed arrangement is likely to result in higher health care costs <br/>
<a id="pl.1.16"></a><var>1.16</var>or diminished access to or quality of health care than would occur in the competitive <br/>
<a id="pl.1.17"></a><var>1.17</var>marketplace. The cost of developing the criteria and procedures, as determined by the <br/>
<a id="pl.1.18"></a><var>1.18</var>commissioner and notwithstanding section 16A.1283, shall be paid by health provider <br/>
<a id="pl.1.19"></a><var>1.19</var>cooperatives operating under this chapter.<br/>
<a id="pl.1.20"></a><var>1.20</var>    (b) Within 30 days after receiving an application, the commissioner may request <br/>
<a id="pl.1.21"></a><var>1.21</var>additional information that is necessary to complete the review required under this section. <br/>
<a id="pl.1.22"></a><var>1.22</var>If the commissioner does not request additional information and does not act within 60 <br/>
<a id="pl.1.23"></a><var>1.23</var>days after receipt of an application, the application shall be deemed approved if the <br/>
<a id="pl.1.24"></a><var>1.24</var>commissioner does not act within 60 days of receiving the additional information.<br/>
<a id="pl.2.1"></a><var>2.1</var>    (c) The commissioner may condition approval of a proposed arrangement on a <br/>
<a id="pl.2.2"></a><var>2.2</var>modification of all or part of the arrangement to eliminate any restriction on competition <br/>
<a id="pl.2.3"></a><var>2.3</var>that is not reasonably related to the goals of improving health care access or quality. The <br/>
<a id="pl.2.4"></a><var>2.4</var>commissioner may also establish conditions for approval that are reasonably necessary <br/>
<a id="pl.2.5"></a><var>2.5</var>to protect against abuses of private economic power and to ensure that the arrangement <br/>
<a id="pl.2.6"></a><var>2.6</var>has oversight by the state.<br/>
<a id="pl.2.7"></a><var>2.7</var>    (d) The commissioner shall monitor arrangements approved under this section <br/>
<a id="pl.2.8"></a><var>2.8</var>to ensure that the arrangement remains in compliance with the conditions of approval. <br/>
<a id="pl.2.9"></a><var>2.9</var>The commissioner may revoke an approval upon a finding that the arrangement is not in <br/>
<a id="pl.2.10"></a><var>2.10</var>substantial compliance with the terms of the application or the conditions of approval.<br/>
<a id="pl.2.11"></a><var>2.11</var>    Subd. 2. <b>Applications.</b> Applications for approval under this section must describe <br/>
<a id="pl.2.12"></a><var>2.12</var>the proposed arrangement in detail. The application must include: the identities of all the <br/>
<a id="pl.2.13"></a><var>2.13</var>parties to the arrangement; the intent of the arrangement; the expected outcome of the <br/>
<a id="pl.2.14"></a><var>2.14</var>arrangement; and an explanation of how the arrangement will improve access or quality <br/>
<a id="pl.2.15"></a><var>2.15</var>of care. Data on providers collected under this section are private data on individuals or <br/>
<a id="pl.2.16"></a><var>2.16</var>nonpublic data, as defined in section 13.02.<br/>
<a id="pl.2.17"></a><var>2.17</var>    Subd. 3. <b>Application fee.</b> When submitting an application to the commissioner, a <br/>
<a id="pl.2.18"></a><var>2.18</var>health care cooperative shall pay a fee of $2,000 for the commissioner's cost of reviewing <br/>
<a id="pl.2.19"></a><var>2.19</var>and monitoring the arrangement.<br/>
<a id="pl.2.20"></a><var>2.20</var>    Subd. 4. <b>Appropriation.</b> Money received by the commissioner under this section <br/>
<a id="pl.2.21"></a><var>2.21</var>shall be deposited into a revolving fund and is appropriated to the commissioner of health <br/>
<a id="pl.2.22"></a><var>2.22</var>for the purpose of administering this section.<br/>
<br/>
<a id="bill.0.2.0"></a><a id="pl.2.23"></a><var>2.23</var>    Sec. 2. Minnesota Statutes 2007 Supplement, section 256B.69, subdivision 4, is <br/>
<a id="pl.2.24"></a><var>2.24</var>amended to read:<br/>
<a id="pl.2.25"></a><var>2.25</var>    Subd. 4. <b>Limitation of choice.</b> (a) The commissioner shall develop criteria to <br/>
<a id="pl.2.26"></a><var>2.26</var>determine when limitation of choice may be implemented in the experimental counties. <br/>
<a id="pl.2.27"></a><var>2.27</var>The criteria shall ensure that all eligible individuals in the county have continuing access <br/>
<a id="pl.2.28"></a><var>2.28</var>to the full range of medical assistance services as specified in subdivision 6.<br/>
<a id="pl.2.29"></a><var>2.29</var>    (b) The commissioner shall exempt the following persons from participation in the <br/>
<a id="pl.2.30"></a><var>2.30</var>project, in addition to those who do not meet the criteria for limitation of choice:<br/>
<a id="pl.2.31"></a><var>2.31</var>    (1) persons eligible for medical assistance according to section 
         <statute_ref>256B.055, <br/>
<a id="pl.2.32"></a><var>2.32</var>subdivision 1
         </statute_ref>;<br/>
<a id="pl.2.33"></a><var>2.33</var>    (2) persons eligible for medical assistance due to blindness or disability as <br/>
<a id="pl.2.34"></a><var>2.34</var>determined by the Social Security Administration or the state medical review team, unless:<br/>
<a id="pl.2.35"></a><var>2.35</var>    (i) they are 65 years of age or older; or<br/>
<a id="pl.3.1"></a><var>3.1</var>    (ii) they reside in Itasca County or they reside in a county in which the commissioner <br/>
<a id="pl.3.2"></a><var>3.2</var>conducts a pilot project under a waiver granted pursuant to section 1115 of the Social <br/>
<a id="pl.3.3"></a><var>3.3</var>Security Act;<br/>
<a id="pl.3.4"></a><var>3.4</var>    (3) recipients who currently have private coverage through a health maintenance <br/>
<a id="pl.3.5"></a><var>3.5</var>organization;<br/>
<a id="pl.3.6"></a><var>3.6</var>    (4) recipients who are eligible for medical assistance by spending down excess <br/>
<a id="pl.3.7"></a><var>3.7</var>income for medical expenses other than the nursing facility per diem expense;<br/>
<a id="pl.3.8"></a><var>3.8</var>    (5) recipients who receive benefits under the Refugee Assistance Program, <br/>
<a id="pl.3.9"></a><var>3.9</var>established under United States Code, title 8, section 1522(e);<br/>
<a id="pl.3.10"></a><var>3.10</var>    (6) children who are both determined to be severely emotionally disturbed and <br/>
<a id="pl.3.11"></a><var>3.11</var>receiving case management services according to section 
         <statute_ref>256B.0625, subdivision 20</statute_ref>, <br/>
<a id="pl.3.12"></a><var>3.12</var>except children who are eligible for and who decline enrollment in an approved preferred <br/>
<a id="pl.3.13"></a><var>3.13</var>integrated network under section 
         <statute_ref>245.4682</statute_ref>;<br/>
<a id="pl.3.14"></a><var>3.14</var>    (7) adults who are both determined to be seriously and persistently mentally ill and <br/>
<a id="pl.3.15"></a><var>3.15</var>received case management services according to section 
         <statute_ref>256B.0625, subdivision 20</statute_ref>;<br/>
<a id="pl.3.16"></a><var>3.16</var>    (8) persons eligible for medical assistance according to section 
         <statute_ref>256B.057, <br/>
<a id="pl.3.17"></a><var>3.17</var>subdivision 10
         </statute_ref>; and<br/>
<a id="pl.3.18"></a><var>3.18</var>    (9) persons with access to cost-effective employer-sponsored private health <br/>
<a id="pl.3.19"></a><var>3.19</var>insurance or persons enrolled in a non-Medicare individual health plan determined to be <br/>
<a id="pl.3.20"></a><var>3.20</var>cost-effective according to section 
         <statute_ref>256B.0625, subdivision 15</statute_ref>.<br/>
<a id="pl.3.21"></a><var>3.21</var>Children under age 21 who are in foster placement may enroll in the project on an elective <br/>
<a id="pl.3.22"></a><var>3.22</var>basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an <br/>
<a id="pl.3.23"></a><var>3.23</var>elective basis. The commissioner may enroll recipients in the prepaid medical assistance <br/>
<a id="pl.3.24"></a><var>3.24</var>program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by <br/>
<a id="pl.3.25"></a><var>3.25</var>spending down excess income.<br/>
<a id="pl.3.26"></a><var>3.26</var>    (c) The commissioner may allow persons with a one-month spenddown who are <br/>
<a id="pl.3.27"></a><var>3.27</var>otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay <br/>
<a id="pl.3.28"></a><var>3.28</var>their monthly spenddown to the state.<br/>
<a id="pl.3.29"></a><var>3.29</var>    (d) The commissioner may require those individuals to enroll in the prepaid medical <br/>
<a id="pl.3.30"></a><var>3.30</var>assistance program who otherwise would have been excluded under paragraph (b), clauses <br/>
<a id="pl.3.31"></a><var>3.31</var>(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.<br/>
<a id="pl.3.32"></a><var>3.32</var>    (e) Before limitation of choice is implemented, eligible individuals shall be notified <br/>
<a id="pl.3.33"></a><var>3.33</var>and after notification, shall be allowed to choose only among demonstration providers. <br/>
<a id="pl.3.34"></a><var>3.34</var>The commissioner may assign an individual with private coverage through a health <br/>
<a id="pl.3.35"></a><var>3.35</var>maintenance organization, to the same health maintenance organization for medical <br/>
<a id="pl.3.36"></a><var>3.36</var>assistance coverage, if the health maintenance organization is under contract for medical <br/>
<a id="pl.4.1"></a><var>4.1</var>assistance in the individual's county of residence. After initially choosing a provider, <br/>
<a id="pl.4.2"></a><var>4.2</var>the recipient is allowed to change that choice only at specified times as allowed by the <br/>
<a id="pl.4.3"></a><var>4.3</var>commissioner. If a demonstration provider ends participation in the project for any reason, <br/>
<a id="pl.4.4"></a><var>4.4</var>a recipient enrolled with that provider must select a new provider but may change providers <br/>
<a id="pl.4.5"></a><var>4.5</var>without cause once more within the first 60 days after enrollment with the second provider.<br/>
<a id="pl.4.6"></a><var>4.6</var>    (f) An infant born to a woman who is eligible for and receiving medical assistance <br/>
<a id="pl.4.7"></a><var>4.7</var>and who is enrolled in the prepaid medical assistance program shall be retroactively <br/>
<a id="pl.4.8"></a><var>4.8</var>enrolled to the month of birth in the same managed care plan as the mother once the <br/>
<a id="pl.4.9"></a><var>4.9</var>child is enrolled in medical assistance unless the child is determined to be excluded from <br/>
<a id="pl.4.10"></a><var>4.10</var>enrollment in a prepaid plan under this section.<br/>
<a id="pl.4.11"></a><var>4.11</var>    (g) For an eligible individual under the age of 65, in the absence of a specific <br/>
<a id="pl.4.12"></a><var>4.12</var>managed care plan choice by the individual, the commissioner shall assign the individual <br/>
<a id="pl.4.13"></a><var>4.13</var>to the county-based purchasing health plan in Olmsted, Winona, Houston, Fillmore, <br/>
<a id="pl.4.14"></a><var>4.14</var>and Mower Counties, if the individual resides in one of these counties. For an eligible <br/>
<a id="pl.4.15"></a><var>4.15</var>individual over the age of 65, the commissioner shall make this default assignment upon <br/>
<a id="pl.4.16"></a><var>4.16</var>the county-based purchasing plan entering into a contract with the commissioner to serve <br/>
<a id="pl.4.17"></a><var>4.17</var>this population and receiving federal approval as a special needs plan.<br/>
<br/>
<a id="bill.0.3.0"></a><a id="pl.4.18"></a><var>4.18</var>    Sec. 3. <b>STATEMENT OF COSTS; APPROPRIATION.</b><br/>
<a id="pl.4.19"></a><var>4.19</var>    By June 1, 2009, the commissioner of human services shall submit to Olmsted <br/>
<a id="pl.4.20"></a><var>4.20</var>County an itemized statement of costs incurred by the Department of Human Services for <br/>
<a id="pl.4.21"></a><var>4.21</var>necessary changes to the department's computer system to implement Minnesota Statutes, <br/>
<a id="pl.4.22"></a><var>4.22</var>section 256B.69, subdivision 4, paragraph (g), along with a bill for the amount of these <br/>
<a id="pl.4.23"></a><var>4.23</var>costs, up to $18,000. By June 30, 2009, Olmsted County must remit to the commissioner <br/>
<a id="pl.4.24"></a><var>4.24</var>the amount billed. The amount received by the commissioner must be deposited in the <br/>
<a id="pl.4.25"></a><var>4.25</var>state treasury and credited to a special account and is appropriated to the commissioner as <br/>
<a id="pl.4.26"></a><var>4.26</var>reimbursement for the costs billed.<br/>