1.1A bill for an act1.2relating to health and human services; establishing oversight for rural health 1.3cooperative; revising requirements for county-based purchasing for state health 1.4care programs; appropriating money;amending Minnesota Statutes 2007 1.5Supplement, section 256B.69, subdivision 4; proposing coding for new law 1.6in Minnesota Statutes, chapter 62R.1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:1.8    Section 1. [62R.09] RURAL HEALTH COOPERATIVE CONTRACT 1.9OVERSIGHT.1.10    Subdivision 1.Review and approval; monitoring.(a) The commissioner shall 1.11establish criteria and procedures to review and authorize contracts and business or 1.12financial arrangements under section 62R.06, subdivision 1. All contracts and business 1.13or financial arrangements must be submitted on an application for approval to the 1.14commissioner. The commissioner shall not deny any application unless the commissioner 1.15determines that the proposed arrangement is likely to result in higher health care costs 1.16or diminished access to or quality of health care than would occur in the competitive 1.17marketplace. The cost of developing the criteria and procedures, as determined by the 1.18commissioner and notwithstanding section 16A.1283, shall be paid by health provider 1.19cooperatives operating under this chapter.1.20    (b) Within 30 days after receiving an application, the commissioner may request 1.21additional information that is necessary to complete the review required under this section. 1.22If the commissioner does not request additional information and does not act within 60 1.23days after receipt of an application, the application shall be deemed approved if the 1.24commissioner does not act within 60 days of receiving the additional information.2.1    (c) The commissioner may condition approval of a proposed arrangement on a 2.2modification of all or part of the arrangement to eliminate any restriction on competition 2.3that is not reasonably related to the goals of improving health care access or quality. The 2.4commissioner may also establish conditions for approval that are reasonably necessary 2.5to protect against abuses of private economic power and to ensure that the arrangement 2.6has oversight by the state.2.7    (d) The commissioner shall monitor arrangements approved under this section 2.8to ensure that the arrangement remains in compliance with the conditions of approval. 2.9The commissioner may revoke an approval upon a finding that the arrangement is not in 2.10substantial compliance with the terms of the application or the conditions of approval.2.11    Subd. 2.Applications.Applications for approval under this section must describe 2.12the proposed arrangement in detail. The application must include: the identities of all the 2.13parties to the arrangement; the intent of the arrangement; the expected outcome of the 2.14arrangement; and an explanation of how the arrangement will improve access or quality 2.15of care. Data on providers collected under this section are private data on individuals or 2.16nonpublic data, as defined in section 13.02.2.17    Subd. 3.Application fee.When submitting an application to the commissioner, a 2.18health care cooperative shall pay a fee of $2,000 for the commissioner's cost of reviewing 2.19and monitoring the arrangement.2.20    Subd. 4.Appropriation.Money received by the commissioner under this section 2.21shall be deposited into a revolving fund and is appropriated to the commissioner of health 2.22for the purpose of administering this section.2.23    Sec. 2. Minnesota Statutes 2007 Supplement, section 256B.69, subdivision 4, is 2.24amended to read:2.25    Subd. 4. Limitation of choice. (a) The commissioner shall develop criteria to 2.26determine when limitation of choice may be implemented in the experimental counties. 2.27The criteria shall ensure that all eligible individuals in the county have continuing access 2.28to the full range of medical assistance services as specified in subdivision 6.2.29    (b) The commissioner shall exempt the following persons from participation in the 2.30project, in addition to those who do not meet the criteria for limitation of choice:2.31    (1) persons eligible for medical assistance according to section 
         256B.055, 2.32subdivision 1
         ;2.33    (2) persons eligible for medical assistance due to blindness or disability as 2.34determined by the Social Security Administration or the state medical review team, unless:2.35    (i) they are 65 years of age or older; or3.1    (ii) they reside in Itasca County or they reside in a county in which the commissioner 3.2conducts a pilot project under a waiver granted pursuant to section 1115 of the Social 3.3Security Act;3.4    (3) recipients who currently have private coverage through a health maintenance 3.5organization;3.6    (4) recipients who are eligible for medical assistance by spending down excess 3.7income for medical expenses other than the nursing facility per diem expense;3.8    (5) recipients who receive benefits under the Refugee Assistance Program, 3.9established under United States Code, title 8, section 1522(e);3.10    (6) children who are both determined to be severely emotionally disturbed and 3.11receiving case management services according to section 
         256B.0625, subdivision 20, 3.12except children who are eligible for and who decline enrollment in an approved preferred 3.13integrated network under section 
         245.4682;3.14    (7) adults who are both determined to be seriously and persistently mentally ill and 3.15received case management services according to section 
         256B.0625, subdivision 20;3.16    (8) persons eligible for medical assistance according to section 
         256B.057, 3.17subdivision 10
         ; and3.18    (9) persons with access to cost-effective employer-sponsored private health 3.19insurance or persons enrolled in a non-Medicare individual health plan determined to be 3.20cost-effective according to section 
         256B.0625, subdivision 15.3.21Children under age 21 who are in foster placement may enroll in the project on an elective 3.22basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an 3.23elective basis. The commissioner may enroll recipients in the prepaid medical assistance 3.24program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by 3.25spending down excess income.3.26    (c) The commissioner may allow persons with a one-month spenddown who are 3.27otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay 3.28their monthly spenddown to the state.3.29    (d) The commissioner may require those individuals to enroll in the prepaid medical 3.30assistance program who otherwise would have been excluded under paragraph (b), clauses 3.31(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.3.32    (e) Before limitation of choice is implemented, eligible individuals shall be notified 3.33and after notification, shall be allowed to choose only among demonstration providers. 3.34The commissioner may assign an individual with private coverage through a health 3.35maintenance organization, to the same health maintenance organization for medical 3.36assistance coverage, if the health maintenance organization is under contract for medical 4.1assistance in the individual's county of residence. After initially choosing a provider, 4.2the recipient is allowed to change that choice only at specified times as allowed by the 4.3commissioner. If a demonstration provider ends participation in the project for any reason, 4.4a recipient enrolled with that provider must select a new provider but may change providers 4.5without cause once more within the first 60 days after enrollment with the second provider.4.6    (f) An infant born to a woman who is eligible for and receiving medical assistance 4.7and who is enrolled in the prepaid medical assistance program shall be retroactively 4.8enrolled to the month of birth in the same managed care plan as the mother once the 4.9child is enrolled in medical assistance unless the child is determined to be excluded from 4.10enrollment in a prepaid plan under this section.4.11    (g) For an eligible individual under the age of 65, in the absence of a specific 4.12managed care plan choice by the individual, the commissioner shall assign the individual 4.13to the county-based purchasing health plan in Olmsted, Winona, Houston, Fillmore, 4.14and Mower Counties, if the individual resides in one of these counties. For an eligible 4.15individual over the age of 65, the commissioner shall make this default assignment upon 4.16the county-based purchasing plan entering into a contract with the commissioner to serve 4.17this population and receiving federal approval as a special needs plan.4.18    Sec. 3. STATEMENT OF COSTS; APPROPRIATION.4.19    By June 1, 2009, the commissioner of human services shall submit to Olmsted 4.20County an itemized statement of costs incurred by the Department of Human Services for 4.21necessary changes to the department's computer system to implement Minnesota Statutes, 4.22section 256B.69, subdivision 4, paragraph (g), along with a bill for the amount of these 4.23costs, up to $18,000. By June 30, 2009, Olmsted County must remit to the commissioner 4.24the amount billed. The amount received by the commissioner must be deposited in the 4.25state treasury and credited to a special account and is appropriated to the commissioner as 4.26reimbursement for the costs billed.