SF 2876

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/25/2025 09:35 a.m.

A bill for an act
relating to human services; establishing a coordinated services organization
demonstration project; appropriating money; proposing coding for new law in
Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.7705] COORDINATED SERVICES ORGANIZATION
DEMONSTRATION PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin The commissioner shall establish a demonstration project to
test a provider-led coordinated service model, implemented by disability services providers
for people with disabilities, that coordinates services across the continuum of covered
services under medical assistance and Medicare, addresses health-related social needs, and
prioritizes enrollee choice.
new text end

new text begin Subd. 2. new text end

new text begin Application. new text end

new text begin The commissioner shall develop a request for applications for
participation in the coordinated services organization demonstration project. In developing
the request for applications, the commissioner shall:
new text end

new text begin (1) identify, in consultation with interested parties, key indicators of well-being, quality,
access, satisfaction, and other performance indicators;
new text end

new text begin (2) identify, in consultation with interested parties, indicators for measuring cost savings;
new text end

new text begin (3) establish quality standards for the coordinated service organization that are appropriate
for the populations served;
new text end

new text begin (4) encourage the coordination of services across home and community-based services,
crisis services, primary care, dental care, and pharmacy;
new text end

new text begin (5) allow flexibility in the application evaluation methodology to encourage applicants
to propose innovation and disability services provider collaborations that may be customized
for the special needs and barriers of patient populations receiving home and community-based
waiver services and dual-eligible populations; and
new text end

new text begin (6) allow flexibility in the application evaluation methodology to facilitate the delivery
of eligibility and claims data to the coordinated services organization, including collaborating
on data use agreements with the Centers for Medicare & Medicaid Services for dual-eligible
Medicare claims and eligibility data.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible to participate in the coordinated services
organization demonstration project an applicant must demonstrate in its application that it
will:
new text end

new text begin (1) include providers of home and community-based services and long-term services
and supports;
new text end

new text begin (2) have partnership or joint venture arrangements between home and community-based
providers and health care providers;
new text end

new text begin (3) have partnership or joint venture agreements with managed care plans serving people
enrolled in special needs basic care programs to improve the coordination and integration
of medical, behavioral health, and long-term services and supports for enrollees served by
the coordinated services organization;
new text end

new text begin (4) have an established, nonprofit, shared governance structure;
new text end

new text begin (5) develop a process for enrollees to opt into the coordinated service organization and
establish a mechanism to monitor enrollment;
new text end

new text begin (6) establish a process to ensure the quality of care and services provided;
new text end

new text begin (7) have the capacity to provide care coordination and population health activities for
enrollees;
new text end

new text begin (8) have the capacity to provide community intervention programming, including
upstream early identification and enhanced care to reduce preventable emergency department
use, services to reduce avoidable hospitalization and readmission, transitions of care,
enhanced primary care, medication therapy management, in-home technology, and specialized
dental coordination and services;
new text end

new text begin (9) in cooperation with counties and community social service agencies, coordinate the
delivery of health care services with existing social services programs;
new text end

new text begin (10) have a mechanism to ensure compliance with conflict-free case management
requirements;
new text end

new text begin (11) have the ability to provide population health analysis, risk stratification, and quality
and performance reporting to its participating providers for the purposes of meeting cost
and quality measures; and
new text end

new text begin (12) adopt innovative and cost-effective methods of care delivery and coordination,
which may include the use of telehealth, care coordinators, community health workers, and
peer support.
new text end

new text begin (b) A successful applicant may contract with a third party, including for the administration
of a payment system using the payment methods established by the commissioner for
integrated health partnerships.
new text end

new text begin Subd. 4. new text end

new text begin Enrollment. new text end

new text begin (a) An individual is eligible to enroll with a coordinated services
organization if the individual is either dually eligible for medical assistance and Medicare
and eligible to receive waiver services under section 256B.49 or enrolled in medical
assistance special needs basic care and receiving waiver services under section 256B.49.
new text end

new text begin (b) An individual eligible under paragraph (a) may enroll in a coordinated services
organization if the organization and its participating providers serve the county in which
the eligible individual resides.
new text end

new text begin Subd. 5. new text end

new text begin Accountability. new text end

new text begin (a) A coordinated services organization must accept
responsibility for the quality of care and services based on standards established under
subdivision 2 and the cost of care or utilization of services provided to its enrollees.
Accountability standards must be appropriate to people with disabilities and specific
subpopulations served.
new text end

new text begin (b) A coordinated services organization must demonstrate to the commissioner how it
coordinates services affecting its enrollees' health, quality of care, and cost of care that are
provided by other providers, county agencies, and other organizations in the local service
area.
new text end

new text begin (c) After the expiration of an initial contract term under this section, the commissioner
may evaluate additional activities for inclusion in coordinated services organization contracts.
Additional activities the commissioner may include in the contract include but are not limited
to long-term care consultation services assessments under section 256B.0911, community
first services and supports consultative services under section 256B.85, waiver case
management under sections 256B.092 and 256B.49, and financial management services
under chapter 256B.
new text end

new text begin Subd. 6. new text end

new text begin Payments. new text end

new text begin (a) The commissioner shall establish a per member, per month
population-based payment that reflects the ongoing activities, scope, and metrics of the
coordinated services organization. The payment must be risk-adjusted to reflect varying
levels of care and case management intensiveness for enrollees with chronic conditions,
dependencies in activities of daily living, need for assistance due to behaviors, and other
factors that recognize the medical complexity of the populations served. The payment must
be paid at least on a quarterly basis.
new text end

new text begin (b) The commissioner shall collaborate with the coordinated services organization in
developing a total cost of care risk-gain sharing payment model.
new text end

new text begin (c) The commissioner may include in the payment system incentive payments to the
coordinated services organization that meet or exceed annual quality and performance targets
realized through the coordination of care.
new text end

new text begin (d) The population-based payment must not duplicate services under already existing
special need basic care coordination delegation agreements.
new text end

new text begin (e) The coordinated services organization must develop a value-based arrangement
between the parties participating in its approved demonstration project, including the
Department of Human Services, and establish a shared risk-savings distribution agreement
among parties.
new text end

new text begin (f) The commissioner must continue to pay providers participating in an approved
coordinated services organization demonstration project contractual or fee-for-service rates
for individual services covered by medical assistance.
new text end

new text begin (g) A coordinated services organization receiving this payment must continue to meet
cost and quality metrics under the program to maintain eligibility for the population-based
payment.
new text end

new text begin Subd. 7. new text end

new text begin Federal approval. new text end

new text begin The commissioner shall apply for any federal approval
required to implement this project and seek to maximize federal financial participation.
new text end

new text begin Subd. 8. new text end

new text begin Innovation grants. new text end

new text begin The commissioner shall, from within appropriations
available for this purpose, establish coordinated service organization innovation and
capacity-building grants. The commissioner shall award grants to assist approved coordinated
services organizations in covering initial start-up costs and maximizing the coordination
and integration of the organization and its partners.
new text end

Sec. 2. new text begin APPROPRIATION; COORDINATED SERVICE ORGANIZATION
INNOVATION AND CAPACITY-BUILDING GRANTS.
new text end

new text begin $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
fund to the commissioner of human services for coordinated service organization innovation
and capacity-building grants under Minnesota Statutes, section 256B.7705. The commissioner
must not award a grant exceeding $2,000,000 to a coordinated service organization during
the biennium.
new text end