1st Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to human services; authorizing a medical 1.3 assistance capitated payment option for waivered 1.4 services, day training and habilitation services, and 1.5 intermediate care facility services for persons with 1.6 mental retardation or a related condition; amending 1.7 Minnesota Statutes 2002, sections 252.46, by adding a 1.8 subdivision; 256B.69, subdivisions 6a, 23; proposing 1.9 coding for new law in Minnesota Statutes, chapter 256B. 1.10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.11 Section 1. Minnesota Statutes 2002, section 252.46, is 1.12 amended by adding a subdivision to read: 1.13 Subd. 21. [MANAGED CARE PILOT.] (a) The commissioner may 1.14 initiate a capitated risk-based managed care option for persons 1.15 with mental retardation or related conditions, which includes 1.16 capitated payments for day training and habilitation and 1.17 alternative active treatment services. The commissioner may 1.18 permit the health plan, care system, or other health plan 1.19 network participating in this managed care option to negotiate 1.20 day training and habilitation rates. The commissioner may grant 1.21 a variance to any of the provisions in sections 252.40 to 252.46 1.22 and Minnesota Rules, parts 9525.1200 to 9525.1580, necessary to 1.23 implement the pilot. 1.24 (b) The commissioner shall report to the legislature 1.25 financial and program results along with a recommendation as to 1.26 whether the pilot should be expanded. 1.27 Sec. 2. [256B.5016] [ICF/MR MANAGED CARE OPTION.] 2.1 Subdivision 1. [MANAGED CARE PILOT.] The commissioner may 2.2 initiate a capitated risk-based managed care option for services 2.3 in an intermediate care facility for persons with mental 2.4 retardation or related conditions according to the terms and 2.5 conditions of the federal agreement governing the managed care 2.6 pilot. The commissioner may grant a variance to any of the 2.7 provisions in sections 256B.501 to 256B.5015 and Minnesota 2.8 Rules, parts 9525.1200 to 9525.1330 and 9525.1580. 2.9 Subd. 2. [REPORT.] The commissioner shall report to the 2.10 legislature financial and program results along with a 2.11 recommendation as to whether the pilot should be expanded. 2.12 Sec. 3. Minnesota Statutes 2002, section 256B.69, 2.13 subdivision 6a, is amended to read: 2.14 Subd. 6a. [NURSING HOME SERVICES.] (a) Notwithstanding 2.15 Minnesota Rules, part 9500.1457, subpart 1, item B, up to 90 2.16 days of nursing facility services as defined in section 2.17 256B.0625, subdivision 2, which are provided in a nursing 2.18 facility certified by the Minnesota department of health for 2.19 services provided and eligible for payment under Medicaid, shall 2.20 be covered under the prepaid medical assistance program for 2.21 individuals who are not residing in a nursing facility at the 2.22 time of enrollment in the prepaid medical assistance program. 2.23 (b) For individuals enrolled in the Minnesota senior health 2.24 options project or in other demonstrations authorized under 2.25 subdivision 23, nursing facility services shall be covered 2.26 according to the terms and conditions of the federal agreement 2.27 governing that demonstration project. 2.28 (c) For individuals enrolled in demonstrations authorized 2.29 under subdivision 23, services in an intermediate care facility 2.30 for persons with mental retardation or related conditions shall 2.31 be covered according to the terms and conditions of the federal 2.32 agreement governing the demonstration project. 2.33 Sec. 4. Minnesota Statutes 2002, section 256B.69, 2.34 subdivision 23, is amended to read: 2.35 Subd. 23. [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 2.36 ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 3.1 implement demonstration projects to create alternative 3.2 integrated delivery systems for acute and long-term care 3.3 services to elderly persons and persons with disabilities as 3.4 defined in section 256B.77, subdivision 7a, that provide 3.5 increased coordination, improve access to quality services, and 3.6 mitigate future cost increases. The commissioner may seek 3.7 federal authority to combine Medicare and Medicaid capitation 3.8 payments for the purpose of such demonstrations. Medicare funds 3.9 and services shall be administered according to the terms and 3.10 conditions of the federal waiver and demonstration provisions. 3.11 For the purpose of administering medical assistance funds, 3.12 demonstrations under this subdivision are subject to 3.13 subdivisions 1 to 22. The provisions of Minnesota Rules, parts 3.14 9500.1450 to 9500.1464, apply to these demonstrations, with the 3.15 exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 3.16 subpart 1, items B and C, which do not apply to persons 3.17 enrolling in demonstrations under this section. An initial open 3.18 enrollment period may be provided. Persons who disenroll from 3.19 demonstrations under this subdivision remain subject to 3.20 Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is 3.21 enrolled in a health plan under these demonstrations and the 3.22 health plan's participation is subsequently terminated for any 3.23 reason, the person shall be provided an opportunity to select a 3.24 new health plan and shall have the right to change health plans 3.25 within the first 60 days of enrollment in the second health 3.26 plan. Persons required to participate in health plans under 3.27 this section who fail to make a choice of health plan shall not 3.28 be randomly assigned to health plans under these demonstrations. 3.29 Notwithstanding section 256L.12, subdivision 5, and Minnesota 3.30 Rules, part 9505.5220, subpart 1, item A, if adopted, for the 3.31 purpose of demonstrations under this subdivision, the 3.32 commissioner may contract with managed care organizations, 3.33 including counties, to serve only elderly persons eligible for 3.34 medical assistance, elderly and disabled persons, or disabled 3.35 persons only. For persons with primary diagnoses of mental 3.36 retardation or a related condition, serious and persistent 4.1 mental illness, or serious emotional disturbance, the 4.2 commissioner must ensure that the county authority has approved 4.3 the demonstration and contracting design. Enrollment in these 4.4 projects for persons with disabilities shall be voluntary. The 4.5 commissioner shall not implement any demonstration project under 4.6 this subdivision for persons with primary diagnoses of mental 4.7 retardation or a related condition, serious and persistent 4.8 mental illness, or serious emotional disturbance, without 4.9 approval of the county board of the county in which the 4.10 demonstration is being implemented. 4.11 (b) Notwithstanding chapter 245B, sections 252.40 to 4.12 252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 4.13 parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 4.14 and 9525.1800 to 9525.1930, the commissioner may implement under 4.15 this section projects for persons with developmental 4.16 disabilities. The commissioner may capitate payments for ICF/MR 4.17 services, waivered services for mental retardation or related 4.18 conditions, including case management services, day training and 4.19 habilitation and alternative active treatment services, and 4.20 other services as approved by the state and by the federal 4.21 government. Case management and active treatment must be 4.22 individualized and developed in accordance with a 4.23 person-centered plan. Costs under these projects may not exceed 4.24 costs that would have been incurred under fee-for-service. 4.25 Beginning July 1, 2003, and until two years after the pilot 4.26 project implementation date, subcontractor participation in the 4.27 long-term care developmental disability pilot is limited to a 4.28 nonprofit long-term care system providing ICF/MR services, home 4.29 and community-based waiver services, and in-home services to no 4.30 more than 120 consumers with developmental disabilities in 4.31 Carver, Hennepin, and Scott counties. The commissioner shall 4.32 report to the legislature prior to expansion of the 4.33 developmental disability pilot project. This paragraph expires 4.34 two years after the implementation date of the pilot project. 4.35 (c) Before implementation of a demonstration project for 4.36 disabled persons, the commissioner must provide information to 5.1 appropriate committees of the house of representatives and 5.2 senate and must involve representatives of affected disability 5.3 groups in the design of the demonstration projects. 5.4
(b)(d) A nursing facility reimbursed under the alternative 5.5 reimbursement methodology in section 256B.434 may, in 5.6 collaboration with a hospital, clinic, or other health care 5.7 entity provide services under paragraph (a). The commissioner 5.8 shall amend the state plan and seek any federal waivers 5.9 necessary to implement this paragraph. 5.10 Sec. 5. [NOTIFICATION.] 5.11 The commissioner of human services shall notify the revisor 5.12 of statutes of the implementation date of the pilot project 5.13 established under Minnesota Statutes, section 256B.69, 5.14 subdivision 23, paragraph (b).