HF 1346

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:48am

A bill for an act
relating to health; requiring the commissioners of health and human services
to develop and implement certification standards for obstetric health care
homes; requiring the commissioners to provide payments for the coordination of
obstetric services; authorizing rulemaking; amending Minnesota Statutes 2008,
sections 256B.0751, subdivisions 3, 7, by adding a subdivision; 256B.0752,
subdivision 2; 256B.0753, subdivisions 1, 2.

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

Section 1.

Minnesota Statutes 2008, section 256B.0751, is amended by adding a
subdivision to read:

new text begin Subd. 2a. new text end

new text begin Development and implementation of standards for obstetric health
care homes. new text end

new text begin (a) By July 1, 2010, the commissioners of health and human services shall
develop and implement standards of certification for obstetric health care homes for state
health care programs. The standards must be based on and compatible with the standards
for certification of health care homes developed under subdivision 2. In addition, the
standards developed by the commissioners must:
new text end

new text begin (1) encourage and remove barriers to the use of certified nurse midwives;
new text end

new text begin (2) require obstetric health care homes to establish package prices under section
62U.05, subdivision 2, for the obstetric basket of care defined by the commissioner under
section 62U.05, subdivision 1;
new text end

new text begin (3) encourage the use of birthing center units within, attached to, or within close
proximity to hospitals that provide obstetrical care; and
new text end

new text begin (4) require the coordination of care provided by obstetric health care homes with
care provided by other health care homes.
new text end

new text begin (b) In developing these standards, the commissioners shall consider existing
standards developed by national independent accrediting and medical home organizations,
and shall consult with national and local organizations working on obstetric health care
home models, physicians specializing in family practice, obstetrics, and maternal fetal
medicine, certified nurse midwives, licensed traditional midwives, relevant state agencies,
health plan companies, hospitals and other providers, and patients and patient advocates.
new text end

new text begin (c) For purposes of developing and implementing these standards, the commissioners
may use the expedited rulemaking process under section 14.389.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0751, subdivision 3, is amended to read:

Subd. 3.

Requirements for clinicians certified as health care homes.

(a) A
personal clinician or a primary care clinic may be certified as a health care home. If a
primary care clinic is certified, all of the primary care clinic's clinicians must meet the
criteria of a health care home. In order to be certified as a health care home, a clinician or
clinic must meet the standards set by the commissioners in accordance with this section.
Certification as a health care home is voluntary. In order to maintain their status as health
care homes, clinicians or clinics must renew their certification annually.

(b) Clinicians or clinics certified as health care homes must offer their health care
home services to all their patients with complex or chronic health conditions new text begin or who are
pregnant, new text end who are interested in participation.

(c) Health care homes must participate in the health care home collaborative
established under subdivision 5.

Sec. 3.

Minnesota Statutes 2008, section 256B.0751, subdivision 7, is amended to read:

Subd. 7.

Outreach.

Beginning July 1, 2009, the commissioner shall encourage state
health care program enrollees who have a complex or chronic condition new text begin , and by July 1,
2010, shall encourage state health care program enrollees who are pregnant, new text end to select a
primary care clinic with clinicians who have been certified as health care homes.

Sec. 4.

Minnesota Statutes 2008, section 256B.0752, subdivision 2, is amended to read:

Subd. 2.

Evaluation reports.

The commissioners shall provide to the legislature
comprehensive evaluations of the health care home model three years and five years after
implementation. The report must include:

(1) the number of state health care program enrollees in health care homes and the
number and characteristics of enrollees with complex or chronic conditions new text begin or who are
pregnant new text end , identified by income, race, ethnicity, and language;

(2) the number and geographic distribution of health care home providers;

(3) the performance and quality of care of health care homes;

(4) measures of preventive care;

(5) health care home payment arrangements, and costs related to implementation
and payment of care coordination fees;

(6) the estimated impact of health care homes on health disparities; and

(7) estimated savings from implementation of the health care home model for the
fee-for-service, managed care, and county-based purchasing sectors.

Sec. 5.

Minnesota Statutes 2008, section 256B.0753, subdivision 1, is amended to read:

Subdivision 1.

Development.

The commissioner of human services, in coordination
with the commissioner of health, shall develop a payment system that provides per-person
care coordination payments to health care homes certified under section 256B.0751 for
providing care coordination services and directly managing on-site or employing care
coordinators. The care coordination payments under this section are in addition to the
quality incentive payments in section 256B.0754, subdivision 1. The care coordination
payment system must vary the fees paid by thresholds of care complexity, with the
highest fees being paid for care provided to individuals requiring the most intensive care
coordination. In developing the criteria for care coordination payments, the commissioner
shall consider the feasibility of including the additional time and resources needed by
patients with limited English-language skills, cultural differences, or other barriers to
health care. The commissioner may determine a schedule for phasing in care coordination
fees such that the fees will be applied first to individuals who have, or are at risk of
developing, complex or chronic health conditions. Development of the payment system
must be completed by January 1, 2010 new text begin , except that development of care coordination
payments for care provided to pregnant women must be completed by January 1, 2011 new text end .

Sec. 6.

Minnesota Statutes 2008, section 256B.0753, subdivision 2, is amended to read:

Subd. 2.

Implementation.

The commissioner of human services shall implement
care coordination payments as specified under this section by July 1, 2010, or upon
federal approval, whichever is later new text begin , except that care coordination payments for care
provided to pregnant women must be implemented by July 1, 2011, or upon federal
approval, whichever is later new text end . For enrollees served under the fee-for-service system, the
care coordination payment shall be determined by the commissioner in contracts with
certified health care homes. For enrollees served by managed care or county-based
purchasing plans, the commissioner's contracts with these plans shall require the payment
of care coordination fees to certified health care homes.