HF 1642

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:53am

A bill for an act
relating to human services; establishing a medical assistance health opportunity
account demonstration project; requiring reports; 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.695] HEALTH OPPORTUNITY ACCOUNT
DEMONSTRATION.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner shall establish a five-year health
opportunity account demonstration project that meets the criteria specified in section 6082
of the Deficit Reduction Act of 2005, Public Law 109-171. In selecting demonstration
counties, the commissioner shall ensure geographic balance. Enrollment in the
demonstration project is voluntary. The commissioner shall implement the demonstration
project effective January 1, 2010, or upon federal approval, whichever is later.
new text end

new text begin Subd. 2. new text end

new text begin General criteria. new text end

new text begin (a) The demonstration project must provide participants
with alternative benefits, consisting of coverage of:
new text end

new text begin (1) all medical assistance services, after an annual deductible has been met; and
new text end

new text begin (2) contributions into a health opportunity account, which may be used to pay for
services subject to the deductible.
new text end

new text begin (b) The demonstration project must:
new text end

new text begin (1) create patient awareness of the high cost of medical care;
new text end

new text begin (2) provide incentives for patients to seek preventive health services;
new text end

new text begin (3) reduce the inappropriate use of health care services;
new text end

new text begin (4) enable patients to take responsibility for health care outcomes;
new text end

new text begin (5) provide enrollment counselors and ongoing education activities;
new text end

new text begin (6) require transactions involving health opportunity accounts to be conducted
electronically; and
new text end

new text begin (7) provide participants with access to negotiated provider payment rates.
new text end

new text begin Subd. 3. new text end

new text begin Eligible persons. new text end

new text begin (a) Participation in the demonstration project is limited
to families and children who are eligible for medical assistance under section 256B.055,
subdivisions 3, 3a, 9, 10, and 10b. Individuals who, at the time of application, are
disabled, age 65 or older, or pregnant, and others excluded under section 1938(b) of the
Social Security Act, are not eligible to participate in the demonstration project.
new text end

new text begin (b) Participation in the demonstration project is voluntary. Enrollment is effective
for a period of 12 months and may be extended for additional 12-month periods with
the consent of the individual. Enrollment in the demonstration project is subject to the
individual maintaining eligibility for medical assistance.
new text end

new text begin (c) An individual who, for any reason, is disenrolled from the demonstration project
shall not be permitted to re-enroll before the end of the one-year period that begins on the
effective date of disenrollment.
new text end

new text begin Subd. 4. new text end

new text begin Alternative benefits. new text end

new text begin (a) Participants in the demonstration project shall
receive the following alternative benefits:
new text end

new text begin (1) coverage for medical expenses for items and services for which benefits are
otherwise provided under medical assistance, after the annual deductible specified in
paragraph (b) has been met; and
new text end

new text begin (2) contributions into a health opportunity account.
new text end

new text begin (b) The amount of the annual deductible shall be 100 percent of the annualized
amount of contributions to the health opportunity account.
new text end

new text begin (c) The following services shall not be subject to the annual deductible: (1)
preventive services as specified by the commissioner; and (2) prescription drugs prescribed
for the treatment of diabetes, high blood pressure, high cholesterol, epilepsy, and other
health conditions as determined by the commissioner.
new text end

new text begin (d) After an individual has satisfied the annual deductible, alternative benefits for that
individual shall consist of the benefits that would otherwise be provided to that individual
under medical assistance had the individual not been enrolled in the demonstration project.
The individual shall be subject to all medical assistance cost-sharing requirements.
new text end

new text begin (e) Subject to any limitations under paragraph (f), each individual may obtain the
alternative benefits specified in paragraph (a), clause (1), from a managed care plan,
county-based purchasing plan, or other health plan company whose proposal to provide
the alternative benefits has been approved by the commissioner, and which has entered
into a contract with the commissioner to provide the alternative benefits. The per capita
payment to the managed care plan, county-based purchasing plan, or other health plan
company for the provision of the alternative benefits to the individual must not exceed
the per capita payment that would otherwise apply under the prepaid medical assistance
program, adjusted for the deductible and any differences in the use of health care services
by the population served under the demonstration project.
new text end

new text begin (f) The commissioner may contract directly with health care providers to provide the
alternative benefits specified in paragraph (a), clause (1), and purchase reinsurance for
the cost of providing these alternative benefits. If the commissioner chooses to contract
directly with health care providers, the commissioner is not required to, but still may,
contract with managed care plans, county-based purchasing plans, or other health plan
companies under paragraph (e).
new text end

new text begin Subd. 5. new text end

new text begin Contributions to and administration of health opportunity accounts.
new text end

new text begin (a) Contributions into a health opportunity account may be made by the state and by other
persons and entities, such as charitable organizations. The state shall contribute an annual
amount into the health opportunity account of each participating individual. For calendar
year 2009, the amount contributed by the state shall equal $1,150 for an individual and
$2,300 for a family. For future calendar years, these amounts must be increased by the
change in the medical component of the consumer price index for all urban consumers
(CPI-U).
new text end

new text begin (b) The commissioner shall contract with a third-party administrator to administer
health opportunity accounts. A managed care plan providing services under section
256B.69, a county-based purchasing plan providing services under section 256B.692, a
health plan company providing alternative services under this section, or the financial
institution under contract under paragraph (c), may not serve as a third-party administrator.
new text end

new text begin (c) The commissioner shall contract with a financial institution, as defined in
section 47.59, subdivision 1, paragraph (k), to establish health opportunity accounts for
demonstration project participants. The commissioner shall negotiate, as part of the
contract, the amount of any administrative fee to be paid by the financial institution to the
third-party administrator on behalf of demonstration project participants, and the interest
rate to be paid by the financial institution to demonstration project participants.
new text end

new text begin (d) Amounts in, or contributed to, a health opportunity account shall not be counted
as income or assets for purposes of determining medical assistance eligibility.
new text end

new text begin Subd. 6. new text end

new text begin Incentives for preventive care. new text end

new text begin The commissioner shall develop and
provide positive incentives for individuals enrolled in the demonstration project to
obtain appropriate preventive care. In developing these incentives, the commissioner
shall consider additional account contributions for individuals demonstrating healthy
prevention practices and shall also consider the provision of positive incentives for
accessing preventive services that are in addition to those available to medical assistance
enrollees not participating in the demonstration project.
new text end

new text begin Subd. 7. new text end

new text begin Use of money in the health opportunity account. new text end

new text begin (a) Except as provided
in subdivision 10, money in a health opportunity account may be used only for payment
for medical care, as defined in section 213(d) of the Internal Revenue Code of 1986.
new text end

new text begin (b) Money in a health opportunity account may not be used to pay providers for
items and services unless:
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new text begin (1) the providers are licensed or otherwise authorized under state law to provide
the item or service; and
new text end

new text begin (2) the provider meets medical assistance program quality standards and complies
with medical assistance prohibitions related to fraud and abuse.
new text end

new text begin (c) Money in a health opportunity account may not be used to pay a provider for an
item or service if the commissioner determines that the item or service is not medically
appropriate or necessary.
new text end

new text begin (d) The commissioner shall establish procedures to:
new text end

new text begin (1) penalize or disenroll from the demonstration project individuals who make
nonqualified withdrawals from a health opportunity account; and
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new text begin (2) recoup costs that derive from nonqualified withdrawals.
new text end

new text begin Subd. 8. new text end

new text begin Electronic transactions required. new text end

new text begin The commissioner shall require all
withdrawals and payments from health opportunity accounts to be made using electronic
debit cards. The debit card developed or selected for the demonstration project must
provide real-time, encounter level payment to health care providers. The debit card may:
new text end

new text begin (1) allow information from a patient's medical record to be stored and accessed by
the patient and health care providers; and
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new text begin (2) be capable of storing and transferring for analysis the encounter level data for
provider and enrollee-specific, and aggregate, health care quality measurement and
monitoring.
new text end

new text begin Subd. 9. new text end

new text begin Access to negotiated provider payment rates. new text end

new text begin The commissioner shall
require managed care plans and county-based purchasing plans to:
new text end

new text begin (1) allow demonstration project participants, when subject to a deductible, to obtain
services from providers under contract with the plan at the same payment rate that the
provider would otherwise receive from the plan had the individual not been participating
in the demonstration project; and
new text end

new text begin (2) allow demonstration project participants, when subject to a deductible, to obtain
services from providers who are not under contract with the plan and who voluntarily
choose to serve demonstration project participants, at payment rates that do not exceed
125 percent of the medical assistance fee-for-service payment rate.
new text end

new text begin Subd. 10. new text end

new text begin Maintenance of a health opportunity account for persons who become
ineligible; vesting. new text end

new text begin (a) If a participant becomes ineligible for medical assistance because
of an increase in income or assets:
new text end

new text begin (1) the state shall make no further contributions to the participant's health
opportunity account; and
new text end

new text begin (2) the balance in the account that is not attributable to private contributions shall
be reduced by 25 percent.
new text end

new text begin (b) Following application of paragraph (a), money in the account shall remain
available to the account holder for three years from the date on which the individual
became ineligible for medical assistance, under the same terms and conditions that would
apply had the individual remained eligible for the demonstration project, except that the
money may also be used as provided in paragraphs (c) and (d).
new text end

new text begin (c) Money in the account may be used to purchase health coverage from a health plan
company. Money used for this purpose must be transferred by the third-party administrator
directly from the account to the health plan company. An account holder is not required to
purchase a high-deductible policy as a condition for maintaining or using the account.
new text end

new text begin (d) Individuals who have participated in the demonstration project for at least one
year may also use money in the account for job training, educational expenses, and other
uses as specified by the commissioner, if:
new text end

new text begin (1) money in the account is transferred by the third-party administrator directly from
the account to the entity providing the service; and
new text end

new text begin (2) the entity providing the service has been approved by the commissioner.
new text end

new text begin Subd. 11. new text end

new text begin Participation of enrollees served by managed care and county-based
purchasing. new text end

new text begin (a) Participation in the demonstration project by enrollees served by managed
care and county-based purchasing plans under sections 256B.69 and 256B.692 is subject
to the following conditions:
new text end

new text begin (1) the number of individuals enrolled in a specific plan who participate in the
demonstration project must not exceed five percent of the total statewide medical
assistance enrollment in the plan; and
new text end

new text begin (2) the proportion of medical assistance enrollees in a specific plan who participate
in the demonstration project must not be significantly disproportionate to the proportion of
medical assistance enrollees in other plans who participate.
new text end

new text begin (b) The commissioner shall adjust capitation payment rates and application of the
risk adjustment system under section 62Q.03 to reflect differences in the likely use of
health care services between plan enrollees who participate in the demonstration project
and plan enrollees who do not participate in the demonstration project.
new text end

new text begin (c) The commissioner, in consultation with managed care and county-based
purchasing plans, shall develop procedures to encourage demonstration project
participants with complex or chronic conditions to receive health care services from
providers certified as health care homes under section 256B.0751.
new text end

new text begin Subd. 12. new text end

new text begin Additional duties of commissioner. new text end

new text begin (a) The commissioner shall provide
enrollment counselors and ongoing education for demonstration project participants.
The counseling and education must be designed to meet the project goals specified
in subdivision 2, clauses (1) to (4), provide participants with assistance in the use of
electronic debit cards and in accessing providers and obtaining negotiated provider
payment rates, and provide participants with information on the benefits of maintaining
continuity of care by receiving services through the same health care provider both prior
to and after meeting the required deductible.
new text end

new text begin (b) The commissioner shall make the services of the office of ombudsman for state
managed care programs available to demonstration project participants and shall require
the office to address access, service, and billing problems related to the provision of
alternative benefits under subdivision 4.
new text end

new text begin (c) The commissioner shall implement a streamlined medical assistance renewal
process for demonstration project participants. This process must include:
new text end

new text begin (1) requiring eligibility renewals every 12 months;
new text end

new text begin (2) allowing passive renewal, under which individuals receive from the
commissioner a completed renewal form; and
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new text begin (3) providing to the commissioner updated information or a signed statement
attesting that the individual's eligibility information has not changed.
new text end

new text begin (d) The commissioner shall request, and may approve, proposals from managed care
plans, county-based purchasing plans, and other health plan companies, as defined in
section 62Q.01, subdivision 4, to provide the alternative benefits specified in subdivision
4, paragraph (a), clause (1).
new text end

new text begin (e) The commissioner shall present annual progress reports on the demonstration
project to the legislature, beginning October 1, 2010, and each October 1 thereafter through
October 1, 2014. The commissioner shall include in the progress reports recommendations
for any state law changes necessary to improve operation of the demonstration project
or to comply with federal requirements. The commissioner shall include, in the report
due October 1, 2013, recommendations on whether the demonstration project should be
continued and expanded to include additional participants.
new text end

new text begin Subd. 13. new text end

new text begin Federal approval. new text end

new text begin The commissioner shall seek all federal approvals
necessary to establish and implement the health opportunity demonstration project as
required under this section.
new text end