HF 2334

1st Engrossment - 91st Legislature (2019 - 2020) Posted on 07/09/2019 01:28pm

A bill for an act
relating to human services; modifying policy provisions governing health care;
amending Minnesota Statutes 2018, sections 62U.03; 62U.04, subdivision 11;
256.01, subdivision 29; 256B.04, subdivision 21; 256B.056, subdivisions 1a, 4,
7, 7a, 10; 256B.0561, subdivision 2; 256B.057, subdivision 1; 256B.0575,
subdivision 2; 256B.0625, subdivisions 1, 27; 256B.0751; 256B.0753, subdivision
1, by adding a subdivision; 256B.75; 256L.03, subdivision 1; 256L.15, subdivision
1; repealing Minnesota Statutes 2018, sections 62U.15, subdivision 2; 256B.057,
subdivision 8; 256B.0752; 256B.79, subdivision 7; 256L.04, subdivision 13.

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

Section 1.

Minnesota Statutes 2018, section 62U.03, is amended to read:

62U.03 PAYMENT RESTRUCTURING; CARE COORDINATION PAYMENTS.

(a) By January 1, 2010, health plan companies shall include health care homes in their
provider networks and by July 1, 2010, shall pay a care coordination fee for their members
who choose to enroll in health care homes certified by the deleted text begin commissioners of health and
human services deleted text end new text begin commissioner new text end under section 256B.0751. Health plan companies shall develop
payment conditions and terms for the care coordination fee for health care homes participating
in their network in a manner that is consistent with the system developed under section
256B.0753. Nothing in this section shall restrict the ability of health plan companies to
selectively contract with health care providers, including health care homes. Health plan
companies may reduce or reallocate payments to other providers to ensure that
implementation of care coordination payments is cost neutral.

(b) By July 1, 2010, the commissioner of management and budget shall implement the
care coordination payments for participants in the state employee group insurance program.
The commissioner of management and budget may reallocate payments within the health
care system in order to ensure that the implementation of this section is cost neutral.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62U.04, subdivision 11, is amended to read:

Subd. 11.

Restricted uses of the all-payer claims data.

(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:

(1) to evaluate the performance of the health care home program as authorized under
deleted text begin sections deleted text end new text begin section new text end 256B.0751, subdivision 6 deleted text begin , and 256B.0752, subdivision 2 deleted text end ;

(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;

(ii) not identify individual patients, payers, or providers;

(iii) be updated by the commissioner, at least annually, with the most current data
available;

(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and

(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.

(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.

(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.

(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.

(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256.01, subdivision 29, is amended to read:

Subd. 29.

State medical review team.

(a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under sections
256B.055, deleted text begin subdivision deleted text end new text begin subdivisions new text end 7, paragraph (b), new text begin and 12; and new text end 256B.057, subdivision 9,
deleted text begin and 256B.055, subdivision 12, deleted text end the commissioner shall review all medical evidence deleted text begin submitted
by county agencies with a referral deleted text end and seek deleted text begin additional deleted text end information from providers, applicants,
and enrollees to support the determination of disability where necessary. Disability shall
be determined according to the rules of title XVI and title XIX of the Social Security Act
and pertinent rules and policies of the Social Security Administration.

(b) Prior to a denial or withdrawal of a requested determination of disability due to
insufficient evidence, the commissioner shall (1) ensure that the missing evidence is necessary
and appropriate to a determination of disability, and (2) assist applicants and enrollees to
obtain the evidence, including, but not limited to, medical examinations and electronic
medical records.

(c) The commissioner shall provide the chairs of the legislative committees with
jurisdiction over health and human services finance and budget the following information
on the activities of the state medical review team by February 1 of each year:

(1) the number of applications to the state medical review team that were denied,
approved, or withdrawn;

(2) the average length of time from receipt of the application to a decision;

(3) the number of appeals, appeal results, and the length of time taken from the date the
person involved requested an appeal for a written decision to be made on each appeal;

(4) for applicants, their age, health coverage at the time of application, hospitalization
history within three months of application, and whether an application for Social Security
or Supplemental Security Income benefits is pending; and

(5) specific information on the medical certification, licensure, or other credentials of
the person or persons performing the medical review determinations and length of time in
that position.

(d) Any appeal made under section 256.045, subdivision 3, of a disability determination
made by the state medical review team must be decided according to the timelines under
section 256.0451, subdivision 22, paragraph (a). If a written decision is not issued within
the timelines under section 256.0451, subdivision 22, paragraph (a), the appeal must be
immediately reviewed by the chief human services judge.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Minnesota Statutes 2018, section 256B.04, subdivision 21, is amended to read:

Subd. 21.

Provider enrollment.

(a) If the commissioner or the Centers for Medicare
and Medicaid Services determines that a provider is designated "high-risk," the commissioner
may withhold payment from providers within that category upon initial enrollment for a
90-day period. The withholding for each provider must begin on the date of the first
submission of a claim.

(b) An enrolled provider that is also licensed by the commissioner under chapter 245A,
or is licensed as a home care provider by the Department of Health under chapter 144A and
has a home and community-based services designation on the home care license under
section 144A.484, must designate an individual as the entity's compliance officer. The
compliance officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;

(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

(c) The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.

(d) The commissioner shall terminate or deny the enrollment of any individual or entity
if the individual or entity has been terminated from participation in Medicare or under the
Medicaid program or Children's Health Insurance Program of any other state. new text begin The
commissioner may exempt a rehabilitation agency from termination or denial that would
otherwise be required under this paragraph, if the rehabilitation agency:
new text end

new text begin (1) is unable to retain Medicare certification and enrollment solely due to a lack of billing
to the Medicare program;
new text end

new text begin (2) meets all other applicable Medicare certification requirements based on an on-site
review completed by the commissioner of health; and
new text end

new text begin (3) serves primarily a pediatric population.
new text end

(e) As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

(f) As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.

(g)(1) Upon initial enrollment, reenrollment, and notification of revalidation, all durable
medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.

(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.

(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.

(h) The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph (a) and as
per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an
amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.056, subdivision 1a, is amended to read:

Subd. 1a.

Income and assets generally.

(a)(1) Unless specifically required by state law
or rule or federal law or regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons whose eligibility category is based
on blindness, disability, or age of 65 or more years, the methodologies for the Supplemental
Security Income program shall be used, except as provided under subdivision 3, paragraph
(a), clause (6).

(2) Increases in benefits under title II of the Social Security Act shall not be counted as
income for purposes of this subdivision until July 1 of each year. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments made
by an obligor in satisfaction of or in addition to a temporary or permanent order for child
support, and Social Security payments are not counted as income.

(b)(1) The modified adjusted gross income methodology as defined in deleted text begin the Affordable
Care Act deleted text end new text begin United States Code, title 42, section 1396a(e)(14), new text end shall be used for eligibility
categories based on:

(i) children under age 19 and their parents and relative caretakers as defined in section
256B.055, subdivision 3a;

(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;

(iii) pregnant women as defined in section 256B.055, subdivision 6;

(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057, subdivision
deleted text begin 8 deleted text end new text begin 1 new text end ; and

(v) adults without children as defined in section 256B.055, subdivision 15.

For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.

(2) For individuals whose income eligibility is determined using the modified adjusted
gross income methodology in clause (1) deleted text begin , deleted text end new text begin :
new text end

new text begin (i) new text end the commissioner shall subtract from the individual's modified adjusted gross income
an amount equivalent to five percent of the federal poverty guidelines deleted text begin . deleted text end new text begin ; and
new text end

new text begin (ii) the individual's current monthly income and household size is used to determine
eligibility for the 12-month eligibility period. If an individual's income is expected to vary
month to month, eligibility is determined based on the income predicted for the 12-month
eligibility period.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2018, section 256B.056, subdivision 4, is amended to read:

Subd. 4.

Income.

(a) To be eligible for medical assistance, a person eligible under section
256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of the federal
poverty guidelines. Effective January 1, 2000, and each successive January, recipients of
Supplemental Security Income may have an income up to the Supplemental Security Income
standard in effect on that date.

(b) deleted text begin Effective January 1, 2014, deleted text end To be eligible for medical assistance deleted text begin , deleted text end under section
256B.055, subdivision 3a, a parent or caretaker relative may have an income up to 133
percent of the federal poverty guidelines for the household size.

(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.

(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.

(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size deleted text begin or an equivalent standard when converted using modified adjusted gross
income methodology as required under the Affordable Care Act. Children who are enrolled
in medical assistance as of December 31, 2013, and are determined ineligible for medical
assistance because of the elimination of income disregards under modified adjusted gross
income methodology as defined in subdivision 1a remain eligible for medical assistance
under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law
111-3, until the date of their next regularly scheduled eligibility redetermination as required
in subdivision 7a deleted text end .

(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 7.

Minnesota Statutes 2018, section 256B.056, subdivision 7, is amended to read:

Subd. 7.

Period of eligibility.

new text begin (a) new text end Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.

new text begin (b) For a person eligible for an insurance affordability program who reports a change
that makes the person eligible for medical assistance, eligibility is available for the month
the change was reported and for three months prior to the month the change was reported,
if the person was eligible in those prior months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.056, subdivision 7a, is amended to read:

Subd. 7a.

Periodic renewal of eligibility.

(a) The commissioner shall make an annual
redetermination of eligibility based on information contained in the enrollee's case file and
other information available to the agency, including but not limited to information accessed
through an electronic database, without requiring the enrollee to submit any information
when sufficient data is available for the agency to renew eligibility.

(b) If the commissioner cannot renew eligibility in accordance with paragraph (a), the
commissioner must provide the enrollee with a prepopulated renewal form containing
eligibility information available to the agency and permit the enrollee to submit the form
with any corrections or additional information to the agency and sign the renewal form via
any of the modes of submission specified in section 256B.04, subdivision 18.

(c) An enrollee who is terminated for failure to complete the renewal process may
subsequently submit the renewal form and required information within four months after
the date of termination and have coverage reinstated without a lapse, if otherwise eligible
under this chapter.

(d) Notwithstanding paragraph (a), deleted text begin individuals deleted text end new text begin a person who is new text end eligible under subdivision
5 shall be deleted text begin required to renew eligibility deleted text end new text begin subject to a review of the person's income new text end every six
months.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 9.

Minnesota Statutes 2018, section 256B.056, subdivision 10, is amended to read:

Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the 60-day
postpartum period to update their income and asset information and to submit any required
income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph deleted text begin (b) deleted text end new text begin (c) new text end , and shall pay for private-sector coverage if this
is determined to be cost-effective.

(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.

(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.

new text begin (e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to identify unreported accounts as required in section
256.01, subdivision 18f. If a person refuses or revokes the authorization, the commissioner
may determine that the applicant or recipient is ineligible for medical assistance. For purposes
of this paragraph, an authorization to identify unreported accounts meets the requirements
of the Right to Financial Privacy Act, United States Code, title 12, chapter 35, and need not
be furnished to the financial institution.
new text end

new text begin (f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon implementation of Minnesota
Statutes, section 256.01, subdivision 18f. The commissioner of human services shall notify
the revisor of statutes when this section is effective.
new text end

Sec. 10.

Minnesota Statutes 2018, section 256B.0561, subdivision 2, is amended to read:

Subd. 2.

Periodic data matching.

(a) deleted text begin Beginning April 1, 2018, deleted text end The commissioner shall
conduct periodic data matching to identify recipients who, based on available electronic
data, may not meet eligibility criteria for the public health care program in which the recipient
is enrolled. The commissioner shall conduct data matching for medical assistance or
MinnesotaCare recipients at least once during a recipient's 12-month period of eligibility.

(b) If data matching indicates a recipient may no longer qualify for medical assistance
or MinnesotaCare, the commissioner must notify the recipient and allow the recipient no
more than 30 days to confirm the information obtained through the periodic data matching
or provide a reasonable explanation for the discrepancy to the state or county agency directly
responsible for the recipient's case. If a recipient does not respond within the advance notice
period or does not respond with information that demonstrates eligibility or provides a
reasonable explanation for the discrepancy within the 30-day time period, the commissioner
shall terminate the recipient's eligibility in the manner provided for by the laws and
regulations governing the health care program for which the recipient has been identified
as being ineligible.

(c) The commissioner shall not terminate eligibility for a recipient who is cooperating
with the requirements of paragraph (b) and needs additional time to provide information in
response to the notification.

new text begin (d) A recipient whose eligibility was terminated according to paragraph (b) may be
eligible for medical assistance no earlier than the first day of the month in which the recipient
provides information that demonstrates the recipient's eligibility.
new text end

deleted text begin (d) deleted text end new text begin (e) new text end Any termination of eligibility for benefits under this section may be appealed as
provided for in sections 256.045 to 256.0451, and the laws governing the health care
programs for which eligibility is terminated.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 11.

Minnesota Statutes 2018, section 256B.057, subdivision 1, is amended to read:

Subdivision 1.

Infants and pregnant women.

(a) An infant less than two years of age
deleted text begin or a pregnant woman deleted text end is eligible for medical assistance if the deleted text begin individual's deleted text end new text begin infant's new text end countable
household income is equal to or less than deleted text begin 275 deleted text end new text begin 283 new text end percent of the federal poverty guideline
for the same household size deleted text begin or an equivalent standard when converted using modified
adjusted gross income methodology as required under the Affordable Care Act deleted text end . new text begin Medical
assistance for an uninsured infant younger than two years of age may be paid with federal
funds available under title XXI of the Social Security Act and the state children's health
insurance program, for an infant with countable income above 275 percent and equal to or
less than 283 percent of the federal poverty guideline for the household size.
new text end

new text begin (b) A pregnant woman is eligible for medical assistance if the woman's countable income
is equal to or less than 278 percent of the federal poverty guideline for the applicable
household size.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end An infant born to a woman who was eligible for and receiving medical assistance
on the date of the child's birth shall continue to be eligible for medical assistance without
redetermination until the child's first birthday.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 12.

Minnesota Statutes 2018, section 256B.0575, subdivision 2, is amended to read:

Subd. 2.

Reasonable expenses.

For the purposes of subdivision 1, paragraph (a), clause
(9), reasonable expenses are limited to expenses that have not been previously used as a
deduction from income and were not:

(1) for long-term care expenses incurred during a period of ineligibility as defined in
section 256B.0595, subdivision 2;

(2) incurred more than three months before the month of application associated with the
current period of eligibility;

(3) for expenses incurred by a recipient that are duplicative of services that are covered
under chapter 256B; deleted text begin or
deleted text end

(4) nursing facility expenses incurred without a timely assessment as required under
section 256B.0911 deleted text begin . deleted text end new text begin ; or
new text end

new text begin (5) for private room fees incurred by an assisted living client as defined in section
144G.01, subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 13.

Minnesota Statutes 2018, section 256B.0625, subdivision 1, is amended to read:

Subdivision 1.

Inpatient hospital services.

(a) Medical assistance covers inpatient
hospital services new text begin performed by hospitals holding Medicare certifications for the services
performed new text end . deleted text begin A second medical opinion is required prior to reimbursement for elective surgeries
requiring a second opinion. The commissioner shall publish in the State Register a list of
elective surgeries that require a second medical opinion prior to reimbursement, and the
criteria and standards for deciding whether an elective surgery should require a second
medical opinion. The list and the criteria and standards are not subject to the requirements
of sections 14.001 to 14.69. The commissioner's decision whether a second medical opinion
is required, made in accordance with rules governing that decision, is not subject to
administrative appeal.
deleted text end

(b) When determining medical necessity for inpatient hospital services, the medical
review agent shall follow industry standard medical necessity criteria in determining the
following:

(1) whether a recipient's admission is medically necessary;

(2) whether the inpatient hospital services provided to the recipient were medically
necessary;

(3) whether the recipient's continued stay was or will be medically necessary; and

(4) whether all medically necessary inpatient hospital services were provided to the
recipient.

The medical review agent will determine medical necessity of inpatient hospital services,
including inpatient psychiatric treatment, based on a review of the patient's medical condition
and records, in conjunction with industry standard evidence-based criteria to ensure consistent
and optimal application of medical appropriateness criteria.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 14.

Minnesota Statutes 2018, section 256B.0625, subdivision 27, is amended to read:

Subd. 27.

Organ and tissue transplants.

deleted text begin All organ transplants must be performed at
transplant centers meeting united network for organ sharing criteria or at Medicare-approved
organ transplant centers. deleted text end new text begin Organ and tissue transplants are a covered service. new text end Stem cell or
bone marrow transplant centers must meet the standards established by the Foundation for
the Accreditation of Hematopoietic Cell Therapy.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 15.

Minnesota Statutes 2018, section 256B.0751, is amended to read:

256B.0751 HEALTH CARE HOMES.

Subdivision 1.

Definitions.

(a) For purposes of deleted text begin sections deleted text end new text begin section new text end 256B.0751 deleted text begin to 256B.0753 deleted text end ,
the following definitions apply.

(b) "Commissioner" means the commissioner of deleted text begin human services deleted text end new text begin health new text end .

deleted text begin (c) "Commissioners" means the commissioner of human services and the commissioner
of health, acting jointly.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end "Health plan company" has the meaning provided in section 62Q.01, subdivision
4.

deleted text begin (e) deleted text end new text begin (d) new text end "Personal clinician" means a physician licensed under chapter 147, a physician
assistant licensed and practicing under chapter 147A, or an advanced practice nurse licensed
and registered to practice under chapter 148.

deleted text begin (f) "State health care program" means the medical assistance and MinnesotaCare
programs.
deleted text end

Subd. 2.

Development and implementation of standards.

(a) deleted text begin By July 1, 2009, deleted text end The
deleted text begin commissioners deleted text end new text begin commissioner new text end of health deleted text begin and human services deleted text end shall develop and implement
standards of certification for health care homes deleted text begin for state health care programs deleted text end . In developing
these standards, the deleted text begin commissioners deleted text end new text begin commissioner new text end shall consider existing standards developed
by national independent accrediting and medical home organizations. The standards
developed by the deleted text begin commissioners deleted text end new text begin commissioner new text end must meet the following criteria:

(1) emphasize, enhance, and encourage the use of primary care, and include the use of
primary care physicians, advanced practice nurses, and physician assistants as personal
clinicians;

(2) focus on delivering high-quality, efficient, and effective health care services;

(3) encourage patient-centered care, including active participation by the patient and
family or a legal guardian, or a health care agent as defined in chapter 145C, as appropriate
in decision making and care plan development, and providing care that is appropriate to the
patient's race, ethnicity, and language;

(4) provide patients with a consistent, ongoing contact with a personal clinician or team
of clinical professionals to ensure continuous and appropriate care for the patient's condition;

(5) ensure that health care homes develop and maintain appropriate comprehensive care
plans for their patients with complex or chronic conditions, including an assessment of
health risks and chronic conditions;

(6) enable and encourage utilization of a range of qualified health care professionals,
including dedicated care coordinators, in a manner that enables providers to practice to the
fullest extent of their license;

(7) focus initially on patients who have or are at risk of developing chronic health
conditions;

(8) incorporate measures of quality, resource use, cost of care, and patient experience;

(9) ensure the use of health information technology and systematic follow-up, including
the use of patient registries; and

(10) encourage the use of scientifically based health care, patient decision-making aids
that provide patients with information about treatment options and their associated benefits,
risks, costs, and comparative outcomes, and other clinical decision support tools.

(b) In developing these standards, the deleted text begin commissioners deleted text end new text begin commissioner new text end shall consult with
national and local organizations working on health care home models, physicians, relevant
state agencies, health plan companies, hospitals, other providers, patients, and patient
advocates. deleted text begin The commissioners may satisfy this requirement by continuing the provider
directed care coordination advisory committee.
deleted text end

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

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 deleted text begin commissioners deleted text end new text begin commissioner new text end 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 every three years.

(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 who are interested
in participation.

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

Subd. 4.

Alternative models and waivers of requirements.

(a) Nothing in this section
shall preclude the continued development of existing medical or health care home projects
currently operating or under development by the commissioner of human services or preclude
the commissioner new text begin of human services new text end from establishing alternative models and payment
mechanisms for persons who are enrolled in integrated Medicare and Medicaid programs
under section 256B.69, subdivisions 23 and 28, are enrolled in managed care long-term
care programs under section 256B.69, subdivision 6b, are dually eligible for Medicare and
medical assistance, are in the waiting period for Medicare, or who have other primary
coverage.

(b) The commissioner deleted text begin of health deleted text end shall waive health care home certification requirements
if an applicant demonstrates that compliance with a certification requirement will create a
major financial hardship or is not feasible, and the applicant establishes an alternative way
to accomplish the objectives of the certification requirement.

Subd. 5.

Health care home collaborative.

deleted text begin By July 1, 2009, deleted text end The deleted text begin commissioners deleted text end new text begin
commissioner new text end shall establish a health care home collaborative to provide an opportunity for
health care homes and state agencies to exchange information related to quality improvement
and best practices.

Subd. 6.

Evaluation and continued development.

(a) For continued certification under
this section, health care homes must meet process, outcome, and quality standards as
developed and specified by the deleted text begin commissioners deleted text end new text begin commissioner new text end . The deleted text begin commissioners deleted text end new text begin
commissioner new text end shall collect data from health care homes necessary for monitoring compliance
with certification standards and for evaluating the impact of health care homes on health
care quality, cost, and outcomes.

(b) The deleted text begin commissioners deleted text end new text begin commissioner new text end may contract with a private entity to perform an
evaluation of the effectiveness of health care homes. Data collected under this subdivision
is classified as nonpublic data under chapter 13.

Subd. 7.

Outreach.

deleted text begin Beginning July 1, 2009, deleted text end The commissioner new text begin of human services new text end shall
encourage state health care program enrollees who have a complex or chronic condition to
select a primary care clinic with clinicians who have been certified as health care homes.

Subd. 8.

Coordination with local services.

The health care home and the county shall
coordinate care and services provided to patients enrolled with a health care home who have
complex medical needs or a disability, and who need and are eligible for additional local
services administered by counties, including but not limited to waivered services, mental
health services, social services, public health services, transportation, and housing. The
coordination of care and services must be as provided in the plan established by the patient
and new text begin the new text end health care home.

Subd. 9.

Pediatric care coordination.

The commissioner new text begin of human services new text end shall
implement a pediatric care coordination service for children with high-cost medical or
high-cost psychiatric conditions who are at risk of recurrent hospitalization or emergency
room use for acute, chronic, or psychiatric illness, who receive medical assistance services.
Care coordination services must be targeted to children not already receiving care
coordination through another service and may include but are not limited to the provision
of health care home services to children admitted to hospitals that do not currently provide
care coordination. Care coordination services must be provided by care coordinators who
are directly linked to provider teams in the care delivery setting, but who may be part of a
community care team shared by multiple primary care providers or practices. For purposes
of this subdivision, the commissioner new text begin of human services new text end shall, to the extent possible, use
the existing health care home certification and payment structure established under this
section and section 256B.0753.

Subd. 10.

Health care homes advisory committee.

(a) The deleted text begin commissioners of health
and human services deleted text end new text begin commissioner new text end shall establish a health care homes advisory committee
to advise the deleted text begin commissioners deleted text end new text begin commissioner new text end on the ongoing statewide implementation of the
health care homes program authorized in this section.

(b) The deleted text begin commissioners deleted text end new text begin commissioner new text end shall establish an advisory committee that includes
representatives of the health care professions such as primary care providers; mental health
providers; nursing and care coordinators; certified health care home clinics with statewide
representation; health plan companies; state agencies; employers; academic researchers;
consumers; and organizations that work to improve health care quality in Minnesota. At
least 25 percent of the committee members must be consumers or patients in health care
homes. The deleted text begin commissioners deleted text end new text begin commissioner new text end , in making appointments to the committee, shall
ensure geographic representation of all regions of the state.

(c) The advisory committee shall advise the deleted text begin commissioners deleted text end new text begin commissioner new text end on ongoing
implementation of the health care homes program, including, but not limited to, the following
activities:

(1) implementation of certified health care homes across the state on performance
management and implementation of benchmarking;

(2) implementation of modifications to the health care homes program based on results
of the legislatively mandated health care homes evaluation;

(3) statewide solutions for engagement of employers and commercial payers;

(4) potential modifications of the health care homes rules or statutes;

(5) consumer engagement, including patient and family-centered care, patient activation
in health care, and shared decision making;

(6) oversight for health care homes subject matter task forces or workgroups; and

(7) other related issues as requested by the deleted text begin commissioners deleted text end new text begin commissioner new text end .

(d) The advisory committee shall have the ability to establish subcommittees on specific
topics. The advisory committee is governed by section 15.059. Notwithstanding section
15.059, the advisory committee does not expire.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 16.

Minnesota Statutes 2018, 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. deleted text begin Development of the payment system must be completed by
January 1, 2010.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 17.

Minnesota Statutes 2018, section 256B.0753, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Definitions. new text end

new text begin For the purposes of this section, the definitions in section
256B.0751, subdivision 1, apply.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 18.

Minnesota Statutes 2018, section 256B.75, is amended to read:

256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.

(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.

(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in deleted text begin 2016 deleted text end new text begin 2017 new text end , the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.

(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.

(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.

(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.

(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 19.

Minnesota Statutes 2018, section 256L.03, subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation
services, personal care assistance and case management services, new text begin behavioral health home
services, new text end and nursing home or intermediate care facilities services.

(b) No public funds shall be used for coverage of abortion under MinnesotaCare except
where the life of the female would be endangered or substantial and irreversible impairment
of a major bodily function would result if the fetus were carried to term; or where the
pregnancy is the result of rape or incest.

(c) Covered health services shall be expanded as provided in this section.

(d) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.

Sec. 20.

Minnesota Statutes 2018, section 256L.15, subdivision 1, is amended to read:

Subdivision 1.

Premium determination for MinnesotaCare.

(a) Families with children
and individuals shall pay a premium determined according to subdivision 2.

(b) Members of the military and their families who meet the eligibility criteria for
MinnesotaCare upon eligibility approval made within 24 months following the end of the
member's tour of active duty shall have their premiums paid by the commissioner. The
effective date of coverage for an individual or family who meets the criteria of this paragraph
shall be the first day of the month following the month in which eligibility is approved. This
exemption applies for 12 months.

(c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and their
families shall have their premiums waived by the commissioner in accordance with section
5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. An
individual must indicate status as an American Indian, as defined under Code of Federal
Regulations, title 42, section 447.50, to qualify for the waiver of premiums. The
commissioner shall accept attestation of an individual's status as an American Indian as
verification until the United States Department of Health and Human Services approves an
electronic data source for this purpose.

deleted text begin (d) For premiums effective August 1, 2015, and after, the commissioner, after consulting
with the chairs and ranking minority members of the legislative committees with jurisdiction
over human services, shall increase premiums under subdivision 2 for recipients based on
June 2015 program enrollment. Premium increases shall be sufficient to increase projected
revenue to the fund described in section 16A.724 by at least $27,800,000 for the biennium
ending June 30, 2017. The commissioner shall publish the revised premium scale on the
Department of Human Services website and in the State Register no later than June 15,
2015. The revised premium scale applies to all premiums on or after August 1, 2015, in
place of the scale under subdivision 2.
deleted text end

deleted text begin (e) By July 1, 2015, the commissioner shall provide the chairs and ranking minority
members of the legislative committees with jurisdiction over human services the revised
premium scale effective August 1, 2015, and statutory language to codify the revised
premium schedule.
deleted text end

deleted text begin (f) Premium changes authorized under paragraph (d) must only apply to enrollees not
otherwise excluded from paying premiums under state or federal law. Premium changes
authorized under paragraph (d) must satisfy the requirements for premiums for the Basic
Health Program under title 42 of Code of Federal Regulations, section 600.505.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 21. new text begin REVISOR INSTRUCTION.
new text end

new text begin (a) The revisor of statutes shall renumber the provisions of Minnesota Statutes listed in
column A to the references listed in column B.
new text end

	new text begin Column A new text end	new text begin Column B new text end
	new text begin 256B.0751, subd. 1 new text end	new text begin 62U.03, subd. 2 new text end
	new text begin 256B.0751, subd. 2 new text end	new text begin 62U.03, subd. 3 new text end
	new text begin 256B.0751, subd. 3 new text end	new text begin 62U.03, subd. 4 new text end
	new text begin 256B.0751, subd. 4 new text end	new text begin 62U.03, subd. 5 new text end
	new text begin 256B.0751, subd. 5 new text end	new text begin 62U.03, subd. 6 new text end
	new text begin 256B.0751, subd. 6 new text end	new text begin 62U.03, subd. 7 new text end
	new text begin 256B.0751, subd. 7 new text end	new text begin 62U.03, subd. 8 new text end
	new text begin 256B.0751, subd. 8 new text end	new text begin 62U.03, subd. 9 new text end
	new text begin 256B.0751, subd. 9 new text end	new text begin 62U.03, subd. 10 new text end
	new text begin 256B.0751, subd. 10 new text end	new text begin 62U.03, subd. 11 new text end

new text begin (b) The revisor of statutes shall change the applicable references to Minnesota Statutes,
section 256B.0751, to section 62U.03. The revisor shall make necessary cross-reference
changes in Minnesota Statutes consistent with the renumbering. The revisor shall also make
technical and other necessary changes to sentence structure to preserve the meaning of the
text.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 22. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 62U.15, subdivision 2; 256B.057, subdivision 8;
256B.0752; 256B.79, subdivision 7; and 256L.04, subdivision 13, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

APPENDIX

Repealed Minnesota Statutes: H2334-1

62U.15 ALZHEIMER'S DISEASE; PREVALENCE AND SCREENING MEASURES.

Subd. 2.

Learning collaborative.

By July 1, 2012, the commissioner shall develop a health care home learning collaborative curriculum that includes screening and education on best practices regarding identification and management of Alzheimer's and other dementia patients under section 256B.0751, subdivision 5, for providers, clinics, care coordinators, clinic administrators, patient partners and families, and community resources including public health.

256B.057 ELIGIBILITY REQUIREMENTS FOR SPECIAL CATEGORIES.

Subd. 8.

Children under age two.

Medical assistance may be paid for a child under two years of age whose countable household income is above 275 percent of the federal poverty guidelines for the same household size but less than or equal to 280 percent of the federal poverty guidelines for the same household size or an equivalent standard when converted using modified adjusted gross income methodology as required under the Affordable Care Act.

256B.0752 HEALTH CARE HOME REPORTING REQUIREMENTS.

Subdivision 1.

Annual reports on implementation and administration.

The commissioners shall report annually to the legislature on the implementation and administration of the health care home model for state health care program enrollees in the fee-for-service, managed care, and county-based purchasing sectors beginning December 15, 2009, and each December 15 thereafter.

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, 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.

256B.79 INTEGRATED CARE FOR HIGH-RISK PREGNANT WOMEN.

Subd. 7.

Expiration.

This section expires June 30, 2019.

256L.04 ELIGIBLE PERSONS.

Subd. 13.

Families with relative caretakers, foster parents, or legal guardians.

Beginning January 1, 1999, in families that include a relative caretaker as defined in the medical assistance program, foster parent, or legal guardian, the relative caretaker, foster parent, or legal guardian may apply as a family or may apply separately for the children. If the caretaker applies separately for the children, only the children's income is counted and the provisions of subdivision 1, paragraph (b), do not apply. If the relative caretaker, foster parent, or legal guardian applies with the children, their income is included in the gross family income for determining eligibility and premium amount.