HF 2394

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/25/2021 02:08pm

A bill for an act
relating to health care; establishing a Primary Care Case Management program;
authorizing direct state payments to health care providers; appropriating money;
proposing coding for new law in Minnesota Statutes, chapter 256.

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

Section 1.

new text begin [256.9631] PRIMARY CARE CASE MANAGEMENT AND DIRECT
PAYMENT FOR MEDICAL ASSISTANCE AND MINNESOTACARE.
new text end

new text begin Subdivision 1. new text end

new text begin Program established. new text end

new text begin (a) The Primary Care Case Management (PCCM)
program is established to achieve better health outcomes and reduce the cost of health care
for the state. The commissioner shall pay health care providers directly to provide services
for all medical assistance enrollees who are eligible under section 256B.055 and
MinnesotaCare enrollees eligible under section 256L.05.
new text end

new text begin (b) In counties that choose to use a county-based purchasing (CBP) system under section
256B.692, the commissioner shall permit those counties to form a new CBP or participate
in an existing CBP. The commissioner shall have the CBP administer the program and pay
providers unless a county requests that the commissioner take over the responsibility.
new text end

new text begin Subd. 2. new text end

new text begin Payment to providers. new text end

new text begin (a) The commissioner of human services shall pay
licensed health care providers directly for all services provided to medical assistance enrollees
under section 256B.0625 and MinnesotaCare enrollees under section 256L.03. To the extent
allowable under contract requirements, payments for services shall be made to individual
providers and clinics for the services they provide, not to hospital systems or networks of
providers.
new text end

new text begin (b) At the CBP's election, the commissioner shall provide payment to the CBP either
through pass-through of costs or according to a per capita payment structure.
new text end

new text begin (c) Providers shall bill the state or the county-based purchaser directly for the services
they provide.
new text end

new text begin (d) The commissioner shall not renew the state's contracts with managed care plans
under sections 256B.69 and 256L.12 for providing services to enrollees in the medical
assistance and MinnesotaCare programs.
new text end

new text begin Subd. 3. new text end

new text begin Care coordination. new text end

new text begin (a) In addition to paying providers under subdivision 2,
the commissioner shall pay primary care providers for coordinating services for medical
assistance and MinnesotaCare enrollees who have specific or complex medical conditions
that require more intensive care coordination.
new text end

new text begin Under the program, patients may choose a primary care provider to act as the enrollee's
care coordinator. Primary care physicians, nurses, and other qualified licensed or certified
case management professionals may provide care coordination.
new text end

new text begin Each individual clinic of care providers that provide care coordination services beyond
what is generally provided for all patients, or counties that provide such coordination, shall
receive a fee for performing the services according to subdivision 2, paragraph (a). The
commissioner shall set care coordination fees to reflect the time and services required for
the provider to coordinate care based on the complexity of a patient's health needs and
socioeconomic factors that lead to health disparities.
new text end

new text begin (b) The primary care provider shall provide overall oversight of the enrollee's health and
coordinate with any case manager of the enrollee as well as ensure 24-hour access to health
care, emergency treatment, and referrals.
new text end

new text begin (c) The commissioner shall provide funding through grants to community health clinics
and CBPs to hire nurses, social workers, and other community health workers who shall,
in coordination with social service agencies, do outreach and deliver medical care and care
coordination services in the community for patients who, because of mental illness,
homelessness, or other circumstances, are unlikely to obtain needed care and treatment. In
addition to helping people obtain care, the clinics shall work to help patients enroll in medical
assistance.
new text end

new text begin (d) The commissioner shall provide funding through grants to community health clinics
and CBPs or other social service providers to collaborate with medical providers to reduce
hospital readmissions by providing discharge planning and services, including medical
respite and transitional care for patients leaving medical facilities and mental health and
chemical dependency treatment programs.
new text end

new text begin Subd. 4. new text end

new text begin Duties. new text end

new text begin (a) For enrollees, the commissioner shall:
new text end

new text begin (1) maintain a hotline and website to assist enrollees in locating providers;
new text end

new text begin (2) provide a nurse consultation helpline 24 hours per day, seven days a week; and
new text end

new text begin (3) contact enrollees based on claims data who have not had preventive visits and help
them select a primary care provider.
new text end

new text begin Counties that elect a CBP system may choose to provide these services with reimbursement
through the Department of Human Services.
new text end

new text begin (b) For providers, the commissioner shall:
new text end

new text begin (1) review provider reimbursement rates to ensure reasonable and fair compensation,
meet the requirements of the Centers for Medicare and Medicaid Services, and are adequate
to address and prevent shortages of providers for services such as mental health and dental
services;
new text end

new text begin (2) ensure that providers are reimbursed on a timely basis; and
new text end

new text begin (3) collaborate with individual frontline providers to explore means of improving health
care quality and reducing costs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. Direct
payments to providers under the Primary Care Case Management program shall be effective
when the current contracts with managed care plans under Minnesota Statutes, sections
256B.69 and 256L.12, for medical assistance and MinnesotaCare services expire on January
1, 2023.
new text end

Sec. 2. new text begin APPROPRIATIONS.
new text end

new text begin (a) $....... in fiscal year .... is appropriated from the general fund to the commissioner of
human services for grants to community health clinics and to CBPs to do outreach and
deliver medical care and care coordination services to people who are unlikely to obtain
needed care and treatment under section 1, subdivision 3, paragraph (c).
new text end

new text begin (b) $....... in fiscal year .... is appropriated from the general fund to the commissioner of
human services for grants to community health clinics and CBPs or other social service
providers to reduce hospitalization and readmissions by providing discharge planning and
services under section 1, subdivision 3, paragraph (d).
new text end