HF 2546

as introduced - 90th Legislature (2017 - 2018) Posted on 03/27/2017 10:03am

A bill for an act
relating to human services; requiring the commissioner of human services to
develop and implement a health care delivery system demonstration project;
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.0759] HEALTH CARE DELIVERY SYSTEM DEMONSTRATION
PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Implementation. new text end

new text begin (a) The commissioner shall develop and implement a
demonstration project to test alternative and innovative health care delivery system payment
and care models that provide services to medical assistance and MinnesotaCare enrollees
for an agreed-upon, prospective per capita or total cost of care payment. The commissioner
shall implement this demonstration project in coordination with, and as an expansion of,
the demonstration project authorized under section 256B.0755.
new text end

new text begin (b) In developing the demonstration project, the commissioner shall:
new text end

new text begin (1) establish uniform statewide methods of forecasting utilization and cost of care for
the medical assistance and MinnesotaCare populations to be served under the health care
delivery system demonstration project;
new text end

new text begin (2) identify key indicators of quality, access, and patient satisfaction, and identify methods
to measure cost savings;
new text end

new text begin (3) allow maximum flexibility to encourage innovation and variation so that a variety
of provider collaborations are able to participate as health care delivery systems, and health
care delivery systems can be customized to address the special needs and barriers of patient
populations;
new text end

new text begin (4) authorize participation by health care delivery systems representing a variety of
geographic locations, patient populations, provider relationships, and care coordination
models;
new text end

new text begin (5) recognize the close partnerships between health care delivery systems and the counties
and nonprofit agencies that also provide services to patients enrolled in the health care
delivery system, including social services, public health, mental health, community-based
services, and continuing care;
new text end

new text begin (6) identify services to be included under a prospective per capita payment model, and
project utilization and cost of these services under a total cost of care risk/gain sharing
model;
new text end

new text begin (7) establish a mechanism to monitor enrollment and attribute enrollees to a specific
health care delivery system; and
new text end

new text begin (8) establish quality standards for delivery systems that are appropriate for the specific
patient populations served.
new text end

new text begin Subd. 2. new text end

new text begin Requirements for health care delivery system. new text end

new text begin (a) To be eligible to participate
in the demonstration project, a health care delivery system must:
new text end

new text begin (1) provide required services and care coordination to individuals enrolled in the health
care delivery system;
new text end

new text begin (2) establish a process to monitor enrollment and ensure the quality of care provided;
new text end

new text begin (3) in cooperation with counties and community social service agencies, coordinate the
delivery of health care services with existing social services programs;
new text end

new text begin (4) provide a system for advocacy and consumer protection; and
new text end

new text begin (5) adopt innovative and cost-effective methods of care delivery and coordination that
may include the use of allied health professionals, telemedicine, patient educators, care
coordinators, community paramedics, and community health workers.
new text end

new text begin (b) A health care delivery system may be formed by the following types of health care
providers, if they have established, as applicable, a mechanism for shared governance:
new text end

new text begin (1) health care providers in group practice arrangements;
new text end

new text begin (2) networks of health care providers in individual practice;
new text end

new text begin (3) partnerships or joint venture arrangements between hospitals and health care providers;
new text end

new text begin (4) hospitals employing or contracting with the necessary range of health care providers;
and
new text end

new text begin (5) other entities, as the commissioner determines appropriate.
new text end

new text begin (c) A health care delivery system must contract with a third-party administrator to provide
administrative services, including the administration of the payment system established
under the demonstration project. The third-party administrator must conduct an assessment
of risk, and must purchase stop-loss insurance or another form of insurance risk management
related to the delivery of care. The commissioner may waive the requirement for contracting
with a third-party administrator, if the health care delivery system can demonstrate to the
commissioner that it can satisfactorily perform all of the duties assigned to the third-party
administrator.
new text end

new text begin Subd. 3. new text end

new text begin Enrollment. new text end

new text begin (a) Individuals eligible for medical assistance or MinnesotaCare
shall be eligible for enrollment in a health care delivery system. Individuals required to
enroll in the prepaid medical assistance program or prepaid MinnesotaCare may opt out of
receiving care from a managed care or county-based purchasing plan, and elect to receive
care through a health care delivery system established under this section.
new text end

new text begin (b) Eligible applicants and recipients may enroll in a health care delivery system if the
system serves the county in which the applicant or recipient resides. If more than one health
care delivery system serves a county, the applicant or recipient may choose among the
delivery systems.
new text end

new text begin (c) The commissioner shall assign an applicant or recipient to a health care delivery
system if:
new text end

new text begin (1) the applicant or recipient is currently or has recently been attributed to the health
care delivery system as part of an integrated health partnership under section 256B.0755;
or
new text end

new text begin (2) no choice has been made by the applicant or recipient. In this case, the commissioner
shall assign an applicant or recipient based on geographic criteria or based on the health
care providers from whom the applicant or recipient has received prior care.
new text end

new text begin Subd. 4. new text end

new text begin Accountability. new text end

new text begin (a) A health care delivery system is responsible for the quality
of care based on standards established by the commissioner, and for enrollee cost of care
and utilization of services. The commissioner shall adjust accountability standards, and the
quality, cost, and utilization of care, to take into account the social, economic, racial, or
ethnic barriers experienced by the health care delivery system's patient population.
new text end

new text begin (b) A health care delivery system must contract with community health clinics, federally
qualified health centers, community mental health centers or programs, county agencies,
and rural health clinics to the extent practicable.
new text end

new text begin (c) A health care delivery system must indicate to the commissioner how it will coordinate
its services with those delivered by other providers, county agencies, and other organizations
in the local service area. The health care delivery system must indicate how it will engage
other providers, counties, and organizations that provide services to patients of the health
care delivery system on issues related to local population health, including applicable local
needs, priorities, and public health goals. The health care delivery system must describe
how local providers, counties, and organizations were consulted in developing the application
submitted to the commissioner requiring participation in the demonstration project.
new text end

new text begin Subd. 5. new text end

new text begin Payment system. new text end

new text begin The commissioner shall develop a payment system for the
health care delivery system demonstration project that includes prospective per capita
payments, total cost of care benchmarks, and risk/gain sharing payment options. The payment
system may include incentive payments to health care delivery systems that meet or exceed
annual quality and performance targets through the coordination of care.
new text end

new text begin Subd. 6. new text end

new text begin Federal waiver or approval. new text end

new text begin The commissioner shall seek all federal waivers
or approval necessary to implement the health care delivery system demonstration project.
The commissioner shall notify the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance of any
federal action related to the request for waivers and approval.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2018, or upon receipt of
federal waivers or approval, whichever is later.
new text end