HF 3231

as introduced - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; changing provisions for 
  1.3             the county-based purchasing and the expansion of the 
  1.4             prepaid medical assistance program; amending Minnesota 
  1.5             Statutes 1997 Supplement, sections 256B.69, 
  1.6             subdivision 3a; and 256B.692, subdivision 5. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.9   256B.69, subdivision 3a, is amended to read: 
  1.10     Subd. 3a.  [COUNTY AUTHORITY.] (a) The commissioner, when 
  1.11  implementing the general assistance medical care, or medical 
  1.12  assistance prepayment program within a county, must include the 
  1.13  county board in the process of development, approval, and 
  1.14  issuance of the request for proposals to provide services to 
  1.15  eligible individuals within the proposed county.  County boards 
  1.16  must be given reasonable opportunity to make recommendations 
  1.17  regarding the development, issuance, review of responses, and 
  1.18  changes needed in the request for proposals.  The commissioner 
  1.19  must provide county boards the opportunity to review each 
  1.20  proposal based on the identification of community needs under 
  1.21  chapters 145A and 256E and county advocacy activities.  If a 
  1.22  county board finds that a proposal does not address certain 
  1.23  community needs, the county board and commissioner shall 
  1.24  continue efforts for improving the proposal and network prior to 
  1.25  the approval of the contract.  The county board shall make 
  1.26  recommendations regarding the approval of local networks and 
  2.1   their operations to ensure adequate availability and access to 
  2.2   covered services.  The provider or health plan must respond 
  2.3   directly to county advocates and the state prepaid medical 
  2.4   assistance ombudsperson regarding service delivery and must be 
  2.5   accountable to the state regarding contracts with medical 
  2.6   assistance and general assistance medical care funds.  The 
  2.7   county board may recommend a maximum number of participating 
  2.8   health plans after considering the size of the enrolling 
  2.9   population; ensuring adequate access and capacity; considering 
  2.10  the client and county administrative complexity; and considering 
  2.11  the need to promote the viability of locally developed health 
  2.12  plans.  The county board or a single entity representing a group 
  2.13  of county boards and the commissioner shall mutually select 
  2.14  health plans for participation at the time of initial 
  2.15  implementation of the prepaid medical assistance program in that 
  2.16  county or group of counties and at the time of contract renewal. 
  2.17  The commissioner shall also seek input for contract requirements 
  2.18  from the county or single entity representing a group of county 
  2.19  boards at each contract renewal and incorporate those 
  2.20  recommendations into the contract negotiation process.  The 
  2.21  commissioner, in conjunction with the county board, shall 
  2.22  actively seek to develop a mutually agreeable timetable prior to 
  2.23  the development of the request for proposal, but counties must 
  2.24  agree to initial enrollment beginning on or before January 1, 
  2.25  1999, in either the prepaid medical assistance and general 
  2.26  assistance medical care programs or county-based purchasing 
  2.27  under section 256B.692.  At least 90 days before enrollment in 
  2.28  the medical assistance and general assistance medical care 
  2.29  prepaid programs begins in a county in which the prepaid 
  2.30  programs have not been established, the commissioner shall 
  2.31  provide a report to the chairs of senate and house committees 
  2.32  having jurisdiction over state health care programs which 
  2.33  verifies that the commissioner complied with the requirements 
  2.34  for county involvement that are specified in this subdivision. 
  2.35     (b) The commissioner shall seek a federal waiver to allow a 
  2.36  fee-for-service plan option to MinnesotaCare enrollees.  The 
  3.1   commissioner shall develop an increase of the premium fees 
  3.2   required under section 256L.06 up to 20 percent of the premium 
  3.3   fees for the enrollees who elect the fee-for-service option.  
  3.4   Prior to implementation, the commissioner shall submit this fee 
  3.5   schedule to the chair and ranking minority member of the senate 
  3.6   health care committee, the senate health care and family 
  3.7   services funding division, the house of representatives health 
  3.8   and human services committee, and the house of representatives 
  3.9   health and human services finance division. 
  3.10     (c) At the option of the county board, the board may 
  3.11  develop contract requirements related to the achievement of 
  3.12  local public health goals to meet the health needs of medical 
  3.13  assistance and general assistance medical care enrollees.  These 
  3.14  requirements must be reasonably related to the performance of 
  3.15  health plan functions and within the scope of the medical 
  3.16  assistance and general assistance medical care benefit sets.  If 
  3.17  the county board and the commissioner mutually agree to such 
  3.18  requirements, the department shall include such requirements in 
  3.19  all health plan contracts governing the prepaid medical 
  3.20  assistance and general assistance medical care programs in that 
  3.21  county at initial implementation of the program in that county 
  3.22  and at the time of contract renewal.  The county board may 
  3.23  participate in the enforcement of the contract provisions 
  3.24  related to local public health goals. 
  3.25     (d) For counties in which prepaid medical assistance and 
  3.26  general assistance medical care programs have not been 
  3.27  established, the commissioner shall not implement those programs 
  3.28  if a county board submits acceptable and timely preliminary and 
  3.29  final proposals under section 256B.692, until county-based 
  3.30  purchasing is no longer operational in that county.  For 
  3.31  counties in which prepaid medical assistance and general 
  3.32  assistance medical care programs are in existence on or after 
  3.33  September 1, 1997, the commissioner must terminate contracts 
  3.34  with health plans according to section 256B.692, subdivision 5, 
  3.35  if the county board submits and the commissioner accepts 
  3.36  preliminary and final proposals according to that subdivision.  
  4.1   The commissioner is not required to terminate contracts that 
  4.2   begin on or after September 1, 1997, according to section 
  4.3   256B.692 until two years have elapsed from the date of initial 
  4.4   enrollment. 
  4.5      (e) In the event that a county board or a single entity 
  4.6   representing a group of county boards and the commissioner 
  4.7   cannot reach agreement regarding:  (i) the selection of 
  4.8   participating health plans in that county; (ii) contract 
  4.9   requirements; or (iii) implementation and enforcement of county 
  4.10  requirements including provisions regarding local public health 
  4.11  goals, the commissioner shall resolve all disputes after taking 
  4.12  into account the recommendations of a three-person mediation 
  4.13  panel.  The panel shall be composed of one designee of the 
  4.14  president of the association of Minnesota counties, one designee 
  4.15  of the commissioner of human services, and one designee of the 
  4.16  commissioner of health. 
  4.17     (f) If a county which elects to implement county-based 
  4.18  purchasing ceases to implement county-based purchasing, it is 
  4.19  prohibited from assuming the responsibility of county-based 
  4.20  purchasing for a period of five years from the date it 
  4.21  discontinues purchasing. 
  4.22     (g) Notwithstanding the requirement in paragraph (a) that a 
  4.23  county must agree to initial enrollment on or before January 1, 
  4.24  1999, the commissioner shall grant a delay of up to nine months 
  4.25  in the implementation of the county-based purchasing authorized 
  4.26  in section 256B.692 if the county or group of counties has 
  4.27  submitted a preliminary proposal for county-based purchasing by 
  4.28  September 1, 1997, has not already implemented the prepaid 
  4.29  medical assistance program before January 1, 1998, and has 
  4.30  submitted a written request for the delay to the commissioner by 
  4.31  July 1, 1998.  The request must: 
  4.32     (1) identify the proposed date of implementation, not later 
  4.33  than October 1, 1999; 
  4.34     (2) include copies of the county board resolutions which 
  4.35  authorize the implementation of county-based purchasing by the 
  4.36  proposed date of implementation; 
  5.1      (3) if more than one county is involved in the proposal, 
  5.2   demonstrate actions taken for the establishment of a governance 
  5.3   structure between the participating counties and describe how 
  5.4   the fiduciary responsibilities of county-based purchasing will 
  5.5   be allocated between the counties; 
  5.6      (4) describe actions taken to identify how the risk of a 
  5.7   deficit will be managed in the event expenditures are greater 
  5.8   than total capitation payments.  This description must identify 
  5.9   how any of the following strategies will be assessed: 
  5.10     (i) risk contracts with licensed health plans; 
  5.11     (ii) risk arrangements with providers who are not licensed 
  5.12  health plans; 
  5.13     (iii) risk arrangements with other licensed insurance 
  5.14  entities; and 
  5.15     (iv) funding from other county resources; 
  5.16     (5) include, if county-based purchasing will not contract 
  5.17  with licensed health plans or provider networks, letters from 
  5.18  local providers in at least the categories of hospital, 
  5.19  physician, mental health, and pharmacy which express interest in 
  5.20  contracting for services; and 
  5.21     (6) describe the options being considered to obtain the 
  5.22  administrative services required in section 256B.692, 
  5.23  subdivision 3, clauses (3) and (5). 
  5.24     For counties which receive a delay under this subdivision, 
  5.25  the final proposals required under section 256B.692, subdivision 
  5.26  5, paragraph (b), must be submitted at least six months prior to 
  5.27  the requested implementation date.  Authority to implement 
  5.28  county-based purchasing remains contingent on approval of the 
  5.29  final proposal as required under section 256B.692. 
  5.30     Sec. 2.  Minnesota Statutes 1997 Supplement, section 
  5.31  256B.692, subdivision 5, is amended to read: 
  5.32     Subd. 5.  [COUNTY PROPOSALS.] (a) On or before September 1, 
  5.33  1997, a county board that wishes to purchase or provide health 
  5.34  care under this section must submit a preliminary proposal that 
  5.35  substantially demonstrates the county's ability to meet all the 
  5.36  requirements of this section in response to criteria for 
  6.1   proposals issued by the department on or before July 1, 1997.  
  6.2   Counties submitting preliminary proposals must establish a local 
  6.3   planning process that involves input from medical assistance and 
  6.4   general assistance medical care recipients, recipient advocates, 
  6.5   providers and representatives of local school districts, labor, 
  6.6   and tribal government to advise on the development of a final 
  6.7   proposal and its implementation.  
  6.8      (b) The county board must submit a final proposal on or 
  6.9   before July 1, 1998, that demonstrates the ability to meet all 
  6.10  the requirements of this section, including beginning enrollment 
  6.11  on January 1, 1999, unless a delay has been granted under 
  6.12  section 256B.69, subdivision 3a, paragraph (g).  
  6.13     (c) After January 1, 1999, for a county in which the 
  6.14  prepaid medical assistance program is in existence, the county 
  6.15  board must submit a preliminary proposal at least 15 months 
  6.16  prior to termination of health plan contracts in that county and 
  6.17  a final proposal six months prior to the health plan contract 
  6.18  termination date in order to begin enrollment after the 
  6.19  termination.  Nothing in this section shall impede or delay 
  6.20  implementation or continuation of the prepaid medical assistance 
  6.21  and general assistance medical care programs in counties for 
  6.22  which the board does not submit a proposal, or submits a 
  6.23  proposal that is not in compliance with this section. 
  6.24     (d) The commissioner is not required to terminate contracts 
  6.25  for the prepaid medical assistance and prepaid general 
  6.26  assistance medical care programs that begin on or after 
  6.27  September 1, 1997, in a county for which a county board has 
  6.28  submitted a proposal under this paragraph, until two years have 
  6.29  elapsed from the date of initial enrollment in the prepaid 
  6.30  medical assistance and prepaid general assistance medical care 
  6.31  programs.