HF 3282

as introduced - 89th Legislature (2015 - 2016) Posted on 03/17/2016 02:33pm

A bill for an act
relating to human services; modifying county-based purchasing plan contract
negotiations; amending Minnesota Statutes 2014, sections 256B.69, subdivisions
3a, 33, 35; 256B.692, subdivisions 5, 6, 7; 256B.694.

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

Section 1.

Minnesota Statutes 2014, section 256B.69, subdivision 3a, is amended to
read:

Subd. 3a.

County authority.

(a) The commissioner, when implementing the
medical assistance prepayment program within a county, must include the county board
in the process of development, approval, and issuance of the request for proposals to
provide services to eligible individuals within the proposed county. County boards must
be given reasonable opportunity to make recommendations regarding the development,
issuance, review of responses, and changes needed in the request for proposals. The
commissioner must provide county boards the opportunity to review each proposal
based on the identification of community needs under chapters 145A and 256E and
county advocacy activities. If a county board finds that a proposal does not address
certain community needs, the county board and commissioner shall continue efforts for
improving the proposal and network prior to the approval of the contract. The county
board shall make recommendations regarding the approval of local networks and their
operations to ensure adequate availability and access to covered services. The provider
or health plan must respond directly to county advocates and the state prepaid medical
assistance ombudsperson regarding service delivery and must be accountable to the state
regarding contracts with medical assistance funds. The county board may recommend a
maximum number of participating health plans after considering the size of the enrolling
population; ensuring adequate access and capacity; considering the client and county
administrative complexity; and considering the need to promote the viability of locally
developed health plans. The county board or a single entity representing a group of county
boards and the commissioner shall mutually select health plans for participation at the
time of initial implementation of the prepaid medical assistance program in that county or
group of counties and at the time of contract renewal. The commissioner shall also seek
input for contract requirements from the county or single entity representing a group of
county boards at each contract renewal and incorporate those recommendations into
the contract negotiation process.

(b) At the option of the county board, the board may develop contract requirements
related to the achievement of local public health goals to meet the health needs of medical
assistance enrollees. These requirements must be reasonably related to the performance
of health plan functions and within the scope of the medical assistance benefit set. If the
county board and the commissioner mutually agree to such requirements, the department
shall include such requirements in all health plan contracts governing the prepaid medical
assistance program in that county at initial implementation of the program in that county
and at the time of contract renewal. The county board may participate in the enforcement
of the contract provisions related to local public health goals.

(c) For counties in which a prepaid medical assistance program has not been
established, the commissioner shall not implement that program if a county board submits
an acceptable and timely preliminary and final proposal under section 256B.692, until
county-based purchasing is no longer operational in that county. For counties in which
a prepaid medical assistance program is in existence on or after September 1, 1997, the
commissioner must terminate contracts with health plans according to section 256B.692,
subdivision 5, if the county board submits and the commissioner accepts a preliminary and
final proposal according to that subdivision. The commissioner is not required to terminate
contracts that begin on or after September 1, 1997, according to section 256B.692 until
two years have elapsed from the date of initial enrollment.

(d) In the event that a county board or a single entity representing a group of county
boards and the commissioner cannot reach agreement regarding: (i) the selection of
participating health plans in that county; (ii) contract requirements; or (iii) implementation
and enforcement of county requirements including provisions regarding local public
health goals, the commissioner shall resolve all disputes after taking into account the
recommendations of a three-person mediation panel. The panel shall be composed of one
designee of the president of the association of Minnesota counties, one designee of the
commissioner of human services, and one person selected jointly by the designee of
the commissioner of human services and the designee of the Association of Minnesota
Counties. Within a reasonable period of time before the hearing, the panelists new text begin and the
parties to the mediation new text end must be provided all documents and information relevant to
the mediation. The parties to the mediation must be given 30 days' notice of a hearing
before the mediation panel. new text begin If the county involved has elected to implement county-based
purchasing, the three-person mediation panel shall be composed according to section
256B.692, subdivision 7.
new text end

(e) If a county which elects to implement county-based purchasing ceases to
implement county-based purchasing, it is prohibited from assuming the responsibility of
county-based purchasing for a period of five years from the date it discontinues purchasing.

(f) The commissioner shall not require that contractual disputes between
county-based purchasing entities and the commissioner be mediated by a panel that
includes a representative of the Minnesota Council of Health Plans.

(g) At the request of a county-purchasing entity, the commissioner shall adopt a
contract reprocurement or renewal schedule under which all counties included in the
entity's service area are reprocured or renewed at the same time.

(h) The commissioner shall provide a written report under section 3.195 to the chairs
of the legislative committees having jurisdiction over human services in the senate and the
house of representatives describing in detail the activities undertaken by the commissioner
to ensure full compliance with this section. The report must also provide an explanation
for any decisions of the commissioner not to accept the recommendations of a county or
group of counties required to be consulted under this section. The report must be provided
at least 30 days prior to the effective date of a new or renewed prepaid or managed care
contract in a county.

Sec. 2.

Minnesota Statutes 2014, section 256B.69, subdivision 33, is amended to read:

Subd. 33.

Competitive bidding.

(a) For managed care contracts effective on or
after January 1, 2014, the commissioner may utilize a competitive price bidding program
for nonelderly, nondisabled adults and children in medical assistance and MinnesotaCare
in the seven-county metropolitan area. The program must allow a minimum of two
managed care plans to serve the metropolitan area.

(b) In designing the competitive bid program, the commissioner shall consider,
and incorporate where appropriate, the procedures and criteria used in the competitive
bidding pilot authorized under Laws 2011, First Special Session chapter 9, article 6,
section 96. The pilot program operating in Hennepin County under the authority of section
256B.0756 new text begin , and county-based purchasing plans operating under the authority of section
256B.692, new text end shall deleted text begin continue to deleted text end be exempt from competitive bid.

(c) The commissioner shall use past performance data as a factor in selecting vendors
and shall consider this information, along with competitive bid and other information, in
determining whether to contract with a managed care plan under this subdivision. Where
possible, the assessment of past performance in serving persons on public programs shall
be based on encounter data submitted to the commissioner. The commissioner shall
evaluate past performance based on both the health outcomes of care and success rates
in securing participation in recommended preventive and early diagnostic care. Data
provided by managed care plans must be provided in a uniform manner as specified by
the commissioner and must include only data on medical assistance and MinnesotaCare
enrollees. The data submitted must include health outcome measures on reducing the
incidence of low birth weight established by the managed care plan under subdivision 32.

Sec. 3.

Minnesota Statutes 2014, section 256B.69, subdivision 35, is amended to read:

Subd. 35.

Statewide procurement.

(a) For calendar year 2015, the commissioner
may extend a demonstration provider's contract under this section for a sixth year after
the most recent procurement. For calendar year 2015, section 16B.98, subdivision 5,
paragraph (b), and section 16C.05, subdivision 2, paragraph (b), shall not apply to
contracts under this section.

(b) For calendar year 2016 contracts under this section, the commissioner shall
procure through a statewide procurement, which includes all 87 counties, demonstration
providers, and participating entities as defined in section 256L.01, subdivision 7. The
commissioner shall publish a request for proposals by January 5, 2015. As part of the
procurement process, the commissioner shall:

(1) seek each individual county's input;

(2) organize counties into regional groups, and consider single counties for the
largest and most diverse counties; and

(3) seek regional and county input regarding the respondent's ability to fully and
adequately deliver required health care services, offer an adequate provider network,
provide care coordination with county services, and serve special populations, including
enrollees with language and cultural needs.

new text begin (c) Any statewide procurement process occurring after calendar year 2016 shall not
include counties participating in a county-based purchasing plan. Procurement for these
counties shall occur every five years or earlier upon the request of the county or group of
counties, but shall not occur earlier than every two years.
new text end

Sec. 4.

Minnesota Statutes 2014, section 256B.692, subdivision 5, is amended to read:

Subd. 5.

County proposals.

(a) A county board that wishes to purchase or provide
health care under this section must submit a preliminary proposal that substantially
demonstrates the county's ability to meet all the requirements of this section in response
to criteria for proposals issued by the department. Counties submitting preliminary
proposals must establish a local planning process that involves input from medical
assistance recipients, recipient advocates, providers and representatives of local school
districts, labor, and tribal government to advise on the development of a final proposal
and its implementation.

(b) The county board must submit a final proposal that demonstrates the ability to
meet all the requirements of this section.

(c) For a county in which the prepaid medical assistance program is in existence, the
county board must submit a preliminary proposal at least 15 months prior to termination of
health plan contracts in that county and a final proposal six months prior to the health plan
contract termination date in order to begin enrollment after the termination. Nothing in
this section shall impede or delay implementation or continuation of the prepaid medical
assistance program in counties for which the board does not submit a proposal, or submits
a proposal that is not in compliance with this section.

new text begin (d) Once a county or group of counties has elected to implement county-based
purchasing, the commissioner shall not replace, terminate, or fail to renew the
county-based purchasing plan in that county or group of counties, except as permitted
in subdivision 6, paragraph (b).
new text end

Sec. 5.

Minnesota Statutes 2014, section 256B.692, subdivision 6, is amended to read:

Subd. 6.

Commissioner's authority.

new text begin (a) new text end The commissioner may deleted text begin :
deleted text end

deleted text begin (1) deleted text end reject any preliminary or final proposal that:

deleted text begin (a) deleted text end new text begin (1) new text end substantially fails to meet the requirements of this section deleted text begin , or deleted text end new text begin ;
new text end

deleted text begin (b) that deleted text end new text begin (2) new text end the commissioner determines would substantially impair the state's
ability to purchase health care services in other areas of the state deleted text begin , or deleted text end new text begin ;
new text end

deleted text begin (c) deleted text end new text begin (3) new text end would substantially impair an enrollee's choice of care systems when
reasonable choice is possible deleted text begin , deleted text end new text begin ; new text end or

deleted text begin (d) deleted text end new text begin (4) new text end would substantially impair the implementation and operation of the
Minnesota senior health options demonstration project authorized under section 256B.69,
subdivision 23 deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (2) assume operation of a county's purchasing of health care for enrollees in medical
assistance in the event that the contract with the county is terminated.
deleted text end

new text begin (b) If a county or group of counties is providing health care through a county-based
purchasing plan and the county, group of counties, or the plan substantially fails to comply
with the applicable requirements of this section or section 256B.69, or the county or group
of counties elects to cease providing health care through a county-based purchasing plan,
the commissioner may terminate the contract with the county or group of counties and
shall assume the operation of purchasing health care for enrollees covered under the
county-based purchasing plan upon the termination of the contract subject to subdivision 7.
new text end

Sec. 6.

Minnesota Statutes 2014, section 256B.692, subdivision 7, is amended to read:

Subd. 7.

Dispute resolution.

In the event the commissioner rejects a proposal
under subdivision 6, new text begin paragraph (a), or the commissioner intends to terminate the contract
with the county under subdivision 6, paragraph (b), new text end the county board new text begin or a single entity
representing a group of county boards new text end may request the recommendation of a three-person
mediation panel. The commissioner shall resolve all disputes after taking into account the
recommendations of the mediation panel. The panel shall be composed of one designee of
the deleted text begin president of the Association of Minnesota Counties deleted text end new text begin requesting county board or the
single entity representing a group of county boards new text end , one designee of the commissioner of
human services, and one person selected jointly by the designee of the commissioner of
human services and the designee of the deleted text begin Association of Minnesota Counties deleted text end new text begin requesting
county board or the single entity representing a group of county boards new text end . Within a
reasonable period of time before the hearing, the panelists new text begin and parties to the mediation
new text end must be provided all documents and information relevant to the mediation. The parties to
the mediation must be given 30 days' notice of a hearing before the mediation panel.

Sec. 7.

Minnesota Statutes 2014, section 256B.694, is amended to read:

256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
CONTRACT.

new text begin (a) The commissioner shall contract on a single health plan basis with county-based
purchasing plans that have been approved under section 256B.692 in counties where the
county board has elected to operate a county-based purchasing plan.
new text end

new text begin (b) new text end The commissioner shall consider, and may approve, contracting on a
single-health plan basis with deleted text begin county-based purchasing plans, or with other qualified deleted text end health
plans that have coordination arrangements with counties, to serve persons enrolled in state
public health care programs, in order to promote better coordination or integration of
health care services, social services and other community-based services, provided that
all requirements applicable to health plan purchasing, including those in deleted text begin sections deleted text end new text begin section
new text end 256B.69 deleted text begin and 256B.692 deleted text end , are satisfied.