as introduced - 92nd Legislature (2021 - 2022) Posted on 04/07/2022 01:05pm
A bill for an act
relating to human services; allowing medical assistance enrollees to opt out of
managed care enrollment; amending Minnesota Statutes 2020, sections 256B.69,
subdivisions 4, 28, 36; 256B.692, subdivision 1.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2020, section 256B.69, subdivision 4, is amended to read:
(a) The commissioner shall
develop criteria to determine when limitation of choice may be implemented in the
experimental countiesnew text beginnew text end. The criteria shall ensure that all eligible
individuals in the county have continuing access to the full range of medical assistance
services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to section 256B.055, subdivision
(2) persons eligible for medical assistance due to blindness or disability as determined
by the Social Security Administration or the state medical review team, unless:
(i) they are 65 years of age or older; or
(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
(3) recipients who currently have private coverage through a health maintenance
(4) recipients who are eligible for medical assistance by spending down excess income
for medical expenses other than the nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee Assistance Program, established
under United States Code, title 8, section 1522(e);
(6) children who are both determined to be severely emotionally disturbed and receiving
case management services according to section 256B.0625, subdivision 20, except children
who are eligible for and who decline enrollment in an approved preferred integrated network
under section 245.4682;
(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;
(8) persons eligible for medical assistance according to section 256B.057, subdivision
(9) persons with access to cost-effective employer-sponsored private health insurance
or persons enrolled in a non-Medicare individual health plan determined to be cost-effective
according to section 256B.0625, subdivision 15; and
(10) persons who are absent from the state for more than 30 consecutive days but still
deemed a resident of Minnesota, identified in accordance with section 256B.056, subdivision
1, paragraph (b).
Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an elective
basis. The commissioner may enroll recipients in the prepaid medical assistance program
for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by spending
down excess income.
(c) The commissioner may allow persons with a one-month spenddown who are otherwise
eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay their monthly
spenddown to the state.
(d) The commissioner may requirenew text beginnew text end
those individuals to enroll in the prepaid medical assistance program who otherwise would
have been excluded under paragraph (b), clauses (1), (3), and (8), and under Minnesota
Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible individuals shall be notified and
new text beginnew text endAfter notification, new text beginnew text endshall be allowed to choose only among demonstration
providers. The commissioner may assign an individual with private coverage through a
health maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider, the
recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.
(f) An infant born to a woman who is eligible for and receiving medical assistance and
who is enrolled in the prepaid medical assistance program shall be retroactively enrolled to
the month of birth in the same managed care plan as the mother once the child is enrolled
in medical assistance unless the child is determined to be excluded from enrollment in a
prepaid plan under this section.
new text begin new text end
Minnesota Statutes 2020, section 256B.69, subdivision 28, is amended to read:
The commissioner may contract with demonstration providers and current or former sponsors
of qualified Medicare-approved special needs plans, to provide medical assistance basic
health care services to persons with disabilities, including those with developmental
disabilities. Basic health care services include:
(1) those services covered by the medical assistance state plan except for ICF/DD services,
home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care and
certain home care services defined by the commissioner in consultation with the stakeholder
group established under paragraph (d); and
(2) basic health care services may also include risk for up to 100 days of nursing facility
services for persons who reside in a noninstitutional setting and home health services related
to rehabilitation as defined by the commissioner after consultation with the stakeholder
The commissioner may exclude other medical assistance services from the basic health
care benefit set. Enrollees in these plans can access any excluded services on the same basis
as other medical assistance recipients who have not enrolled.
(b) The commissioner may contract with demonstration providers and current and former
sponsors of qualified Medicare special needs plans, to provide basic health care services
under medical assistance to persons who are dually eligible for both Medicare and Medicaid
and those Social Security beneficiaries eligible for Medicaid but in the waiting period for
Medicare. The commissioner shall consult with the stakeholder group under paragraph (d)
in developing program specifications for these services. Payment for Medicaid services
provided under this subdivision for the months of May and June will be made no earlier
than July 1 of the same calendar year.
(c) deleted text beginNotwithstanding subdivision 4, beginning January 1, 2012,deleted text end The commissioner shall
enroll persons with disabilities in managed care under this section, unless the individual
chooses to opt out of enrollment. The commissioner shall establish enrollment and opt out
procedures consistent with applicable enrollment procedures under this section.
(d) The commissioner shall establish a state-level stakeholder group to provide advice
on managed care programs for persons with disabilities, including both MnDHO and contracts
with special needs plans that provide basic health care services as described in paragraphs
(a) and (b). The stakeholder group shall provide advice on program expansions under this
subdivision and subdivision 23, including:
(1) implementation efforts;
(2) consumer protections; and
(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.
(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the counties
covered by the plan, members, consumer advocates, and providers, for advice on issues that
arise in the local or regional area.
(f) The commissioner is prohibited from providing the names of potential enrollees to
health plans for marketing purposes. The commissioner shall mail no more than two sets
of marketing materials per contract year to potential enrollees on behalf of health plans, at
the health plan's request. The marketing materials shall be mailed by the commissioner
within 30 days of receipt of these materials from the health plan. The health plans shall
cover any costs incurred by the commissioner for mailing marketing materials.
new text begin new text end
Minnesota Statutes 2020, section 256B.69, subdivision 36, is amended to read:
(a) The commissioner shall establish an enrollee
support system that provides support to an enrollee before and during enrollment in a
managed care plan.
(b) The enrollee support system must:
(1) provide access to counseling for each potential enrollee on choosing a managed care
plannew text beginnew text end;
(2) assist an enrollee in understanding enrollment in a managed care plan;
(3) provide an access point for complaints regarding enrollment, covered services, and
other related matters;
(4) provide information on an enrollee's grievance and appeal rights within the managed
care organization and the state's fair hearing process, including an enrollee's rights and
(5) provide assistance to an enrollee, upon request, in navigating the grievance and
appeals process within the managed care organization and in appealing adverse benefit
determinations made by the managed care organization to the state's fair hearing process
after the managed care organization's internal appeals process has been exhausted. Assistance
does not include providing representation to an enrollee at the state's fair hearing, but may
include a referral to appropriate legal representation sources.
(c) Outreach to enrollees through the support system must be accessible to an enrollee
through multiple formats, including telephone, Internet, in-person, and, if requested, through
auxiliary aids and services.
(d) The commissioner may designate enrollment brokers to assist enrollees on selecting
a managed care organization and providing necessary enrollment information. For purposes
of this subdivision, "enrollment broker" means an individual or entity that performs choice
counseling or enrollment activities in accordance with Code of Federal Regulations, part
42, section 438.810, or both.
new text begin new text end
Minnesota Statutes 2020, section 256B.692, subdivision 1, is amended to read:
County boards or groups of county boards may elect to
purchase or provide health care services on behalf of persons eligible for medical assistance
who would otherwise be required to or may elect to participate in the prepaid medical
assistance program according to section 256B.69new text beginnew text end. Counties that elect to purchase or provide health
care under this section must provide all services included in prepaid managed care programs
according to section 256B.69, subdivisions 1 to 22. County-based purchasing under this
section is governed by section 256B.69, unless otherwise provided for under this section.
new text begin new text end