HF 927

as introduced - 87th Legislature (2011 - 2012) Posted on 03/07/2011 09:51am

A bill for an act
relating to human services; requiring the commissioner of human services to seek
a waiver from the federal government to reform the medical assistance program;
setting guidelines for the reformed medical assistance program; providing
for rulemaking authority; requiring reports; 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.841] WAIVER APPLICATION AND PROCESS.
new text end

new text begin Subdivision 1. new text end

new text begin Intent. new text end

new text begin It is the intent of the legislature that medical assistance be:
new text end

new text begin (1) a sustainable, cost-effective, person-centered, and opportunity-driven program
utilizing competitive and value-based purchasing to maximize available service options;
and
new text end

new text begin (2) a results-oriented system of coordinated care that focuses on independence
and choice, promotes accountability and transparency, encourages and rewards healthy
outcomes and responsible choices, and promotes efficiency.
new text end

new text begin Subd. 2. new text end

new text begin Waiver application. new text end

new text begin (a) The commissioner of human services shall apply
for a waiver and any necessary state plan amendments from the secretary of the United
States Department of Health and Human Services, including, but not limited to, a waiver
of the appropriate sections of title XIX of the federal Social Security Act, United States
Code, title 42, section 1396 et seq. and a waiver of maintenance of effort provisions in
section 2001 of the Patient Protection and Affordable Care Act, Public Law 111-148, as
amended by the Health Care and Education Reconciliation Act of 2010, Public Law
111-152, that provide program flexibility and under which Minnesota will operate all
facets of the state's medical assistance program.
new text end

new text begin (b) The commissioner of human services shall provide the legislative committees
with jurisdiction over health and human services finance and policy with the waiver
application and financial and other related materials, at least ten days prior to submitting
the application and materials to the federal Centers for Medicare and Medicaid Services.
new text end

new text begin (c) If the state's waiver application is approved, the commissioner of human services
shall:
new text end

new text begin (1) notify the chairs of the legislative committees with jurisdiction over health and
human services finance and policy and allow the legislative committees with jurisdiction
over health and human services finance and policy to review the terms of the waiver; and
new text end

new text begin (2) not implement the waiver until ten legislative days have passed following
notification of the chairs.
new text end

new text begin Subd. 3. new text end

new text begin Rulemaking; legislative proposals. new text end

new text begin Upon acceptance of the terms of the
waiver, the commissioner of human services shall:
new text end

new text begin (1) adopt rules to implement the waiver; and
new text end

new text begin (2) propose any legislative changes necessary to implement the terms of the waiver.
new text end

new text begin Subd. 4. new text end

new text begin Joint commission on waiver implementation. new text end

new text begin (a) After acceptance
of the terms of the waiver, the governor shall establish a joint commission on waiver
implementation. The commission shall consist of eight members; four of whom shall
be members of the senate, not more than three from the same political party, to be
appointed by the Subcommittee on Committees of the senate Committee on Rules and
Administration, and four of whom shall be members of the house of representatives, not
more than three from the same political party, to be appointed by the speaker of the house.
new text end

new text begin (b) The commission shall:
new text end

new text begin (1) oversee implementation of the waiver;
new text end

new text begin (2) confer as necessary with state agency commissioners;
new text end

new text begin (3) make recommendations on services covered under the medical assistance
program;
new text end

new text begin (4) monitor and make recommendations on quality and access to care under the
global waiver; and
new text end

new text begin (5) make recommendations for the efficient and cost-effective administration of the
medical assistance program under the terms of the waiver.
new text end

Sec. 2.

new text begin [256B.842] PRINCIPLES AND GOALS FOR MEDICAL ASSISTANCE
REFORM.
new text end

new text begin Subdivision 1. new text end

new text begin Goals for reform. new text end

new text begin In developing the waiver application and
implementing the waiver, the commissioner of human services shall ensure that the
reformed medical assistance program is a person-centered, financially sustainable, and
cost-effective program.
new text end

new text begin Subd. 2. new text end

new text begin Reformed medical assistance criteria. new text end

new text begin The reformed medical assistance
program established through the waiver must:
new text end

new text begin (1) empower consumers to make informed and cost-effective choices about their
health and offer consumers rewards for healthy decisions;
new text end

new text begin (2) ensure adequate access to needed services;
new text end

new text begin (3) enable consumers to receive individualized health care that is outcome-oriented
and focused on prevention, disease management, recovery, and maintaining independence;
new text end

new text begin (4) promote competition between health care providers to ensure best value
purchasing, leverage resources, and to create opportunities for improving service quality
and performance;
new text end

new text begin (5) redesign purchasing and payment methods and encourage and reward
high-quality and cost-effective care by incorporating and expanding upon current payment
reform and quality of care initiatives, including but not limited to those initiatives
authorized under chapter 62U; and
new text end

new text begin (6) continually improve technology to take advantage of recent innovations and
advances that help decision makers, consumers, and providers make informed and
cost-effective decisions regarding health care.
new text end

new text begin Subd. 3. new text end

new text begin Annual report. new text end

new text begin The commissioner of human services shall annually
submit a report to the governor and the legislature, beginning December 1, 2012, and each
December 1 thereafter, describing the status of the administration and implementation
of the waiver.
new text end

Sec. 3.

new text begin [256B.843] WAIVER APPLICATION REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Requirements for waiver request. new text end

new text begin The commissioner shall seek
federal approval to:
new text end

new text begin (1) enter into a five-year agreement with the United States Department of Health and
Human Services and Centers for Medicaid and Medicare Services (CMS) under section
1115a to waive provisions of title XIX of the federal Social Security Act, United States
Code, title 42, section 1396 et seq., requiring:
new text end

new text begin (i) state-wideness to allow for the provision of different services in different areas or
regions of the state;
new text end

new text begin (ii) comparability of services to allow for the provision of different services to
members of the same or different coverage groups;
new text end

new text begin (iii) no prohibitions restricting the amount, duration, and scope of services included
in the medical assistance state plan;
new text end

new text begin (iv) no prohibitions limiting freedom of choice of providers; and
new text end

new text begin (v) retroactive payment for medical assistance, at the state's discretion;
new text end

new text begin (2) waive the applicable provisions of title XIX of the federal Social Security Act,
United States Code, title 42, section 1396 et seq., in order to:
new text end

new text begin (i) expand cost sharing requirements above the five percent of income threshold for
beneficiaries in certain populations;
new text end

new text begin (ii) establish health savings or power accounts that encourage and reward
beneficiaries who reach certain prevention and wellness targets; and
new text end

new text begin (iii) implement a tiered set of parameters to use as the basis for determining
long-term service care and setting needs;
new text end

new text begin (3) modify income and resource rules in a manner consistent with the goals of the
reformed program;
new text end

new text begin (4) provide enrollees with a choice of appropriate private sector health coverage
options, with full federal financial participation;
new text end

new text begin (5) treat payments made toward the cost of care as a monthly premium for
beneficiaries receiving home and community-based services when applicable;
new text end

new text begin (6) provide health coverage and services to individuals over the age of 65 that are
limited in scope and are available only in the home and community-based setting;
new text end

new text begin (7) consolidate all home and community-based services currently provided under
title XIX of the federal Social Security Act, United States Code, title 42, section 1915(c),
into a single program of home and community-based services that include options for
consumer direction and shared living;
new text end

new text begin (8) expand disease management, care coordination, and wellness programs for all
medical assistance recipients; and
new text end

new text begin (9) empower and encourage able-bodied medical assistance recipients to work,
whenever possible.
new text end

new text begin Subd. 2. new text end

new text begin Agency coordination. new text end

new text begin The commissioner shall establish an intraagency
assessment and coordination unit to ensure that decision making and program planning for
recipients who may need long-term care, residential placement, and community support
services are coordinated. The assessment and coordination unit shall determine level of
care, develop service plans and a service budget, make referrals to appropriate settings,
provide education and choice counseling to consumers and providers, track utilization,
and monitor outcomes.
new text end