SF 866

as introduced - 87th Legislature (2011 - 2012) Posted on 02/23/2012 09:24am

A bill for an act
relating to health care; modifying county roles and rights related to state health
care program purchasing; authorizing county-based purchasing arrangements;
establishing a process to reduce administrative reporting; amending Minnesota
Statutes 2010, sections 256B.0755, by adding a subdivision; 256B.69,
subdivision 3a; 256B.692, subdivisions 2, 5, 7; 256B.694.

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

ARTICLE 1

LOCAL AND COUNTY ROLES IN STATE HEALTH CARE
PROGRAM PURCHASING

Section 1.

Minnesota Statutes 2010, section 256B.69, subdivision 3a, is amended to
read:

Subd. 3a.

County authority.

(a) The commissioner, when implementing new text begin or
administering new text end 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 new text begin , including
proposals for demonstration projects established under section 256B.0755 new text end . County boards
must be given reasonable opportunity to deleted text begin make recommendations regarding deleted text end new text begin assist in new text end
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 deleted text begin recommendations deleted text end new text begin determinations new text end regarding the approval
of local networks and their operations to ensure adequate new text begin local new text end 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 deleted text begin may recommend deleted text end new text begin shall decide new text end a maximum number of participating health
plans new text begin including county-based purchasing plans new text end 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 new text begin , managed care plans, or demonstration projects established under
section 256B.0755 new text end . The county board or a single entity representing a group of county
boards and the commissioner shall mutually select new text begin one or more qualified new text end health plans new text begin or
county-based purchasing plans new text end for participation at the time of initial implementation of the
prepaid medical assistance program new text begin or a demonstration project established under section
256B.0755 new text end 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 new text begin and health care delivery and access
goals new text end to meet the health needs of medical assistance enrollees. These requirements must
be reasonably related to the performance of health plan new text begin managed care or delivery system
demonstration project new text end functions and within the scope of the medical assistance benefit
set. deleted text begin If the county board and the commissioner mutually agree to such requirements, the
department deleted text end new text begin The commissioner new text end shall include such requirements in all deleted text begin health plan deleted text end contracts
governing the prepaid medical assistance program in that county at initial implementation
of the program new text begin or demonstration project new text end in that county and at the time of contract renewal.
The county board may participate in the enforcement of the contract deleted text begin provisions related to
local public health goals deleted text end .

(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 deleted text begin preliminary and
final deleted text end 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 new text begin or demonstration projects under section 256B.0755 new text end 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 deleted text begin after taking into account deleted text end new text begin by approving new text end 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 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.

(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.

new text begin (i) This section also applies to other Minnesota health care programs administered
by the commissioner including, but not limited to, the MinnesotaCare program.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256B.692, subdivision 2, is amended to read:

Subd. 2.

Duties of commissioner of health.

(a) Notwithstanding chapters 62D and
62N, a county that elects to purchase medical assistance in return for a fixed sum without
regard to the frequency or extent of services furnished to any particular enrollee is not
required to obtain a certificate of authority under chapter 62D or 62N. The county board
of commissioners is the governing body of a county-based purchasing program. In a
multicounty arrangement, the governing body is a joint powers board established under
section 471.59.

(b) A county that elects to purchase medical assistance services under this section
must satisfy the commissioner of health that the requirements for assurance of consumer
protection, provider protection, and, effective January 1, 2010, fiscal solvency of chapter
62D, applicable to health maintenance organizations will be met according to the
following schedule:

(1) for a county-based purchasing plan approved on or before June 30, 2008, the
plan must have in reserve:

(i) at least 50 percent of the minimum amount required under chapter 62D as
of January 1, 2010;

(ii) at least 75 percent of the minimum amount required under chapter 62D as of
January 1, 2011;

(iii) at least 87.5 percent of the minimum amount required under chapter 62D as
of January 1, 2012; and

(iv) at least 100 percent of the minimum amount required under chapter 62D as
of January 1, 2013; and

(2) for a county-based purchasing plan first approved after June 30, 2008, the plan
must have in reserve:

(i) at least 50 percent of the minimum amount required under chapter 62D at the
time the plan begins enrolling enrollees;

(ii) at least 75 percent of the minimum amount required under chapter 62D after
the first full calendar year;

(iii) at least 87.5 percent of the minimum amount required under chapter 62D after
the second full calendar year; and

(iv) at least 100 percent of the minimum amount required under chapter 62D after
the third full calendar year.

(c) Until a plan is required to have reserves equaling at least 100 percent of the
minimum amount required under chapter 62D, the plan may demonstrate its ability
to cover any losses by satisfying the requirements of chapter 62N. new text begin Notwithstanding
this paragraph and paragraph (b), a county-based purchasing plan may satisfy its fiscal
solvency requirements by obtaining written financial guarantees from participating
counties in amounts equivalent to the minimum amounts that would otherwise apply. new text end
A county-based purchasing plan must also assure the commissioner of health that the
requirements of sections 62J.041; 62J.48; 62J.71 to 62J.73; 62M.01 to 62M.16; all
applicable provisions of chapter 62Q, including sections 62Q.075; 62Q.1055; 62Q.106;
62Q.12; 62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23, paragraph (c); 62Q.43; 62Q.47;
62Q.50; 62Q.52 to 62Q.56; 62Q.58; 62Q.68 to 62Q.72; and 72A.201 will be met.

(d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M,
62N, and 62Q are hereby granted to the commissioner of health with respect to counties
that purchase medical assistance services under this section.

(e) The commissioner, in consultation with county government, shall develop
administrative and financial reporting requirements for county-based purchasing programs
relating to sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 62N.31,
and other sections as necessary, that are specific to county administrative, accounting, and
reporting systems and consistent with other statutory requirements of counties.

(f) The commissioner shall collect from a county-based purchasing plan under
this section the following fees:

(1) fees attributable to the costs of audits and other examinations of plan financial
operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800,
subpart 1, item F;

(2) an annual fee of $21,500, to be paid by June 15 of each calendar year, beginning
in calendar year 2009; and

(3) for fiscal year 2009 only, a per-enrollee fee of 14.6 cents, based on the number of
enrollees as of December 31, 2008.

All fees collected under this paragraph shall be deposited in the state government special
revenue fund.

Sec. 3.

Minnesota Statutes 2010, section 256B.692, subdivision 5, is amended to read:

Subd. 5.

County proposals.

(a) On or before September 1, 1997, 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 on or before
July 1, 1997. 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 on or before July 1, 1998, that
demonstrates the ability to meet all the requirements of this section, including beginning
enrollment on January 1, 1999, unless a delay has been granted under section 256B.69,
subdivision 3a, paragraph (g).

(c) After January 1, 1999, for a county in which the prepaid medical assistance
program is in existence, the county board must submit a deleted text begin preliminary proposal at least 15
months prior to termination of health plan contracts in that county and a final deleted text end proposal new text begin
that meets the requirements of this section new text end 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.

(d) The commissioner is not required to terminate contracts for the prepaid medical
assistance program that begin on or after September 1, 1997, in a county for which a
county board has submitted a proposal under this paragraph, until two years have elapsed
from the date of initial enrollment in the prepaid medical assistance program.

Sec. 4.

Minnesota Statutes 2010, section 256B.692, subdivision 7, is amended to read:

Subd. 7.

Dispute resolution.

In the event the commissioner rejects a proposal
under subdivision 6, the county board may request the deleted text begin recommendation deleted text end new text begin decision new text end of a
three-person mediation panel. The commissioner shall resolve all disputes deleted text begin after taking
into account deleted text end new text begin by following new text end the deleted text begin recommendations deleted text end new text begin decision new text end of the 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 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. 5.

Minnesota Statutes 2010, section 256B.694, is amended to read:

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

(a) Notwithstanding section 256B.692, subdivision 6, clause (1), paragraph (c),
the commissioner of human services shall approve a county-based purchasing health
plan proposal, submitted on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena
Counties, that requires county-based purchasing on a single-plan basis contract if the
implementation of the single-plan purchasing proposal does not limit an enrollee's
provider choice or access to services and all other requirements applicable to health plan
purchasing are satisfied. The commissioner shall continue to use single-health plan,
county-based purchasing arrangements for medical assistance and general assistance
medical care programs and products for the counties that were in single-health plan,
county-based purchasing arrangements on March 1, 2008. This paragraph does not require
the commissioner to terminate an existing contract with a noncounty-based purchasing
plan that had enrollment in a medical assistance program or product in these counties on
March 1, 2008. This paragraph expires on December 31, 2010, or the effective date
of a new contract for medical assistance and general assistance medical care managed
care programs entered into at the conclusion of the commissioner's next scheduled
reprocurement process for the county-based purchasing entities covered by this paragraph,
whichever is later.

(b) new text begin At the request of a county or group of counties, new text end the commissioner shall deleted text begin consider,
and may deleted text end approve deleted text begin , deleted text end contracting on a single-health plan basis with deleted text begin other deleted text end county-based
purchasing plans, or with other qualified health plans that have coordination arrangements
with counties, to serve persons deleted text begin with a disability who voluntarily enroll, deleted text end new text begin enrolled in
Minnesota health care programs new text end 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 section
256B.69, subdivision 23, are satisfied. Nothing in this paragraph supersedes or modifies
the requirements in paragraph (a).

ARTICLE 2

RURAL HEALTH CARE DELIVERY DEMONSTRATION PROJECTS

Section 1.

Minnesota Statutes 2010, section 256B.0755, is amended by adding a
subdivision to read:

new text begin Subd. 8. new text end

new text begin Rural demonstration projects. new text end

new text begin For demonstration projects serving
rural areas, the commissioner shall consult with rural hospitals, primary care providers,
county boards, health plans, and other key stakeholders primarily domiciled in the
service area regarding the development and approval of alternative rural health care
delivery demonstration projects under this section. In addition to organizations eligible
to establish a demonstration project under subdivision 1, a rural demonstration project
may be established by a county public health or social services agency or a county-based
purchasing plan. In a rural area where multiple, competing provider-based demonstration
projects are not possible, the commissioner shall not approve more than one demonstration
project to serve the primary geographic area and shall follow the applicable procedures
and requirements in section 256B.692 regarding participation of county boards in
reviewing and approving demonstration project proposals.
new text end

ARTICLE 3

REDUCTION OF REDUNDANT, UNNECESSARY, AND OBSOLETE
STATE-MANDATED ADMINISTRATIVE REPORTS

Section 1. new text begin REDUCTION OF STATE-MANDATED ADMINISTRATIVE
REPORTS.
new text end

new text begin (a) The commissioner of management and budget shall convene a report reduction
working group of persons designated by the commissioners of health, human services, and
commerce to eliminate redundant, unnecessary, obsolete, and low-priority state-mandated
administrative reports required of health plans and county-based purchasing plans
that serve persons enrolled in Minnesota health care programs. The commissioner of
management and budget and the report reduction working group shall develop a plan to
oversee the report reduction activities of the individual state agencies and coordinate the
activities of multiple state agencies to consolidate reports or eliminate redundant reports
required by more than one state agency on the same or a similar topic.
new text end

new text begin (b) The commissioners of health, human services, and commerce shall reduce,
eliminate, or consolidate state-mandated reports according to the plan developed by the
commissioner of management and budget through the report reduction working group.
In addition to other report reduction actions the commissioners or the working group
may undertake, the commissioners shall:
new text end

new text begin (1) collect encounter data, including provider payment data if collected, in a
consolidated report provided to a single state agency, with the data collected by that state
agency to be shared with other state agencies who need the data;
new text end

new text begin (2) collect only one provider network report annually through a single state agency,
with the data collected by that state agency to be shared with other state agencies who
need the data;
new text end

new text begin (3) collect only one standard financial report through a single state agency, with
the data collected by that state agency to be shared with other state agencies who need
the data. Data collected must be of a nature and in a format to allow comparison of the
cost-effectiveness of fee-for-service payment systems and prepaid programs administered
by health plans and county-based purchasing plans;
new text end

new text begin (4) consolidate and simplify reports and documentation requirements relating to
member communications and marketing materials, and establish a single review process
for all programs, products, and agencies in order to ensure uniform and consistent
regulation of health plan contracts;
new text end

new text begin (5) consolidate state regulation and oversight of health plans and county-based
purchasing plans so that activities of multiple agencies are administered through an
efficient and uniform multiagency process of oversight and audits, with consistent
standards, measures, and definitions for state oversight of quality, utilization management,
care management, delegation accountability, access to care, appeals and grievances, and
financial management;
new text end

new text begin (6) establish uniform requirements and procedures for denial, termination, or
reduction of services, and member appeals and grievances, and align state requirements
and procedures with federal requirements and procedures;
new text end

new text begin (7) reform the state's performance improvement projects, requirements, and
procedures to be more flexible and efficient, and to place greater focus on measuring
improvement of outcomes and less on mandating detailed or prescriptive requirements for
specific performance improvement projects or activities;
new text end

new text begin (8) new reporting requirements or ad hoc report requests shall be established by a
state agency only:
new text end

new text begin (i) if required by a federal agency;
new text end

new text begin (ii) if needed for a state regulatory audit or corrective action plan; or
new text end

new text begin (iii) after the completion of a review and analysis, and the development of
recommendations by the commissioner of management and budget, in consultation
with the report reduction working group, regarding the necessity, importance, and
administrative cost of the new report, and after completing a review to determine
whether the information sought can be obtained through another available state or federal
report. The results of the review, analysis, and recommendations of the commissioner of
management and budget must be provided to health plans and county-based purchasing
plans for review and comment at least 60 days before a new report or requirement is
established; and
new text end

new text begin (9) to the extent possible, all state agencies shall use the procedures, reports,
and audits of the Centers for Medicare and Medicaid Services instead of requiring an
additional state-mandated report on the same or a similar topic.
new text end

new text begin (c) By January 15, 2012, the commissioner of management and budget shall provide
a report on the activities and results of the report reduction project to the chairs and
ranking minority members of the legislative committees of the house of representatives
and senate with jurisdiction over health plans or county-based purchasing payments,
regulations, and performance. The report must include:
new text end

new text begin (1) a timetable for report reduction actions already taken or planned by the
commissioners or the report reduction working group;
new text end

new text begin (2) the specific reports that have been or will be eliminated or consolidated;
new text end

new text begin (3) the amount of money that will be saved through reductions in administrative
costs of health plans and county-based purchasing plans as a result of the report reduction
project; and
new text end

new text begin (4) proposed legislation for changes to laws or rules that are needed to allow state
agencies to further reduce, consolidate, or eliminate reports when the changes cannot
be made administratively.
new text end