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SF 1105

as introduced - 90th Legislature (2017 - 2018) Posted on 02/17/2017 09:17am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to human services; requiring the commissioner of human services to
establish and implement a bundled payment system for perinatal services under
medical assistance and MinnesotaCare; appropriating money; 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.0759] BUNDLED PAYMENT FOR PERINATAL SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Implementation. new text end

new text begin The commissioner of human services, in cooperation
with the commissioner of health, shall implement a bundled payment system for perinatal
services, effective January 1, 2018. The payment system shall apply to medical assistance
and MinnesotaCare services delivered through managed care plans under section 256B.69,
county-based purchasing plans under section 256B.692, integrated health partnerships under
the health care delivery system demonstration project authorized under section 256B.0755,
and through the medical assistance fee-for-service delivery system.
new text end

new text begin Subd. 2. new text end

new text begin Establishment of perinatal bundle. new text end

new text begin (a) The commissioner of human services
shall enter into an interagency agreement with the commissioner of health to implement
this subdivision and subdivision 5.
new text end

new text begin (b) The commissioner of health shall define the clinical components of the perinatal
bundle, develop criteria for accountable entities, and measure the quality of services provided
by accountable entities.
new text end

new text begin (c) The perinatal bundle shall include the standard perinatal services provided during
pregnancy, labor, and birth; a 60-day postpartum period for the mother; and the first year
of newborn care. These services shall include hospital and professional services and other
high-value services and providers, including but not limited to midwives, licensed birth
centers, and doula care.
new text end

new text begin (d) The perinatal bundle episode shall begin with confirmation of pregnancy and initiation
of prenatal care. To be eligible for bundled payment, the accountable entity must initiate
care by 20 weeks' gestation. The perinatal bundle episode ends 60 days postpartum for the
woman and one year postbirth for the infant.
new text end

new text begin (e) The target population for payment through the perinatal bundle shall be low-risk
pregnant women and their infants. The commissioner of health shall use nationally recognized
criteria to define "low-risk." If a mother who has a stillborn infant or a mother who has an
infant with lethal anomalies chooses perinatal hospice care, the mother is eligible for services
paid as part of the perinatal bundle.
new text end

new text begin Subd. 3. new text end

new text begin Accountable entities. new text end

new text begin (a) The commissioner of human services shall contract
with accountable entities to provide the perinatal bundle for a fixed price to low-risk
Minnesota health care program recipient mothers and infants. The commissioner shall ensure
that at least one accountable entity is available to residents of each Minnesota county.
new text end

new text begin (b) An accountable entity may be established by a health care provider or health care
provider group, a hospital or hospital system, a managed care or county-based purchasing
plan, or an integrated health partnership.
new text end

new text begin (c) An accountable entity must:
new text end

new text begin (1) be certified by the commissioner of health;
new text end

new text begin (2) have the financial resources to accept some degree of financial risk for episodes of
care; and
new text end

new text begin (3) have a consultation relationship with at least one level III perinatal center.
new text end

new text begin Subd. 4. new text end

new text begin Payment for perinatal bundle; risk pool. new text end

new text begin (a) The perinatal bundle payment
amount shall include the cost of all standard perinatal services. The initial payment amount
shall equal 85 percent of average payments provided under section 256B.69 for mother-infant
pairs in 2016. Future perinatal bundle payments shall be set by the commissioner of human
services based on the most current expenditure data available, and any payment increases
must not exceed the increase in the Consumer Price Index for All Urban Consumers: Medical
Care. The commissioner of human services shall make payments to accountable entities
within six weeks of birth.
new text end

new text begin (b) The commissioner of human services shall retain 15 percent of the average payments
provided under section 256B.69 for mother-infant pairs in 2016, to be administered by the
commissioner as a separate perinatal risk pool fund. The fund shall be used by the
commissioner to adjust base payment rates to pay for:
new text end

new text begin (1) the care of high-risk pregnancies and newborns;
new text end

new text begin (2) nonperinatal health care for the mother; and
new text end

new text begin (3) the cost of care that exceeds 250 percent of the perinatal bundle payment rate.
new text end

new text begin (c) The commissioner of human services shall adjust capitation payments made under
sections 256B.69, 256B.692, and 256L.12, and total cost of care payments made to integrated
health partnerships operating under section 256B.0755, to reflect separate payment for
perinatal bundles under this section.
new text end

new text begin Subd. 5. new text end

new text begin Measures of quality and cost. new text end

new text begin Accountable entities shall annually report
perinatal encounter, outcome, and cost data to the commissioners of health and human
services in the time and format specified by the commissioners. The information must also
include patient-reported outcomes. The commissioner of health shall develop quality
scorecards to track and compare the performance of accountable entities. Quality and cost
information must be made available to the public on the departments of health and human
services Web sites.
new text end

new text begin Subd. 6. new text end

new text begin Federal approval and waivers. new text end

new text begin The commissioner of human services shall
seek any necessary federal approvals and waivers necessary to implement this section.
new text end

Sec. 2. new text begin APPROPRIATION.
new text end

new text begin $....... in fiscal year 2018 is appropriated from the general fund to the commissioner of
human services to implement Minnesota Statutes, section 256B.0759. Of this amount, $.......
is for the commissioner of human services to enter into an interagency agreement with the
commissioner of health. The unencumbered balance in the first year does not cancel but is
available for the second year.
new text end