SF 2126

as introduced - 90th Legislature (2017 - 2018) Posted on 03/16/2017 09:29am

A bill for an act
relating to human services; requiring improved oversight of MNsure, medical
assistance, and MinnesotaCare eligibility determinations; establishing a special
revenue account for savings; requiring savings to be used for long-term care
provider rate increases; 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.

[256B.0562] IMPROVED OVERSIGHT OF MNSURE ELIGIBILITY
DETERMINATIONS.

Subdivision 1.

Implementation of legislative auditor's findings.

(a) The commissioner
shall ensure that medical assistance and MinnesotaCare eligibility determinations through
the MNsure information technology system and through agency eligibility determination
systems fully implement the recommendations made by the Office of the Legislative Auditor
in Report 14-22, Oversight of MNsure Eligibility Determinations for Public Health Care
Programs and Report 16-02, Oversight of MNsure Eligibility Determinations for Public
Health Care Programs, Internal Controls and Compliance Audit.

(b) The commissioner may contract with a vendor to provide technical assistance to the
commissioner in fully implementing the legislative auditor's findings.

(c) The commissioner shall coordinate implementation of this section with the periodic
data matching required under section 256B.0561.

(d) The commissioner shall implement this section using existing resources.

Subd. 2.

Duties of the commissioner.

(a) In fully implementing the legislative auditor's
recommendations, the commissioner shall:

(1) adequately verify that persons enrolled in public health care programs through MNsure
are eligible for those programs;

(2) provide adequate controls to ensure the accurate and complete transfer of recipient
data from MNsure to the Department of Human Services' medical payment system, and to
detect whether Office of MN.IT Services staff inappropriately access recipients' personal
information;

(3) provide county human service eligibility workers with sufficient training on MNsure;

(4) re-verify that medical assistance and MinnesotaCare enrollees who enroll through
MNsure remain eligible for the program within the required time frames established in
federal and state laws;

(5) establish an effective process to resolve discrepancies with Social Security numbers,
citizenship or immigration status, or household income that MNsure identifies as needing
further verification;

(6) eliminate payment of medical assistance and MinnesotaCare benefits for recipients
whose income exceeds federal and state program limits;

(7) verify household size and member relationships when determining eligibility;

(8) ensure that applicants and recipients are enrolled in the correct public health care
program;

(9) eliminate payment of benefits for MinnesotaCare recipients who are also enrolled
in Medicare;

(10) verify that newborns turning age one remain eligible for medical assistance;

(11) correct MinnesotaCare billing errors, ensure that enrollees pay their premiums, and
terminate coverage for failure to pay premiums; and

(12) take all other steps necessary to fully implement the recommendations.

(b) The commissioner shall implement the legislative auditor's recommendations for
medical assistance and MinnesotaCare applications and renewals submitted on or after July
1, 2017. The commissioner shall present quarterly reports to the legislative auditor and the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance, beginning October 1, 2017, and quarterly
thereafter. The quarterly report submitted October 1, 2017, must include a timetable for
fully implementing the legislative auditor's recommendations. Each quarterly report must
include information on:

(1) progress in implementing the legislative auditor's recommendations;

(2) the number of medical assistance and MinnesotaCare applicants and enrollees whose
eligibility status was affected by implementation of the legislative auditor's recommendations,
reported quarterly, beginning with the July 1, 2017, through September 30, 2017, calendar
quarter; and

(3) savings to the state from implementing the legislative auditor's recommendations.

Subd. 3.

Office of Legislative Auditor.

The legislative auditor shall review each quarterly
report submitted by the commissioner of human services under subdivision 2 for accuracy
and shall review compliance by the Department of Human Services with the legislative
auditor's recommendations. The legislative auditor shall notify the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance on whether or not these requirements were met.

Subd. 4.

Special revenue account; use of savings.

(a) A medical assistance audit special
revenue account is established in the general fund. The commissioner shall deposit into this
account:

(1) all savings achieved from implementing this section for applications and renewals
submitted on or after July 1, 2017;

(2) all savings achieved from implementation of periodic data matching under section
256B.0561 that are above the forecasted savings for that initiative; and

(3) all state savings resulting from implementation of the vendor contract under section
256B.0563, minus any payments to the vendor made under the terms of the revenue sharing
agreement.

(b) Once the medical assistance audit special revenue account fund balance has reached
a sufficient level, the commissioner shall provide a onetime, five percent increase in medical
assistance payment rates for intermediate care facilities for persons with developmental
disabilities and the long-term care and community-based providers listed in Laws 2014,
chapter 312, article 27, section 75, paragraph (b). The increase shall be limited to a 12-month
period.

(c) Any further expenditures from the medical assistance audit special revenue account
are subject to legislative authorization.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 2.

[256B.0563] ELIGIBILITY VERIFICATION.

Subdivision 1.

Verification required; vendor contract.

(a) The commissioner shall
ensure that medical assistance and MinnesotaCare eligibility determinations through the
MNsure information technology system and through agency eligibility determination systems
include the computerized verification of income, residency, identity, and, when applicable,
assets.

(b) The commissioner shall contract with a vendor to verify the eligibility of all persons
enrolled in medical assistance and MinnesotaCare during a specified audit period. This
contract shall be exempt from sections 16C.08, subdivision 2, clause (1); 16C.09, paragraph
(a), clause (1); 43A.047, paragraph (a), and any other law to the contrary.

(c) The contract must require the vendor to comply with enrollee data privacy
requirements and to use encryption to safeguard enrollee identity. The contract must also
provide penalties for vendor noncompliance.

(d) The contract must include a revenue sharing agreement, under which vendor
compensation is limited to a portion of any savings to the state resulting from the vendor's
implementation of eligibility verification initiatives under this section.

(e) The commissioner shall use existing resources to fund any agency administrative
and technology-related costs incurred as a result of implementing this section.

Subd. 2.

Verification process; vendor duties.

(a) The verification process implemented
by the vendor must include but is not limited to data matches of the name, date of birth,
address, and Social Security number of each medical assistance and MinnesotaCare enrollee
against relevant information in federal and state data sources, including the federal data hub
established under the Affordable Care Act. In designing the verification process, the vendor,
to the extent feasible, shall incorporate procedures that are compatible and coordinated with,
and build upon or improve, existing procedures used by the MNsure information technology
system and agency eligibility determination systems.

(b) The vendor, upon preliminary determination that an enrollee is eligible or ineligible,
shall notify the commissioner. Within 20 business days of notification, the commissioner
shall accept the preliminary determination or reject the preliminary determination with a
stated reason. The commissioner shall retain final authority over eligibility determinations.
The vendor shall keep a record of all preliminary determinations of ineligibility submitted
to the commissioner.

(c) The vendor shall recommend to the commissioner an eligibility verification process
that allows ongoing verification of enrollee eligibility under the MNsure information
technology system and agency eligibility determination systems.

(d) The commissioner and the vendor, following the conclusion of the initial contract
period, shall jointly submit an eligibility verification audit report to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance. The report shall include, but is not limited to, information, in
the form of unidentified summary data, on preliminary determinations of eligibility or
ineligibility communicated by the vendor; the actions taken on those preliminary
determinations by the commissioner; and the commissioner's reasons for rejecting preliminary
determinations by the vendor. The report must also include the recommendations for ongoing
verification of enrollee eligibility required under paragraph (c).

(e) An eligibility verification vendor contract shall be awarded for an initial one-year
period. The commissioner shall renew the contract for up to three additional one-year periods
and require additional eligibility verification audits, if the commissioner or the legislative
auditor determines that the MNsure information technology system and agency eligibility
determination systems cannot effectively verify the eligibility of medical assistance and
MinnesotaCare enrollees.