SF 2337

as introduced - 86th Legislature (2009 - 2010) Posted on 03/12/2010 03:33pm

A bill for an act
relating to human services; establishing an intensive care management program
for medical assistance enrollees; reducing funding for the medical assistance
program; requiring a request for proposals; requiring a report; appropriating
money; amending Laws 2009, chapter 79, article 13, section 3, subdivision 6, as
amended; 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.0755] INTENSIVE CARE MANAGEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Report. new text end

new text begin The commissioner shall review medical assistance
enrollment and by July 1, 2010, present a report to the legislature that describes the
common characteristics and costs of those enrollees whose annual medical costs are
greater than 95 percent of all other enrollees, using de-identified data.
new text end

new text begin Subd. 2. new text end

new text begin Intensive care management system established. new text end

new text begin The commissioner
shall implement, by January 1, 2011, a program to provide intensive care management
to medical assistance enrollees currently served under fee-for-service, managed care, or
county-based purchasing, whose annual medical care costs are in the top five percent of all
medical assistance enrollees. The intensive care management program must reduce these
enrollees' medical assistance costs by at least 20 percent on average, improve quality of
care through care coordination, and provide financial incentives for providers to deliver
care efficiently. The commissioner may require medical assistance enrollees meeting
the criteria specified in this subdivision to participate in the intensive care management
program, and may reassign enrollees from existing managed care and county-based
purchasing plans to those plans that are participating in the demonstration program. The
commissioner shall seek all federal approvals and waivers necessary to implement the
intensive care management program.
new text end

new text begin Subd. 3. new text end

new text begin Request for proposals. new text end

new text begin The commissioner of human services shall request
proposals by September 1, 2010, from health care providers, managed care plans, and
county-based purchasing plans to provide intensive care management services under the
requirements of subdivision 1. Proposals submitted must:
new text end

new text begin (1) designate the medical assistance population and geographic area of the state
to be served;
new text end

new text begin (2) describe in detail the proposed intensive care management program;
new text end

new text begin (3) provide estimates of cost savings to the state and the evidence supporting these
estimates;
new text end

new text begin (4) describe the extent to which the intensive care management program is consistent
with and builds upon current state health care home, care coordination, and payment
reform initiatives; and
new text end

new text begin (5) meet quality assurance, data reporting, and other criteria specified by the
commissioner in the request for proposals.
new text end

new text begin The commissioner shall accept proposals that, in the aggregate, provide savings to
the medical assistance program equal to the reduction in funding under section 2.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Laws 2009, chapter 79, article 13, section 3, subdivision 6, as amended by
Laws 2009, chapter 173, article 2, section 1, subdivision 6, is amended to read:

Subd. 6. Basic Health Care Grants

The amounts that may be spent from this
appropriation for each purpose are as follows:

(a) MinnesotaCare Grants

391,785,000

485,370,000

This appropriation is from the health care
access fund.

(b) MA Basic Health Care Grants - Families and Children

751,166,000

deleted text begin 972,901,000 deleted text end new text begin 968,036,495 new text end

Medical Education Research Costs
(MERC). Of these funds, the commissioner
of human services shall transfer $38,000,000
in fiscal year 2010 to the medical education
research fund. These funds must restore the
fiscal year 2009 unallotment of the transfers
under Minnesota Statutes, section 256B.69,
subdivision 5c, paragraph (a), for the July 1,
2008, through June 30, 2009, period.

Newborn Screening Fee. Of the general
fund appropriation, $34,000 in fiscal year
2011 is to the commissioner for the hospital
reimbursement increase described under
Minnesota Statutes, section 256.969,
subdivision 29.

Local Share Payment Modification
Required for ARRA Compliance.
Effective retroactively from October 1, 2008,
to December 31, 2010, Hennepin County's
monthly contribution to the nonfederal share
of medical assistance costs must be reduced
to the percentage required on September
1, 2008, to meet federal requirements for
enhanced federal match under the American
Reinvestment and Recovery Act (ARRA)
of 2009. Notwithstanding the requirements
of Minnesota Statutes, section 256B.19,
subdivision 1c, paragraph (d), for the period
beginning October 1, 2008, to December 31,
2010, Hennepin County's monthly payment
under that provision is reduced to $434,688.
This provision is effective the day following
final enactment.

Capitation Payments. Effective
retroactively from October 1, 2008, to
December 31, 2010, notwithstanding
the provisions of Minnesota Statutes
2008, section 256B.19, subdivision 1c,
paragraph (c), the commissioner shall
increase capitation payments made to the
Metropolitan Health Plan under Minnesota
Statutes 2008, section 256B.69, by
$6,800,000 to recognize higher than average
medical education costs. The increased
amount includes federal matching funds.
This provision is effective the day following
final enactment.

Use of Savings. Any savings derived
from implementation of the prohibition in
Minnesota Statutes, section 256B.032, on the
enrollment of low-quality, high-cost health
care providers as vendors of state health care
program services shall be used to offset on a
pro rata basis the reimbursement reductions
for basic care services in Minnesota Statutes,
section 256B.766.

(c) MA Basic Health Care Grants - Elderly and Disabled

969,992,000

deleted text begin 1,141,575,000 deleted text end new text begin 1,135,867,125 new text end

Minnesota Disability Health Options.
Notwithstanding Minnesota Statutes, section
256B.69, subdivision 5a, paragraph (b), for
the period beginning July 1, 2009, to June
30, 2011, the monthly enrollment of persons
receiving home and community-based
waivered services under Minnesota
Disability Health Options shall not exceed
1,000. If the budget neutrality provision
in Minnesota Statutes, section 256B.69,
subdivision 23, paragraph (f), is reached
prior to June 30, 2013, the commissioner may
waive this monthly enrollment requirement.

Hospital Fee-for-Service Payment Delay.
Payments from the Medicaid Management
Information System that would otherwise
have been made for inpatient hospital
services for Minnesota health care program
enrollees must be delayed as follows: for
fiscal year 2011, payments in the month of
June equal to $15,937,000 must be included
in the first payment of fiscal year 2012 and
for fiscal year 2013, payments in the month
of June equal to $6,666,000 must be included
in the first payment of fiscal year 2014. The
provisions of Minnesota Statutes, section
16A.124, do not apply to these delayed
payments. Notwithstanding any contrary
provision in this article, this paragraph
expires December 31, 2014.

Nonhospital Fee-for-Service Payment
Delay. Payments from the Medicaid
Management Information System that would
otherwise have been made for nonhospital
acute care services for Minnesota health
care program enrollees must be delayed as
follows: payments in the month of June equal
to $23,438,000 for fiscal year 2011 must be
included in the first payment for fiscal year
2012, and payments in the month of June
equal to $27,156,000 for fiscal year 2013
must be included in the first payment for
fiscal year 2014. This payment delay must
not include nursing facilities, intermediate
care facilities for persons with developmental
disabilities, home and community-based
services, prepaid health plans, personal care
provider organizations, and home health
agencies. The provisions of Minnesota
Statutes, section 16A.124, do not apply to
these delayed payments. Notwithstanding
any contrary provision in this article, this
paragraph expires December 31, 2014.

(d) General Assistance Medical Care Grants

344,907,000

381,081,000

* (The preceding text "381,081,000" was indicated as vetoed by the Governor.)

(e) Other Health Care Grants

Appropriations by Fund
General	295,000	295,000
Health Care Access	23,533,000	7,080,000

Base Adjustment. The health care access
fund base is reduced by $6,890,000 in fiscal
year 2012 and $6,890,000 in fiscal year 2013.

Sec. 3. new text begin REDUCTION IN APPROPRIATION.
new text end

new text begin The base funding under the current law forecast used to calculate the state
appropriation for the medical assistance program is reduced by one-half of one percent
for fiscal year 2011 and by one percent for the 2012-2013 biennium, as provided in
section 2. This reduction is ongoing and shall apply to future bienniums, or for as long
as the program described in Minnesota Statutes, section 256B.0755, is determined to be
cost-effective by the commissioner of human services.
new text end

Sec. 4. new text begin APPROPRIATIONS.
new text end

new text begin $15,000 for fiscal year 2010 is appropriated from the general fund to the
commissioner of human services for the report required by Minnesota Statutes, section
256B.0755, subdivision 1.
new text end