SF 2809

as introduced - 89th Legislature (2015 - 2016) Posted on 03/18/2016 10:02am

A bill for an act
relating to health care; establishing a Primary Care Case Management program;
authorizing direct state contracting with health care providers; proposing coding
for new law in Minnesota Statutes, chapter 256.

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

Section 1.

new text begin [256.9631] PRIMARY CASE MANAGEMENT AND DIRECT
CONTRACTING FOR MEDICAL ASSISTANCE AND MINNESOTACARE.
new text end

new text begin Subdivision 1. new text end

new text begin Program established. new text end

new text begin The Primary Care Case Management (PCCM)
program is established to achieve better health outcomes, track health care expenditures,
and reduce the cost of health care for the state. The commissioner shall contract directly
with health care providers to provide services under the PCCM program for medical
assistance and MinnesotaCare enrollees. Individuals eligible for the PCCM program are
individuals eligible for medical assistance under section 256B.055 and MinnesotaCare
enrollees under section 256L.05.
new text end

new text begin Subd. 2. new text end

new text begin Case management. new text end

new text begin (a) The commissioner shall utilize the PCCM
program to coordinate services for medical assistance and MinnesotaCare enrollees.
Under the program, patients may choose a primary care provider to act as the enrollee's
case manager. Primary care physicians, clinics, nurses, and other qualified medical
professionals may provide primary care case management. Specialists who routinely
provide care for patients with specific or complex medical conditions may also be primary
care providers for purposes of case management.
new text end

new text begin (b) Providers shall bill the state directly for the services they provide. Primary care
providers who offer the PCCM program shall also receive a flat per-member per-month
fee. The commissioner shall determine fees for the following groups:
new text end

new text begin (1) children;
new text end

new text begin (2) adults;
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new text begin (3) people with disabilities or chronic or complex medical conditions;
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new text begin (4) people from communities of color and racial, ethnic, cultural, and other
socioeconomic groups that face health disparities; and
new text end

new text begin (5) the elderly.
new text end

new text begin The commissioner shall set higher primary care case management fees based on the
level of medical and social complexity for patients with chronic or complex conditions
or disabilities as well as patients who have other challenges due to poverty, or other
socioeconomic factors that lead to health disparities.
new text end

new text begin (c) The primary care provider (PCP) shall provide overall oversight of the enrollee's
health and coordinate with any other case manager of the enrollee as well as ensure
24-hour access to health care, emergency treatment, and referrals.
new text end

new text begin (d) The commissioner shall collaborate with community health clinics and social
service providers through planning and financing to provide outreach, medical care, and
case management services in the community for patients who, because of mental illness,
homelessness, or other circumstances, are unlikely to obtain needed care.
new text end

new text begin (e) The commissioner shall collaborate with medical and social service providers
through planning and financing to reduce hospital readmissions by providing discharge
planning and services, including medical respite and transitional care for patients leaving
medical facilities and mental health and chemical dependency treatment programs.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin (a) For enrollees, the commissioner shall:
new text end

new text begin (1) maintain a hotline and Web site to assist enrollees in locating providers;
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new text begin (2) provide a nurse consultation helpline 24 hours per day, seven days a week; and
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new text begin (3) contact enrollees based on claims data who have not had preventive visits and
help them select a PCP.
new text end

new text begin (b) For the state fiscal management, the commissioner shall:
new text end

new text begin (1) track utilization rates in all levels of service; and
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new text begin (2) track health care targets which include:
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new text begin (i) improved health outcomes for enrollees;
new text end

new text begin (ii) reduction in avoidable costs, unnecessary emergency room visits, and inpatient
utilization;
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new text begin (iii) improved care coordination;
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new text begin (iv) improved patient self-management knowledge and treatment of chronic disease;
and
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new text begin (v) improved implementation of evidence-based clinical practice guidelines.
new text end

new text begin (c) For providers, the commissioner shall:
new text end

new text begin (1) review provider reimbursement rates to ensure reasonable and fair compensation;
new text end

new text begin (2) ensure that providers are reimbursed on a timely basis; and
new text end

new text begin (3) collaborate with providers to explore means of improving health care quality
and reducing costs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
Contracts for the Primary Care Case Management program shall be effective when the
current contracts for medical assistance and MinnesotaCare services expire.
new text end