Minnesota Legislature
SF 2855
as introduced - 89th Legislature (2015 - 2016) Posted on 03/18/2016 10:29am
Current Version - as introduced
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A bill for an act
relating to human services; establishing an alternative payment methodology for
federally qualified health centers and rural health clinics; clarifying allowable
costs for change of scope of services; amending Minnesota Statutes 2014, section
256B.0625, subdivision 30.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2014, section 256B.0625, subdivision 30, is amended to
read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic
services, federally qualified health center services, nonprofit community health clinic
services, and public health clinic services. Rural health clinic services and federally
qualified health center services mean services defined in United States Code, title 42,
section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified
health center services shall be made according to applicable federal law and regulation.
(b) A federally qualified health centernew text begin (FQHC)new text end that is beginning initial operation
shall submit an estimate of budgeted costs and visits for the initial reporting period in the
form and detail required by the commissioner. deleted text begin A federally qualified health centerdeleted text end new text begin An
FQHCnew text end that is already in operation shall submit an initial report using actual costs and
visits for the initial reporting period. Within 90 days of the end of its reporting period, deleted text begin a
federally qualified health centerdeleted text end new text begin an FQHCnew text end shall submit, in the form and detail required by
the commissioner, a report of its operations, including allowable costs actually incurred
for the period and the actual number of visits for services furnished during the period,
and other information required by the commissioner. deleted text begin Federally qualified health centersdeleted text end new text begin
FQHCsnew text end that file Medicare cost reports shall provide the commissioner with a copy of the
most recent Medicare cost report filed with the Medicare program intermediary for the
reporting year which support the costs claimed on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), deleted text begin a federally qualified health centerdeleted text end new text begin an FQHCnew text end or rural
health clinic must apply for designation as an essential community provider within six
months of final adoption of rules by the Department of Health according to section
62Q.19, subdivision 7. For those deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health
clinics that have applied for essential community provider status within the six-month time
prescribed, medical assistance payments will continue to be made according to paragraphs
(a) and (b) for the first three years after application. For deleted text begin federally qualified health centersdeleted text end new text begin
FQHCsnew text end and rural health clinics that either do not apply within the time specified above
or who have had essential community provider status for three years, medical assistance
payments for health services provided by these entities shall be according to the same rates
and conditions applicable to the same service provided by health care providers that are
not deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end or rural health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring deleted text begin a federally
qualified health centerdeleted text end new text begin an FQHCnew text end or a rural health clinic to make application for an essential
community provider designation in order to have cost-based payments made according
to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b)
shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, each deleted text begin federally qualified health centerdeleted text end new text begin FQHCnew text end and rural
health clinic may elect to be paid either under the prospective payment system new text begin (PPS)
new text end established in United States Code, title 42, section 1396a(aa), or under an alternative
payment methodology new text begin meeting the requirements of subdivision 30, paragraph (j), or under
existing alternative payment methodologies new text end consistent with the requirements of United
States Code, title 42, section 1396a(aa), and approved by the Centers for Medicare and
Medicaid Services. The alternative payment methodology shall be 100 percent of cost as
determined according to Medicare cost principles.
(g) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups,
uninsured, high-risk and special needs populations, underserved and other special needs
populations;
(4) employs professional staff at least one-half of which are familiar with the
cultural background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or
public assistance status and provides no-cost care as needed.
(h) Effective for services provided on or after January 1, 2015, all claims for
payment of clinic services provided by deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural
health clinics shall be paid by the commissioner. The commissioner shall determine the
most feasible method for paying claims from the following options:
(1) deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health clinics submit
claims directly to the commissioner for payment, and the commissioner provides claims
information for recipients enrolled in a managed care or county-based purchasing plan to
the plan, on a regular basis; or
(2) deleted text begin federally qualified health centersdeleted text end new text begin FQHCsnew text end and rural health clinics submit claims
for recipients enrolled in a managed care or county-based purchasing plan to the plan, and
those claims are submitted by the plan to the commissioner for payment to the clinic.
(i) For clinic services provided prior to January 1, 2015, the commissioner shall
calculate and pay monthly the proposed managed care supplemental payments to clinics,
and clinics shall conduct a timely review of the payment calculation data in order to
finalize all supplemental payments in accordance with federal law. Any issues arising
from a clinic's review must be reported to the commissioner by January 1, 2017. Upon
final agreement between the commissioner and a clinic on issues identified under this
subdivision, and in accordance with United States Code, title 42, section 1396a(bb), no
supplemental payments for managed care plan or county-based purchasing plan claims
for services provided prior to January 1, 2015, shall be made after June 30, 2017. If the
commissioner and clinics are unable to resolve issues under this subdivision, the parties
shall submit the dispute to the arbitration process under section 14.57.
new text begin
(j) Effective January 1, 2018, all claims for payment of clinic services provided
by FQHCs and rural health clinics shall be paid by the commissioner according to the
following requirements:
new text end
new text begin
(1) each FQHC and rural health clinic must receive a single medical and a single
dental organization rate;
new text end
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(2) the commissioner shall reimburse FQHCs and rural health clinics their allowable
costs, including direct patient care costs and patient-related support services. These costs
include, but are not limited to, the costs of:
new text end
new text begin
(i) acquisition, implementation, and maintenance of electronic health records and
patient management systems;
new text end
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(ii) community health workers who need acute and chronic care management;
new text end
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(iii) care coordination;
new text end
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(iv) the new FQHC or rural health clinic service that is not incorporated in the
baseline PPS rate, or a deletion of an FQHC or rural health clinic service that is
incorporated in the baseline rate;
new text end
new text begin
(v) a change in service due to amended regulatory requirements or rules;
new text end
new text begin
(vi) a change in service resulting from relocating or remodeling an FQHC or rural
health clinic;
new text end
new text begin
(vii) a change in types of services due to a change in applicable technology and
medical practice utilized by the center or clinic;
new text end
new text begin
(viii) an increase in service intensity attributable to changes in the types of patients
served, including, but not limited to, populations with HIV or AIDS, mental health or
chemical dependency conditions, or other chronic diseases, or homeless, elderly, migrant,
or other special populations;
new text end
new text begin
(ix) a change in the services described in United States Code, title 42, section
1396d(a)(2)(B) and (C), or in the provider mix of an FQHC or rural health clinic or one of
its sites;
new text end
new text begin
(x) a change in operating costs attributable to capital expenditures associated with
a modification of the scope of the services described in United States Code, title 42,
section 1396d(a)(2)(B) and (C), including new or expanded service facilities, regulatory
compliance, or changes in technology or medical practices at the center or clinic;
new text end
new text begin
(xi) indirect medical education adjustments and a direct graduate medical education
payment that reflects the costs of providing teaching services to interns and residents; and
new text end
new text begin
(xii) a change in the scope of a project approved by the federal Health Resources and
Service Administration (HRSA);
new text end
new text begin
(3) the base year payment rates for FQHCs and rural health clinics:
new text end
new text begin
(i) must be determined using each FQHC's and rural health clinic's Medicare cost
reports from 2014 and 2015;
new text end
new text begin
(ii) must be according to current Medicare cost principles as applicable to FQHCs
and rural health clinics without the application of productivity screens and upper payment
limits or the Medicare PPS FQHC aggregate mean upper payment limit; and
new text end
new text begin
(iii) provide for a 90-day appeals process under section 14.57;
new text end
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(4) the commissioner shall annually inflate the payment rates for FQHCs and rural
health clinics from the base year payment rate to the effective date by using the Bureau of
Economic Analysis' Personal Consumption Expenditures medical care inflator;
new text end
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(5) FQHCs' and rural health clinics' payment rates shall be rebased by the
commissioner every two years and adjusted biannually by the Medicare Economic Index;
new text end
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(6) the commissioner shall seek approval from the Centers for Medicare and
Medicaid Services to modify payments to FQHCs and rural health clinics according
to subdivision 63;
new text end
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(7) the commissioner shall reimburse FQHCs and rural health clinics an additional
two percent of their medical and dental rates established under this subdivision, only if the
payment of the two percent provided tax is required to be paid according to section 295.52;
new text end
new text begin
(8) for FQHCs and rural health clinics seeking a change of scope of services:
new text end
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(i) FQHCs and rural health clinics shall submit requests with the commissioner if
the change of scope would result in a 2-1/2 percent increase or decrease in the medical or
dental rate currently received by the FQHC or rural health clinic;
new text end
new text begin
(ii) FQHCs and rural health clinics shall submit the request to the commissioner
within seven business days of submission of the scope change to the federal Health
Resources Services Administration;
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(iii) the effective date of the payment change is the date the Health Resources Services
Administration approved the FQHC's or rural health clinic's change of scope request;
new text end
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(iv) for change of scope requests that do not require Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner prior to implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request; and
new text end
new text begin
(v) the commissioner shall provide a response to the FQHC's or rural health clinic's
request within 45 days of submission and provide a final approval within 120 days of
submission. This timeline may be waived at the mutual agreement of the commissioner and
the FQHC or rural health clinic if more information is needed to evaluate the request; and
new text end
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(9) the commissioner shall establish a rate setting process for new FQHCs and rural
health clinics considering the following factors:
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(i) a comparison of patient caseload of FQHCs and rural health clinics in a 60-mile
radius for organizations established outside of the seven-county metropolitan area and in a
five-mile radius for organizations in the seven-county metropolitan area; and
new text end
new text begin
(ii) if comparison is not feasible under paragraph (a), the commissioner may use
Medicare cost reports or audited financial statements to establish base rate.
new text end