SF 3181

3rd Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; revising requirements for county-based purchasing
for state health care programs; requiring a mandated report; amending Minnesota
Statutes 2006, sections 256B.69, subdivision 3a; 256B.692, subdivision 7;
Minnesota Statutes 2007 Supplement, section 256B.69, subdivision 4; Laws
2005, First Special Session chapter 4, article 8, section 84, as amended.

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

Section 1.

Minnesota Statutes 2006, section 256B.69, subdivision 3a, is amended to
read:

Subd. 3a.

County authority.

(a) The commissioner, when implementing the general
assistance medical care, or medical assistance prepayment program within a county,
must include the county board in the process of development, approval, and issuance of
the request for proposals to provide services to eligible individuals within the proposed
county. County boards must be given reasonable opportunity to make recommendations
regarding the development, issuance, review of responses, and changes needed in the
request for proposals. The commissioner must provide county boards the opportunity to
review each proposal based on the identification of community needs under chapters 145A
and 256E and county advocacy activities. If a county board finds that a proposal does not
address certain community needs, the county board and commissioner shall continue
efforts for improving the proposal and network prior to the approval of the contract. The
county board shall make recommendations regarding the approval of local networks
and their operations to ensure adequate availability and access to covered services. The
provider or health plan must respond directly to county advocates and the state prepaid
medical assistance ombudsperson regarding service delivery and must be accountable to
the state regarding contracts with medical assistance and general assistance medical care
funds. The county board may recommend a maximum number of participating health
plans after considering the size of the enrolling population; ensuring adequate access and
capacity; considering the client and county administrative complexity; and considering
the need to promote the viability of locally developed health plans. The county board
or a single entity representing a group of county boards and the commissioner shall
mutually select health plans for participation at the time of initial implementation of the
prepaid medical assistance program in that county or group of counties and at the time
of contract renewal. The commissioner shall also seek input for contract requirements
from the county or single entity representing a group of county boards at each contract
renewal and incorporate those recommendations into the contract negotiation process.
deleted text begin The commissioner, in conjunction with the county board, shall actively seek to develop
a mutually agreeable timetable prior to the development of the request for proposal, but
counties must agree to initial enrollment beginning on or before January 1, 1999, in
either the prepaid medical assistance and general assistance medical care programs or
county-based purchasing under section 256B.692. At least 90 days before enrollment in
the medical assistance and general assistance medical care prepaid programs begins in
a county in which the prepaid programs have not been established, the commissioner
shall provide a report to the chairs of senate and house committees having jurisdiction
over state health care programs which verifies that the commissioner complied with the
requirements for county involvement that are specified in this subdivision. deleted text end

(b) At the option of the county board, the board may develop contract requirements
related to the achievement of local public health goals to meet the health needs of medical
assistance and general assistance medical care enrollees. These requirements must be
reasonably related to the performance of health plan functions and within the scope of the
medical assistance and general assistance medical care benefit sets. If the county board
and the commissioner mutually agree to such requirements, the department shall include
such requirements in all health plan contracts governing the prepaid medical assistance
and general assistance medical care programs in that county at initial implementation of
the program in that county and at the time of contract renewal. The county board may
participate in the enforcement of the contract provisions related to local public health goals.

(c) For counties in which prepaid medical assistance and general assistance medical
care programs have not been established, the commissioner shall not implement those
programs if a county board submits acceptable and timely preliminary and final proposals
under section 256B.692, until county-based purchasing is no longer operational in that
county. For counties in which prepaid medical assistance and general assistance medical
care programs are in existence on or after September 1, 1997, the commissioner must
terminate contracts with health plans according to section 256B.692, subdivision 5, if
the county board submits and the commissioner accepts preliminary and final proposals
according to that subdivision. The commissioner is not required to terminate contracts that
begin on or after September 1, 1997, according to section 256B.692 until two years have
elapsed from the date of initial enrollment.

(d) In the event that a county board or a single entity representing a group of county
boards and the commissioner cannot reach agreement regarding: (i) the selection of
participating health plans in that county; (ii) contract requirements; or (iii) implementation
and enforcement of county requirements including provisions regarding local public
health goals, the commissioner shall resolve all disputes after taking into account the
recommendations of a three-person mediation panel. The panel shall be composed of one
designee of the president of the association of Minnesota counties, one designee of the
commissioner of human services, and one deleted text begin designee of the commissioner of health deleted text end new text begin person
selected jointly by the designee of the commissioner of human services and the designee
of the Association of Minnesota Counties. Within a reasonable period of time before
the hearing the panelists must be provided all documents and information relevant to
the mediation. The parties to the mediation must be given 30 days' notice of a hearing
before the mediation panel new text end .

(e) If a county which elects to implement county-based purchasing ceases to
implement county-based purchasing, it is prohibited from assuming the responsibility of
county-based purchasing for a period of five years from the date it discontinues purchasing.

deleted text begin (f) Notwithstanding the requirement in this subdivision that a county must agree to
initial enrollment on or before January 1, 1999, the commissioner shall grant a delay in
the implementation of the county-based purchasing authorized in section 256B.692 until
federal waiver authority and approval has been granted, if the county or group of counties
has submitted a preliminary proposal for county-based purchasing by September 1, 1997,
has not already implemented the prepaid medical assistance program before January 1,
1998, and has submitted a written request for the delay to the commissioner by July
1, 1998. In order for the delay to be continued, the county or group of counties must
also submit to the commissioner the following information by December 1, 1998. The
information must:
deleted text end

deleted text begin (1) identify the proposed date of implementation, as determined under section
256B.692, subdivision 5;
deleted text end

deleted text begin (2) include copies of the county board resolutions which demonstrate the continued
commitment to the implementation of county-based purchasing by the proposed date.
County board authorization may remain contingent on the submission of a final proposal
which meets the requirements of section 256B.692, subdivision 5, paragraph (b);
deleted text end

deleted text begin (3) demonstrate actions taken for the establishment of a governance structure
between the participating counties and describe how the fiduciary responsibilities of
county-based purchasing will be allocated between the counties, if more than one county
is involved in the proposal;
deleted text end

deleted text begin (4) describe how the risk of a deficit will be managed in the event expenditures are
greater than total capitation payments. This description must identify how any of the
following strategies will be used:
deleted text end

deleted text begin (i) risk contracts with licensed health plans;
deleted text end

deleted text begin (ii) risk arrangements with providers who are not licensed health plans;
deleted text end

deleted text begin (iii) risk arrangements with other licensed insurance entities; and
deleted text end

deleted text begin (iv) funding from other county resources;
deleted text end

deleted text begin (5) include, if county-based purchasing will not contract with licensed health plans
or provider networks, letters of interest from local providers in at least the categories of
hospital, physician, mental health, and pharmacy which express interest in contracting
for services. These letters must recognize any risk transfer identified in clause (4), item
(ii); and
deleted text end

deleted text begin (6) describe the options being considered to obtain the administrative services
required in section 256B.692, subdivision 3, clauses (3) and (5).
deleted text end

deleted text begin (g) For counties which receive a delay under this subdivision, the final proposals
required under section 256B.692, subdivision 5, paragraph (b), must be submitted at
least six months prior to the requested implementation date. Authority to implement
county-based purchasing remains contingent on approval of the final proposal as required
under section 256B.692.
deleted text end

deleted text begin (h) If the commissioner is unable to provide county-specific, individual-level
fee-for-service claims to counties by June 4, 1998, the commissioner shall grant a delay
under paragraph (f) of up to 12 months in the implementation of county-based purchasing,
and shall require implementation not later than January 1, 2000. In order to receive an
extension of the proposed date of implementation under this paragraph, a county or group
of counties must submit a written request for the extension to the commissioner by August
1, 1998, must submit the information required under paragraph (f) by December 1, 1998,
and must submit a final proposal as provided under paragraph (g).
deleted text end

deleted text begin (i) Notwithstanding other requirements of this subdivision, the commissioner
shall not require the implementation of the county-based purchasing authorized in
section 256B.692 until six months after federal waiver approval has been obtained for
county-based purchasing, if the county or counties have submitted the final plan as
required in section 256B.692, subdivision 5. The commissioner shall allow the county or
counties which submitted information under section 256B.692, subdivision 5, to submit
supplemental or additional information which was not possible to submit by April 1, 1999.
A county or counties shall continue to submit the required information and substantive
detail necessary to obtain a prompt response and waiver approval. If amendments to
the final plan are necessary due to the terms and conditions of the waiver approval, the
commissioner shall allow the county or group of counties 60 days to make the necessary
amendments to the final plan and shall not require implementation of the county-based
purchasing until six months after the revised final plan has been submitted.
deleted text end

new text begin (f) The commissioner shall not require that contractual disputes between
county-based purchasing entities and the commissioner be mediated by a panel that
includes a representative of the Minnesota Council of Health Plans.
new text end

new text begin (g) At the request of a county-purchasing entity, the commissioner shall adopt a
contract reprocurement or renewal schedule under which all counties included in the
entity's service area are reprocured or renewed at the same time.
new text end

new text begin (h) The commissioner shall provide a written report under section 3.195 to the chairs
of the legislative committees having jurisdiction over human services in the senate and the
house of representatives describing in detail the activities undertaken by the commissioner
to ensure full compliance with this section. The report must also provide an explanation
for any decisions of the commissioner not to accept the recommendations of a county or
group of counties required to be consulted under this section. The report must be provided
at least 30 days prior to the effective date of a new or renewed prepaid or managed care
contract in a county.
new text end

Sec. 2.

Minnesota Statutes 2007 Supplement, section 256B.69, subdivision 4, is
amended to read:

Subd. 4.

Limitation of choice.

(a) The commissioner shall develop criteria to
determine when limitation of choice may be implemented in the experimental counties.
The criteria shall ensure that all eligible individuals in the county have continuing access
to the full range of medical assistance services as specified in subdivision 6.

(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:

(1) persons eligible for medical assistance according to section 256B.055,
subdivision 1;

(2) persons eligible for medical assistance due to blindness or disability as
determined by the Social Security Administration or the state medical review team, unless:

(i) they are 65 years of age or older; or

(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
Security Act;

(3) recipients who currently have private coverage through a health maintenance
organization;

(4) recipients who are eligible for medical assistance by spending down excess
income for medical expenses other than the nursing facility per diem expense;

(5) recipients who receive benefits under the Refugee Assistance Program,
established under United States Code, title 8, section 1522(e);

(6) children who are both determined to be severely emotionally disturbed and
receiving case management services according to section 256B.0625, subdivision 20,
except children who are eligible for and who decline enrollment in an approved preferred
integrated network under section 245.4682;

(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;

(8) persons eligible for medical assistance according to section 256B.057,
subdivision 10; and

(9) persons with access to cost-effective employer-sponsored private health
insurance or persons enrolled in a non-Medicare individual health plan determined to be
cost-effective according to section 256B.0625, subdivision 15.

Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an
elective basis. The commissioner may enroll recipients in the prepaid medical assistance
program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by
spending down excess income.

(c) The commissioner may allow persons with a one-month spenddown who are
otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay
their monthly spenddown to the state.

(d) The commissioner may require those individuals to enroll in the prepaid medical
assistance program who otherwise would have been excluded under paragraph (b), clauses
(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.

(e) Before limitation of choice is implemented, eligible individuals shall be notified
and after notification, shall be allowed to choose only among demonstration providers.
The commissioner may assign an individual with private coverage through a health
maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider,
the recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.

(f) An infant born to a woman who is eligible for and receiving medical assistance
and who is enrolled in the prepaid medical assistance program shall be retroactively
enrolled to the month of birth in the same managed care plan as the mother once the
child is enrolled in medical assistance unless the child is determined to be excluded from
enrollment in a prepaid plan under this section.

new text begin (g) The commissioner shall assign an eligible individual, in the absence of a specific
managed care plan choice by the individual, to the county-based purchasing health plan
in Olmsted, Winona, Houston, Fillmore, and Mower Counties, if the individual resides
in one of these counties.
new text end

Sec. 3.

Minnesota Statutes 2006, section 256B.692, subdivision 7, is amended to read:

Subd. 7.

Dispute resolution.

In the event the commissioner rejects a proposal
under subdivision 6, the county board may request the recommendation of a three-person
mediation panel. The commissioner shall resolve all disputes after taking into account the
recommendations of the mediation panel. The panel shall be composed of one designee of
the president of the Association of Minnesota Counties, one designee of the commissioner
of human services, and one deleted text begin designee of the commissioner of health deleted text end new text begin person selected jointly
by the designee of the commissioner of human services and the designee of the Association
of Minnesota Counties. Within a reasonable period of time before the hearing the panelists
must be provided all documents and information relevant to the mediation. The parties to
the mediation must be given 30 days' notice of a hearing before the mediation panel new text end .

Sec. 4.

Laws 2005, First Special Session chapter 4, article 8, section 84, as amended by
Laws 2006, chapter 264, section 15, is amended to read:

Sec. 84. deleted text begin SOLE-SOURCE OR deleted text end SINGLE-PLAN MANAGED CARE
CONTRACT.

new text begin (a) new text end Notwithstanding Minnesota Statutes, section 256B.692, subdivision 6, clause
(1), paragraph (c), the commissioner of human services shall approve a county-based
purchasing health plan proposal, submitted on behalf of Cass, Crow Wing, Morrison,
Todd, and Wadena Counties, that requires county-based purchasing on a single-plan basis
contract if the implementation of the single-plan purchasing proposal does not limit an
enrollee's provider choice or access to services and all other requirements applicable to
health plan purchasing are satisfied. deleted text begin The commissioner shall continue single health plan
purchasing arrangements with county-based purchasing entities in the service deleted text end deleted text begin areas in
existence on deleted text end deleted text begin May 1, 2006, including arrangements for which a proposal was submitted deleted text end deleted text begin by
May 1, deleted text end deleted text begin 2006, on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena Counties, in
response to a request for proposals issued by the commissioner deleted text end new text begin The commissioner shall
continue to use single-health plan, county-based purchasing arrangements for medical
assistance and general assistance medical care managed care programs and products for
the counties that were in single-health plan, county-based purchasing arrangements on
March 1, 2008. This paragraph does not require the commissioner to terminate an existing
contract with a noncounty-based purchasing health plan that had enrollment in a medical
assistance program or product in these counties on March 1, 2008. This paragraph expires
on December 31, 2010, or the effective date of new contracts for medical assistance and
general assistance medical care managed care programs entered into at the conclusion of
the commissioner's next scheduled reprocurement process for the county-based purchasing
entities covered by this paragraph, whichever is later new text end .

new text begin (b) new text end The commissioner shall consider, and may approve, contracting on a
single-health plan basis with new text begin other new text end county-based purchasing plans, or with other qualified
health plans that have coordination arrangements with counties, to serve persons with a
disability who voluntarily enroll, in order to promote better coordination or integration of
health care services, social services and other community-based services, provided that all
requirements applicable to health plan purchasing, including those in Minnesota Statutes,
section 256B.69, subdivision 23, are satisfied. deleted text begin By January 15, 2007, the commissioner
shall report to the chairs of the appropriate legislative committees in the house and senate
an analysis of the advantages and disadvantages of using single-health plan purchasing
to serve persons with a disability who are eligible for health care programs. The report
shall include consideration of the impact of federal health care programs and policies
for persons who are eligible for both federal and state health care programs and shall
consider strategies to improve coordination between federal and state health care programs
for those persons deleted text end new text begin Nothing in this paragraph supersedes or modifies the requirements in
paragraph (a) new text end .

Sec. 5. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall codify section 3 as a new subdivision of Minnesota
Statutes, section 256B.692.
new text end