SF 3399

1st Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; allowing the commissioner of human services
to contract with Medicare-approved special needs plans to provide medical
assistance services to persons with disabilities; creating a stakeholder group;
requiring legislative approval; appropriating money; amending Minnesota
Statutes 2004, section 256B.69, subdivision 9, by adding a subdivision;
Minnesota Statutes 2005 Supplement, section 256B.69, subdivision 23.

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

Section 1.

Minnesota Statutes 2004, section 256B.69, subdivision 9, is amended to read:

Subd. 9.

Reporting.

new text begin (a) new text end Each demonstration provider shall submit information as
required by the commissioner, including data required for assessing client satisfaction,
quality of care, cost, and utilization of services for purposes of project evaluation. The
commissioner shall also develop methods of data new text begin reporting and new text end collection deleted text begin from county
advocacy activities deleted text end in order to provide aggregate enrollee information on encounters
and outcomes to determine access and quality assurance. Required information shall be
specified before the commissioner contracts with a demonstration provider.

new text begin (b) Nonpersonally identifiable health plan encounter data, aggregate spending data,
and criteria for service authorization and service use are public data that the commissioner
shall make available and use in public reports. The commissioner shall require each health
plan and county-based purchasing plan to provide:
new text end

new text begin (1) encounter data for each service provided, using standard codes and unit of
service definitions set by the commissioner, in a form that the commissioner can report
by age, eligibility groups, and health plan;
new text end

new text begin (2) total aggregate medical assistance spending for major categories of service
as reported to the commissioner of commerce under section 62D.08, subdivision 3,
paragraph (a), in a form that the commissioner can report by age, eligibility group, and
health plan; and
new text end

new text begin (3) criteria, written policies, and procedures required to be disclosed under section
62M.10, subdivision 7, and Code of Federal Regulations, title 42, part 438.210(b)(1), used
for each type of service for which authorization is required.
new text end

Sec. 2.

Minnesota Statutes 2005 Supplement, section 256B.69, subdivision 23, is
amended to read:

Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations new text begin and may contract with
Medicare-approved special needs plans to provide Medicaid services new text end . Medicare funds and
services shall be administered according to the terms and conditions of the federal waiver
and demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, with the
exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, items B and
C, which do not apply to persons enrolling in demonstrations under this section. An initial
open enrollment period may be provided. Persons who disenroll from demonstrations
under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464.
When a person is enrolled in a health plan under these demonstrations and the health
plan's participation is subsequently terminated for any reason, the person shall be provided
an opportunity to select a new health plan and shall have the right to change health plans
within the first 60 days of enrollment in the second health plan. Persons required to
participate in health plans under this section who fail to make a choice of health plan shall
not be randomly assigned to health plans under these demonstrations. Notwithstanding
section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, subpart 1, item A,
if adopted, for the purpose of demonstrations under this subdivision, the commissioner
may contract with managed care organizations, including counties, to serve only elderly
persons eligible for medical assistance, elderly and disabled persons, or disabled persons
only. For persons with primary diagnoses of mental retardation or a related condition,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with primary diagnoses of mental retardation or a related condition, serious and
persistent mental illness, or serious emotional disturbance, without approval of the county
board of the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for mental retardation or
related conditions, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until two years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
two years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas
of the state. new text begin Until January 1, 2008, expansion for MnDHO projects that include home
and community-based services is limited to the two projects and service areas in effect
on March 1, 2006. Enrollment in integrated MnDHO programs that include home and
community-based services shall remain voluntary. Costs for home and community-based
services included under MnDHO must not exceed costs that would have been incurred
under the fee-for-service program. In developing program specifications for expansion of
integrated programs, the commissioner shall involve and consult the state-level stakeholder
group established in subdivision 28, paragraph (d), including consultation on whether and
how to include home and community-based waiver programs. Plans for further expansion
of MnDHO projects shall be presented to the chairs of the house and senate committees
with jurisdiction over health and human services policy and finance by February 1, 2007.
new text end

(g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2004, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 28. new text end

new text begin Medicare special needs plans and medical assistance basic health
care for persons with disabilities. new text end

new text begin (a) The commissioner may contract with qualified
Medicare-approved special needs plans to provide medical assistance basic health care
services to persons with disabilities, including those with developmental disabilities.
Basic health care services include:
new text end

new text begin (1) those services covered by the medical assistance state plan except for ICF/MR
services, home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care
and certain home care services defined by the commissioner in consultation with the
stakeholder group established under paragraph (d);
new text end

new text begin (2) basic health care services may also include risk for up to 100 days of nursing
facility services for persons who reside in a noninstitutional setting and home health
services related to rehabilitation as defined by the commissioner after consultation with
the stakeholder group; and
new text end

new text begin (3) the commissioner may exclude other medical assistance services from the basic
health care benefit set. Enrollees in these plans can access any excluded services on the
same basis as other medical assistance recipients who have not enrolled.
new text end

new text begin Unless a person is otherwise required to enroll in managed care, enrollment in these
plans for Medicaid services must be voluntary. For purposes of this subdivision, automatic
enrollment with an option to opt out is not voluntary enrollment.
new text end

new text begin (b) Beginning January 1, 2007, the commissioner may contract with qualified
Medicare special needs plans to provide basic health care services under medical assistance
to persons who are dually eligible for both Medicare and Medicaid and those Social
Security beneficiaries eligible for Medicaid but in the waiting period for Medicare. The
commissioner shall consult with the stakeholder group under paragraph (d) in developing
program specifications for these services. The commissioner shall report to the chairs of
the house and senate committees with jurisdiction over health and human services policy
and finance by February 1, 2007, on implementation of these programs and the need for
increased funding for the ombudsman for managed care and other consumer assistance
and protections needed due to enrollment in managed care of persons with disabilities.
new text end

new text begin (c) Beginning January 1, 2008, the commissioner may expand contracting under this
subdivision to all persons with disabilities not otherwise required to enroll in managed
care.
new text end

new text begin (d) The commissioner shall establish a state-level stakeholder group to provide
advice on managed care programs for persons with disabilities, including both MnDHO
and contracts with special needs plans that provide basic health care services as described
in paragraphs (a) and (b). The stakeholder group shall provide advice on program
expansions under this subdivision and subdivision 23, including:
new text end

new text begin (1) implementation efforts;
new text end

new text begin (2) consumer protections; and
new text end

new text begin (3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.
new text end

new text begin (e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the
counties covered by the plan, members, consumer advocates, and providers, for advice on
issues that arise in the local or regional area.
new text end

Sec. 4. new text begin STAKEHOLDER PARTICIPATION.
new text end

new text begin The commissioner of human services shall establish one or more stakeholder groups
of interested persons, including representatives of recipients, advocacy groups, counties,
providers, and health plans to provide information and advice on the development of any
proposals for changes in the medical assistance program authorized by the federal Deficit
Reduction Act of 2005, Public Law 109-171.
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. 5. new text begin LEGISLATIVE AUTHORIZATION REQUIRED.
new text end

new text begin Any changes to the medical assistance program proposed as a result of the
federal Deficit Reduction Act of 2005, Public Law 109-171, which affect cost sharing,
co-payments, premiums, eligibility, covered services, service limitations, or benefit set
changes, must receive legislative approval prior to being implemented or submitted to the
Centers for Medicare and Medicaid Services.
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. 6. new text begin APPROPRIATION; OMBUDSMAN FOR MANAGED CARE.
new text end

new text begin $200,000 is appropriated from the general fund to the commissioner of human
services in fiscal year 2007 to increase staff for the development and management of
contract requirements associated with enrolling persons with disabilities in managed
care and for the ombudsman for managed care office in order to assist persons with
disabilities on issues involving health coverage under Minnesota Statutes, section
256B.69, subdivision 28.
new text end