SF 3417

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; expanding fee-for-service health care delivery
under medical assistance, general assistance medical care, and MinnesotaCare;
eliminating delivery of services to state health care program enrollees by prepaid
health plans; proposing coding for new law in Minnesota Statutes, chapter 256;
repealing Minnesota Statutes 2004, sections 256B.031; 256B.69, subdivisions 1,
2, 3, 3a, 3b, 4b, 5, 5a, 5b, 5c, 5d, 5e, 5f, 5g, 5h, 6, 6a, 6b, 6c, 6d, 7, 8, 9, 10, 11,
16, 17, 18, 19, 20, 21, 22, 24a, 25, 26, 27; 256L.12, subdivisions 1, 2, 3, 4, 5,
6, 7, 8, 9, 9a, 10, 11; Minnesota Statutes 2005 Supplement, sections 256B.69,
subdivisions 4, 23; 256L.12, subdivision 9b.

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

Section 1.

new text begin [256.0135] EXPANSION OF FEE-FOR-SERVICE HEALTH CARE
DELIVERY.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
apply.
new text end

new text begin (b) "Prepaid health plan" means an entity under contract with the commissioner to
provide health care services on a prepaid capitated basis to enrollees of a state-managed
care program.
new text end

new text begin (c) "State health care program" means the medical assistance, general assistance
medical care, and MinnesotaCare programs.
new text end

new text begin (d) "State-managed care program" means the prepaid medical assistance program
established under section 256B.69, the prepaid general assistance medical care established
under section 256D.03, subdivision 4, paragraph (c), and the prepaid MinnesotaCare
program established under section 256L.12. State-managed care program does not include
county-based purchasing projects established under section 256B.692.
new text end

new text begin Subd. 2. new text end

new text begin Expansion of fee-for-service. new text end

new text begin Beginning January 1, 2008, the
commissioner shall deliver health care services to state health care program enrollees
receiving health care services through a state-managed care program as of December 31,
2007, through a fee-for-service system, and shall not contract with prepaid health plans to
provide health care services to these enrollees after December 31, 2007.
new text end

new text begin Subd. 3. new text end

new text begin Elimination of prior authorization and utilization controls. new text end

new text begin Beginning
January 1, 2008, the commissioner shall not use prior authorization or other utilization
controls when providing health care services under the fee-for-service system to state
health care program enrollees. This prohibition applies both to services provided to
enrollees who had been receiving services through state-managed care programs and
services provided to enrollees who had been excluded from mandatory enrollment in a
state-managed care program. This subdivision does not apply to: (1) the coverage and
provision of prescription drugs; (2) preadmission screening for nursing facility admission;
and (3) utilization control activities required by federal law.
new text end

new text begin Subd. 4. new text end

new text begin Exemption for county-based purchasing. new text end

new text begin County-based purchasing
projects are exempt from this section and shall continue to be governed by section
256B.692.
new text end

Sec. 2. new text begin RECOMMENDATIONS ON TRANSITION TO EXPANDED
FEE-FOR-SERVICE SYSTEM.
new text end

new text begin The commissioner of human services shall present to the legislature, by December
15, 2006, recommendations and draft legislation for any changes in the operation of state
health care programs necessary to comply with and implement section 1.
new text end

Sec. 3. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin (a) The revisor of statutes shall prepare, for the 2007 legislature, draft legislation
containing any additional repealers and conforming changes needed to terminate health
care delivery through state-managed care programs and to eliminate the use of prior
authorization and other utilization controls under the expanded fee-for-service system
for state program enrollees, as provided in Minnesota Statutes, section 256.0135. The
commissioner shall include in this draft legislation a repeal of Minnesota Statutes, section
256D.03, subdivision 4, paragraph (c).
new text end

new text begin (b) The revisor of statutes shall correct internal cross-references to sections that are
affected by section 4, the repealer section in this bill. The revisor may make changes
necessary to correct the punctuation, grammar, or structure of the remaining test and
preserve its meaning.
new text end

Sec. 4. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, sections 256B.031; 256B.69, subdivisions 1, 2, 3, 3a, 3b,
4b, 5, 5a, 5b, 5c, 5d, 5e, 5f, 5g, 5h, 6, 6a, 6b, 6c, 6d, 7, 8, 9, 10, 11, 16, 17, 18, 19, 20, 21,
22, 24a, 25, 26, and 27; and 256L.12, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 9a, 10, and 11, new text end new text begin
and new text end new text begin Minnesota Statutes 2005 Supplement, sections 256B.69, subdivisions 4 and 23; and
256L.12, subdivision 9b, new text end new text begin are repealed, effective January 1, 2008.
new text end