SF 3621

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/15/2024 03:04pm

A bill for an act
relating to human services; establishing Family Medical Account service delivery
model; requiring reports; proposing coding for new law in Minnesota Statutes,
chapter 256B.

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

Section 1.

new text begin [256B.695] FAMILY MEDICAL ACCOUNT SERVICE DELIVERY
MODEL.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of human services shall establish the
Family Medical Account (FMA) service delivery model under this section. The commissioner
shall place all new and reenrolling medical assistance enrollees eligible under subdivision
4, and not excluded by subdivision 5, on an FMA service delivery model beginning January
1, 2025.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Chronically ill individual" has the meaning given in United States Code, title 26,
section 7702B, (c)(2)(A).
new text end

new text begin (c) "Disability" has the meaning given in United States Code, title 42, section 12102.
new text end

new text begin (d) "Financial institution" has the meaning given in section 47.59, subdivision 1,
paragraph (k).
new text end

new text begin (e) "Enrollee" means an individual enrolled in the FMA service delivery model.
new text end

new text begin Subd. 3. new text end

new text begin General criteria. new text end

new text begin (a) The FMA service delivery model must provide enrollees
with medical assistance benefits according to subdivision 6.
new text end

new text begin (b) The FMA service delivery model must provide enrollment counseling to enrollees
by providing enrollees:
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new text begin (1) incentives to seek preventive health care services;
new text end

new text begin (2) with individual guidance regarding the enrollment process and related information;
and
new text end

new text begin (3) with access to negotiated provider payment rates.
new text end

new text begin (c) The FMA service delivery model must provide ongoing education to enrollees on:
new text end

new text begin (1) the high cost of medical care;
new text end

new text begin (2) reducing the inappropriate use of health care services; and
new text end

new text begin (3) taking individual enrollee responsibility for health care outcomes.
new text end

new text begin (d) The commissioner shall provide for retrospective medical billing as allowed under
medical assistance guidelines.
new text end

new text begin Subd. 4. new text end

new text begin Participation requirements. new text end

new text begin (a) The commissioner must require any new or
reenrolling medical assistance enrollee who meets all the following qualifications to receive
medical assistance in the FMA service delivery model:
new text end

new text begin (1) the person is eligible for medical assistance under section 256B.055, subdivisions
3a, 9, 10, 15, and 16;
new text end

new text begin (2) the person has an income of 138 percent or less of the federal poverty guideline;
new text end

new text begin (3) the person would otherwise receive medical assistance services under a managed
care organization or a similar service delivery model; and
new text end

new text begin (4) the person is not excluded under subdivision 5.
new text end

new text begin (b) Individuals enrolled in the FMA service delivery model may opt out and elect to
enroll in medical assistance under a managed care organization or a similar service delivery
model at annual reenrollment and at any other reenrollment time determined by the
commissioner.
new text end

new text begin (c) The commissioner shall fully inform eligible persons of the comparative attributes
of the FMA service delivery model and other service delivery models.
new text end

new text begin (d) Enrollment in the FMA service delivery model is effective for 12 months and may
be extended for additional 12-month periods. Enrollment is subject to the individual
maintaining eligibility for medical assistance.
new text end

new text begin Subd. 5. new text end

new text begin Excluded persons. new text end

new text begin (a) A person who, when applying, has a disability or is 65
years of age or older is excluded from enrollment in the FMA service delivery model.
new text end

new text begin (b) A medical assistance enrollee subject to a federal waiver that requires a specific
delivery service model is excluded from enrollment in the FMA service delivery model.
new text end

new text begin (c) A medical assistance enrollee receiving services under a delivery service model other
than a managed care organization or a similar service delivery model is not required to
newly enroll or reenroll in the FMA service delivery model.
new text end

new text begin Subd. 6. new text end

new text begin Medical assistance benefits. new text end

new text begin (a) Enrollees in the FMA service delivery model
must be deemed consumers and must receive the following medical assistance benefits:
new text end

new text begin (1) coverage for medical expenses for medical goods and services for which benefits
are otherwise provided under medical assistance, after the annual deductible specified in
paragraph (d) has been met; and
new text end

new text begin (2) contributions into an FMA.
new text end

new text begin (b) Use of an FMA is limited to outpatient and emergency room goods and services,
including monthly fees for direct primary care.
new text end

new text begin (c) Any outpatient treatment service is limited to a $300 co-payment per service
occurrence.
new text end

new text begin (d) Notwithstanding section 256B.0631, subdivision 1a, the amount of the annual
deductible for an enrollee in the FMA service delivery model is 100 percent of the annualized
amount of contributions to the FMA.
new text end

new text begin (e) The following services are not subject to the annual deductible:
new text end

new text begin (1) preventive services as specified by the commissioner;
new text end

new text begin (2) prescription drugs prescribed for the treatment of diabetes, high blood pressure, high
cholesterol, epilepsy, respiratory diseases, and other health conditions as determined by the
commissioner;
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new text begin (3) lifesaving devices needed for the treatment of anaphylaxis;
new text end

new text begin (4) medical equipment necessary for the treatment of respiratory diseases; and
new text end

new text begin (5) inpatient hospital care and services at surgery centers. The commissioner must not
deduct an FMA emergency room charge if the enrollee is admitted to inpatient care.
new text end

new text begin (f) After an enrollee has met the annual deductible, medical assistance benefits for that
enrollee consist of the benefits that would otherwise be provided to that enrollee under
medical assistance had the enrollee not enrolled in the FMA service delivery model.
new text end

new text begin (g) The commissioner shall contract directly with health care providers as defined in
section 62A.63, subdivision 2, to provide the medical assistance benefits specified in
paragraph (a), clause (1), and may purchase reinsurance through open national bids for the
cost of providing these medical assistance benefits.
new text end

new text begin Subd. 7. new text end

new text begin Operation of an FMA. new text end

new text begin (a) The commissioner shall contribute an annual amount
into the FMA of each enrollee. Enrollees must use an FMA debit card to pay for benefits
under the program.
new text end

new text begin (b) For the initial calendar year of the FMA service delivery model, the prefund amount
for the FMA debit card is:
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new text begin (1) $1,500 for children;
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new text begin (2) $2,500 for adults with children; and
new text end

new text begin (3) $2,500 for adults without children.
new text end

new text begin (c) The commissioner shall pay the entire yearly prefund amount on January 1 each year
as long as the enrollee is eligible.
new text end

new text begin (d) The commissioner shall annually adjust the amount under paragraph (b) to meet 40
percent of Centers for Medicare and Medicaid Services annual enrollee costs as determined
using data available to the commissioner.
new text end

new text begin (e) Remaining FMA service delivery model prefund money vests one year after
enrollment. Any money remaining from the yearly prefund amount under paragraph (b)
must be placed into an investment account according to paragraph (h). Accumulated money
transferred to an investment account must not be counted toward the enrollee meeting the
prefund deductible in the subsequent year.
new text end

new text begin (f) If an enrollee is disenrolled from the FMA service delivery model or otherwise
becomes ineligible for any reason other than fraud, the operation of the FMA and any
associated investment account is controlled by subdivision 13.
new text end

new text begin (g) The commissioner shall contract with a third-party administrator to administer and
coordinate FMAs. The third-party administrator must be audited annually by an independent
auditor under parameters determined by the commissioner. A health plan company, or a
financial institution under contract under paragraph (h), must not serve as a third-party
administrator.
new text end

new text begin (h) The commissioner shall contract with a financial institution to establish investment
accounts for enrollees with unused FMA money at the end of the calendar year. FMA service
delivery model investment accounts do not have a dollar maximum. The commissioner shall
negotiate, as part of the contract, the interest rate to be paid by the financial institution to
an enrollee.
new text end

new text begin (i) The commissioner may contract for private bank services.
new text end

new text begin (j) The commissioner shall not count amounts in or contributed to an FMA as income
or assets for purposes of determining medical assistance eligibility.
new text end

new text begin (k) All payments must be made by the commissioner or the third-party administrator
directly to providers of medical goods and services.
new text end

new text begin (l) All payments to providers of medical goods and services for medical assistance must
be made at levels equivalent to the federal Medicare service fee rates.
new text end

new text begin (m) The commissioner shall create a process to coordinate care for high cost, chronically
ill enrollees with any medical illness, addiction, mental illness, dental care needs, or high
medical costs due to prolonged acute illness or injury. The use of enrollee personal clinical
data for this process must include each enrollee's authorized release of information, except
that no enrollee approval is required for release of information if the chronic illness severity
requires that the enrollee be transferred to a fee-for-service delivery model.
new text end

new text begin Subd. 8. new text end

new text begin Data. new text end

new text begin All data under the FMA service delivery model, including protected
enrollee identified data, is available to the commissioner. All data except protected health
information is available to any party pursuant to chapter 13, and no such data may be declared
protected data or trade secret by the commissioner.
new text end

new text begin Subd. 9. new text end

new text begin Incentives for preventive care. new text end

new text begin (a) The commissioner may develop and provide
positive incentives for enrollees to obtain prenatal care and other appropriate preventive
care. In developing these incentives, the commissioner may consider various rewards for
enrollees demonstrating healthy prevention practices.
new text end

new text begin (b) The commissioner may provide additional payments to providers who coordinate
care for enrollees.
new text end

new text begin Subd. 10. new text end

new text begin Using money in an FMA. new text end

new text begin (a) Except as provided in subdivision 13, enrollees
must only use money in an FMA for paying for medical care, as defined in section 213(d)
of the Internal Revenue Code of 1986.
new text end

new text begin (b) Enrollees must not use money in an FMA to pay providers for medical goods and
services unless:
new text end

new text begin (1) the providers are licensed or otherwise authorized under state law to provide the
goods or services;
new text end

new text begin (2) the provider meets medical assistance program standards, except there must be no
mandated electronic health records or report requirement for cash clinics; and
new text end

new text begin (3) the provider complies with medical assistance prohibitions related to fraud and abuse.
new text end

new text begin (c) The commissioner shall establish procedures to:
new text end

new text begin (1) penalize or disenroll from the FMA service delivery model enrollees and providers
who make nonqualified withdrawals from an FMA; and
new text end

new text begin (2) recoup costs that derive from nonqualified withdrawals.
new text end

new text begin (d) Enrollee use of FMA money after age 65 is governed by federal health savings
account rules.
new text end

new text begin (e) Medical assistance payment rates for medical goods and services do not apply unless
the enrollee remains on medical assistance. For those individuals no longer enrolled in the
FMA service delivery model, use of FMA money for medical goods and services is not
subject to medical assistance payment rates.
new text end

new text begin Subd. 11. new text end

new text begin Electronic transactions required. new text end

new text begin The commissioner shall require all
withdrawals and payments from FMAs be made electronically. The method developed or
selected for the FMA service delivery model must include photo identification and electronic
locks to prevent unauthorized use and must provide real-time, encounter-level payment to
health care providers. The method used must:
new text end

new text begin (1) allow information from an enrollee's medical record to be stored and accessed by
the enrollee and health care providers;
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new text begin (2) allow storage and transfer of encounter-level data for analysis for both provider- and
enrollee-specific and aggregate health care quality measurement and monitoring; and
new text end

new text begin (3) enable the provider to confirm that the electronic means accurately identify the
enrollee.
new text end

new text begin Subd. 12. new text end

new text begin Access to negotiated provider payment rates. new text end

new text begin The commissioner shall allow
enrollees who are subject to a deductible or co-payment to obtain medical goods and services
from providers, including cash only clinics, individual clinics, and individual mental health
clinics, that choose to serve enrollees at payment rates that do not exceed the medical
assistance payment rates.
new text end

new text begin Subd. 13. new text end

new text begin Maintaining an FMA for enrollees who become ineligible; vesting. new text end

new text begin (a) If
an enrollee becomes ineligible for medical assistance, the commissioner must make no
further contributions to the individual's FMA.
new text end

new text begin (b) If an enrollee becomes ineligible for medical assistance, money in the FMA remains
available to the account holder for one year from the date on which the individual became
ineligible for medical assistance under the same terms and conditions that would apply had
the individual remained eligible for the FMA service delivery model, except that the money
in the FMA may also be used as provided in paragraph (c).
new text end

new text begin (c) For those individuals no longer enrolled in the FMA service delivery model, money
in the FMA may be used to purchase medical goods and services from health care providers.
Money used for this purpose must be transferred by the commissioner or the third-party
administrator directly from the FMA to the medical provider of goods and services or from
an investment account of which the use is limited to the provision of medical goods and
services.
new text end

new text begin (d) In the event of the individual's death, the amount in the investment account must be
distributed to the primary beneficiary of the estate or, if there is no named beneficiary, to
the estate.
new text end

new text begin (e) The money in the FMA investment account is not recoverable by the state.
new text end

new text begin Subd. 14. new text end

new text begin Commissioner duties. new text end

new text begin (a) Notwithstanding section 256B.0631, subdivision
1a, the commissioner shall establish and publish co-payment amounts for the benefits
provided to an enrollee under the FMA service delivery model.
new text end

new text begin (b) The commissioner shall provide enrollment counselors and ongoing education for
enrollees. The counseling and education must be designed to:
new text end

new text begin (1) meet the FMA service delivery model requirements specified in subdivision 3,
paragraphs (b) and (c);
new text end

new text begin (2) provide enrollees with assistance accessing providers and obtaining negotiated
provider payment rates; and
new text end

new text begin (3) provide enrollees with information on the benefits of maintaining continuity of care
both before and after meeting the deductible.
new text end

new text begin (c) The commissioner shall make the services of the Office of Ombudsperson for Public
Managed Health Care Programs available to enrollees in the FMA service delivery model
and shall require the office to address access, service, and billing problems related to
providing medical assistance benefits under subdivision 6.
new text end

new text begin (d) The commissioner shall provide FMA service delivery model enrollees a monthly
report detailing transactions, including FMA balances.
new text end

new text begin (e) The commissioner shall implement a streamlined medical assistance renewal process
for FMA service delivery model enrollees. This process must include:
new text end

new text begin (1) requiring eligibility renewals every 12 months;
new text end

new text begin (2) allowing for passive renewal in which an enrollee receives a completed renewal form
from the commissioner; and
new text end

new text begin (3) allowing enrollees to provide to the commissioner updated information or a signed
statement attesting that the enrollee's eligibility information has not changed.
new text end

new text begin (f) The commissioner may adopt rules under chapter 14 to establish criteria for the
operation of the FMA service delivery model and may establish conditions limiting the use
of money in an account, including but not limited to a deduction of $25 from the enrollee's
FMA if the enrollee does not contact the nurse hotline before going to the emergency room.
If the medical event requires hospitalization, this deduction must not apply. Except for
necessary emergency services that do not result in hospitalization, the commissioner must
charge an enrollee an ambulance co-payment.
new text end

new text begin (g) To ensure access, the commissioner shall recruit willing medical assistance providers
and shall publish monthly updated provider listings, including location and ordinary office
business and call hours and procedure prices that medical assistance pays for health care
services based on common actuarial rates related to the expenses.
new text end

new text begin (h) In implementing the FMA service delivery model, the commissioner shall also raise
all service fees for medical assistance provided under the FMA service delivery model to
levels equivalent to the federal Medicare service fee rates.
new text end

new text begin (i) The commissioner shall present progress reports on the FMA service delivery model
to the legislative committees with jurisdiction over health and human services finance and
policy by October 1, 2025, and October 1, 2026. The commissioner shall include in the
progress reports recommendations for any changes in law necessary to improve operation
of the FMA service delivery model or to comply with federal requirements.
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