Minnesota Legislature
SF 654
as introduced - 88th Legislature (2013 - 2014) Posted on 02/28/2013 12:40pm
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A bill for an act
relating to human services; modifying provisions related to health care and
medical assistance; amending Minnesota Statutes 2012, sections 62J.495,
subdivision 15; 256.01, subdivision 34; 256.962, subdivision 8; 256B.0625,
subdivisions 8, 8a, 8b, 25.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2012, section 62J.495, subdivision 15, is amended to read:
Subd. 15.
Appeals review process.
(a) Upon receipt of an appeal notice
satisfying subdivision 14, the commissioner shall review the appeal and issue a written
appeal determination on each appealed item with 90 days. Upon mutual agreement, the
commissioner and the provider may extend the time for issuing a determination for a
specified period. The commissioner shall notify the provider deleted text begin by first class maildeleted text end of the
appeal determination. The appeal determination takes effect upon the date of issuance
specified in the determination.
(b) In reviewing the appeal, the commissioner may request additional written or oral
information from the provider.
(c) The provider has the right to present information by telephone, in writing, or
in person concerning the appeal to the commissioner prior to the issuance of the appeal
determination within 30 days of the date the appeal was received by the commissioner.
The provider must request an in-person conference in writing, separate from the appeal
letter. Statements made during the review process are not admissible in a contested case
hearing absent an express stipulation by the parties to the contested case.
(d) For an appeal item on which the provider disagrees with the appeal determination,
the provider may file with the commissioner a written demand for a contested case
hearing to determine the proper resolution of specified appeal items. The demand must
be postmarked or received by the commissioner within 30 days of the date of issuance
specified in the determination. A contested case demand for an appeal item nullifies
the written appeal determination issued by the commissioner for that appeal item. The
commissioner shall refer any contested case demand to the Office of the Attorney General.
(e) A contested case hearing must be heard by an administrative law judge according
to sections 14.48 to 14.56. In any proceeding under this section, the appealing party must
demonstrate by a preponderance of the evidence that the Minnesota electronic health
record incentives program eligibility determination is incorrect.
(f) Regardless of any appeal, the Minnesota electronic health record incentives
program eligibility determination must remain in effect until final resolution of the appeal.
(g) The commissioner has discretion to issue to the provider a proposed resolution
for specified appeal items upon a request from the provider filed separately from the
notice of appeal. The proposed resolution is final upon written acceptance by the provider
within 30 days of the date the proposed resolution was mailed to or personally received by
the provider, whichever is earlier.
Sec. 2.
Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:
Subd. 34.
Federal administrative reimbursement dedicated.
Federal
administrative reimbursement resulting from the following activities is appropriated to the
commissioner for the designated purposes:
(1) reimbursement for the Minnesota senior health options project; and
(2) reimbursement related to prior authorizationnew text begin , review of medical necessity,new text end and
inpatient admission certification by a professional review organization. A portion of
these funds must be used for activities to decrease unnecessary pharmaceutical costs in
medical assistance.
Sec. 3.
Minnesota Statutes 2012, section 256.962, subdivision 8, is amended to read:
Subd. 8.
Eligibility deleted text begin enddeleted text end new text begin review new text end dates.
The commissioner shall develop and
implement a process by January 1, 2013, to provide eligibility deleted text begin enddeleted text end new text begin review new text end dates upon
request from the managed care and county-based purchasing plans for medical assistance
and MinnesotaCare enrollees.
Sec. 4.
Minnesota Statutes 2012, section 256B.0625, subdivision 8, is amended to read:
Subd. 8.
Physical therapy.
(a) Medical assistance covers physical therapy and
related services. Specialized maintenance therapy is covered for recipients age 20 and
under.
(b) deleted text begin Authorization by the commissioner is required to provide medically necessary
services to a recipient.deleted text end Services provided by a physical therapy assistant shall be
reimbursed at the same rate as services performed by a physical therapist when the
services of the physical therapy assistant are provided under the direction of a physical
therapist who is on the premises. Services provided by a physical therapy assistant that
are provided under the direction of a physical therapist who is not on the premises shall
be reimbursed at 65 percent of the physical therapist rate.
Sec. 5.
Minnesota Statutes 2012, section 256B.0625, subdivision 8a, is amended to read:
Subd. 8a.
Occupational therapy.
(a) Medical assistance covers occupational
therapy and related services. Specialized maintenance therapy is covered for recipients
age 20 and under.
(b) deleted text begin Authorization by the commissioner is required to provide medically necessary
services to a recipient.deleted text end Services provided by an occupational therapy assistant shall be
reimbursed at the same rate as services performed by an occupational therapist when the
services of the occupational therapy assistant are provided under the direction of the
occupational therapist who is on the premises. Services provided by an occupational
therapy assistant that are provided under the direction of an occupational therapist who is
not on the premises shall be reimbursed at 65 percent of the occupational therapist rate.
Sec. 6.
Minnesota Statutes 2012, section 256B.0625, subdivision 8b, is amended to read:
Subd. 8b.
Speech-language pathology and audiology services.
(a) Medical
assistance covers speech-language pathology and related services. Specialized
maintenance therapy is covered for recipients age 20 and under.
(b) deleted text begin Authorization by the commissioner is required to provide medically necessary
speech-language pathology services to a recipient.
deleted text end
deleted text begin (c)deleted text end Medical assistance covers audiology services and related services. Services
provided by a person who has been issued a temporary registration under section 148.5161
shall be reimbursed at the same rate as services performed by a speech-language pathologist
or audiologist as long as the requirements of section 148.5161, subdivision 3, are met.
Sec. 7.
Minnesota Statutes 2012, section 256B.0625, subdivision 25, is amended to read:
Subd. 25.
Prior authorization required.
(a) The commissioner shall publish in
the Minnesota health care programs provider manual and on the department's Web site a
list of health services that require prior authorization, deleted text begin as well asdeleted text end the criteria and standards
used to select health services on the listnew text begin , and the criteria and standards used to determine
whether certain providers must obtain prior authorization for their servicesnew text end . The list new text begin of
services requiring prior authorization new text end and the criteria and standards used to formulate deleted text begin it
deleted text end new text begin the list of services or the selection of providers for whom prior authorization is required
new text end are not subject to the requirements of sections 14.001 to 14.69. The commissioner's
decision whether prior authorization is required for a health service new text begin or is required for a
provider new text end is not subject to administrative appeal.
(b) The commissioner shall implement a modernized electronic system for providers
to request prior authorization. The modernized electronic system must include at least the
following functionalities:
(1) authorizations are recipient-centric, not provider-centric;
(2) adequate flexibility to support authorizations for an episode of care, continuous
drug therapy, or for individual onetime services and allows an ordering and a rendering
provider to both submit information into one request;
(3) allows providers to review previous authorization requests and determine where
a submitted request is within the authorization process;
(4) supports automated workflows that allow providers to securely submit medical
information that can be accessed by medical and pharmacy review vendors as well as
department staff; and
(5) supports development of automated clinical algorithms that can verify
information and provide responses in real time.
(c) The system described in paragraph (b) shall be completed by March 1, 2012. All
authorization requests submitted on and after March 1, 2012, or upon completion of the
modernized authorization system, whichever is later, must be submitted electronically by
providers, except requests for drugs dispensed by an outpatient pharmacy, services that
are provided outside of the state and surrounding local trade area, and services included
on a service agreement.