SF 823

as introduced - 91st Legislature (2019 - 2020) Posted on 02/04/2019 03:01pm

A bill for an act
relating to health care; establishing an alternative payment system for federally
qualified health centers and rural health clinics; amending Minnesota Statutes
2018, section 256B.0625, subdivision 30.

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

Section 1.

Minnesota Statutes 2018, section 256B.0625, subdivision 30, is amended to
read:

Subd. 30.

Other clinic services.

(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.

(b) A federally qualified health center that is beginning initial operation shall submit an
estimate of budgeted costs and visits for the initial reporting period in the form and detail
required by the commissioner. A federally qualified health center that is already in operation
shall submit an initial report using actual costs and visits for the initial reporting period.
Within 90 days of the end of its reporting period, a federally qualified health center shall
submit, in the form and detail required by the commissioner, a report of its operations,
including allowable costs actually incurred for the period and the actual number of visits
for services furnished during the period, and other information required by the commissioner.
Federally qualified health centers that file Medicare cost reports shall provide the
commissioner with a copy of the most recent Medicare cost report filed with the Medicare
program intermediary for the reporting year which support the costs claimed on their cost
report to the state.

(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
must apply for designation as an essential community provider within six months of final
adoption of rules by the Department of Health according to section 62Q.19, subdivision 7.
For those federally qualified health centers and rural health clinics that have applied for
essential community provider status within the six-month time prescribed, medical assistance
payments will continue to be made according to paragraphs (a) and (b) for the first three
years after application. For federally qualified health centers and rural health clinics that
either do not apply within the time specified above or who have had essential community
provider status for three years, medical assistance payments for health services provided
by these entities shall be according to the same rates and conditions applicable to the same
service provided by health care providers that are not federally qualified health centers or
rural health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally qualified
health center or a rural health clinic to make application for an essential community provider
designation in order to have cost-based payments made according to paragraphs (a) and (b)
no longer apply.

(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.

(f) Effective January 1, 2001, new text begin through December 31, 2020, new text end each federally qualified
health center and rural health clinic may elect to be paid either under the prospective payment
system established in United States Code, title 42, section 1396a(aa), or under an alternative
payment methodology consistent with the requirements of United States Code, title 42,
section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services. The
alternative payment methodology shall be 100 percent of cost as determined according to
Medicare cost principles.

new text begin (g) Effective January 1, 2021, each federally qualified health center and rural health
clinic shall elect to be paid under the prospective payment system described in paragraph
(f) or the alternative payment methodology described in paragraph (l).
new text end

deleted text begin (g) deleted text end new text begin (h) new text end For purposes of this section, "nonprofit community clinic" is a clinic that:

(1) has nonprofit status as specified in chapter 317A;

(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);

(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;

(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;

(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and

(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.

deleted text begin (h) deleted text end new text begin (i) new text end Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by federally qualified health centers and rural health clinics shall
be paid by the commissioner. The commissioner shall determine the most feasible method
for paying claims from the following options:

(1) federally qualified health centers and rural health clinics submit claims directly to
the commissioner for payment, and the commissioner provides claims information for
recipients enrolled in a managed care or county-based purchasing plan to the plan, on a
regular basis; or

(2) federally qualified health centers and rural health clinics submit claims for recipients
enrolled in a managed care or county-based purchasing plan to the plan, and those claims
are submitted by the plan to the commissioner for payment to the clinic.

deleted text begin (i) deleted text end new text begin (j) new text end For clinic services provided prior to January 1, 2015, the commissioner shall
calculate and pay monthly the proposed managed care supplemental payments to clinics,
and clinics shall conduct a timely review of the payment calculation data in order to finalize
all supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.

deleted text begin (j) deleted text end new text begin (k) new text end The commissioner shall seek a federal waiver, authorized under section 1115 of
the Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.

new text begin (l) All claims for payment of clinic services provided by a federally qualified health
center and a rural health clinic shall be paid by the commissioner according to the following
requirements:
new text end

new text begin (1) each federally qualified health center and rural health clinic must receive a single
medical and a single dental organization rate;
new text end

new text begin (2) the commissioner shall reimburse a federally qualified health center and a rural health
clinic for allowable costs, including direct patient care costs and patient-related support
services. These costs include but are not limited to:
new text end

new text begin (i) acquiring, implementing, and maintaining electronic health records and patient
management systems;
new text end

new text begin (ii) community health workers who need acute and chronic care management;
new text end

new text begin (iii) care coordinations;
new text end

new text begin (iv) the new federally qualified health center or rural health clinic service that is not
incorporated in the baseline prospective payment system rate, or a deletion of a federally
qualified health center or a rural health clinic service that is incorporated in the baseline
rate;
new text end

new text begin (v) a change in service due to amended regulatory requirements or rules;
new text end

new text begin (vi) a change in service resulting from relocating or remodeling a federally qualified
health center or a rural health clinic;
new text end

new text begin (vii) a change in types of services due to a change in applicable technology and medical
practice used by the center or clinic;
new text end

new text begin (viii) an increase in service intensity attributable to changes in the types of patients
served, including but not limited to populations with HIV or AIDS, mental health or chemical
dependency conditions, or other chronic diseases; or homeless, elderly, migrant, or other
special populations;
new text end

new text begin (ix) a change in the services described in United States Code, title 42, section
1396d(a)(2)(B) and (C), or in the provider mix of a federally qualified health center or a
rural health clinic or one of the federally qualified health center's or rural health clinic's
sites;
new text end

new text begin (x) a change in operating costs attributable to capital expenditures associated with a
modification of the scope of the services described in United States Code, title 42, section
1396d(a)(2)(B) and (C), including new or expanded service facilities, regulatory compliance,
or changes in technology or medical practices at the center or clinic;
new text end

new text begin (xi) indirect medical education adjustments and a direct graduate medical education
payment that reflects the costs of providing teaching services to interns and residents; and
new text end

new text begin (xii) a change in the scope of a project approved by the federal Health Resources and
Services Administration (HRSA);
new text end

new text begin (3) the base year payment rates for a federally qualified health center and a rural health
clinic must:
new text end

new text begin (i) be determined using each federally qualified health center's and rural health clinic's
Medicare cost reports from 2017 and 2018;
new text end

new text begin (ii) be according to current Medicare cost principles as applicable to a federally qualified
health center and a rural health clinic without the application of productivity screens and
upper payment limits or the Medicare prospective payment system federally qualified health
center aggregate mean upper payment limit; and
new text end

new text begin (iii) provide for a 60-day appeals process under section 14.57;
new text end

new text begin (4) the commissioner shall annually inflate the payment rate for a federally qualified
health center and a rural health clinic from the base year payment rate to the effective date
by using the Bureau of Economic Analysis' personal consumption expenditures medical
care inflator;
new text end

new text begin (5) a federally qualified health center's and a rural health clinic's payment rates shall be
rebased by the commissioner every two years and adjusted biannually by the CMS Federally
Qualified Health Center Market Basket;
new text end

new text begin (6) the commissioner shall seek approval from the Centers for Medicare and Medicaid
Services to modify payments to federally qualified health centers and rural health clinics
according to subdivision 63;
new text end

new text begin (7) the commissioner shall reimburse a federally qualified health center and a rural health
clinic an additional two percent of a federally qualified health center's or a rural health
clinic's medical and dental rates established under this subdivision only if payment of the
two percent provider tax is required to be paid according to section 295.52;
new text end

new text begin (8) for a federally qualified health center and a rural health clinic seeking a change of
scope of services:
new text end

new text begin (i) the federally qualified health center and the rural health clinic shall submit requests
with the commissioner if the change of scope would result in a 2.5 percent increase or
decrease in the medical or dental rate currently received by the federally qualified health
center or rural health clinic;
new text end

new text begin (ii) the federally qualified health center and the rural health clinic shall submit the request
to the commissioner within seven business days of submitting the scope change to the federal
HRSA;
new text end

new text begin (iii) the effective date of the payment change is the date the HRSA approved the federally
qualified health center's or rural health clinic's change of scope request;
new text end

new text begin (iv) for change of scope requests that do not require HRSA approval, the federally
qualified health center and rural health clinic shall submit the request to the commissioner
before implementing the change, and the effective date of the change is the date the
commissioner received the federally qualified health center's or rural health clinic's request;
and
new text end

new text begin (v) the commissioner shall respond to the federally qualified health center's or rural
health clinic's request within 45 days of submission and provide a final approval within 120
days of submission. This timeline may be waived by the mutual agreement of the
commissioner and the federally qualified health center or rural health clinic if more
information is needed to evaluate the request; and
new text end

new text begin (9) the commissioner shall establish a rate-setting process for new federally qualified
health centers and rural health clinics considering a comparison of patient caseload of a
federally qualified health center and a rural health clinic in a 30-mile radius for organizations
established outside the seven-county metropolitan area and in a five-mile radius for
organizations in the seven-county metropolitan area. If a comparison is not feasible, the
commissioner may use Medicare cost reports or audited financial statements to establish
base rate.
new text end