SF 890

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:17am

A bill for an act
relating to human services; requiring commissioner of human services to modify
the reimbursement methodology for federally qualified health centers and rural
health clinics and implement related initiatives; requiring reports; amending
Minnesota Statutes 2008, section 256B.0625, subdivision 30.

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

Section 1.

Minnesota Statutes 2008, 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, public health clinic services, and the services of a clinic meeting the criteria
established in rule by the commissioner. 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.

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (f) deleted text end new text begin (b) new text end Effective January 1, 2001, 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. deleted text begin The
alternative payment methodology shall be 100 percent of cost as determined according to
Medicare cost principles.
deleted text end

new text begin (c) The commissioner shall provide supplemental payments to federally qualified
health centers and rural health clinics, in compliance with United States Code, title
42, section 1396a(bb)(5), no less frequently than every four months. In providing
supplemental payments under this paragraph, the commissioner shall base payments on
claims encounter data provided by federally qualified health centers and rural health
clinics.
new text end

new text begin (d) Quarterly supplemental payments made under paragraph (c) shall include
sufficient claims detail so as to allow federally qualified health centers and rural health
clinics to reconcile the payments with the encounter data submitted.
new text end

new text begin (e) If the center or clinic disagrees with the claims detail used to support the
payment amounts, it shall have 30 days to notify the commissioner in writing, and the
commissioner shall have 30 days after the receipt of this notice to consider the center or
clinic's submission and issue a final revised payment or response. The center or clinic may
challenge this final action under section 256B.0643, and the commissioner shall then
initiate an administrative hearing under section 14.57.
new text end

new text begin (f) Absent a challenge under paragraph (e), the commissioner has six months after
the payment of funds under paragraph (c) to reconcile the claims data submitted with
other appropriate data. After this six-month period, the payment for the claims shall be
considered settled.
new text end

new text begin (g) The commissioner shall submit an annual report, beginning January 1, 2010, and
each January 1 thereafter, on implementation of the reconciliation process for federally
qualified health centers and rural health clinics. The annual report must specify, for each
federally qualified health center and rural health clinic, the calendar years for which
the commissioner has finalized medical assistance payments and the calendar years that
are still outstanding.
new text end

new text begin (h) The commissioner, by January 1, 2010, shall modify the reimbursement
methodology for federally qualified health centers and rural health clinics, in order to
classify the adoption and implementation of electronic health record systems as a change
in scope of services, and thereby eligible for a positive prospective payment system rate
adjustment to reflect the costs of the adoption and implementation. With respect to this
change in scope of services, the commissioner's review is limited to consideration of the
adoption and implementation of the electronic health record system and related costs.
new text end

new text begin (i) Effective for services provided on or after July 1, 2009, the commissioner
shall allow federally qualified health centers and rural health clinics to bill under the
fee-for-service system for face-to-face encounters between medical assistance patients and:
new text end

new text begin (1) community health workers, until care coordination payments for health care
homes are implemented in Minnesota;
new text end

new text begin (2) dental hygienists, subject to the collaborative agreement required under section
150A.10, subdivision 1a;
new text end

new text begin (3) licensed pharmacists providing medication therapy management; and
new text end

new text begin (4) oral health practitioners, in the event that oral health practitioners begin practice
in Minnesota.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to paragraphs (c) to (f) are effective July
1, 2009.
new text end

Sec. 2. new text begin PROCEDURES MANUAL FOR CLINIC REIMBURSEMENT.
new text end

new text begin The commissioner of human services, by January 1, 2010, shall develop a
written manual specifying agency procedures and policies related to medical assistance
reimbursement of federally qualified health centers and rural health clinics. The manual
must include, but is not limited to, information on: policies and procedures related to
changes in the scope of services; new rate development; requirements for data submittal
by federally qualified health centers, rural health clinics, and health plan companies;
and changes in methodology related to implementation of Minnesota Statutes, section
256B.0625, subdivision 30, paragraph (h). The commissioner shall regularly update the
manual, and shall make the information in the manual available to federally qualified
health centers, rural health clinics, and other interested parties.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2009.
new text end