HF 1984

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/08/2021 02:23pm

A bill for an act
relating to human services; establishing the family medical account program;
providing rulemaking authority; 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 PROGRAM.
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) program by January 1, 2022, or upon federal approval,
whichever is later.
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) "Participant" means an individual enrolled in the FMA program.
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 program must provide participants with medical
assistance benefits according to subdivision 6.
new text end

new text begin (b) The FMA program must provide enrollment counseling to participants by:
new text end

new text begin (1) providing incentives for patients to seek preventive health services;
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new text begin (2) providing enrollment counseling and related information;
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new text begin (3) requiring that transactions involving FMAs be conducted electronically; and
new text end

new text begin (4) providing participants with access to negotiated provider payment rates.
new text end

new text begin (c) The FMA program must provide ongoing education to participants by:
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new text begin (1) educating patients on the high cost of medical care;
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new text begin (2) reducing the inappropriate use of health care services; and
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new text begin (3) enabling patients to take 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 Eligible persons. new text end

new text begin (a) Persons eligible for medical assistance and having an
income of 138 percent or less of the federal poverty level under section 256B.055,
subdivisions 3a, 9, 10, 15, and 16, may elect to participate in the FMA program. Beneficiaries
in Medicaid-managed care organizations may elect to enroll in the FMA program at annual
re-enrollment and at any other re-enrollment time determined by the commissioner.
new text end

new text begin (b) The commissioner shall fully inform eligible persons of the availability of the FMA
program and the comparative attributes of the FMA program and other programs.
new text end

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

new text begin (d) FMA funds vest one year after enrollment. If a person is disenrolled from the FMA
program for any reason other than fraud, the commissioner must place the funds in a
state-approved investment account for the person's use for medical goods and services.
new text end

new text begin Subd. 5. new text end

new text begin Excluded persons. new text end

new text begin Individuals who, when applying, have a disability or are
65 years of age or older are excluded persons.
new text end

new text begin Subd. 6. new text end

new text begin Medical assistance benefits. new text end

new text begin (a) Participants shall be deemed consumers and
shall 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.
new text end

new text begin (c) Notwithstanding section 256B.0631, any outpatient treatment service is limited to a
$300 co-pay per service occurrence.
new text end

new text begin (d) The amount of the annual deductible 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. No FMA emergency room
charge is deducted if the participant is admitted to inpatient care.
new text end

new text begin (f) After a person has satisfied the annual deductible, medical assistance benefits for
that person consist of the benefits that would otherwise be provided to that person under
medical assistance had the individual not been enrolled in the FMA program. Participants
are subject to all medical assistance cost-sharing requirements.
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 state shall contribute an annual amount into
the FMA funds owned by each participant. For the first calendar year of the FMA program,
the prefund for the FMA debit card for children is $1,500, for adults with children is $2,500,
and for adults without children is $2,700. The commissioner shall annually adjust the amount
to meet 50 percent of CMS annual enrollee costs using data from the Department of Human
Services. The commissioner shall pay in either monthly or biweekly increments as long as
the participant is eligible. There is no accrual limit for family medical accounts.
new text end

new text begin (b) The commissioner shall contract with a third-party administrator to administer and
coordinate FMAs. The third-party administrator shall 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 (c), must not serve as a third-party
administrator.
new text end

new text begin (c) The commissioner shall contract with a financial institution to establish investment
accounts for participants owning FMA funds at the end of the calendar year. Investment
accounts do not have a dollar cap. The commissioner shall negotiate, as part of the contract,
the amount of any administrative fee to be paid by the financial institution to the third-party
administrator on behalf of participants and the interest rate to be paid by the financial
institution to participants.
new text end

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

new text begin (e) Amounts in or contributed to an FMA shall not be counted as income or assets for
purposes of determining medical assistance eligibility.
new text end

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

new text begin (g) The commissioner shall create a process to coordinate care for high-cost chronically
ill individuals with any medical illness, addiction, mental illness, dental care needs, or high
medical costs due to prolonged acute illness or injury. The use of patient personal clinical
data for this process shall include each patient's authorized release of information, except
that no patient approval is required for release of information if the chronic illness severity
requires that the patient be transferred to the Department of Human Services fee-for-service
program.
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 program including protected patient identified
data is available to the commissioner. All data except protected health information is available
to any party pursuant to chapter 13, the Government Data Practices Act, 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 participants to obtain prenatal care and other appropriate preventive
care. In developing these incentives, the commissioner may consider various rewards for
individuals demonstrating healthy prevention practices and may consider providing positive
incentives for accessing preventive services.
new text end

new text begin (b) The commissioner may provide additional payments to providers who coordinate
care for participants.
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, money
in an FMA may be used only 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) Money in an FMA must not be used to pay providers for medical goods and services
unless:
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new text begin (1) the providers are licensed or otherwise authorized under state law to provide the
goods or services; and
new text end

new text begin (2) the provider meets medical assistance program standards, except there shall be no
mandated electronic health records and report requirement for cash clinics, and 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 program persons 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) The use of FMA funds after age 65 is governed by federal health savings account
rules and state Medicaid payment rates for medical goods and services that do not apply
unless the person remains on Medicaid. For those persons no longer in the FMA program,
use of FMA money for medical goods and services are not subject to Medicaid 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 to be made electronically. The method developed
or selected for the FMA program 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 a patient's medical record to be stored and accessed by the
patient and health care providers;
new text end

new text begin (2) be capable of storing and transferring for analysis the encounter-level data 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 identifies the
participant.
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
participants who are subject to a deductible or co-pay to obtain medical goods and services
from providers, including cash only clinics, individual clinics, and individual mental health
clinics, who choose to serve participants 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 persons who become ineligible; vesting. new text end

new text begin (a) If a
participant becomes ineligible for medical assistance, the state shall make no further
contributions to the participant's FMA.
new text end

new text begin (b) Following application of paragraph (a), money in the account 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 program, 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 program, 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 state or third-party administrator directly
from the account 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. In the
event of the person's death, the amount in the investment account shall 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 (d) The funds in the FMA are 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) The commissioner shall provide enrollment
counselors and ongoing education for participants. The counseling and education must be
designed to:
new text end

new text begin (1) meet the FMA program goals specified in subdivision 3, paragraphs (b) and (c);
new text end

new text begin (2) provide participants with assistance accessing providers and obtaining negotiated
provider payment rates; and
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new text begin (3) provide participants with information on the benefits of maintaining continuity of
care both before and after meeting the required deductible.
new text end

new text begin (b) The commissioner shall make the services of the Office of Ombudsman available to
participants 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 (c) The commissioner shall provide FMA enrollees a monthly report detailing transactions
including FMA balances.
new text end

new text begin (d) The commissioner shall implement a streamlined medical assistance renewal process
for participants. 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 passive renewal, under which individuals receive from the commissioner
a completed renewal form; and
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new text begin (3) providing to the commissioner updated information or a signed statement attesting
that the individual's eligibility information has not changed.
new text end

new text begin (e) The commissioner may adopt rules under chapter 14 to establish criteria for the
operation of FMAs and may establish conditions limiting the use of money in an account
to include a deduction of $25 from the participant's FMA account if the participant does
not contact the nurse hotline before going to the emergency room. If the medical event
requires hospitalization, this deduction does not apply. Except for necessary emergency
services that do not result in hospitalization, a participant shall be charged an ambulance
co-pay charge if the participant is not admitted to the hospital.
new text end

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

new text begin (g) The commissioner shall present annual progress reports on the FMA program to the
legislature, beginning October 1, one year after implementation of the FMA program and
each October 1 thereafter. The commissioner shall include in the progress reports
recommendations for any changes in law necessary to improve operation of the FMA
program or to comply with federal requirements. The commissioner shall include in the
report due October 1, 2026, recommendations on whether the FMA program should be
expanded to include additional participants.
new text end

new text begin Subd. 15. new text end

new text begin Federal approval. new text end

new text begin The commissioner shall seek all federal approvals necessary
to establish and implement the FMA program.
new text end