SF 1299

as introduced - 90th Legislature (2017 - 2018) Posted on 02/23/2017 09:43am

A bill for an act
relating to health care; establishing a Primary Care Case Management program;
authorizing direct state payments to health care providers; proposing coding for
new law in Minnesota Statutes, chapter 256.

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

Section 1.

new text begin [256.9631] PRIMARY CARE CASE MANAGEMENT AND DIRECT
CONTRACTING FOR MEDICAL ASSISTANCE AND MINNESOTACARE.
new text end

new text begin Subdivision 1. new text end

new text begin Program established. new text end

new text begin The Primary Care Case Management (PCCM)
program is established to achieve better health outcomes and reduce the cost of health care
for the state. The commissioner shall pay health care providers directly to provide services
for all medical assistance enrollees who are eligible under section 256B.055 and
MinnesotaCare enrollees eligible under section 256L.05. In counties where there is a
county-based purchasing system under section 256B.692, the commissioner shall have the
county-based purchaser administer the program and pay providers unless the counties request
that the commissioner take over the responsibility.
new text end

new text begin Subd. 2. new text end

new text begin Payment to providers. new text end

new text begin (a) The commissioner of human services shall pay
licensed health care providers directly for all services provided to medical assistance enrollees
under section 256B.0625 and MinnesotaCare enrollees under section 256L.03.
new text end

new text begin (b) Providers shall bill the state or the county-based purchaser directly for the services
they provide.
new text end

new text begin (c) The commissioner shall not renew the state's contracts with managed care plans
under sections 256B.69 and 256L.12 for providing services to enrollees in the medical
assistance and MinnesotaCare programs.
new text end

new text begin Subd. 3. new text end

new text begin Case management. new text end

new text begin (a) In addition to paying providers under subdivision 2,
the commissioner shall use the PCCM program to pay primary care providers for coordinating
services for medical assistance and MinnesotaCare enrollees.
new text end

new text begin Under the program, patients may choose a primary care provider to act as the enrollee's
case manager. Primary care physicians, nurses, and other qualified medical professionals
may provide primary care case management. Specialists who routinely provide care for
patients with specific or complex medical conditions may also be primary care providers
for purposes of case management.
new text end

new text begin Primary care providers who offer PCCM services shall also receive a flat per-member,
per-month fee for performing care coordination services. The commissioner shall set case
management fees to reflect the variation in time and services required for a primary care
provider to coordinate care based on the complexity of a patient's health needs and
socioeconomic factors that lead to health disparities.
new text end

new text begin (b) The primary care provider shall provide overall oversight of the enrollee's health and
coordinate with any other case manager of the enrollee as well as ensure 24-hour access to
health care, emergency treatment, and referrals.
new text end

new text begin (c) The commissioner shall collaborate with community health clinics and social service
providers through planning and financing to provide outreach, medical care, and case
management services in the community for patients who, because of mental illness,
homelessness, or other circumstances, are unlikely to obtain needed care.
new text end

new text begin (d) The commissioner shall collaborate with medical and social service providers through
planning and financing to reduce hospital readmissions by providing discharge planning
and services, including medical respite and transitional care for patients leaving medical
facilities and mental health and chemical dependency treatment programs.
new text end

new text begin Subd. 4. new text end

new text begin Duties. new text end

new text begin (a) For enrollees, the commissioner shall:
new text end

new text begin (1) maintain a hotline and Web site to assist enrollees in locating providers;
new text end

new text begin (2) provide a nurse consultation helpline 24 hours per day, seven days a week; and
new text end

new text begin (3) contact enrollees based on claims data who have not had preventive visits and help
them select a primary care provider.
new text end

new text begin (b) For providers, the commissioner shall:
new text end

new text begin (1) review provider reimbursement rates to ensure reasonable and fair compensation;
new text end

new text begin (2) ensure that providers are reimbursed on a timely basis; and
new text end

new text begin (3) collaborate with providers to explore means of improving health care quality and
reducing costs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment. Direct
payments to providers under the Primary Care Case Management program shall be effective
when the current contracts with managed care plans under Minnesota Statutes, sections
256B.69 and 256L.12, for medical assistance and MinnesotaCare services expire.
new text end