HF 2230

as introduced - 87th Legislature (2011 - 2012) Posted on 02/16/2012 05:09pm

A bill for an act
relating to human services; providing pediatric care coordination services;
requiring demonstration providers to include in provider networks all providers
that agree to standard contract terms; requiring patient-centered decision
making under all medical assistance for certain procedures; requiring managed
care and county-based purchasing plans to reduce the incidence of low birth
weight; establishing a competitive bidding program for the seven-county
metropolitan area; requiring the commissioner of human services to report
on a draft methodology to allow the release of certain health data to research
institutions; amending Minnesota Statutes 2010, sections 256B.0625, by adding
a subdivision; 256B.69, subdivisions 6, 9, by adding subdivisions; proposing
coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2010, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 51a. new text end

new text begin Pediatric care coordination. new text end

new text begin The commissioner shall develop and
implement a pediatric care coordination program for children with high-cost medical or
high-cost psychiatric conditions who are at risk of recurrent hospitalization or emergency
room use for acute, chronic, or psychiatric illness, who receive medical assistance
services on a fee-for-service basis. In developing the pediatric care coordination program,
the commissioner shall consider incorporating features of the U Special Kids Program
operated by the University of Minnesota Department of Pediatrics. Care coordination
services must be provided by care coordinators employed by or under contract with
the commissioner and must be targeted to children admitted to hospitals that do not
currently provide care coordination services. For purposes of this subdivision, "care
coordination" means collaboration between the patient and patient's family, the hospital,
and providers of health care and psychiatric services to manage patient care and reduce
unnecessary emergency room use and hospitalization, minimize medical and psychiatric
complications, streamline and improve communication and access to patient care
management information, and develop and promote patient compliance with care plans for
high-cost medical and high-cost psychiatric conditions. Care coordination services must
be available through in-home video, telehealth management, and other methods.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) Each demonstration provider shall be responsible for
the health care coordination for eligible individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to
enrollees. Notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide relocation
service coordination to enrolled persons age 65 and over;

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated health care services for eligible
individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide
services to enrollees; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

new text begin (c) A demonstration provider must accept into its medical assistance and
MinnesotaCare provider networks any health care or social service provider that agrees
to accept payment, quality assurance, and other contract terms that the demonstration
provider applies to other similarly situated providers in its provider network.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2013, and applies to
provider contracts that take effect on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2010, section 256B.69, subdivision 9, is amended to read:

Subd. 9.

Reporting.

(a) Each demonstration provider shall submit information as
required by the commissioner, including data required for assessing client satisfaction,
quality of care, cost, and utilization of services for purposes of project evaluation. The
commissioner shall also develop methods of data reporting and collection in order to
provide aggregate enrollee information on encounters and outcomes to determine access
and quality assurance. Required information shall be specified before the commissioner
contracts with a demonstration provider.

(b) Aggregate nonpersonally identifiable health plan encounter data, aggregate
spending data for major categories of service as reported to the commissioners of
health and commerce under section 62D.08, subdivision 3, clause (a), and criteria for
service authorization and service use are public data that the commissioner shall make
available and use in public reports. The commissioner shall require each health plan and
county-based purchasing plan to provide:

(1) encounter data for each service provided, using standard codes and unit of
service definitions set by the commissioner, in a form that the commissioner can report by
age, eligibility groups, and health plan; and

(2) criteria, written policies, and procedures required to be disclosed under section
62M.10, subdivision 7, and Code of Federal Regulations, title 42, part 438.210(b)(1), used
for each type of service for which authorization is required.

new text begin (c) Each demonstration provider shall report to the commissioner on the extent to
which providers employed by or under contract with the demonstration provider comply
with the patient-centered decision-making requirements of section 256B.7671 and the
steps taken by the demonstration provider to encourage compliance.
new text end

Sec. 4.

Minnesota Statutes 2010, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 32. new text end

new text begin Initiatives to reduce incidence of low birth weight. new text end

new text begin The commissioner
shall require managed care and county-based purchasing plans, as a condition of contract,
to implement strategies to reduce the incidence of low birth weight in geographic areas
identified by the commissioner as having a higher than average incidence of low birth
weight. The strategies must coordinate health care with social services and the local
public health system. Each plan shall develop and report to the commissioner outcome
measures related to reducing the incidence of low birth weight. The commissioner shall
consider the outcomes reported when considering plan participation in the competitive
bidding program established under subdivision 33.
new text end

Sec. 5.

Minnesota Statutes 2010, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 33. new text end

new text begin Competitive bidding. new text end

new text begin (a) For managed care contracts effective on or after
January 1, 2014, the commissioner shall establish a competitive price bidding program for
nonelderly, nondisabled adults and children in medical assistance and MinnesotaCare in
the seven-county metropolitan area. The program must allow a minimum of two managed
care plans to serve the metropolitan area. Competitive bidding contracts shall be reopened
and rebid every two calendar years.
new text end

new text begin (b) In designing the competitive bid program, the commissioner shall consider, and
incorporate where appropriate, the procedures and criteria used in the competitive bidding
pilot authorized under Laws 2011, First Special Session chapter 9, article 6, section 96.
new text end

new text begin (c) The commissioner shall require managed care plans to submit data on enrollee
health outcomes and shall consider this information, along with competitive bid and other
information, in determining whether to contract with a managed care plan under this
subdivision. The data submitted must include health outcome measures on reducing the
incidence of low birth weight established by the managed care plan under subdivision 32.
new text end

Sec. 6.

new text begin [256B.7671] PATIENT-CENTERED DECISION MAKING.
new text end

new text begin (a) For purposes of this section, "patient-centered decision-making process" means a
process that involves directed interaction with the patient to assist the patient in arriving at
an informed objective health care decision regarding the surgical procedure that is both
informed and consistent with the patient's preference and values. The interaction may be
conducted by a health care provider or through the use of electronic decision aids. If
decision aids are used in the process, the aids must meet the criteria established by the
International Patients Decision Aids Standards Collaboration or the Cochrane Decision
Aid Registry.
new text end

new text begin (b) Effective January 1, 2013, the commissioner of human services shall require
active participation in a patient-centered decision-making process before authorization is
approved or payment reimbursement is provided for any of the following:
new text end

new text begin (1) a surgical procedure for abnormal uterine bleeding, benign prostate enlargement,
chronic back pain, early stage of breast and prostate cancers, gastroesophageal reflux
disease, hemorrhoids, spinal stenosis, temporomandibular joint dysfunction, ulcerative
colitis, urinary incontinence, uterine fibroids, or varicose veins; and
new text end

new text begin (2) bypass surgery for coronary disease, angioplasty for stable coronary artery
disease, or total hip replacement.
new text end

new text begin (c) A list of the procedures in paragraph (b) shall be published in the State Register
by October 1, 2012. The list shall be reviewed no less than every two years by the
commissioner, in consultation with the commissioner of health. The commissioner
shall hold a public forum and receive public comment prior to any changes to the list in
paragraph (b). Any changes made shall be published in the State Register.
new text end

new text begin (d) Prior to receiving authorization or reimbursement for the procedures identified
under this section, a health care provider must certify that the patient has participated in a
patient-centered decision-making process. The format for this certification and the process
for coordination between providers shall be developed by the Health Services Policy
Committee under section 256B.0625, subdivision 3c.
new text end

new text begin (e) This section does not apply if any of the procedures identified in this section are
performed under an emergency situation.
new text end

Sec. 7. new text begin DATA ON CLAIMS AND UTILIZATION.
new text end

new text begin The commissioner of human services, in consultation with the legislative committees
with jurisdiction over health care policy, shall develop and provide to the legislature
by December 15, 2012, a methodology and any draft legislation necessary to allow for
the release, upon request, of summary data as defined in Minnesota Statutes, section
13.02, subdivision 19, on claims and utilization for medical assistance and MinnesotaCare
enrollees at no charge to the University of Minnesota Medical School, the Mayo Medical
School, Northwestern Health Sciences University, the Institute for Clinical Systems
Improvement, and other research institutions to conduct analyses of health care outcomes
and treatment effectiveness, provided the research institutions do not release private or
nonpublic data or data for which dissemination is prohibited by law.
new text end