SF 1467

as introduced - 87th Legislature (2011 - 2012) Posted on 02/23/2012 09:44am

A bill for an act
relating to human services; reducing the administrative costs to managed care
plans and county-based purchasing plans under the medical assistance program
and the administrative payments to third-party administrators that administer
the state employee group insurance plan; modifying personal care assistance
services; creating a withhold to managed care plans and county-based purchasing
plans for reducing hospitalizations; modifying the emergency room utilization
rate withhold to managed care plans; delaying capitation payments for single
adults without children in MinnesotaCare; creating demonstration projects for
the delivery of health care services to certain medical assistance populations;
limiting home and community-based waiver services allocations; requiring the
commissioner of human services to issue a request for proposals to provide
claims processing services for the fee-for-service medical assistance program;
amending Minnesota Statutes 2010, sections 43A.23, subdivision 1; 256B.0625,
subdivision 19a; 256B.0652, subdivision 6; 256B.69, subdivisions 5a, 5i, 28;
256L.12, subdivision 9; Laws 2009, chapter 79, article 13, section 3, subdivision
8, as amended.

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

Section 1.

Minnesota Statutes 2010, section 43A.23, subdivision 1, is amended to read:

Subdivision 1.

General.

(a) The commissioner is authorized to request proposals
or to negotiate and to enter into contracts with parties which in the judgment of the
commissioner are best qualified to provide service to the benefit plans. Contracts entered
into are not subject to the requirements of sections 16C.16 to 16C.19. The commissioner
may negotiate premium rates and coverage. The commissioner shall consider the cost of
the plans, conversion options relating to the contracts, service capabilities, character,
financial position, and reputation of the carriers, and any other factors which the
commissioner deems appropriate. Each benefit contract must be for a uniform term of at
least one year, but may be made automatically renewable from term to term in the absence
of notice of termination by either party. A carrier licensed under chapter 62A is exempt
from the taxes imposed by chapter 297I on premiums paid to it by the state.

(b) All self-insured hospital and medical service products must comply with coverage
mandates, data reporting, and consumer protection requirements applicable to the licensed
carrier administering the product, had the product been insured, including chapters 62J,
62M, and 62Q. Any self-insured products that limit coverage to a network of providers
or provide different levels of coverage between network and nonnetwork providers shall
comply with section 62D.123 and geographic access standards for health maintenance
organizations adopted by the commissioner of health in rule under chapter 62D.

(c) Notwithstanding paragraph (b), a self-insured hospital and medical product
offered under sections 43A.22 to 43A.30 is not required to extend dependent coverage to
an eligible employee's unmarried child under the age of 25 to the full extent required under
chapters 62A and 62L. Dependent coverage must, at a minimum, extend to an eligible
employee's unmarried child who is under the age of 19 or an unmarried child under the
age of 25 who is a full-time student. A person who is at least 19 years of age but who is
under the age of 25 and who is not a full-time student must be permitted to be enrolled as
a dependent of an eligible employee until age 25 if the person:

(1) was a full-time student immediately prior to being ordered into active military
service, as defined in section 190.05, subdivision 5b or 5c;

(2) has been separated or discharged from active military service; and

(3) would be eligible to enroll as a dependent of an eligible employee, except that
the person is not a full-time student.

The definition of "full-time student" for purposes of this paragraph includes any student
who by reason of illness, injury, or physical or mental disability as documented by
a physician is unable to carry what the educational institution considers a full-time
course load so long as the student's course load is at least 60 percent of what otherwise
is considered by the institution to be a full-time course load. Any notice regarding
termination of coverage due to attainment of the limiting age must include information
about this definition of "full-time student."

(d) Beginning January 1, 2010, the health insurance benefit plans offered in the
commissioner's plan under section 43A.18, subdivision 2, and the managerial plan under
section 43A.18, subdivision 3, must include an option for a health plan that is compatible
with the definition of a high-deductible health plan in section 223 of the United States
Internal Revenue Code.

new text begin (e) Beginning January 1, 2011, any contract entered into by the commissioner with
a licensed carrier or third-party administrator to administer the health insurance benefit
plans offered under sections 43A.22 to 43A.30 shall reflect a reduction in administrative
costs that equals a per enrollee per month reduction of 21 cents.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256B.0625, subdivision 19a, is amended to
read:

Subd. 19a.

Personal care assistance services.

Medical assistance covers personal
care assistance services in a recipient's home. Effective January 1, 2010, to qualify for
personal care assistance services, a recipient must require assistance and be determined
dependent in one activity of daily living as defined in section 256B.0659, subdivision 1,
paragraph (b), or in a Level I behavior as defined in section 256B.0659, subdivision 1,
paragraph (c). deleted text begin Beginning July 1, 2011, to qualify for personal care assistance services, a
recipient must require assistance and be determined dependent in at least two activities
of daily living as defined in section 256B.0659. deleted text end Recipients or responsible parties must
be able to identify the recipient's needs, direct and evaluate task accomplishment, and
provide for health and safety. Approved hours may be used outside the home when normal
life activities take them outside the home. To use personal care assistance services at
school, the recipient or responsible party must provide written authorization in the care
plan identifying the chosen provider and the daily amount of services to be used at school.
Total hours for services, whether actually performed inside or outside the recipient's
home, cannot exceed that which is otherwise allowed for personal care assistance services
in an in-home setting according to sections 256B.0651 to 256B.0656. Medical assistance
does not cover personal care assistance services for residents of a hospital, nursing facility,
intermediate care facility, health care facility licensed by the commissioner of health, or
unless a resident who is otherwise eligible is on leave from the facility and the facility
either pays for the personal care assistance services or forgoes the facility per diem for the
leave days that personal care assistance services are used. All personal care assistance
services must be provided according to sections 256B.0651 to 256B.0656. Personal care
assistance services may not be reimbursed if the personal care assistant is the spouse or
paid guardian of the recipient or the parent of a recipient under age 18, or the responsible
party or the family foster care provider of a recipient who cannot direct the recipient's own
care unless, in the case of a foster care provider, a county or state case manager visits
the recipient as needed, but not less than every six months, to monitor the health and
safety of the recipient and to ensure the goals of the care plan are met. Notwithstanding
the provisions of section 256B.0659, the unpaid guardian or conservator of an adult,
who is not the responsible party and not the personal care provider organization, may be
reimbursed to provide personal care assistance services to the recipient if the guardian or
conservator meets all criteria for a personal care assistant according to section 256B.0659,
and shall not be considered to have a service provider interest for purposes of participation
on the screening team under section 256B.092, subdivision 7.

Sec. 3.

Minnesota Statutes 2010, section 256B.0652, subdivision 6, is amended to read:

Subd. 6.

Authorization; personal care assistance and qualified professional.

(a) All personal care assistance services, supervision by a qualified professional, and
additional services beyond the limits established in subdivision 11, must be authorized
by the commissioner or the commissioner's designee before services begin except for the
assessments established in subdivision 11 and section 256B.0911. The authorization for
personal care assistance and qualified professional services under section 256B.0659 must
be completed within 30 days after receiving a complete request.

(b) The amount of personal care assistance services authorized must be based
on the recipient's home care rating. The home care rating shall be determined by the
commissioner or the commissioner's designee based on information submitted to the
commissioner identifying the following new text begin for recipients with dependencies in two or more
activities of daily living new text end :

(1) total number of dependencies of activities of daily living as defined in section
256B.0659;

(2) presence of complex health-related needs as defined in section 256B.0659; and

(3) presence of Level I behavior as defined in section 256B.0659.

(c) new text begin For persons meeting the criteria in paragraph (b), new text end the methodology to determine
total time for personal care assistance services for each home care rating is based on
the median paid units per day for each home care rating from fiscal year 2007 data for
the personal care assistance program. Each home care rating has a base level of hours
assigned. Additional time is added through the assessment and identification of the
following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in section 256B.0659;

(2) 30 additional minutes per day for each complex health-related function as
defined in section 256B.0659; and

(3) 30 additional minutes per day for each behavior issue as defined in section
256B.0659, subdivision 4, paragraph (d).

(d) new text begin Effective July 1, 2011, the home care rating for recipients who have a dependency
in one activity of daily living or level one behavior shall equal no more than two units per
day. Recipients with this home care rating are not subject to the methodology in paragraph
(c), and are not eligible for more than two units per day.
new text end

new text begin (e) new text end A limit of 96 units of qualified professional supervision may be authorized for
each recipient receiving personal care assistance services. A request to the commissioner
to exceed this total in a calendar year must be requested by the personal care provider
agency on a form approved by the commissioner.

Sec. 4.

Minnesota Statutes 2010, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and section 256L.12 shall be entered into or renewed on a calendar year basis beginning
January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
31, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B and 256L is responsible for complying with the terms of its
contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B and 256L established after the effective date of a contract with the
commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance program pending completion of performance targets. Each performance target
must be quantifiable, objective, measurable, and reasonably attainable, except in the case
of a performance target based on a federal or state law or rule. Criteria for assessment
of each performance target must be outlined in writing prior to the contract effective
date. The managed care plan must demonstrate, to the commissioner's satisfaction,
that the data submitted regarding attainment of the performance target is accurate. The
commissioner shall periodically change the administrative measures used as performance
targets in order to improve plan performance across a broader range of administrative
services. The performance targets must include measurement of plan efforts to contain
spending on health care services and administrative activities. The commissioner may
adopt plan-specific performance targets that take into account factors affecting only one
plan, including characteristics of the plan's enrollee population. The withheld funds
must be returned no sooner than July of the following year if performance targets in the
contract are achieved. The commissioner may exclude special demonstration projects
under subdivision 23.

(d) Effective for services rendered on or after January 1, 2009, through December
31, 2009, the commissioner shall withhold three percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(e) Effective for services provided on or after January 1, 2010, the commissioner
shall require that managed care plans use the assessment and authorization processes,
forms, timelines, standards, documentation, and data reporting requirements, protocols,
billing processes, and policies consistent with medical assistance fee-for-service or the
Department of Human Services contract requirements consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all
personal care assistance services under section 256B.0659.

(f) Effective for services rendered on or after January 1, 2010, through December
31, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(g) Effective for services rendered on or after January 1, 2011, new text begin through December
31, 2011, new text end the commissioner shall include as part of the performance targets described
in paragraph (c) a reduction in the health plan's emergency room utilization rate for
state health care program enrollees by a measurable rate of five percent from the plan's
utilization rate for state health care program enrollees for the previous calendar year. new text begin
Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the
health plan's emergency room utilization rate for state health care program enrollees by a
measurable rate of ten percent from the plan's utilization rate for state health care program
enrollees for the previous calendar year.
new text end

The withheld funds must be returned no sooner than July 1 and no later than July 31
of the following calendar year if the managed care plan demonstrates to the satisfaction of
the commissioner that deleted text begin a deleted text end new text begin this new text end reduction in the utilization rate was achieved.

The withhold described in this paragraph shall continue for each consecutive
contract period until the plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the plan's emergency room utilization
rate for state health care program enrollees for calendar year 2009. Hospitals shall
cooperate with the health plans in meeting this performance target and shall accept
payment withholds that may be returned to the hospitals if the performance target is
achieved. deleted text begin The commissioner shall structure the withhold so that the commissioner returns
a portion of the withheld funds in amounts commensurate with achieved reductions in
utilization less than the targeted amount. deleted text end The withhold in this paragraph does not apply to
county-based purchasing plans.

new text begin (h) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction in
the plan's hospitalization admission rate for hospitalizations for state health care program
enrollees by a measurable rate of five percent from the plan's utilization rate for state
health care program enrollees for the previous calendar year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that this reduction in the
hospitalization rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for three consecutive
contract periods. Hospitals shall cooperate with the plans in meeting this performance
target and shall accept payment withholds that may be returned to the hospitals if the
performance target is achieved.
new text end

deleted text begin (h) deleted text end new text begin (i) new text end Effective for services rendered on or after January 1, 2011, through December
31, 2011, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

deleted text begin (i) deleted text end new text begin (j) new text end Effective for services rendered on or after January 1, 2012, through December
31, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

deleted text begin (j) deleted text end new text begin (k) new text end Effective for services rendered on or after January 1, 2013, through December
31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

deleted text begin (k) deleted text end new text begin (l) new text end Effective for services rendered on or after January 1, 2014, the commissioner
shall withhold three percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance program. The withheld funds must be returned no sooner than July 1 and
no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.

deleted text begin (l) deleted text end new text begin (m) new text end A managed care plan or a county-based purchasing plan under section
256B.692 may include as admitted assets under section 62D.044 any amount withheld
under this section that is reasonably expected to be returned.

deleted text begin (m) deleted text end new text begin (n) new text end Contracts between the commissioner and a prepaid health plan are exempt
from the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
(a), and 7.

deleted text begin (n) deleted text end new text begin (o) new text end The return of the withhold under paragraphs (d), (f), and (h) to (k) is not
subject to the requirements of paragraph (c).

Sec. 5.

Minnesota Statutes 2010, section 256B.69, subdivision 5i, is amended to read:

Subd. 5i.

Administrative expenses.

(a) Managed care plan and county-based
purchasing plan administrative costs for a prepaid health plan provided under this section
or section 256B.692 must not exceed by more than five percent that prepaid health plan's
or county-based purchasing plan's actual calculated administrative spending for the
previous calendar year as a percentage of total revenue. The penalty for exceeding this
limit must be the amount of administrative spending in excess of 105 percent of the actual
calculated amount. The commissioner may waive this penalty if the excess administrative
spending is the result of unexpected shifts in enrollment or member needs or new program
requirements.

(b) Expenses listed under section 62D.12, subdivision 9a, clause (4), are not
allowable administrative expenses for rate-setting purposes under this section, unless
approved by the commissioner.

new text begin (c) Notwithstanding paragraph (a), the portion of the per member per month
capitation rate paid under this section to managed care plans and county-based purchasing
plans for administrative expenditures shall be reduced by 21 cents beginning July 1, 2011.
new text end

Sec. 6.

Minnesota Statutes 2010, section 256B.69, subdivision 28, is amended to read:

Subd. 28.

Medicare special needs plans; medical assistance basic health care.

(a) The commissioner may contract with qualified Medicare-approved special needs
plans to provide medical assistance basic health care services to persons with disabilities,
including those with developmental disabilities. Basic health care services include:

(1) those services covered by the medical assistance state plan except for ICF/MR
services, home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care
and certain home care services defined by the commissioner in consultation with the
stakeholder group established under paragraph (d); and

(2) basic health care services may also include risk for up to 100 days of nursing
facility services for persons who reside in a noninstitutional setting and home health
services related to rehabilitation as defined by the commissioner after consultation with
the stakeholder group.

The commissioner may exclude other medical assistance services from the basic
health care benefit set. Enrollees in these plans can access any excluded services on the
same basis as other medical assistance recipients who have not enrolled.

deleted text begin Unless a person is otherwise required to enroll in managed care, enrollment in these
plans for Medicaid services must be voluntary. For purposes of this subdivision, automatic
enrollment with an option to opt out is not voluntary enrollment.
deleted text end

(b) Beginning January 1, 2007, the commissioner may contract with qualified
Medicare special needs plans to provide basic health care services under medical
assistance to persons who are dually eligible for both Medicare and Medicaid and those
Social Security beneficiaries eligible for Medicaid but in the waiting period for Medicare.
The commissioner shall consult with the stakeholder group under paragraph (d) in
developing program specifications for these services. The commissioner shall report to
the chairs of the house of representatives and senate committees with jurisdiction over
health and human services policy and finance by February 1, 2007, on implementation
of these programs and the need for increased funding for the ombudsman for managed
care and other consumer assistance and protections needed due to enrollment in managed
care of persons with disabilities. Payment for Medicaid services provided under this
subdivision for the months of May and June will be made no earlier than July 1 of the
same calendar year.

(c) new text begin Notwithstanding subdivision 4, new text end beginning January 1, deleted text begin 2008 deleted text end new text begin 2012 new text end , the
commissioner deleted text begin may expand contracting under this subdivision to all deleted text end new text begin shall enroll new text end persons
with disabilities deleted text begin not otherwise required to enroll deleted text end in managed care new text begin under this section,
unless the individual chooses to opt-out of enrollment. The commissioner shall establish
enrollment and opt out procedures consistent with applicable enrollment procedures under
this subdivision new text end .

(d) The commissioner shall establish a state-level stakeholder group to provide
advice on managed care programs for persons with disabilities, including both MnDHO
and contracts with special needs plans that provide basic health care services as described
in paragraphs (a) and (b). The stakeholder group shall provide advice on program
expansions under this subdivision and subdivision 23, including:

(1) implementation efforts;

(2) consumer protections; and

(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.

(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the
counties covered by the plan, members, consumer advocates, and providers, for advice on
issues that arise in the local or regional area.

(f) The commissioner is prohibited from providing the names of potential enrollees
to health plans for marketing purposes. The commissioner may mail marketing materials
to potential enrollees on behalf of health plans, in which case the health plans shall cover
any costs incurred by the commissioner for mailing marketing materials.

Sec. 7.

Minnesota Statutes 2010, section 256L.12, subdivision 9, is amended to read:

Subd. 9.

Rate setting; performance withholds.

(a) Rates will be prospective,
per capita, where possible. The commissioner may allow health plans to arrange for
inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
an independent actuary to determine appropriate rates.

(b) For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments and county-based purchasing
plan payments under this section pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the
contract effective date. The managed care plan must demonstrate, to the commissioner's
satisfaction, that the data submitted regarding attainment of the performance target is
accurate. The commissioner shall periodically change the administrative measures used
as performance targets in order to improve plan performance across a broader range of
administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, such as characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July 1 and no later than July 31 of the
following calendar year if performance targets in the contract are achieved.

(c) For services rendered on or after January 1, 2011, the commissioner shall
withhold an additional three percent of managed care plan or county-based purchasing
plan payments under this section. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following calendar year. The return of the withhold
under this paragraph is not subject to the requirements of paragraph (b).

(d) Effective for services rendered on or after January 1, 2011, new text begin through December
31, 2011, new text end the commissioner shall include as part of the performance targets described in
paragraph (b) a reduction in the plan's emergency room utilization rate for state health
care program enrollees by a measurable rate of five percent from the plan's utilization
rate for the previous calendar year. new text begin Effective for services rendered on or after January
1, 2012, the commissioner shall include as part of the performance targets described in
paragraph (b) a reduction in the plan's emergency room utilization rate for state health
care program enrollees by a measurable rate of ten percent from the plan's utilization
rate for the previous calendar year.
new text end

The withheld funds must be returned no sooner than July 1 and no later than July 31
of the following calendar year if the managed care plan demonstrates to the satisfaction of
the commissioner that deleted text begin a deleted text end new text begin this new text end reduction in the utilization rate was achieved.

The withhold described in this paragraph shall continue for each consecutive
contract period until the plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the plan's emergency room utilization rate
for state health care program enrollees for calendar year 2009. Hospitals shall cooperate
with the health plans in meeting this performance target and shall accept payment
withholds that may be returned to the hospitals if the performance target is achieved.
deleted text begin The commissioner shall structure the withhold so that the commissioner returns a portion
of the withheld funds in amounts commensurate with achieved reductions in utilization
less than the targeted amount. deleted text end The withhold described in this paragraph does not apply to
county-based purchasing plans.

new text begin (e) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (b) a reduction
in the plan's hospitalization admission rate for state health care program enrollees by
a measurable rate of five percent from the plan's hospitalization rate for the previous
calendar year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that this reduction in the
hospitalization rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for three consecutive
contract periods. Hospitals shall cooperate with the plans in meeting this performance
target and shall accept payment withholds that may be returned to the hospitals if the
performance target is achieved.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end A managed care plan or a county-based purchasing plan under section
256B.692 may include as admitted assets under section 62D.044 any amount withheld
under this section that is reasonably expected to be returned.

Sec. 8.

Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by
Laws 2009, chapter 173, article 2, section 1, subdivision 8, Laws 2010, First Special
Session chapter 1, article 15, section 5, and Laws 2010, First Special Session chapter 1,
article 25, section 16, is amended to read:

Subd. 8. Continuing Care Grants

The amounts that may be spent from the
appropriation for each purpose are as follows:

(a) Aging and Adult Services Grants

13,499,000

15,805,000

Base Adjustment. The general fund base is
increased by $5,751,000 in fiscal year 2012
and $6,705,000 in fiscal year 2013.

Information and Assistance
Reimbursement. Federal administrative
reimbursement obtained from information
and assistance services provided by the
Senior LinkAge or Disability Linkage lines
to people who are identified as eligible for
medical assistance shall be appropriated to
the commissioner for this activity.

Community Service Development Grant
Reduction. Funding for community service
development grants must be reduced by
$260,000 for fiscal year 2010; $284,000 in
fiscal year 2011; $43,000 in fiscal year 2012;
and $43,000 in fiscal year 2013. Base level
funding shall be restored in fiscal year 2014.

Community Service Development Grant
Community Initiative. Funding for
community service development grants shall
be used to offset the cost of aging support
grants. Base level funding shall be restored
in fiscal year 2014.

Senior Nutrition Use of Federal Funds.
For fiscal year 2010, general fund grants
for home-delivered meals and congregate
dining shall be reduced by $500,000. The
commissioner must replace these general
fund reductions with equal amounts from
federal funding for senior nutrition from the
American Recovery and Reinvestment Act
of 2009.

(b) Alternative Care Grants

50,234,000

48,576,000

Base Adjustment. The general fund base is
decreased by $3,598,000 in fiscal year 2012
and $3,470,000 in fiscal year 2013.

Alternative Care Transfer. Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.

(c) Medical Assistance Grants; Long-Term Care Facilities.

367,444,000

419,749,000

(d) Medical Assistance Long-Term Care Waivers and Home Care Grants

853,567,000

1,039,517,000

Manage Growth in TBI and CADI
Waivers. During the fiscal years beginning
on July 1, 2009, and July 1, 2010, the
commissioner shall allocate money for home
and community-based waiver programs
under Minnesota Statutes, section 256B.49,
to ensure a reduction in state spending that is
equivalent to limiting the caseload growth of
the TBI waiver to 12.5 allocations per month
each year of the biennium and the CADI
waiver to 95 allocations per month each year
of the biennium. Limits do not apply: (1)
when there is an approved plan for nursing
facility bed closures for individuals under
age 65 who require relocation due to the
bed closure; (2) to fiscal year 2009 waiver
allocations delayed due to unallotment; or (3)
to transfers authorized by the commissioner
from the personal care assistance program
of individuals having a home care rating
of "CS," "MT," or "HL." Priorities for the
allocation of funds must be for individuals
anticipated to be discharged from institutional
settings or who are at imminent risk of a
placement in an institutional setting.

Manage Growth in DD Waiver. The
commissioner shall manage the growth in
the DD waiver by limiting the allocations
included in the February 2009 forecast to 15
additional diversion allocations each month
for the calendar years that begin on January
1, 2010, and January 1, 2011. Additional
allocations must be made available for
transfers authorized by the commissioner
from the personal care program of individuals
having a home care rating of "CS," "MT,"
or "HL."

Adjustment to Lead Agency Waiver
Allocations. Prior to the availability of the
alternative license defined in Minnesota
Statutes, section 245A.11, subdivision 8,
the commissioner shall reduce lead agency
waiver allocations for the purposes of
implementing a moratorium on corporate
foster care.

deleted text begin Alternatives to Personal Care Assistance
Services. Base level funding of $3,237,000
in fiscal year 2012 and $4,856,000 in
fiscal year 2013 is to implement alternative
services to personal care assistance services
for persons with mental health and other
behavioral challenges who can benefit
from other services that more appropriately
meet their needs and assist them in living
independently in the community. These
services may include, but not be limited to, a
1915(i) state plan option.
deleted text end

(e) Mental Health Grants

Appropriations by Fund
General	77,739,000	77,739,000
Health Care Access	750,000	750,000
Lottery Prize	1,508,000	1,508,000

Funding Usage. Up to 75 percent of a fiscal
year's appropriation for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.

(f) Deaf and Hard-of-Hearing Grants

1,930,000

1,917,000

(g) Chemical Dependency Entitlement Grants

111,303,000

122,822,000

Payments for Substance Abuse Treatment.
For placements beginning during fiscal years
2010 and 2011, county-negotiated rates and
provider claims to the consolidated chemical
dependency fund must not exceed the lesser
of:

(1) rates charged for these services on
January 1, 2009; deleted text begin and deleted text end or

(2) 160 percent of the average rate on January
1, 2009, for each group of vendors with
similar attributes.

Rates for fiscal years 2010 and 2011 must
not exceed 160 percent of the average rate on
January 1, 2009, for each group of vendors
with similar attributes.

Effective July 1, 2010, rates that were above
the average rate on January 1, 2009, are
reduced by five percent from the rates in
effect on June 1, 2010. Rates below the
average rate on January 1, 2009, are reduced
by 1.8 percent from the rates in effect on
June 1, 2010. Services provided under
this section by state-operated services are
exempt from the rate reduction. For services
provided in fiscal years 2012 and 2013, the
statewide aggregate payment under the new
rate methodology to be developed under
Minnesota Statutes, section 254B.12, must
not exceed the projected aggregate payment
under the rates in effect for fiscal year 2011
excluding the rate reduction for rates that
were below the average on January 1, 2009,
plus a state share increase of $3,787,000 for
fiscal year 2012 and $5,023,000 for fiscal
year 2013. Notwithstanding any provision
to the contrary in this article, this provision
expires on June 30, 2013.

Chemical Dependency Special Revenue
Account. For fiscal year 2010, $750,000
must be transferred from the consolidated
chemical dependency treatment fund
administrative account and deposited into the
general fund.

County CD Share of MA Costs for
ARRA Compliance. Notwithstanding the
provisions of Minnesota Statutes, chapter
254B, for chemical dependency services
provided during the period October 1, 2008,
to December 31, 2010, and reimbursed by
medical assistance at the enhanced federal
matching rate provided under the American
Recovery and Reinvestment Act of 2009, the
county share is 30 percent of the nonfederal
share. This provision is effective the day
following final enactment.

(h) Chemical Dependency Nonentitlement Grants

1,729,000

1,729,000

(i) Other Continuing Care Grants

19,201,000

17,528,000

Base Adjustment. The general fund base is
increased by $2,639,000 in fiscal year 2012
and increased by $3,854,000 in fiscal year
2013.

Technology Grants. $650,000 in fiscal
year 2010 and $1,000,000 in fiscal year
2011 are for technology grants, case
consultation, evaluation, and consumer
information grants related to developing and
supporting alternatives to shift-staff foster
care residential service models.

Other Continuing Care Grants; HIV
Grants. Money appropriated for the HIV
drug and insurance grant program in fiscal
year 2010 may be used in either year of the
biennium.

Quality Assurance Commission. Effective
July 1, 2009, state funding for the quality
assurance commission under Minnesota
Statutes, section 256B.0951, is canceled.

Sec. 9. new text begin CAPITATION PAYMENT DELAY.
new text end

new text begin (a) The commissioner of human services shall delay the MinnesotaCare capitation
payment due in May of 2013 to managed care plans for single adults without children
eligible under Minnesota Statutes, section 256L.04, subdivision 7, until July of 2013.
new text end

new text begin (b) The commissioner of human services shall delay payments due in April of 2013
for medical assistance services provided under Minnesota Statutes, section 256B.69,
subdivision 28, until after July 1, 2013.
new text end

Sec. 10. new text begin HEALTH CARE DELIVERY SYSTEMS DEMONSTRATION
PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Implementation. new text end

new text begin (a) The commissioner shall develop and authorize
a demonstration project to test alternative and innovative health care delivery systems,
including accountable care organizations that provide services to a specified patient
population for an agreed-upon total cost of care payment arrangement in accordance with
subdivision 4. The commissioner shall develop one request for proposals to provide
services to the elderly population eligible for medical assistance, and one request for
proposals to provide services to families and children eligible for medical assistance
and the MinnesotaCare program.
new text end

new text begin (b) In developing the request for proposals, the commissioner shall:
new text end

new text begin (1) establish uniform statewide methods of forecasting utilization and cost of care
for the specified populations, to be used by the commissioner for the health care delivery
system projects;
new text end

new text begin (2) identify key indicators of quality, access, patient satisfaction, and other
performance indicators that will be measured, in addition to indicators for measuring
cost savings;
new text end

new text begin (3) allow maximum flexibility to encourage innovation and variation so that a variety
of provider collaborations are able to become health care delivery systems; and
new text end

new text begin (4) establish quality standards for the delivery system demonstrations.
new text end

new text begin (c) To be eligible to participate in the demonstration project, a health care delivery
system must:
new text end

new text begin (1) provide required covered services and care coordination to recipients enrolled in
the demonstration project;
new text end

new text begin (2) establish a process to ensure the quality of care provided;
new text end

new text begin (3) in cooperation with counties and community social service agencies, coordinate
the delivery of health care services with existing social services programs;
new text end

new text begin (4) provide a system for advocacy and consumer protection; and
new text end

new text begin (5) adopt innovative and cost-effective methods of care delivery and coordination,
which may include the use of allied health professionals, telemedicine, patient educators,
care coordinators, and community health workers.
new text end

new text begin (d) A health care delivery system demonstration may be formed by the following
groups of providers of services and suppliers if they have established a mechanism for
shared governance:
new text end

new text begin (1) professionals in group practice arrangements;
new text end

new text begin (2) networks of individual practices of professionals;
new text end

new text begin (3) partnerships or joint venture arrangements between hospitals and health care
professionals;
new text end

new text begin (4) hospitals employing professionals; and
new text end

new text begin (5) other groups of providers of services and suppliers as the commissioner
determines appropriate.
new text end

new text begin A managed care plan or county-based purchasing plan may participate in this
demonstration in collaboration with one or more of the entities listed in clauses (1) to (5).
new text end

new text begin A health care delivery system may contract with a managed care plan or a
county-based purchasing plan to provide administrative services, including the
administration of a payment system using the payment methods approved by the
commissioner for health care delivery systems.
new text end

new text begin (e) The commissioner may require a health care delivery system to enter into
additional third-party contractual relationships for the assessment of risk and purchase of
stop loss insurance or another form of insurance risk management related to the delivery
of care described in paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Enrollment. new text end

new text begin (a) The commissioner shall develop and authorize at least
two demonstration projects: one for families and children eligible for medical assistance
and MinnesotaCare; and one for individuals 65 years of age or older eligible for medical
assistance.
new text end

new text begin (b) Eligible applicants and recipients shall enroll in a health care delivery system
if a system serves the county in which the applicant or recipient resides. If more than
one health care delivery system serves a county, the applicant or recipient may choose
among the delivery systems. The commissioner shall assign an applicant or recipient to a
health care delivery system if a health care delivery system is available and no choice has
been made by the applicant or recipient.
new text end

new text begin Subd. 3. new text end

new text begin Accountability. new text end

new text begin (a) Health care delivery systems must accept responsibility
for the quality of care based on standards established under subdivision 1, paragraph (b),
clause (4), and the cost of care or utilization of services provided to its enrollees under
subdivision 1, paragraph (b), clause (1).
new text end

new text begin (b) A health care delivery system may contract and coordinate with providers and
clinics for the delivery of services and shall contract with community health clinics,
federally qualified health centers, community mental health centers or programs, and rural
clinics to the extent practicable.
new text end

new text begin Subd. 4. new text end

new text begin Payment system. new text end

new text begin (a) In developing a payment system for health care
delivery systems, the commissioner shall establish a total cost of care benchmark to be
paid for services provided to the recipients enrolled in a health care delivery system.
new text end

new text begin (b) The total cost of care payment system shall not exceed the payments made
in fiscal year 2011 by the commissioner under fee-for-service or managed care for the
delivery of services to the specified populations within the geographic area served by the
health care delivery system minus five percent.
new text end

new text begin (c) The payment system developed under this section shall incorporate the withhold
and performance target requirements in Minnesota Statutes, section 256B.69, subdivision
5a.
new text end

Sec. 11. new text begin MANAGE GROWTH IN TRAUMATIC BRAIN INJURY AND
COMMUNITY ALTERNATIVES FOR DISABLED INDIVIDUALS WAIVERS.
new text end

new text begin During the fiscal years beginning July 1, 2011, and July 1, 2012, the commissioner
shall allocate money for home and community-based waiver programs under Minnesota
Statutes, section 256B.49, to ensure a reduction in state spending that is equivalent to
limiting the caseload growth of the traumatic brain injury waiver to six allocations per
month each year of the biennium and the community alternatives for disabled individuals
waiver to 60 allocations per month. The limits do not apply:
new text end

new text begin (1) when there is an approved plan for nursing facility bed closures for individuals
under age 65 who require relocation due to the bed closure;
new text end

new text begin (2) to fiscal year 2009 waiver allocations delayed due to unallotment; or
new text end

new text begin (3) to transfers authorized by the commissioner from the personal care assistance
program of individuals having a home care rating of CS, MT, or HL. Priorities for the
allocation of funds must be for individuals anticipated to be discharged from institutional
settings or who are at imminent risk of a placement in an institutional setting.
new text end

Sec. 12. new text begin MANAGE GROWTH IN DEVELOPMENTAL DISABILITY (DD)
WAIVER.
new text end

new text begin The commissioner shall manage the growth in the developmental disability waiver
by limiting the allocations included in the November 2010 forecast to six additional
diversion allocations each month for the fiscal year that begins on July 1, 2011. Additional
allocations must be made available for transfers authorized by the commissioner from the
personal care assistance program of individuals having a home care rating of CS, MT,
or HL. This provision is effective through June 30, 2013.
new text end

Sec. 13. new text begin REQUEST FOR PROPOSALS; CLAIMS PROCESSING FOR
FEE-FOR-SERVICE MEDICAL ASSISTANCE.
new text end

new text begin (a) The commissioner of human services shall issue a request for proposal for a
contract to provide claims processing services for the fee-for-service medical assistance
program, excluding outpatient pharmacy services. The contractor must be able to:
new text end

new text begin (1) process provider claims in a timely manner and within state and federal
requirements;
new text end

new text begin (2) provide electronic claims submission access for providers;
new text end

new text begin (3) validate claims data;
new text end

new text begin (4) file and reconcile claims;
new text end

new text begin (5) identify fraud and abuse;
new text end

new text begin (6) measure quality assurance and performance outcomes; and
new text end

new text begin (7) coordinate benefits on the front end of a claim.
new text end

new text begin (b) The commissioner shall enter into a contract for claims processing by January 1,
2012. Payment under the contract shall not exceed $1.75 on average per claim processed.
new text end

new text begin (c) The commissioner shall apply for any federal grants that may be available.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end