SF 9

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:10am

A bill for an act
relating to human services; creating the Minnesota health security account;
establishing the Minnesota health security program; specifying eligibility criteria,
covered services, and administrative procedures; requiring an independent
actuarial analysis of health care system efficiency; ensuring access to health care
for all adults; appropriating money; proposing coding for new law in Minnesota
Statutes, chapter 16A; proposing coding for new law as Minnesota Statutes,
chapter 256N.

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

Section 1.

new text begin [16A.726] MINNESOTA HEALTH SECURITY ACCOUNT.
new text end

new text begin The Minnesota health security account is created in a special revenue fund in
the state treasury. The commissioner shall deposit to the credit of the account money
made available to the account. Notwithstanding section 11A.20, any investment income
attributable to the investment of the Minnesota health security account not currently
needed shall be credited to the Minnesota health security account.
new text end

Sec. 2.

new text begin [256N.01] CITATION.
new text end

new text begin This chapter may be cited as the Minnesota Health Security Act.
new text end

Sec. 3.

new text begin [256N.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin The terms used in this chapter have the following
meanings unless otherwise provided for by text.
new text end

new text begin Subd. 2. new text end

new text begin Child. new text end

new text begin "Child" means an individual as defined in section 256L.01,
subdivision 1a.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of human
services.
new text end

Sec. 4.

new text begin [256N.03] ESTABLISHMENT.
new text end

new text begin The commissioner shall establish the Minnesota health security program to provide
health coverage to children in Minnesota. No funding from existing health care programs
for children in Minnesota may be diverted for purposes other than children's health care.
In the implementation of the Minnesota health security program, the commissioner shall
seek to streamline all existing health care programs for children in order to maximize
efficiency. The commissioner shall begin implementation of the program on July 1, 2010,
or upon federal approval, whichever is later.
new text end

Sec. 5.

new text begin [256N.05] ELIGIBILITY.
new text end

new text begin Subdivision 1. new text end

new text begin General requirements. new text end

new text begin Children meeting the eligibility
requirements of this section are eligible for the Minnesota health security program.
new text end

new text begin Subd. 2. new text end

new text begin Residency. new text end

new text begin (a) To be eligible for health coverage under the Minnesota
health security program, a child must be a Minnesota resident who meets the medical
assistance criteria for state residency specified in Code of Federal Regulations, title 42,
section 435.403.
new text end

new text begin (b) A child who is temporarily absent from the state does not lose eligibility for the
Minnesota health security program. "Temporarily absent from the state" means the person
is out of the state for a temporary purpose and intends to return when the purpose of the
absence has been accomplished.
new text end

new text begin (c) A child who moved to Minnesota primarily to obtain medical treatment is not
eligible for health coverage under the Minnesota health security program.
new text end

new text begin (d) Children who are not eligible for medical assistance due to immigration status
are eligible for health coverage under the Minnesota health security program.
new text end

new text begin Subd. 3. new text end

new text begin Enrollment voluntary. new text end

new text begin Enrollment in the Minnesota health security
program is voluntary. Parents or guardians may retain private sector or Medicare coverage
for a child as the sole source of coverage. Parents or guardians who have private sector
or Medicare coverage for children may also enroll children in the Minnesota health
security program. If a child is enrolled in either private coverage or Medicare and the
Minnesota health security program, coverage under the Minnesota health security program
is secondary to the private sector or Medicare coverage.
new text end

Sec. 6.

new text begin [256N.07] COVERED SERVICES.
new text end

new text begin Covered services under the Minnesota health security program shall consist of
all covered services under chapter 256B.
new text end

Sec. 7.

new text begin [256N.09] NO ENROLLEE PREMIUMS OR COST-SHARING.
new text end

new text begin In order to ensure broad access to coverage, the Minnesota health security program
has no enrollee premium or cost-sharing requirements.
new text end

Sec. 8.

new text begin [256N.11] APPLICATION PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin Application procedure. new text end

new text begin Applications for the program must be made
available to provider offices, local human services agencies, school districts, schools,
community health offices, and other sites willing to cooperate in program outreach.
These sites may accept applications and forward applications to the commissioner or
local county human services agencies that choose to participate as an enrollment site.
Otherwise, applicants may apply directly to the commissioner or to participating local
county human services agencies.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility determination. new text end

new text begin The commissioner shall determine an
applicant's eligibility for the program within 30 days of the date the application is received
by the Department of Human Services. This requirement also applies to local county
human services agencies that determine eligibility for the program. The effective date
of coverage is the day upon which eligibility is approved.
new text end

new text begin Subd. 3. new text end

new text begin Renewal of eligibility. new text end

new text begin The commissioner shall require enrollees to renew
coverage every 12 months.
new text end

new text begin Subd. 4. new text end

new text begin Retroactive coverage. new text end

new text begin If any individual has been determined to be
eligible for the Minnesota health security program, it will be made available for care and
services included under the plan and furnished in or after the 30 days before the month
in which the individual made application for such assistance, if such individual was, or
upon application would have been, eligible for medical assistance at the time the care and
services were furnished.
new text end

Sec. 9.

new text begin [256N.13] SERVICE DELIVERY.
new text end

new text begin Subdivision 1. new text end

new text begin Contracts for service delivery. new text end

new text begin The commissioner may contract
with health maintenance organizations licensed under chapter 62D and county-based
purchasing plans established under section 256B.692 to provide covered health care
services to program enrollees, and may contract with health care and social service
providers to provide services under a fee-for-service system. In determining the method
for service delivery, the commissioner shall consider:
new text end

new text begin (1) the cost and quality of health care services;
new text end

new text begin (2) the breadth of services offered, including medical, dental, and mental health
services, and the breadth of choice of medical providers for enrollees;
new text end

new text begin (3) the ease of access to quality medical care for enrollees;
new text end

new text begin (4) the efficiency and cost effectiveness of service delivery, including minimizing
the number of provider payment, care management, and pharmacy benefit management
systems; and
new text end

new text begin (5) the extent to which service delivery under this chapter can be integrated with the
health care home and payment reform initiatives of sections 256B.0751 to 256B.0754 and
chapter 62U.
new text end

new text begin Subd. 2. new text end

new text begin Contract requirements. new text end

new text begin Eligible entities under contract are responsible
for coordinating covered health care services provided to eligible individuals. Eligible
entities under contract:
new text end

new text begin (1) shall authorize and arrange for the provision of all needed covered health
services under chapter 256B, with the exception of services available only under a medical
assistance home and community-based waiver, in order to ensure appropriate health care
is delivered to enrollees;
new text end

new text begin (2) shall accept the payment from the commissioner in return for the provision of
comprehensive and coordinated health care services for enrollees;
new text end

new text begin (3) may contract with health care and social service providers to provide covered
services to enrollees; and
new text end

new text begin (4) shall institute enrollee grievance procedures according to the method established
by the commissioner, utilizing applicable requirements of chapter 62D. Disputes not
resolved through this process may be appealed to the commissioner using the procedures
in section 256.045.
new text end

new text begin Subd. 3. new text end

new text begin Fee-for-services delivery. new text end

new text begin Disputes related to services provided under
the fee-for-service system may be appealed to the commissioner using the procedures
in section 256.045.
new text end

Sec. 10.

new text begin [256N.14] SERVICES FOR DISABLED CHILDREN.
new text end

new text begin Subdivision 1. new text end

new text begin Contracts for waiver services. new text end

new text begin The commissioner shall contract
with health care and social service providers, on a fee-for-service basis, to provide
program enrollees with covered services available only under a medical assistance home
and community-based waiver. The commissioner shall determine eligibility for home and
community-based waiver services using the criteria and procedures in chapter 256B.
Disputes related to services provided on a fee-for-service basis may be appealed to the
commissioner using the procedures in section 256.045.
new text end

new text begin Subd. 2. new text end

new text begin Service delivery for Minnesota disabilities health options recipient.
new text end

new text begin Individuals who voluntarily enroll in the Minnesota disability health options (MnDHO)
program, established under section 256B.69, subdivision 23, shall continue to receive their
home and community-based waiver services through MnDHO.
new text end

new text begin Subd. 3. new text end

new text begin Disabled or blind children. new text end

new text begin Children eligible for medical assistance due
to blindness or disability as determined by the Social Security Administration or the state
medical review team are exempt from enrolling in a managed care organization and shall
be provided health benefits on a fee-for-service basis.
new text end

Sec. 11.

new text begin [256N.15] PAYMENT RATES.
new text end

new text begin The commissioner, in consultation with a health care actuary, shall establish the
method and amount of payments for services. The commissioner shall annually contract
with eligible entities to provide services to program enrollees. The commissioner, in
consultation with the Risk Adjustment Association established under section 62Q.03,
subdivision 6, shall develop and implement a risk adjustment system for the program.
new text end

Sec. 12.

new text begin [256N.17] CONSUMER ASSISTANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Assistance to applicants. new text end

new text begin If the Department of Human Services
contracts with more than one eligible entity and multiple options are available to potential
enrollees, the commissioner shall assist applicants in choosing a plan by:
new text end

new text begin (1) establishing a Web site to provide information about applicant options and to
allow online enrollment;
new text end

new text begin (2) make information on applicant options available at the sites specified in section
256N.11, subdivision 1;
new text end

new text begin (3) make applications and information available in Spanish, Hmong, Laotian,
Russian, Somali, Vietnamese, and Cambodian, and provide language interpreter services
as necessary to assist applicants; and
new text end

new text begin (4) make benefit educators available to assist applicants.
new text end

new text begin Subd. 2. new text end

new text begin Ombudsperson. new text end

new text begin The commissioner shall designate an ombudsperson
to advocate for children enrolled in the Minnesota health security program. The
ombudsperson shall assist enrollees in understanding and making use of complaint and
appeal procedures and ensure that necessary medical services are provided to enrollees. At
the time of enrollment, the commissioner shall inform enrollees about: the ombudsperson
program; the right to a resolution of the enrollee's complaint by the health plan company
if the enrollee experiences a problem with the health plan company or its providers; and
appeal rights under section 256.045.
new text end

Sec. 13.

new text begin [256N.19] MONITORING AND EVALUATION OF QUALITY AND
COSTS.
new text end

new text begin The commissioner, as a condition of contract, shall require each participating
entity and participating provider to submit, in the form and manner specified by the
commissioner, data required for assessing enrollee satisfaction, quality of care, cost, and
utilization of services. The commissioner shall evaluate this data in order to:
new text end

new text begin (1) make summary information on the quality of care across contracting entities,
medical clinics, and providers available to consumers;
new text end

new text begin (2) require contracting entities and providers, as a condition of contract, to
implement quality improvement plans; and
new text end

new text begin (3) compare the cost and quality of services under the program to the cost and
quality of services provided to private sector enrollees.
new text end

new text begin The commissioner, to the extent possible, shall implement this section in a manner
consistent with the health care data collection and quality initiatives of chapter 62U.
new text end

Sec. 14. new text begin FEDERAL APPROVAL.
new text end

new text begin The commissioner shall seek all federal waivers and approvals necessary to
implement this chapter including, but not limited to, waivers and approvals necessary
to maximize the receipt of federal funds.
new text end

Sec. 15. new text begin IMPLEMENTATION PLAN.
new text end

new text begin The commissioner of human services shall develop an implementation plan for
the Minnesota health security program, and shall present this plan and any necessary
conforming legislation for review by the legislature by January 15, 2010.
new text end

Sec. 16. new text begin AFFORDABLE HEALTH CARE FOR ALL ADULTS.
new text end

new text begin The state of Minnesota shall ensure that all adults in the state have access to
comprehensive, affordable health care by January 1, 2012, consistent with the following
criteria:
new text end

new text begin (1) health care must be affordable, with a guarantee that the family share of premium
costs and cost-sharing in total does not exceed five percent of family income;
new text end

new text begin (2) a comprehensive benefit set must be provided that includes preventive care
and all other medically necessary services including dental and comprehensive mental
health benefits;
new text end

new text begin (3) breadth of choice of providers must be available with adequate access to services
throughout geographic areas;
new text end

new text begin (4) enrollment must be simple and seamless; and
new text end

new text begin (5) improving health outcomes of all enrollees and reducing health disparities must
be prioritized.
new text end

Sec. 17. new text begin INDEPENDENT ACTUARIAL ANALYSIS OF HEALTH CARE
SYSTEM EFFICIENCY.
new text end

new text begin The Legislative Commission on Health Care Access shall commission an
independent actuarial analysis of the costs and benefits of several health care delivery
system options in order to provide the most efficient and effective health care to Minnesota
children and adults, as described under the Minnesota Health Security Act. The analysis
shall identify the administrative costs associated with care provided under public health
plans in Minnesota, and provide recommendations for greater transparency of those
costs as needed. The analysis shall be completed and submitted to the legislature by
July 1, 2010, and shall include recommendations on the ongoing implementation of the
Minnesota Health Security Act.
new text end

Sec. 18. new text begin APPROPRIATION.
new text end

new text begin $....... is appropriated from the general fund to the commissioner of human services
for the biennium beginning July 1, 2009, to implement and administer the Minnesota
health security program under Minnesota Statutes, chapter 256N.
new text end