Minnesota Session Laws - 2003, Regular Session

                            CHAPTER 47-H.F.No. 1026 
                  An act relating to human services; authorizing a 
                  medical assistance capitated payment option for 
                  waivered services, day training and habilitation 
                  services, and intermediate care facility services for 
                  persons with mental retardation or a related 
                  condition; amending Minnesota Statutes 2002, sections 
                  252.46, by adding a subdivision; 256B.69, subdivisions 
                  6a, 23; 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 2002, section 252.46, is 
        amended by adding a subdivision to read: 
           Subd. 21.  [MANAGED CARE PILOT.] (a) The commissioner may 
        initiate a capitated risk-based managed care option for persons 
        with mental retardation or related conditions, which includes 
        capitated payments for day training and habilitation and 
        alternative active treatment services.  The commissioner may 
        permit the health plan, care system, or other health plan 
        network participating in this managed care option to negotiate 
        day training and habilitation rates.  The commissioner may grant 
        a variance to any of the provisions in sections 252.40 to 252.46 
        and Minnesota Rules, parts 9525.1200 to 9525.1580, necessary to 
        implement the pilot. 
           (b) The commissioner shall report to the legislature 
        financial and program results along with a recommendation as to 
        whether the pilot should be expanded. 
           Sec. 2.  [256B.5016] [ICF/MR MANAGED CARE OPTION.] 
           Subdivision 1.  [MANAGED CARE PILOT.] The commissioner may 
        initiate a capitated risk-based managed care option for services 
        in an intermediate care facility for persons with mental 
        retardation or related conditions according to the terms and 
        conditions of the federal agreement governing the managed care 
        pilot.  The commissioner may grant a variance to any of the 
        provisions in sections 256B.501 to 256B.5015 and Minnesota 
        Rules, parts 9525.1200 to 9525.1330 and 9525.1580. 
           Subd. 2.  [REPORT.] The commissioner shall report to the 
        legislature financial and program results along with a 
        recommendation as to whether the pilot should be expanded. 
           Sec. 3.  Minnesota Statutes 2002, section 256B.69, 
        subdivision 6a, is amended to read: 
           Subd. 6a.  [NURSING HOME SERVICES.] (a) Notwithstanding 
        Minnesota Rules, part 9500.1457, subpart 1, item B, up to 90 
        days of nursing facility services as defined in section 
        256B.0625, subdivision 2, which are provided in a nursing 
        facility certified by the Minnesota department of health for 
        services provided and eligible for payment under Medicaid, shall 
        be covered under the prepaid medical assistance program for 
        individuals who are not residing in a nursing facility at the 
        time of enrollment in the prepaid medical assistance program.  
           (b) For individuals enrolled in the Minnesota senior health 
        options project or in other demonstrations authorized under 
        subdivision 23, nursing facility services shall be covered 
        according to the terms and conditions of the federal agreement 
        governing that demonstration project. 
           (c) For individuals enrolled in demonstrations authorized 
        under subdivision 23, services in an intermediate care facility 
        for persons with mental retardation or related conditions shall 
        be covered according to the terms and conditions of the federal 
        agreement governing the demonstration project. 
           Sec. 4.  Minnesota Statutes 2002, section 256B.69, 
        subdivision 23, is amended to read: 
           Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
        ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
        implement demonstration projects to create alternative 
        integrated delivery systems for acute and long-term care 
        services to elderly persons and persons with disabilities as 
        defined in section 256B.77, subdivision 7a, that provide 
        increased coordination, improve access to quality services, and 
        mitigate future cost increases.  The commissioner may seek 
        federal authority to combine Medicare and Medicaid capitation 
        payments for the purpose of such demonstrations.  Medicare funds 
        and services shall be administered according to the terms and 
        conditions of the federal waiver and demonstration provisions.  
        For the purpose of administering medical assistance funds, 
        demonstrations under this subdivision are subject to 
        subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
        9500.1450 to 9500.1464, apply to these demonstrations, with the 
        exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
        subpart 1, items B and C, which do not apply to persons 
        enrolling in demonstrations under this section.  An initial open 
        enrollment period may be provided.  Persons who disenroll from 
        demonstrations under this subdivision remain subject to 
        Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
        enrolled in a health plan under these demonstrations and the 
        health plan's participation is subsequently terminated for any 
        reason, the person shall be provided an opportunity to select a 
        new health plan and shall have the right to change health plans 
        within the first 60 days of enrollment in the second health 
        plan.  Persons required to participate in health plans under 
        this section who fail to make a choice of health plan shall not 
        be randomly assigned to health plans under these demonstrations. 
        Notwithstanding section 256L.12, subdivision 5, and Minnesota 
        Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
        purpose of demonstrations under this subdivision, the 
        commissioner may contract with managed care organizations, 
        including counties, to serve only elderly persons eligible for 
        medical assistance, elderly and disabled persons, or disabled 
        persons only.  For persons with primary diagnoses of mental 
        retardation or a related condition, serious and persistent 
        mental illness, or serious emotional disturbance, the 
        commissioner must ensure that the county authority has approved 
        the demonstration and contracting design.  Enrollment in these 
        projects for persons with disabilities shall be voluntary.  The 
        commissioner shall not implement any demonstration project under 
        this subdivision for persons with primary diagnoses of mental 
        retardation or a related condition, serious and persistent 
        mental illness, or serious emotional disturbance, without 
        approval of the county board of the county in which the 
        demonstration is being implemented.  
           (b) Notwithstanding chapter 245B, sections 252.40 to 
        252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 
        parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 
        and 9525.1800 to 9525.1930, the commissioner may implement under 
        this section projects for persons with developmental 
        disabilities.  The commissioner may capitate payments for ICF/MR 
        services, waivered services for mental retardation or related 
        conditions, including case management services, day training and 
        habilitation and alternative active treatment services, and 
        other services as approved by the state and by the federal 
        government.  Case management and active treatment must be 
        individualized and developed in accordance with a 
        person-centered plan.  Costs under these projects may not exceed 
        costs that would have been incurred under fee-for-service. 
        Beginning July 1, 2003, and until two years after the pilot 
        project implementation date, subcontractor participation in the 
        long-term care developmental disability pilot is limited to a 
        nonprofit long-term care system providing ICF/MR services, home 
        and community-based waiver services, and in-home services to no 
        more than 120 consumers with developmental disabilities in 
        Carver, Hennepin, and Scott counties.  The commissioner shall 
        report to the legislature prior to expansion of the 
        developmental disability pilot project.  This paragraph expires 
        two years after the implementation date of the pilot project.  
           (c) Before implementation of a demonstration project for 
        disabled persons, the commissioner must provide information to 
        appropriate committees of the house of representatives and 
        senate and must involve representatives of affected disability 
        groups in the design of the demonstration projects. 
           (b) (d) A nursing facility reimbursed under the alternative 
        reimbursement methodology in section 256B.434 may, in 
        collaboration with a hospital, clinic, or other health care 
        entity provide services under paragraph (a).  The commissioner 
        shall amend the state plan and seek any federal waivers 
        necessary to implement this paragraph. 
           Sec. 5.  [NOTIFICATION.] 
           The commissioner of human services shall notify the revisor 
        of statutes of the implementation date of the pilot project 
        established under Minnesota Statutes, section 256B.69, 
        subdivision 23, paragraph (b). 
           Presented to the governor May 12, 2003 
           Signed by the governor May 15, 2003, 3:40 p.m.