1.1                          A bill for an act 
  1.2             relating to human services; requiring the commissioner 
  1.3             of human services to develop proposals to implement 
  1.4             medical assistance reimbursement for mental health and 
  1.5             other treatment in children's residential treatment 
  1.6             programs, rehabilitation services for adults with 
  1.7             mental illness or other disabilities, and targeted 
  1.8             case management services for vulnerable adults; 
  1.9             amending Minnesota Statutes 1998, section 245.4932, by 
  1.10            adding a subdivision.  
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1998, section 245.4932, is 
  1.13  amended by adding a subdivision to read: 
  1.14     Subd. 5.  [CAPITATION PAYMENT SYSTEM.] The commissioner 
  1.15  shall assist the collaboratives that are implementing a 
  1.16  capitation payment system to ensure that all federally 
  1.17  reimbursable services are permitted in the expenditures base 
  1.18  used to determine allowable and reimbursable aggregate 
  1.19  expenditures within the capitation payment contract. 
  1.20     Sec. 2.  [REIMBURSEMENT FOR CHILDREN'S RESIDENTIAL 
  1.21  TREATMENT SERVICES.] 
  1.22     Subdivision 1.  [GENERAL.] The commissioner, in 
  1.23  consultation with the association of Minnesota counties, shall 
  1.24  develop a proposal for providing medical assistance 
  1.25  reimbursement for mental health and other treatment services 
  1.26  that are provided in children's residential treatment programs.  
  1.27  The commissioner's proposal shall include the elements described 
  1.28  in this section.  
  2.1      Subd. 2.  [MEDICAL ASSISTANCE REIMBURSEMENT.] (a) As part 
  2.2   of the proposal, the commissioner shall establish a per diem 
  2.3   cost-based reimbursement rate structure for treatment services.  
  2.4   Counties may certify local expenditures to pay the nonfederal 
  2.5   share of the medical assistance costs if no state funds are 
  2.6   appropriated for this purpose.  
  2.7      (b) The commissioner shall pay all funds generated from 
  2.8   state and federal reimbursement for treatment services to the 
  2.9   counties.  Counties may be reimbursed from the state and federal 
  2.10  reimbursements for any administrative costs incurred by the 
  2.11  counties or by their service providers in submitting claims for 
  2.12  reimbursement for treatment services.  All remaining funds must 
  2.13  be used by the counties to fund health services, mental health 
  2.14  services, social services, juvenile corrections, and other 
  2.15  related placement prevention and early intervention services for 
  2.16  children and their families.  Any enhanced revenues attributable 
  2.17  to this section must not be used by the counties to fund 
  2.18  expanded out-of-home placements for children.  
  2.19     (c) If reimbursement for residential services are paid by 
  2.20  both state and federal funds, the counties must use 40 to 50 
  2.21  percent of new revenue to expand county expenditures for 
  2.22  services in accordance with subdivision 3. 
  2.23     (d) If reimbursement for residential services are paid by 
  2.24  federal and locally certified funds, the counties must use 20 to 
  2.25  25 percent of new revenue to expand county expenditures for 
  2.26  services in accordance with subdivision 3. 
  2.27     (e) The requirements of paragraphs (c) and (d) may be 
  2.28  waived by the commissioner if: 
  2.29     (1) reductions are made in state and federal funding for 
  2.30  mandated services, including, but not limited to, medical 
  2.31  assistance; or 
  2.32     (2) counties can demonstrate to the commissioner that all 
  2.33  of the children's mental health service needs as defined under 
  2.34  Minnesota Statutes, sections 245.487 to 245.4888; or 256F.13, 
  2.35  subdivision 1, paragraph (a), clause (4), items (i) to (iv), are 
  2.36  being met within their county.  
  3.1      (f) Claims for reimbursement for residential services under 
  3.2   this proposal must be based on the financial data that is 
  3.3   required to be collected by counties through their contracts 
  3.4   with children's residential treatment facilities, unless such 
  3.5   data is insufficient to justify claims for federal Medicaid 
  3.6   reimbursement. 
  3.7      (g) The commissioner shall not establish new licensing or 
  3.8   new program certification requirements for facilities or require 
  3.9   new service authorization provisions as a condition for 
  3.10  reimbursement under this proposal. 
  3.11     (h) The counties shall be the sole certified providers of 
  3.12  all authorized services under this proposal.  The counties may 
  3.13  enter into subcontractual agreements with provider agencies. 
  3.14     Subd. 3.  [EXPANDED COUNTY EXPENDITURES FOR SERVICES.] (a) 
  3.15  An expansion of county expenditures for services shall be 
  3.16  defined as an increase in county expenditures above a base level 
  3.17  determined by the commissioner and the county. 
  3.18     (b) Any expansion of county expenditures for services due 
  3.19  to enhanced revenues generated from this proposal shall be based 
  3.20  on recommendations of the local children's mental health 
  3.21  collaborative in counties where a collaborative is established 
  3.22  and shall be incorporated into the collaborative's integrated 
  3.23  funding plan. 
  3.24     Subd. 4.  [CAPITATION PAYMENT SYSTEMS.] Any new revenue 
  3.25  anticipated or generated under this proposal must be 
  3.26  incorporated into the capitation rate paid by the commissioner 
  3.27  to a local children's mental health collaborative if a 
  3.28  collaborative is implementing a capitation payment system. 
  3.29     Subd. 5.  [USE OF REIMBURSEMENT.] The commissioner shall 
  3.30  not use the state and federal reimbursement earned under this 
  3.31  proposal in determining the allocation or distribution of other 
  3.32  funds to counties. 
  3.33     Subd. 6.  [FEDERAL WAIVER DISCUSSIONS.] The commissioner of 
  3.34  human services must incorporate any anticipated or actual 
  3.35  medical assistance reimbursement received under this proposal in 
  3.36  the state's 1115(a) waiver or any other federal waiver 
  4.1   discussions with the Health Care Financing Administration that 
  4.2   could limit federal reimbursement under this proposal.  The 
  4.3   commissioner shall not agree to any federal Medicaid funding 
  4.4   formula under any federal waiver that would prohibit federal 
  4.5   reimbursements under this proposal from being received by the 
  4.6   state. 
  4.7      Subd. 7.  [REPORT.] The commissioner shall submit to the 
  4.8   legislature the proposal design and implementation 
  4.9   recommendations, including draft legislation by January 15, 
  4.10  2000, for implementation by July 1, 2000. 
  4.11     Sec. 3.  [REHABILITATION SERVICES OPTION FOR ADULTS WITH 
  4.12  MENTAL ILLNESS OR OTHER CONDITIONS.] 
  4.13     (a) The commissioner of human services, in consultation 
  4.14  with the association of Minnesota counties, shall design a 
  4.15  proposal to add rehabilitation services to the state medical 
  4.16  assistance plan for adults with mental illness or other 
  4.17  debilitating conditions, including, but not limited to, chemical 
  4.18  dependency.  The proposal must: 
  4.19     (1) include day treatment, in-home and residential support 
  4.20  services, and all treatment services covered by medical 
  4.21  assistance designated by a treatment plan in accordance with 
  4.22  Minnesota Statutes, sections 245.461 to 245.486 for adults with 
  4.23  mental illness; 
  4.24     (2) permit counties to certify local expenditures as the 
  4.25  nonfederal share of the medical assistance costs for these 
  4.26  services if no state funds are appropriated for this purpose; 
  4.27     (3) include provisions for a reimbursement system; and 
  4.28     (4) permit counties that are participating in a 
  4.29  demonstration project for persons with disabilities to 
  4.30  incorporate this rehabilitation services option as part of the 
  4.31  services provided. 
  4.32     (b) The commissioner shall submit to the legislature the 
  4.33  proposal design and implementation recommendations, including 
  4.34  draft legislation by January 15, 2000, for implementation by 
  4.35  July 1, 2000. 
  4.36     (c) The commissioner shall incorporate any medical 
  5.1   assistance reimbursement anticipated under this proposal in the 
  5.2   state's 1115(a) waiver and in any other federal waiver 
  5.3   discussion entered into with the Health Care Financing 
  5.4   Administration that could limit federal reimbursement under this 
  5.5   proposal.  The commissioner shall not agree to any federal 
  5.6   Medicaid funding formula under any federal waiver that would 
  5.7   prohibit federal reimbursement under this proposal from being 
  5.8   received by the state.  
  5.9      Sec. 4.  [TARGETED CASE MANAGEMENT FOR VULNERABLE ADULTS.] 
  5.10     (a) The commissioner of human services, in consultation 
  5.11  with the association of Minnesota counties, shall design a 
  5.12  proposal to provide medical assistance reimbursement for 
  5.13  targeted case management service activities for adults receiving 
  5.14  services through a county or state agency that are in need of 
  5.15  service coordination, including, but not limited to:  seniors, 
  5.16  adult protective services clients, persons applying for welfare 
  5.17  assistance, chemically dependent clients, and other populations 
  5.18  served under Minnesota Statutes, chapter 256E.  The proposal 
  5.19  must: 
  5.20     (1) include provisions for cost-based reimbursement, 
  5.21  documentation, and billing processes; 
  5.22     (2) permit counties to certify local expenditures as the 
  5.23  nonfederal portion of the medical assistance costs, if no state 
  5.24  funds are appropriated for this purpose; 
  5.25     (3) include provisions that require a portion of any 
  5.26  enhanced revenue to be used to expand existing county 
  5.27  expenditures for services similar to the system established 
  5.28  under the proposal for reimbursement for children's residential 
  5.29  treatment services; and 
  5.30     (4) permit counties that are participating in a 
  5.31  demonstration project for persons with disabilities to 
  5.32  incorporate this proposal as part of the services provided. 
  5.33     (b) The commissioner shall submit to the legislature the 
  5.34  proposal design and implementation recommendations, including 
  5.35  draft legislation by January 15, 2000, for implementation by 
  5.36  July 1, 2000. 
  6.1      (c) The commissioner shall incorporate any medical 
  6.2   assistance reimbursement anticipated under this proposal in the 
  6.3   state's 1115(a) waiver and in any other federal waiver 
  6.4   discussion entered into with the Health Care Financing 
  6.5   Administration that could limit federal reimbursement under this 
  6.6   proposal.  The commissioner shall not agree to any federal 
  6.7   Medicaid funding formula under any federal waiver that would 
  6.8   prohibit federal reimbursement under this proposal from being 
  6.9   received by the state.