1.1                          A bill for an act 
  1.2             relating to human services; allowing PACE programs to 
  1.3             be covered under alternative integrated long-term care 
  1.4             services; amending Minnesota Statutes 2004, section 
  1.5             256B.69, subdivision 23. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 2004, section 256B.69, 
  1.8   subdivision 23, is amended to read: 
  1.9      Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
  1.10  ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
  1.11  implement demonstration projects to create alternative 
  1.12  integrated delivery systems for acute and long-term care 
  1.13  services to elderly persons and persons with disabilities as 
  1.14  defined in section 256B.77, subdivision 7a, that provide 
  1.15  increased coordination, improve access to quality services, and 
  1.16  mitigate future cost increases.  The commissioner may seek 
  1.17  federal authority to combine Medicare and Medicaid capitation 
  1.18  payments for the purpose of such demonstrations.  Medicare funds 
  1.19  and services shall be administered according to the terms and 
  1.20  conditions of the federal waiver and demonstration provisions.  
  1.21  For the purpose of administering medical assistance funds, 
  1.22  demonstrations under this subdivision are subject to 
  1.23  subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
  1.24  9500.1450 to 9500.1464, apply to these demonstrations, with the 
  1.25  exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
  2.1   subpart 1, items B and C, which do not apply to persons 
  2.2   enrolling in demonstrations under this section.  An initial open 
  2.3   enrollment period may be provided.  Persons who disenroll from 
  2.4   demonstrations under this subdivision remain subject to 
  2.5   Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
  2.6   enrolled in a health plan under these demonstrations and the 
  2.7   health plan's participation is subsequently terminated for any 
  2.8   reason, the person shall be provided an opportunity to select a 
  2.9   new health plan and shall have the right to change health plans 
  2.10  within the first 60 days of enrollment in the second health 
  2.11  plan.  Persons required to participate in health plans under 
  2.12  this section who fail to make a choice of health plan shall not 
  2.13  be randomly assigned to health plans under these demonstrations. 
  2.14  Notwithstanding section 256L.12, subdivision 5, and Minnesota 
  2.15  Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
  2.16  purpose of demonstrations under this subdivision, the 
  2.17  commissioner may contract with managed care organizations, 
  2.18  including counties, to serve only elderly persons eligible for 
  2.19  medical assistance, elderly and disabled persons, or disabled 
  2.20  persons only.  For persons with primary diagnoses of mental 
  2.21  retardation or a related condition, serious and persistent 
  2.22  mental illness, or serious emotional disturbance, the 
  2.23  commissioner must ensure that the county authority has approved 
  2.24  the demonstration and contracting design.  Enrollment in these 
  2.25  projects for persons with disabilities shall be voluntary.  The 
  2.26  commissioner shall not implement any demonstration project under 
  2.27  this subdivision for persons with primary diagnoses of mental 
  2.28  retardation or a related condition, serious and persistent 
  2.29  mental illness, or serious emotional disturbance, without 
  2.30  approval of the county board of the county in which the 
  2.31  demonstration is being implemented.  
  2.32     (b) Notwithstanding chapter 245B, sections 252.40 to 
  2.33  252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, 
  2.34  parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, 
  2.35  and 9525.1800 to 9525.1930, the commissioner may implement under 
  2.36  this section projects for persons with developmental 
  3.1   disabilities.  The commissioner may capitate payments for ICF/MR 
  3.2   services, waivered services for mental retardation or related 
  3.3   conditions, including case management services, day training and 
  3.4   habilitation and alternative active treatment services, and 
  3.5   other services as approved by the state and by the federal 
  3.6   government.  Case management and active treatment must be 
  3.7   individualized and developed in accordance with a 
  3.8   person-centered plan.  Costs under these projects may not exceed 
  3.9   costs that would have been incurred under fee-for-service. 
  3.10  Beginning July 1, 2003, and until two years after the pilot 
  3.11  project implementation date, subcontractor participation in the 
  3.12  long-term care developmental disability pilot is limited to a 
  3.13  nonprofit long-term care system providing ICF/MR services, home 
  3.14  and community-based waiver services, and in-home services to no 
  3.15  more than 120 consumers with developmental disabilities in 
  3.16  Carver, Hennepin, and Scott Counties.  The commissioner shall 
  3.17  report to the legislature prior to expansion of the 
  3.18  developmental disability pilot project.  This paragraph expires 
  3.19  two years after the implementation date of the pilot project.  
  3.20     (c) Before implementation of a demonstration project for 
  3.21  disabled persons, the commissioner must provide information to 
  3.22  appropriate committees of the house of representatives and 
  3.23  senate and must involve representatives of affected disability 
  3.24  groups in the design of the demonstration projects. 
  3.25     (d) A nursing facility reimbursed under the alternative 
  3.26  reimbursement methodology in section 256B.434 may, in 
  3.27  collaboration with a hospital, clinic, or other health care 
  3.28  entity provide services under paragraph (a).  The commissioner 
  3.29  shall amend the state plan and seek any federal waivers 
  3.30  necessary to implement this paragraph. 
  3.31     (e) The commissioner, in consultation with the 
  3.32  commissioners of commerce and health, may approve and implement 
  3.33  programs for all-inclusive care for the elderly (PACE) according 
  3.34  to federal laws and regulations governing that program and state 
  3.35  laws or rules applicable to participating providers.  The 
  3.36  process for solicitation and approval of these programs shall 
  4.1   only begin after the commissioner receives grant money in an 
  4.2   amount sufficient to cover the state share of the administrative 
  4.3   and actuarial costs to implement the programs during state 
  4.4   fiscal years 2006 and 2007.  Grants for this purpose shall be 
  4.5   deposited in a special revenue account and used solely for the 
  4.6   purpose of PACE administrative and actuarial costs.  A PACE 
  4.7   provider is not required to be licensed or certified as a health 
  4.8   plan company as defined in section 62Q.01, subdivision 4.  
  4.9   Persons age 55 and older who have been screened by the county 
  4.10  and found to be eligible for services under the elderly waiver 
  4.11  or community alternatives for disabled individuals or who are 
  4.12  already eligible for Medicaid but meet level of care criteria 
  4.13  for receipt of waiver services may choose to enroll in the PACE 
  4.14  program.  Medicare and Medicaid services will be provided 
  4.15  according to this subdivision and federal Medicare and Medicaid 
  4.16  requirements governing PACE providers and programs.  PACE 
  4.17  enrollees will receive Medicaid home and community-based 
  4.18  services through the PACE provider as an alternative to services 
  4.19  for which they would otherwise be eligible through home and 
  4.20  community-based waiver programs.  The commissioner shall 
  4.21  establish Medicaid rates for PACE providers that do not exceed 
  4.22  costs that would have been incurred under fee-for-service or 
  4.23  other relevant managed care programs operated by the state.