1.1                          A bill for an act
  1.2             relating to human services; permitting certain 
  1.3             providers to request a state agency hearing; modifying 
  1.4             the conduct of state agency hearings; modifying 
  1.5             certain requirements for prior authorization of 
  1.6             services under medical assistance; creating an 
  1.7             advisory task force on prior authorization for certain 
  1.8             services; amending Minnesota Statutes 1994, sections 
  1.9             256.045, subdivisions 3, 4, and 5; and 256B.0625, 
  1.10            subdivisions 8, 8a, 25, 31, and by adding a 
  1.11            subdivision. 
  1.12  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.13     Section 1.  Minnesota Statutes 1994, section 256.045, 
  1.14  subdivision 3, is amended to read: 
  1.15     Subd. 3.  [STATE AGENCY HEARINGS.] (a) Any person applying 
  1.16  for, receiving or having received public assistance or a program 
  1.17  of social services granted by the state agency or a county 
  1.18  agency under sections 252.32, 256.031 to 256.036, and 256.72 to 
  1.19  256.879, chapters 256B, 256D, 256E, 261, or the federal Food 
  1.20  Stamp Act whose application for assistance is denied, not acted 
  1.21  upon with reasonable promptness, or whose assistance is 
  1.22  suspended, reduced, terminated, or claimed to have been 
  1.23  incorrectly paid, or any patient or relative aggrieved by an 
  1.24  order of the commissioner under section 252.27, or a party 
  1.25  aggrieved by a ruling of a prepaid health plan, may contest that 
  1.26  action or decision before the state agency by submitting a 
  1.27  written request for a hearing to the state agency within 30 days 
  1.28  after receiving written notice of the action or decision, or 
  2.1   within 90 days of such written notice if the applicant, 
  2.2   recipient, patient, or relative shows good cause why the request 
  2.3   was not submitted within the 30-day time limit. 
  2.4      (b) Except for a prepaid health plan, a vendor of medical 
  2.5   care as defined in section 256B.02, subdivision 7, or a vendor 
  2.6   under contract with a county agency to provide social services 
  2.7   under section 256E.08, subdivision 4, is not a party and may not 
  2.8   request a hearing under this section, except if assisting a 
  2.9   recipient as provided in subdivision 4. 
  2.10     (c) An applicant or recipient is not entitled to receive 
  2.11  social services beyond the services included in the amended 
  2.12  community social services plan developed under section 256E.081, 
  2.13  subdivision 3, if the county agency has met the requirements in 
  2.14  section 256E.081. 
  2.15     Sec. 2.  Minnesota Statutes 1994, section 256.045, 
  2.16  subdivision 4, is amended to read: 
  2.17     Subd. 4.  [CONDUCT OF HEARINGS.] All hearings held pursuant 
  2.18  to subdivision 3, 3a, or 4a shall be conducted according to the 
  2.19  provisions of the federal Social Security Act and the 
  2.20  regulations implemented in accordance with that act to enable 
  2.21  this state to qualify for federal grants-in-aid, and according 
  2.22  to the rules and written policies of the commissioner of human 
  2.23  services.  County agencies shall install equipment necessary to 
  2.24  conduct telephone hearings.  A state human services referee may 
  2.25  schedule a telephone conference hearing when the distance or 
  2.26  time required to travel to the county agency offices will cause 
  2.27  a delay in the issuance of an order, or to promote efficiency, 
  2.28  or at the mutual request of the parties.  Hearings may be 
  2.29  conducted by telephone conferences unless the applicant, 
  2.30  recipient, or former recipient objects.  The hearing shall not 
  2.31  be held earlier than five days after filing of the required 
  2.32  notice with the county or state agency.  The state human 
  2.33  services referee shall notify all interested persons of the 
  2.34  time, date, and location of the hearing at least five days 
  2.35  before the date of the hearing.  Interested persons may be 
  2.36  represented by legal counsel or other representative of their 
  3.1   choice, including a provider of therapy services, at the hearing 
  3.2   and may appear personally, testify and offer evidence, and 
  3.3   examine and cross-examine witnesses.  The applicant, recipient, 
  3.4   or former recipient shall have the opportunity to examine the 
  3.5   contents of the case file and all documents and records to be 
  3.6   used by the county or state agency at the hearing at a 
  3.7   reasonable time before the date of the hearing and during the 
  3.8   hearing.  Upon request, the county agency shall provide 
  3.9   reimbursement for transportation, child care, photocopying, 
  3.10  medical assessment, witness fee, and other necessary and 
  3.11  reasonable costs incurred by the applicant, recipient, or former 
  3.12  recipient in connection with the appeal.  All evidence, except 
  3.13  that privileged by law, commonly accepted by reasonable people 
  3.14  in the conduct of their affairs as having probative value with 
  3.15  respect to the issues shall be submitted at the hearing and such 
  3.16  hearing shall not be "a contested case" within the meaning of 
  3.17  section 14.02, subdivision 3.  The agency must present its 
  3.18  evidence prior to or at the hearing, and may not submit evidence 
  3.19  after the hearing except by agreement of the parties at the 
  3.20  hearing, provided the recipient has the opportunity to respond. 
  3.21     Sec. 3.  Minnesota Statutes 1994, section 256.045, 
  3.22  subdivision 5, is amended to read: 
  3.23     Subd. 5.  [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] A 
  3.24  state human services referee shall conduct a hearing on the 
  3.25  appeal and shall recommend an order to the commissioner of human 
  3.26  services.  The recommended order must be based on all relevant 
  3.27  evidence and must not be limited to a review of the propriety of 
  3.28  the state or county agency's action.  A referee may take 
  3.29  official notice of adjudicative facts.  The commissioner of 
  3.30  human services may accept the recommended order of a state human 
  3.31  services referee and issue the order to the county agency and 
  3.32  the applicant, recipient, former recipient, or prepaid health 
  3.33  plan.  The commissioner on refusing to accept the recommended 
  3.34  order of the state human services referee, shall notify the 
  3.35  county agency and the applicant, recipient, former recipient, or 
  3.36  prepaid health plan of that fact and shall state reasons 
  4.1   therefor and shall allow each party ten days' time to submit 
  4.2   additional written argument on the matter.  After the expiration 
  4.3   of the ten-day period, the commissioner shall issue an order on 
  4.4   the matter to the county agency and the applicant, recipient, 
  4.5   former recipient, or prepaid health plan. 
  4.6      A party aggrieved by an order of the commissioner may 
  4.7   appeal under subdivision 7, or request reconsideration by the 
  4.8   commissioner within 30 days after the date the commissioner 
  4.9   issues the order.  The commissioner may reconsider an order upon 
  4.10  request of any party or on the commissioner's own motion.  A 
  4.11  request for reconsideration does not stay implementation of the 
  4.12  commissioner's order.  Upon reconsideration, the commissioner 
  4.13  may issue an amended order or an order affirming the original 
  4.14  order. 
  4.15     Any order of the commissioner issued under this subdivision 
  4.16  shall be conclusive upon the parties unless appeal is taken in 
  4.17  the manner provided by subdivision 7.  Any order of the 
  4.18  commissioner is binding on the parties and must be implemented 
  4.19  by the state agency or a county agency until the order is 
  4.20  reversed by the district court, or unless the commissioner or a 
  4.21  district court orders monthly assistance or aid or services paid 
  4.22  or provided under subdivision 10. 
  4.23     Except for a prepaid health plan, a vendor of medical care 
  4.24  as defined in section 256B.02, subdivision 7, or a vendor under 
  4.25  contract with a county agency to provide social services under 
  4.26  section 256E.08, subdivision 4, is not a party and may not 
  4.27  request a hearing or seek judicial review of an order issued 
  4.28  under this section, unless assisting a recipient as provided in 
  4.29  subdivision 4. 
  4.30     Sec. 4.  Minnesota Statutes 1994, section 256B.0625, 
  4.31  subdivision 8, is amended to read: 
  4.32     Subd. 8.  [PHYSICAL THERAPY.] (a) Medical assistance covers 
  4.33  physical therapy and related services. 
  4.34     (b) By January 1, 1996, the commissioner shall adopt 
  4.35  administrative rules under chapter 14 establishing criteria for 
  4.36  review of prior authorization requests. 
  5.1      Sec. 5.  Minnesota Statutes 1994, section 256B.0625, 
  5.2   subdivision 8a, is amended to read: 
  5.3      Subd. 8a.  [OCCUPATIONAL THERAPY.] (a) Medical assistance 
  5.4   covers occupational therapy and related services. 
  5.5      (b) By January 1, 1996, the commissioner shall adopt 
  5.6   administrative rules under chapter 14 establishing criteria for 
  5.7   review of prior authorization requests. 
  5.8      Sec. 6.  Minnesota Statutes 1994, section 256B.0625, is 
  5.9   amended by adding a subdivision to read: 
  5.10     Subd. 8b.  [SPEECH THERAPY.] (a) Medical assistance covers 
  5.11  speech therapy and related services. 
  5.12     (b) By January 1, 1997, the commissioner shall adopt 
  5.13  administrative rules under chapter 14 establishing criteria for 
  5.14  review of prior authorization requests. 
  5.15     Sec. 7.  Minnesota Statutes 1994, section 256B.0625, 
  5.16  subdivision 25, is amended to read: 
  5.17     Subd. 25.  [PRIOR AUTHORIZATION REQUIRED.] (a) The 
  5.18  commissioner shall publish in the State Register a list of 
  5.19  health services that require prior authorization, as well as the 
  5.20  criteria and standards used to select health services on the 
  5.21  list.  The list and the criteria and standards used to formulate 
  5.22  it are not subject to the requirements of sections 14.001 to 
  5.23  14.69.  The commissioner's decision whether prior authorization 
  5.24  is required for a health service is not subject to 
  5.25  administrative appeal. 
  5.26     (b) A provider who has submitted a prior authorization 
  5.27  request for physical therapy, occupational therapy, speech 
  5.28  therapy, or related services must have access via telephone to 
  5.29  the consultant to whom the request has been assigned.  The 
  5.30  consultant must make a reasonable amount of time available for 
  5.31  providers to contact the consultant by telephone in order to 
  5.32  discuss either a pending request or a request about which a 
  5.33  recommendation has been made.  For purposes of this paragraph, 
  5.34  "consultant" has the meaning given it in Minnesota Rules, part 
  5.35  9505.5005, subpart 3. 
  5.36     Sec. 8.  Minnesota Statutes 1994, section 256B.0625, 
  6.1   subdivision 31, is amended to read: 
  6.2      Subd. 31.  [MEDICAL SUPPLIES AND EQUIPMENT.] (a) Medical 
  6.3   assistance covers medical supplies and equipment.  Separate 
  6.4   payment outside of the facility's payment rate shall be made for 
  6.5   wheelchairs and wheelchair accessories for recipients who are 
  6.6   residents of intermediate care facilities for the mentally 
  6.7   retarded.  Reimbursement for wheelchairs and wheelchair 
  6.8   accessories for ICF/MR recipients shall be subject to the same 
  6.9   conditions and limitations as coverage for recipients who do not 
  6.10  reside in institutions.  A wheelchair purchased outside of the 
  6.11  facility's payment rate is the property of the recipient. 
  6.12     (b) A medical assistance recipient who resides in a nursing 
  6.13  facility or in an ICF/MR and who owns a wheelchair need not 
  6.14  obtain prior authorization from the commissioner for repairs and 
  6.15  adaptations if the combined charges for parts and labor will not 
  6.16  exceed $300, or a higher amount determined by the commissioner. 
  6.17     Sec. 9.  [ADVISORY TASK FORCE TO STANDARDIZE SUPPORTING 
  6.18  DOCUMENTATION FOR PRIOR AUTHORIZATION.] 
  6.19     Subdivision 1.  [COMPOSITION OF TASK FORCE.] A six-member 
  6.20  advisory task force on prior authorization for physical therapy, 
  6.21  occupational therapy, speech therapy, or related services 
  6.22  supporting documentation shall be established.  The task force 
  6.23  shall be comprised of one licensed physiatrist, one licensed 
  6.24  physical therapist, one licensed occupational therapist, one 
  6.25  licensed speech therapist, one licensed rehabilitation nurse, 
  6.26  and one consumer representative.  All licensed task force 
  6.27  members must be actively engaged in the practice of their 
  6.28  profession in Minnesota.  The members of the task force shall be 
  6.29  appointed by the commissioner of human services.  No more than 
  6.30  three members may be of one gender.  All licensed professional 
  6.31  members shall be selected from lists submitted to the 
  6.32  commissioner by the appropriate professional associations.  Task 
  6.33  force members who are licensed professionals shall not be 
  6.34  compensated for their service.  The consumer representative 
  6.35  member must be compensated for time spent on task force 
  6.36  activities as specified in section 15.059, subdivision 3.  The 
  7.1   task force shall expire on December 31, 1996.  
  7.2      Subd. 2.  [DUTIES OF COMMISSIONER AND TASK FORCE.] The task 
  7.3   force shall study the lists of items, specified in the issue of 
  7.4   the medical assistance and general assistance medical care 
  7.5   provider manual which is in effect as of the effective date of 
  7.6   this act, that are required to be submitted by each category of 
  7.7   provider along with the provider's request for prior 
  7.8   authorization.  The task force shall recommend to the 
  7.9   commissioner any amendments or refinements needed to clarify the 
  7.10  lists.  The commissioner shall use the recommendations of the 
  7.11  task force to develop standardized documentation which a 
  7.12  provider must submit with a prior authorization request.  If the 
  7.13  commissioner intends to depart from the recommendations of the 
  7.14  task force, the commissioner shall inform the task force of the 
  7.15  intended departure, provide a written explanation of the reasons 
  7.16  for the departure, and give the task force an opportunity to 
  7.17  comment on the intended departure.  
  7.18     Sec. 10.  [TEMPORARY PRIOR AUTHORIZATION EXEMPTION; STUDY 
  7.19  REQUIRED.] 
  7.20     (a) The commissioner shall not require prior authorization 
  7.21  for physical therapy, occupational therapy, and speech therapy 
  7.22  services provided by an entity that operates a Medicare 
  7.23  certified comprehensive outpatient rehabilitation facility which 
  7.24  was certified prior to January 1, 1993, and is a facility 
  7.25  licensed under Minnesota Rules, parts 9570.2000 to 9570.3600, 
  7.26  when those services are provided within the comprehensive 
  7.27  outpatient rehabilitation facility and not provided in a nursing 
  7.28  facility other than the entity's own.  This exemption expires 
  7.29  June 30, 1996. 
  7.30     (b) The commissioner shall not require prior authorization 
  7.31  for physical therapy, occupational therapy, or speech therapy 
  7.32  services provided to a medical assistance recipient who resides 
  7.33  in a nursing facility licensed on June 1, 1983, under Minnesota 
  7.34  Rules, parts 9570.2000 to 9570.3600 to provide residential 
  7.35  services for the physically handicapped.  This exemption expires 
  7.36  June 30, 1996. 
  8.1      (c) The commissioner shall report on alternative methods, 
  8.2   other than prior authorization, to achieve utilization review of 
  8.3   the therapy services provided by the entities in paragraphs (a) 
  8.4   and (b).  The commissioner must consult with the entities in 
  8.5   paragraphs (a) and (b) to develop recommendations for 
  8.6   alternative methods of utilization review.  By February 1, 1996, 
  8.7   the commissioner must submit a report to the legislature.