Skip to main content Skip to office menu Skip to footer
Capital IconMinnesota Legislature

HF 1379

as introduced - 87th Legislature (2011 - 2012) Posted on 04/05/2011 10:22am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

Line numbers 1.1 1.2 1.3 1.4 1.5
1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13

A bill for an act
relating to accountability and quality in public health care programs; requiring
state contracting directly with health care providers instead of insurance plans;
proposing coding for new law in Minnesota Statutes, chapter 256.

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

Section 1.

new text begin [256.9631] MEDICAL ASSISTANCE AND MINNESOTACARE
REFORM.
new text end

new text begin Subdivision 1. new text end

new text begin Purpose; intent. new text end

new text begin (a) To provide coverage under medical assistance
and MinnesotaCare, Minnesota has large contracts totaling over $3,000,000,000 per year in
state funds. The state began contracting these programs out in 1983 as a pilot project with
the hope of saving money. However, the pilot project was never truly evaluated and no
state agency has conducted an audit of these contracts for quality and cost. Under current
practice, the state covers all expenses that the health plans incur whether justified or not.
new text end

new text begin (b) At a time of state financial troubles, rather than attempt to repair these
dysfunctional contracts, the state can reduce costs and improve care by contracting directly
with medical providers and paying primary care clinics to provide case management to
patients.
new text end

new text begin Subd. 2. new text end

new text begin HMO contracts. new text end

new text begin The commissioner of human services shall not renew
the state's contracts with HMOs providing services to enrollees in the medical assistance
and MinnesotaCare programs, except for Minnesota seniors health options (MSHO) and
special needs basic care (SNBC). To deal with the complexity of interaction between
Medicare and medical assistance, the commissioner shall continue contracting for health
care for MSHO and SNBC. The commissioner shall continue to contract with counties
providing care through county-based purchasing systems. For all other enrollees, the
commissioner shall contract directly with health care providers to deliver covered services.
new text end

new text begin Subd. 3. new text end

new text begin Scope. new text end

new text begin The commissioner shall contract directly with health care providers
for current and future eligible medical assistance and MinnesotaCare enrollees in order
to achieve better health outcomes, track health care expenditures, and reduce the cost of
health care for the state.
new text end

new text begin Subd. 4. new text end

new text begin Case management. new text end

new text begin (a) The commissioner shall use the primary care case
management (PCCM) model for coordinating services for enrollees who choose a primary
care provider to act as the enrollee's case manager. Primary care physicians, clinics, nurses,
and other qualified medical professionals may provide primary care case management.
new text end

new text begin (b) Providers shall bill the state directly for the services they provide. Primary
care providers who offer PCCM shall also receive a flat per-member per-month fee. The
commissioner shall determine fees for the following groups:
new text end

new text begin (1) children;
new text end

new text begin (2) adults; and
new text end

new text begin (3) the elderly.
new text end

new text begin The commissioner shall set a higher PCCM fee based on the level of medical and
social complexity for patients with chronic or complex conditions or disabilities.
new text end

new text begin (c) The primary care provider (PCP) shall provide overall oversight of the enrollee's
health and coordinate with any other case manager of the enrollee as well as ensure
24-hour access to health care, emergency treatment, and referrals.
new text end

new text begin (d) The commissioner shall collaborate with community health clinics and social
service providers through planning and financing to provide outreach, medical care, and
case management services in the community for patients who, because of homelessness or
other circumstances, are unlikely to obtain needed care.
new text end

new text begin (e) The commissioner shall collaborate with medical and social service providers
through planning and financing to reduce hospital readmissions by providing discharge
planning and services, including medical respite and transitional care for patients leaving
medical facilities and mental health and chemical dependency treatment programs.
new text end

new text begin Subd. 5. new text end

new text begin Duties. new text end

new text begin (a) For enrollees, the commissioner shall:
new text end

new text begin (1) maintain a hotline and Web site to assist enrollees in locating providers;
new text end

new text begin (2) provide a nurse consultation helpline 24 hours per day, seven days a week; and
new text end

new text begin (3) contact enrollees based on claims data who have not had preventive visits and
help them select a PCP.
new text end

new text begin (b) For the state fiscal management, the commissioner shall:
new text end

new text begin (1) track utilization rates in all levels of service; and
new text end

new text begin (2) track health care targets which include:
new text end

new text begin (i) improved health outcomes for enrollees;
new text end

new text begin (ii) reduction in avoidable costs, unnecessary emergency room visits, and inpatient
utilization;
new text end

new text begin (iii) improved care coordination;
new text end

new text begin (iv) improved patient self-management knowledge and treatment of chronic disease;
and
new text end

new text begin (v) improved implementation of evidence-based clinical practice guidelines.
new text end

new text begin (c) For providers, the commissioner shall:
new text end

new text begin (1) review provider reimbursement rates to ensure reasonable and fair compensation;
new text end

new text begin (2) ensure that providers are reimbursed on a timely basis; and
new text end

new text begin (3) collaborate with providers to explore means of improving health care quality
and reducing costs.
new text end