SF 1145

as introduced - 87th Legislature (2011 - 2012) Posted on 04/04/2012 02:45pm

A bill for an act
relating to human services; permitting the state to contract with third-party
administrators to provide medical assistance benefits; requiring use of a
competitive request for proposal process; repealing mandatory participation by
health maintenance organizations; amending Minnesota Statutes 2010, sections
256B.0644; 256B.69, subdivisions 2, 5; repealing Minnesota Statutes 2010,
section 62D.04, subdivision 5.

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

Section 1.

Minnesota Statutes 2010, section 256B.0644, is amended to read:

256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
PROGRAMS.

(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, deleted text begin and a
health maintenance organization, as defined in chapter 62D, deleted text end must participate as a provider
or contractor in the medical assistance program, general assistance medical care program,
and MinnesotaCare as a condition of participating as a provider in health insurance plans
and programs or contractor for state employees established under section 43A.18, the
public employees insurance program under section 43A.316, for health insurance plans
offered to local statutory or home rule charter city, county, and school district employees,
the workers' compensation system under section 176.135, and insurance plans provided
through the Minnesota Comprehensive Health Association under sections 62E.01 to
62E.19. The limitations on insurance plans offered to local government employees shall
not be applicable in geographic areas where provider participation is limited by managed
care contracts with the Department of Human Services. new text begin For purposes of this section, a
health maintenance organization, as defined in chapter 62D, is not a vendor of medical
care.
new text end

(b) deleted text begin For providers other than health maintenance organizations, deleted text end Participation in the
medical assistance program means that:

(1) the provider accepts new medical assistance, general assistance medical care,
and MinnesotaCare patients;

(2) for providers other than dental service providers, at least 20 percent of the
provider's patients are covered by medical assistance, general assistance medical care,
and MinnesotaCare as their primary source of coverage; or

(3) for dental service providers, at least ten percent of the provider's patients are
covered by medical assistance, general assistance medical care, and MinnesotaCare as
their primary source of coverage, or the provider accepts new medical assistance and
MinnesotaCare patients who are children with special health care needs. For purposes
of this section, "children with special health care needs" means children up to age 18
who: (i) require health and related services beyond that required by children generally;
and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
neurological diseases; visual impairment or deafness; Down syndrome and other genetic
disorders; autism; fetal alcohol syndrome; and other conditions designated by the
commissioner after consultation with representatives of pediatric dental providers and
consumers.

(c) Patients seen on a volunteer basis by the provider at a location other than
the provider's usual place of practice may be considered in meeting the participation
requirement in this section. The commissioner shall establish participation requirements
for health maintenance organizations. The commissioner shall provide lists of participating
medical assistance providers on a quarterly basis to the commissioner of management and
budget, the commissioner of labor and industry, and the commissioner of commerce. Each
of the commissioners shall develop and implement procedures to exclude as participating
providers in the program or programs under their jurisdiction those providers who do
not participate in the medical assistance program. The commissioner of management
and budget shall implement this section through contracts with participating health and
dental carriers.

(d) For purposes of paragraphs (a) and (b), participation in the general assistance
medical care program applies only to pharmacy providers.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for medical assistance, general
assistance medical care, and MinnesotaCare plan years beginning on or after January
1, 2012.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256B.69, subdivision 2, is amended to read:

Subd. 2.

Definitions.

For the purposes of this section, the following terms have
the meanings given.

(a) "Commissioner" means the commissioner of human services. For the
remainder of this section, the commissioner's responsibilities for methods and policies
for implementing the project will be proposed by the project advisory committees and
approved by the commissioner.

(b) "Demonstration provider" means a health maintenance organization, community
integrated service network, deleted text begin or deleted text end accountable provider network authorized and operating
under chapter 62D, 62N, or 62T new text begin , or vendor of risk management services as defined in
section 60A.23, subdivision 8, new text end that participates in the demonstration project according
to criteria, standards, methods, and other requirements established for the project and
approved by the commissioner. For purposes of this section, a county board, or group of
county boards operating under a joint powers agreement, is considered a demonstration
provider if the county or group of county boards meets the requirements of section
256B.692. Notwithstanding the above, Itasca County may continue to participate as a
demonstration provider until July 1, 2004.

(c) "Eligible individuals" means those persons eligible for medical assistance
benefits as defined in sections 256B.055, 256B.056, and 256B.06.

(d) "Limitation of choice" means suspending freedom of choice while allowing
eligible individuals to choose among the demonstration providers.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for demonstration project years
beginning on or after January 1, 2012.
new text end

Sec. 3.

Minnesota Statutes 2010, section 256B.69, subdivision 5, is amended to read:

Subd. 5.

Prospective per capita payment.

The commissioner shall establish the
method and amount of payments for services. The commissioner shall annually contract
with demonstration providers to provide services consistent with these established
methods and amounts for payment. new text begin The commissioner shall enter into contracts with one
or more demonstration providers on the basis of a request for proposal process as defined
in section 16C.02, subdivision 12. The commissioner need not enter into a contract with
each entity that submits a proposal.
new text end

If allowed by the commissioner, a demonstration provider may contract with
an insurer, health care provider, nonprofit health service plan corporation, or the
commissioner, to provide insurance or similar protection against the cost of care provided
by the demonstration provider or to provide coverage against the risks incurred by
demonstration providers under this section. The recipients enrolled with a demonstration
provider are a permissible group under group insurance laws and chapter 62C, the
Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer
or corporation may make benefit payments to a demonstration provider for services
rendered or to be rendered to a recipient. Any insurer or nonprofit health service plan
corporation licensed to do business in this state is authorized to provide this insurance or
similar protection.

Payments to providers participating in the project are exempt from the requirements
of sections 256.966 and 256B.03, subdivision 2. The commissioner shall complete
development of capitation rates for payments before delivery of services under this section
is begun. For payments made during calendar year 1990 and later years, the commissioner
shall contract with an independent actuary to establish prepayment rates.

By January 15, 1996, the commissioner shall report to the legislature on the
methodology used to allocate to participating counties available administrative
reimbursement for advocacy and enrollment costs. The report shall reflect the
commissioner's judgment as to the adequacy of the funds made available and of the
methodology for equitable distribution of the funds. The commissioner must involve
participating counties in the development of the report.

Beginning July 1, 2004, the commissioner may include payments for elderly waiver
services and 180 days of nursing home care in capitation payments for the prepaid medical
assistance program for recipients age 65 and older. Payments for elderly waiver services
shall be made no earlier than the month following the month in which services were
received.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for demonstration project years
beginning on or after January 1, 2012.
new text end

Sec. 4. new text begin REPEALER; MANDATORY HMO PARTICIPATION AS PROVIDER IN
PUBLIC PROGRAMS.
new text end

new text begin Minnesota Statutes 2010, section 62D.04, subdivision 5, new text end new text begin is repealed effective
January 1, 2012.
new text end