256B.692 COUNTY-BASED PURCHASING.
Subdivision 1. In general.
County boards or groups of county boards may elect to purchase
or provide health care services on behalf of persons eligible for medical assistance and general
assistance medical care who would otherwise be required to or may elect to participate in the
prepaid medical assistance or prepaid general assistance medical care programs according to
. Counties that elect to purchase or provide health care under
this section must provide all services included in prepaid managed care programs according to
256B.69, subdivisions 1 to 22
. County-based purchasing under this section
is governed by section
, unless otherwise provided for under this section.
Subd. 2. Duties of commissioner of health.
(a) Notwithstanding chapters 62D and 62N, a
county that elects to purchase medical assistance and general assistance medical care in return for a
fixed sum without regard to the frequency or extent of services furnished to any particular enrollee
is not required to obtain a certificate of authority under chapter 62D or 62N. The county board of
commissioners is the governing body of a county-based purchasing program. In a multicounty
arrangement, the governing body is a joint powers board established under section
(b) A county that elects to purchase medical assistance and general assistance medical
care services under this section must satisfy the commissioner of health that the requirements
for assurance of consumer protection, provider protection, and fiscal solvency of chapter 62D,
applicable to health maintenance organizations, or chapter 62N, applicable to community
integrated service networks, will be met.
(c) A county must also assure the commissioner of health that the requirements of sections
; all applicable provisions of chapter 62Q,
62Q.23, paragraph (c)
will be met.
(d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M, 62N,
and 62Q are hereby granted to the commissioner of health with respect to counties that purchase
medical assistance and general assistance medical care services under this section.
(e) The commissioner, in consultation with county government, shall develop administrative
and financial reporting requirements for county-based purchasing programs relating to sections
, and other sections as
necessary, that are specific to county administrative, accounting, and reporting systems and
consistent with other statutory requirements of counties.
Subd. 3. Requirements of the county board.
A county board that intends to purchase or
provide health care under this section, which may include purchasing all or part of these services
from health plans or individual providers on a fee-for-service basis, or providing these services
directly, must demonstrate the ability to follow and agree to the following requirements:
(1) purchase all covered services for a fixed payment from the state that does not exceed the
estimated state and federal cost that would have occurred under the prepaid medical assistance
and general assistance medical care programs;
(2) ensure that covered services are accessible to all enrollees and that enrollees have a
reasonable choice of providers, health plans, or networks when possible. If the county is also a
provider of service, the county board shall develop a process to ensure that providers employed
by the county are not the sole referral source and are not the sole provider of health care services
if other providers, which meet the same quality and cost requirements are available;
(3) issue payments to participating vendors or networks in a timely manner;
(4) establish a process to ensure and improve the quality of care provided;
(5) provide appropriate quality and other required data in a format required by the state;
(6) provide a system for advocacy, enrollee protection, and complaints and appeals that is
independent of care providers or other risk bearers and complies with section
(7) ensure that the implementation and operation of the Minnesota senior health options
demonstration project and the Minnesota disability health options demonstration project,
authorized under section
256B.69, subdivision 23
, will not be impeded;
(8) ensure that all recipients that are enrolled in the prepaid medical assistance or general
assistance medical care program will be transferred to county-based purchasing without utilizing
the department's fee-for-service claims payment system;
(9) ensure that all recipients who are required to participate in county-based purchasing are
given sufficient information prior to enrollment in order to make informed decisions; and
(10) ensure that the state and the medical assistance and general assistance medical care
recipients will be held harmless for the payment of obligations incurred by the county if the
county, or a health plan providing services on behalf of the county, or a provider participating
in county-based purchasing becomes insolvent, and the state has made the payments due to the
county under this section.
Subd. 4. Payments to counties.
The commissioner shall pay counties that are purchasing or
providing health care under this section a per capita payment for all enrolled recipients. Payments
shall not exceed payments that otherwise would have been paid to health plans under medical
assistance and general assistance medical care for that county or region. This payment is in
addition to any administrative allocation to counties for education, enrollment, and advocacy.
The state of Minnesota and the United States Department of Health and Human Services are not
liable for any costs incurred by a county that exceed the payments to the county made under
this subdivision. A county whose costs exceed the payments made by the state, or any affected
enrollees or creditors of that county, shall have no rights under chapter 61B or section
A county may assign risk for the cost of care to a third party.
Subd. 5. County proposals.
(a) On or before September 1, 1997, a county board that wishes
to purchase or provide health care under this section must submit a preliminary proposal that
substantially demonstrates the county's ability to meet all the requirements of this section in
response to criteria for proposals issued by the department on or before July 1, 1997. Counties
submitting preliminary proposals must establish a local planning process that involves input
from medical assistance and general assistance medical care recipients, recipient advocates,
providers and representatives of local school districts, labor, and tribal government to advise on
the development of a final proposal and its implementation.
(b) The county board must submit a final proposal on or before July 1, 1998, that demonstrates
the ability to meet all the requirements of this section, including beginning enrollment on January
1, 1999, unless a delay has been granted under section
256B.69, subdivision 3a
, paragraph (g).
(c) After January 1, 1999, for a county in which the prepaid medical assistance program is
in existence, the county board must submit a preliminary proposal at least 15 months prior to
termination of health plan contracts in that county and a final proposal six months prior to the
health plan contract termination date in order to begin enrollment after the termination. Nothing
in this section shall impede or delay implementation or continuation of the prepaid medical
assistance and general assistance medical care programs in counties for which the board does not
submit a proposal, or submits a proposal that is not in compliance with this section.
(d) The commissioner is not required to terminate contracts for the prepaid medical
assistance and prepaid general assistance medical care programs that begin on or after September
1, 1997, in a county for which a county board has submitted a proposal under this paragraph, until
two years have elapsed from the date of initial enrollment in the prepaid medical assistance and
prepaid general assistance medical care programs.
Subd. 6. Commissioner's authority.
The commissioner may:
(1) reject any preliminary or final proposal that:
(a) substantially fails to meet the requirements of this section, or
(b) that the commissioner determines would substantially impair the state's ability to
purchase health care services in other areas of the state, or
(c) would substantially impair an enrollee's choice of care systems when reasonable choice is
(d) would substantially impair the implementation and operation of the Minnesota senior
health options demonstration project authorized under section
256B.69, subdivision 23
(2) assume operation of a county's purchasing of health care for enrollees in medical
assistance and general assistance medical care in the event that the contract with the county is
Subd. 7. Dispute resolution.
In the event the commissioner rejects a proposal under
subdivision 6, the county board may request the recommendation of a three-person mediation
panel. The commissioner shall resolve all disputes after taking into account the recommendations
of the mediation panel. The panel shall be composed of one designee of the president of the
Association of Minnesota Counties, one designee of the commissioner of human services, and
one designee of the commissioner of health.
Subd. 8. Appeals.
A county that conducts county-based purchasing shall be considered to be
a prepaid health plan for purposes of section
Subd. 9. Federal approval.
The commissioner shall request any federal waivers and federal
approval required to implement this section. County-based purchasing shall not be implemented
without obtaining all federal approval required to maintain federal matching funds in the medical
Subd. 10. Report to the legislature.
The commissioner shall submit a report to the legislature
by February 1, 1998, on the preliminary proposals submitted on or before September 1, 1997.
History: 1997 c 203 art 4 s 56; 1998 c 407 art 4 s 49,50; 1999 c 239 s 42; 1999 c 245 art 4 s
76; 2001 c 170 s 8; 2002 c 277 s 25; 2005 c 77 s 6; 2006 c 264 s 12