Bill Text: MN HF1186 | 2011-2012 | 87th Legislature | Introduced
Bill Title: State health care program purchasing county roles and rights modified, county-based purchasing arrangements authorized, and administrative reporting reduction process established.
Spectrum: Slight Partisan Bill (Republican 23-12)
Status: (Introduced - Dead) 2011-03-17 - Introduction and first reading, referred to Health and Human Services Reform [HF1186 Detail]
Download: Minnesota-2011-HF1186-Introduced.html
1.2relating to health care; modifying county roles and rights related to state health
1.3care program purchasing; authorizing county-based purchasing arrangements;
1.4establishing a process to reduce administrative reporting;amending Minnesota
1.5Statutes 2010, sections 256B.0755, by adding a subdivision; 256B.69,
1.6subdivision 3a; 256B.692, subdivisions 2, 5, 7; 256B.694.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.11 Section 1. Minnesota Statutes 2010, section 256B.69, subdivision 3a, is amended to
1.12read:
1.13 Subd. 3a. County authority. (a) The commissioner, when implementing or
1.14administering the medical assistance prepayment program within a county, must include
1.15the county board in the process of development, approval, and issuance of the request for
1.16proposals to provide services to eligible individuals within the proposed county, including
1.17proposals for demonstration projects established under section 256B.0755. County boards
1.18must be given reasonable opportunity tomake recommendations regarding assist in
1.19the development, issuance, review of responses, and changes needed in the request for
1.20proposals. The commissioner must provide county boards the opportunity to review
1.21each proposal based on the identification of community needs under chapters 145A and
1.22256E and county advocacy activities. If a county board finds that a proposal does not
1.23address certain community needs, the county board and commissioner shall continue
1.24efforts for improving the proposal and network prior to the approval of the contract.
1.25The county board shall makerecommendations determinations regarding the approval
2.1of local networks and their operations to ensure adequate local availability and access to
2.2covered services. The provider or health plan must respond directly to county advocates
2.3and the state prepaid medical assistance ombudsperson regarding service delivery and
2.4must be accountable to the state regarding contracts with medical assistance funds. The
2.5county boardmay recommend shall decide a maximum number of participating health
2.6plans including county-based purchasing plans after considering the size of the enrolling
2.7population; ensuring adequate access and capacity; considering the client and county
2.8administrative complexity; and considering the need to promote the viability of locally
2.9developed health plans, managed care plans, or demonstration projects established under
2.10section 256B.0755. The county board or a single entity representing a group of county
2.11boards and the commissioner shall mutually select one or more qualified health plans or
2.12county-based purchasing plans for participation at the time of initial implementation of the
2.13prepaid medical assistance program or a demonstration project established under section
2.14256B.0755 in that county or group of counties and at the time of contract renewal. The
2.15commissioner shall also seek input for contract requirements from the county or single
2.16entity representing a group of county boards at each contract renewal and incorporate
2.17those recommendations into the contract negotiation process.
2.18 (b) At the option of the county board, the board may develop contract requirements
2.19related to the achievement of local public health goals and health care delivery and access
2.20goals to meet the health needs of medical assistance enrollees. These requirements must
2.21be reasonably related to the performance of health plan managed care or delivery system
2.22demonstration project functions and within the scope of the medical assistance benefit
2.23set.If the county board and the commissioner mutually agree to such requirements, the
2.24department The commissioner shall include such requirements in all health plan contracts
2.25governing the prepaid medical assistance program in that county at initial implementation
2.26of the program or demonstration project in that county and at the time of contract renewal.
2.27The county board may participate in the enforcement of the contractprovisions related to
2.28local public health goals.
2.29 (c) For counties in which a prepaid medical assistance program has not been
2.30established, the commissioner shall not implement that program if a county board submits
2.31an acceptable and timely preliminary and final proposal under section256B.692 , until
2.32county-based purchasing is no longer operational in that county. For counties in which
2.33a prepaid medical assistance program is in existence on or after September 1, 1997, the
2.34commissioner must terminate contracts with health plans according to section256B.692,
2.35subdivision 5 , if the county board submits and the commissioner accepts a preliminary and
2.36final proposal according to that subdivision. The commissioner is not required to terminate
3.1contracts that begin on or after September 1, 1997, according to section256B.692 until
3.2two years have elapsed from the date of initial enrollment.
3.3 (d) In the event that a county board or a single entity representing a group of county
3.4boards and the commissioner cannot reach agreement regarding: (i) the selection of
3.5participating health plans or demonstration projects under section 256B.0755 in that
3.6county; (ii) contract requirements; or (iii) implementation and enforcement of county
3.7requirements including provisions regarding local public health goals, the commissioner
3.8shall resolve all disputesafter taking into account by approving the recommendations of
3.9a three-person mediation panel. The panel shall be composed of one designee of the
3.10president of the association of Minnesota counties, one designee of the commissioner of
3.11human services, and one person selected jointly by the designee of the commissioner of
3.12human services and the designee of the Association of Minnesota Counties. Within a
3.13reasonable period of time before the hearing, the panelists must be provided all documents
3.14and information relevant to the mediation. The parties to the mediation must be given
3.1530 days' notice of a hearing before the mediation panel.
3.16 (e) If a county which elects to implement county-based purchasing ceases to
3.17implement county-based purchasing, it is prohibited from assuming the responsibility of
3.18county-based purchasing for a period of five years from the date it discontinues purchasing.
3.19 (f) The commissioner shall not require that contractual disputes between
3.20county-based purchasing entities and the commissioner be mediated by a panel that
3.21includes a representative of the Minnesota Council of Health Plans.
3.22 (g) At the request of a county-purchasing entity, the commissioner shall adopt a
3.23contract reprocurement or renewal schedule under which all counties included in the
3.24entity's service area are reprocured or renewed at the same time.
3.25 (h) The commissioner shall provide a written report under section3.195 to the chairs
3.26of the legislative committees having jurisdiction over human services in the senate and the
3.27house of representatives describing in detail the activities undertaken by the commissioner
3.28to ensure full compliance with this section. The report must also provide an explanation
3.29for any decisions of the commissioner not to accept the recommendations of a county or
3.30group of counties required to be consulted under this section. The report must be provided
3.31at least 30 days prior to the effective date of a new or renewed prepaid or managed care
3.32contract in a county.
3.33(i) This section also applies to other Minnesota health care programs administered
3.34by the commissioner including, but not limited to, the MinnesotaCare program.
3.35 Sec. 2. Minnesota Statutes 2010, section 256B.692, subdivision 2, is amended to read:
4.1 Subd. 2. Duties of commissioner of health. (a) Notwithstanding chapters 62D and
4.262N, a county that elects to purchase medical assistance in return for a fixed sum without
4.3regard to the frequency or extent of services furnished to any particular enrollee is not
4.4required to obtain a certificate of authority under chapter 62D or 62N. The county board
4.5of commissioners is the governing body of a county-based purchasing program. In a
4.6multicounty arrangement, the governing body is a joint powers board established under
4.7section471.59 .
4.8 (b) A county that elects to purchase medical assistance services under this section
4.9must satisfy the commissioner of health that the requirements for assurance of consumer
4.10protection, provider protection, and, effective January 1, 2010, fiscal solvency of chapter
4.1162D, applicable to health maintenance organizations will be met according to the
4.12following schedule:
4.13 (1) for a county-based purchasing plan approved on or before June 30, 2008, the
4.14plan must have in reserve:
4.15 (i) at least 50 percent of the minimum amount required under chapter 62D as
4.16of January 1, 2010;
4.17 (ii) at least 75 percent of the minimum amount required under chapter 62D as of
4.18January 1, 2011;
4.19 (iii) at least 87.5 percent of the minimum amount required under chapter 62D as
4.20of January 1, 2012; and
4.21 (iv) at least 100 percent of the minimum amount required under chapter 62D as
4.22of January 1, 2013; and
4.23 (2) for a county-based purchasing plan first approved after June 30, 2008, the plan
4.24must have in reserve:
4.25 (i) at least 50 percent of the minimum amount required under chapter 62D at the
4.26time the plan begins enrolling enrollees;
4.27 (ii) at least 75 percent of the minimum amount required under chapter 62D after
4.28the first full calendar year;
4.29 (iii) at least 87.5 percent of the minimum amount required under chapter 62D after
4.30the second full calendar year; and
4.31 (iv) at least 100 percent of the minimum amount required under chapter 62D after
4.32the third full calendar year.
4.33 (c) Until a plan is required to have reserves equaling at least 100 percent of the
4.34minimum amount required under chapter 62D, the plan may demonstrate its ability
4.35to cover any losses by satisfying the requirements of chapter 62N. Notwithstanding
4.36this paragraph and paragraph (b), a county-based purchasing plan may satisfy its fiscal
5.1solvency requirements by obtaining written financial guarantees from participating
5.2counties in amounts equivalent to the minimum amounts that would otherwise apply.
5.3A county-based purchasing plan must also assure the commissioner of health that the
5.4requirements of sections62J.041 ;
62J.48 ;
62J.71 to
62J.73 ;
62M.01 to
62M.16 ; all
5.5applicable provisions of chapter 62Q, including sections62Q.075 ;
62Q.1055 ;
62Q.106 ;
5.662Q.12
;
62Q.135 ;
62Q.14 ;
62Q.145 ;
62Q.19 ;
62Q.23, paragraph (c) ;
62Q.43 ;
62Q.47 ;
5.762Q.50
;
62Q.52 to
62Q.56 ;
62Q.58 ;
62Q.68 to
62Q.72 ; and
72A.201 will be met.
5.8 (d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M,
5.962N, and 62Q are hereby granted to the commissioner of health with respect to counties
5.10that purchase medical assistance services under this section.
5.11 (e) The commissioner, in consultation with county government, shall develop
5.12administrative and financial reporting requirements for county-based purchasing programs
5.13relating to sections62D.041 ,
62D.042 ,
62D.045 ,
62D.08 ,
62N.28 ,
62N.29 , and
62N.31 ,
5.14and other sections as necessary, that are specific to county administrative, accounting, and
5.15reporting systems and consistent with other statutory requirements of counties.
5.16 (f) The commissioner shall collect from a county-based purchasing plan under
5.17this section the following fees:
5.18 (1) fees attributable to the costs of audits and other examinations of plan financial
5.19operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800,
5.20subpart 1, item F;
5.21 (2) an annual fee of $21,500, to be paid by June 15 of each calendar year, beginning
5.22in calendar year 2009; and
5.23 (3) for fiscal year 2009 only, a per-enrollee fee of 14.6 cents, based on the number of
5.24enrollees as of December 31, 2008.
5.25All fees collected under this paragraph shall be deposited in the state government special
5.26revenue fund.
5.27 Sec. 3. Minnesota Statutes 2010, section 256B.692, subdivision 5, is amended to read:
5.28 Subd. 5. County proposals. (a) On or before September 1, 1997, a county board
5.29that wishes to purchase or provide health care under this section must submit a preliminary
5.30proposal that substantially demonstrates the county's ability to meet all the requirements
5.31of this section in response to criteria for proposals issued by the department on or before
5.32July 1, 1997. Counties submitting preliminary proposals must establish a local planning
5.33process that involves input from medical assistance recipients, recipient advocates,
5.34providers and representatives of local school districts, labor, and tribal government to
5.35advise on the development of a final proposal and its implementation.
6.1(b) The county board must submit a final proposal on or before July 1, 1998, that
6.2demonstrates the ability to meet all the requirements of this section, including beginning
6.3enrollment on January 1, 1999, unless a delay has been granted under section256B.69,
6.4subdivision 3a , paragraph (g).
6.5(c) After January 1, 1999, for a county in which the prepaid medical assistance
6.6program is in existence, the county board must submit apreliminary proposal at least 15
6.7months prior to termination of health plan contracts in that county and a final proposal
6.8that meets the requirements of this section six months prior to the health plan contract
6.9termination date in order to begin enrollment after the termination. Nothing in this section
6.10shall impede or delay implementation or continuation of the prepaid medical assistance
6.11program in counties for which the board does not submit a proposal, or submits a proposal
6.12that is not in compliance with this section.
6.13(d) The commissioner is not required to terminate contracts for the prepaid medical
6.14assistance program that begin on or after September 1, 1997, in a county for which a
6.15county board has submitted a proposal under this paragraph, until two years have elapsed
6.16from the date of initial enrollment in the prepaid medical assistance program.
6.17 Sec. 4. Minnesota Statutes 2010, section 256B.692, subdivision 7, is amended to read:
6.18 Subd. 7. Dispute resolution. In the event the commissioner rejects a proposal
6.19under subdivision 6, the county board may request therecommendation decision of a
6.20three-person mediation panel. The commissioner shall resolve all disputesafter taking
6.21into account by following the recommendations decision of the mediation panel. The
6.22panel shall be composed of one designee of the president of the Association of Minnesota
6.23Counties, one designee of the commissioner of human services, and one person selected
6.24jointly by the designee of the commissioner of human services and the designee of
6.25the Association of Minnesota Counties. Within a reasonable period of time before the
6.26hearing, the panelists must be provided all documents and information relevant to the
6.27mediation. The parties to the mediation must be given 30 days' notice of a hearing before
6.28the mediation panel.
6.29 Sec. 5. Minnesota Statutes 2010, section 256B.694, is amended to read:
6.30256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
6.31CONTRACT.
6.32 (a) Notwithstanding section256B.692 , subdivision 6, clause (1), paragraph (c),
6.33the commissioner of human services shall approve a county-based purchasing health
6.34plan proposal, submitted on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena
7.1Counties, that requires county-based purchasing on a single-plan basis contract if the
7.2implementation of the single-plan purchasing proposal does not limit an enrollee's
7.3provider choice or access to services and all other requirements applicable to health plan
7.4purchasing are satisfied. The commissioner shall continue to use single-health plan,
7.5county-based purchasing arrangements for medical assistance and general assistance
7.6medical care programs and products for the counties that were in single-health plan,
7.7county-based purchasing arrangements on March 1, 2008. This paragraph does not require
7.8the commissioner to terminate an existing contract with a noncounty-based purchasing
7.9plan that had enrollment in a medical assistance program or product in these counties on
7.10March 1, 2008. This paragraph expires on December 31, 2010, or the effective date
7.11of a new contract for medical assistance and general assistance medical care managed
7.12care programs entered into at the conclusion of the commissioner's next scheduled
7.13reprocurement process for the county-based purchasing entities covered by this paragraph,
7.14whichever is later.
7.15 (b) At the request of a county or group of counties, the commissioner shallconsider,
7.16and may approve, contracting on a single-health plan basis with other county-based
7.17purchasing plans, or with other qualified health plans that have coordination arrangements
7.18with counties, to serve personswith a disability who voluntarily enroll, enrolled in
7.19Minnesota health care programs in order to promote better coordination or integration
7.20of health care services, social services and other community-based services, provided
7.21that all requirements applicable to health plan purchasing, including those in section
7.22256B.69, subdivision 23
, are satisfied. Nothing in this paragraph supersedes or modifies
7.23the requirements in paragraph (a).
7.26 Section 1. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
7.27subdivision to read:
7.28 Subd. 8. Rural demonstration projects. For demonstration projects serving
7.29rural areas, the commissioner shall consult with rural hospitals, primary care providers,
7.30county boards, health plans, and other key stakeholders primarily domiciled in the
7.31service area regarding the development and approval of alternative rural health care
7.32delivery demonstration projects under this section. In addition to organizations eligible
7.33to establish a demonstration project under subdivision 1, a rural demonstration project
7.34may be established by a county public health or social services agency or a county-based
7.35purchasing plan. In a rural area where multiple, competing provider-based demonstration
8.1projects are not possible, the commissioner shall not approve more than one demonstration
8.2project to serve the primary geographic area and shall follow the applicable procedures
8.3and requirements in section 256B.692 regarding participation of county boards in
8.4reviewing and approving demonstration project proposals.
8.8 Section 1. REDUCTION OF STATE-MANDATED ADMINISTRATIVE
8.9REPORTS.
8.10(a) The commissioner of management and budget shall convene a report reduction
8.11working group of persons designated by the commissioners of health, human services, and
8.12commerce to eliminate redundant, unnecessary, obsolete, and low-priority state-mandated
8.13administrative reports required of health plans and county-based purchasing plans
8.14that serve persons enrolled in Minnesota health care programs. The commissioner of
8.15management and budget and the report reduction working group shall develop a plan to
8.16oversee the report reduction activities of the individual state agencies and coordinate the
8.17activities of multiple state agencies to consolidate reports or eliminate redundant reports
8.18required by more than one state agency on the same or a similar topic.
8.19(b) The commissioners of health, human services, and commerce shall reduce,
8.20eliminate, or consolidate state-mandated reports according to the plan developed by the
8.21commissioner of management and budget through the report reduction working group.
8.22In addition to other report reduction actions the commissioners or the working group
8.23may undertake, the commissioners shall:
8.24(1) collect encounter data, including provider payment data if collected, in a
8.25consolidated report provided to a single state agency, with the data collected by that state
8.26agency to be shared with other state agencies who need the data;
8.27(2) collect only one provider network report annually through a single state agency,
8.28with the data collected by that state agency to be shared with other state agencies who
8.29need the data;
8.30(3) collect only one standard financial report through a single state agency, with
8.31the data collected by that state agency to be shared with other state agencies who need
8.32the data. Data collected must be of a nature and in a format to allow comparison of the
8.33cost-effectiveness of fee-for-service payment systems and prepaid programs administered
8.34by health plans and county-based purchasing plans;
9.1(4) consolidate and simplify reports and documentation requirements relating to
9.2member communications and marketing materials, and establish a single review process
9.3for all programs, products, and agencies in order to ensure uniform and consistent
9.4regulation of health plan contracts;
9.5(5) consolidate state regulation and oversight of health plans and county-based
9.6purchasing plans so that activities of multiple agencies are administered through an
9.7efficient and uniform multiagency process of oversight and audits, with consistent
9.8standards, measures, and definitions for state oversight of quality, utilization management,
9.9care management, delegation accountability, access to care, appeals and grievances, and
9.10financial management;
9.11(6) establish uniform requirements and procedures for denial, termination, or
9.12reduction of services, and member appeals and grievances, and align state requirements
9.13and procedures with federal requirements and procedures;
9.14(7) reform the state's performance improvement projects, requirements, and
9.15procedures to be more flexible and efficient, and to place greater focus on measuring
9.16improvement of outcomes and less on mandating detailed or prescriptive requirements for
9.17specific performance improvement projects or activities;
9.18(8) new reporting requirements or ad hoc report requests shall be established by a
9.19state agency only:
9.20(i) if required by a federal agency;
9.21(ii) if needed for a state regulatory audit or corrective action plan; or
9.22(iii) after the completion of a review and analysis, and the development of
9.23recommendations by the commissioner of management and budget, in consultation
9.24with the report reduction working group, regarding the necessity, importance, and
9.25administrative cost of the new report, and after completing a review to determine
9.26whether the information sought can be obtained through another available state or federal
9.27report. The results of the review, analysis, and recommendations of the commissioner of
9.28management and budget must be provided to health plans and county-based purchasing
9.29plans for review and comment at least 60 days before a new report or requirement is
9.30established; and
9.31(9) to the extent possible, all state agencies shall use the procedures, reports,
9.32and audits of the Centers for Medicare and Medicaid Services instead of requiring an
9.33additional state-mandated report on the same or a similar topic.
9.34(c) By January 15, 2012, the commissioner of management and budget shall provide
9.35a report on the activities and results of the report reduction project to the chairs and
9.36ranking minority members of the legislative committees of the house of representatives
10.1and senate with jurisdiction over health plans or county-based purchasing payments,
10.2regulations, and performance. The report must include:
10.3(1) a timetable for report reduction actions already taken or planned by the
10.4commissioners or the report reduction working group;
10.5(2) the specific reports that have been or will be eliminated or consolidated;
10.6(3) the amount of money that will be saved through reductions in administrative
10.7costs of health plans and county-based purchasing plans as a result of the report reduction
10.8project; and
10.9(4) proposed legislation for changes to laws or rules that are needed to allow state
10.10agencies to further reduce, consolidate, or eliminate reports when the changes cannot
10.11be made administratively.
1.3care program purchasing; authorizing county-based purchasing arrangements;
1.4establishing a process to reduce administrative reporting;amending Minnesota
1.5Statutes 2010, sections 256B.0755, by adding a subdivision; 256B.69,
1.6subdivision 3a; 256B.692, subdivisions 2, 5, 7; 256B.694.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.11 Section 1. Minnesota Statutes 2010, section 256B.69, subdivision 3a, is amended to
1.12read:
1.13 Subd. 3a. County authority. (a) The commissioner, when implementing or
1.14administering the medical assistance prepayment program within a county, must include
1.15the county board in the process of development, approval, and issuance of the request for
1.16proposals to provide services to eligible individuals within the proposed county, including
1.17proposals for demonstration projects established under section 256B.0755. County boards
1.18must be given reasonable opportunity to
1.19the development, issuance, review of responses, and changes needed in the request for
1.20proposals. The commissioner must provide county boards the opportunity to review
1.21each proposal based on the identification of community needs under chapters 145A and
1.22256E and county advocacy activities. If a county board finds that a proposal does not
1.23address certain community needs, the county board and commissioner shall continue
1.24efforts for improving the proposal and network prior to the approval of the contract.
1.25The county board shall make
2.1of local networks and their operations to ensure adequate local availability and access to
2.2covered services. The provider or health plan must respond directly to county advocates
2.3and the state prepaid medical assistance ombudsperson regarding service delivery and
2.4must be accountable to the state regarding contracts with medical assistance funds. The
2.5county board
2.6plans including county-based purchasing plans after considering the size of the enrolling
2.7population; ensuring adequate access and capacity; considering the client and county
2.8administrative complexity; and considering the need to promote the viability of locally
2.9developed health plans, managed care plans, or demonstration projects established under
2.10section 256B.0755. The county board or a single entity representing a group of county
2.11boards and the commissioner shall mutually select one or more qualified health plans or
2.12county-based purchasing plans for participation at the time of initial implementation of the
2.13prepaid medical assistance program or a demonstration project established under section
2.14256B.0755 in that county or group of counties and at the time of contract renewal. The
2.15commissioner shall also seek input for contract requirements from the county or single
2.16entity representing a group of county boards at each contract renewal and incorporate
2.17those recommendations into the contract negotiation process.
2.18 (b) At the option of the county board, the board may develop contract requirements
2.19related to the achievement of local public health goals and health care delivery and access
2.20goals to meet the health needs of medical assistance enrollees. These requirements must
2.21be reasonably related to the performance of health plan managed care or delivery system
2.22demonstration project functions and within the scope of the medical assistance benefit
2.23set.
2.24
2.25governing the prepaid medical assistance program in that county at initial implementation
2.26of the program or demonstration project in that county and at the time of contract renewal.
2.27The county board may participate in the enforcement of the contract
2.28
2.29 (c) For counties in which a prepaid medical assistance program has not been
2.30established, the commissioner shall not implement that program if a county board submits
2.31an acceptable and timely preliminary and final proposal under section
2.32county-based purchasing is no longer operational in that county. For counties in which
2.33a prepaid medical assistance program is in existence on or after September 1, 1997, the
2.34commissioner must terminate contracts with health plans according to section
2.35subdivision 5
2.36
3.1contracts that begin on or after September 1, 1997, according to section
3.2two years have elapsed from the date of initial enrollment.
3.3 (d) In the event that a county board or a single entity representing a group of county
3.4boards and the commissioner cannot reach agreement regarding: (i) the selection of
3.5participating health plans or demonstration projects under section 256B.0755 in that
3.6county; (ii) contract requirements; or (iii) implementation and enforcement of county
3.7requirements including provisions regarding local public health goals, the commissioner
3.8shall resolve all disputes
3.9a three-person mediation panel. The panel shall be composed of one designee of the
3.10president of the association of Minnesota counties, one designee of the commissioner of
3.11human services, and one person selected jointly by the designee of the commissioner of
3.12human services and the designee of the Association of Minnesota Counties. Within a
3.13reasonable period of time before the hearing, the panelists must be provided all documents
3.14and information relevant to the mediation. The parties to the mediation must be given
3.1530 days' notice of a hearing before the mediation panel.
3.16 (e) If a county which elects to implement county-based purchasing ceases to
3.17implement county-based purchasing, it is prohibited from assuming the responsibility of
3.18county-based purchasing for a period of five years from the date it discontinues purchasing.
3.19 (f) The commissioner shall not require that contractual disputes between
3.20county-based purchasing entities and the commissioner be mediated by a panel that
3.21includes a representative of the Minnesota Council of Health Plans.
3.22 (g) At the request of a county-purchasing entity, the commissioner shall adopt a
3.23contract reprocurement or renewal schedule under which all counties included in the
3.24entity's service area are reprocured or renewed at the same time.
3.25 (h) The commissioner shall provide a written report under section
3.26of the legislative committees having jurisdiction over human services in the senate and the
3.27house of representatives describing in detail the activities undertaken by the commissioner
3.28to ensure full compliance with this section. The report must also provide an explanation
3.29for any decisions of the commissioner not to accept the recommendations of a county or
3.30group of counties required to be consulted under this section. The report must be provided
3.31at least 30 days prior to the effective date of a new or renewed prepaid or managed care
3.32contract in a county.
3.33(i) This section also applies to other Minnesota health care programs administered
3.34by the commissioner including, but not limited to, the MinnesotaCare program.
3.35 Sec. 2. Minnesota Statutes 2010, section 256B.692, subdivision 2, is amended to read:
4.1 Subd. 2. Duties of commissioner of health. (a) Notwithstanding chapters 62D and
4.262N, a county that elects to purchase medical assistance in return for a fixed sum without
4.3regard to the frequency or extent of services furnished to any particular enrollee is not
4.4required to obtain a certificate of authority under chapter 62D or 62N. The county board
4.5of commissioners is the governing body of a county-based purchasing program. In a
4.6multicounty arrangement, the governing body is a joint powers board established under
4.7section
4.8 (b) A county that elects to purchase medical assistance services under this section
4.9must satisfy the commissioner of health that the requirements for assurance of consumer
4.10protection, provider protection, and, effective January 1, 2010, fiscal solvency of chapter
4.1162D, applicable to health maintenance organizations will be met according to the
4.12following schedule:
4.13 (1) for a county-based purchasing plan approved on or before June 30, 2008, the
4.14plan must have in reserve:
4.15 (i) at least 50 percent of the minimum amount required under chapter 62D as
4.16of January 1, 2010;
4.17 (ii) at least 75 percent of the minimum amount required under chapter 62D as of
4.18January 1, 2011;
4.19 (iii) at least 87.5 percent of the minimum amount required under chapter 62D as
4.20of January 1, 2012; and
4.21 (iv) at least 100 percent of the minimum amount required under chapter 62D as
4.22of January 1, 2013; and
4.23 (2) for a county-based purchasing plan first approved after June 30, 2008, the plan
4.24must have in reserve:
4.25 (i) at least 50 percent of the minimum amount required under chapter 62D at the
4.26time the plan begins enrolling enrollees;
4.27 (ii) at least 75 percent of the minimum amount required under chapter 62D after
4.28the first full calendar year;
4.29 (iii) at least 87.5 percent of the minimum amount required under chapter 62D after
4.30the second full calendar year; and
4.31 (iv) at least 100 percent of the minimum amount required under chapter 62D after
4.32the third full calendar year.
4.33 (c) Until a plan is required to have reserves equaling at least 100 percent of the
4.34minimum amount required under chapter 62D, the plan may demonstrate its ability
4.35to cover any losses by satisfying the requirements of chapter 62N. Notwithstanding
4.36this paragraph and paragraph (b), a county-based purchasing plan may satisfy its fiscal
5.1solvency requirements by obtaining written financial guarantees from participating
5.2counties in amounts equivalent to the minimum amounts that would otherwise apply.
5.3A county-based purchasing plan must also assure the commissioner of health that the
5.4requirements of sections
5.5applicable provisions of chapter 62Q, including sections
5.8 (d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M,
5.962N, and 62Q are hereby granted to the commissioner of health with respect to counties
5.10that purchase medical assistance services under this section.
5.11 (e) The commissioner, in consultation with county government, shall develop
5.12administrative and financial reporting requirements for county-based purchasing programs
5.13relating to sections
5.14and other sections as necessary, that are specific to county administrative, accounting, and
5.15reporting systems and consistent with other statutory requirements of counties.
5.16 (f) The commissioner shall collect from a county-based purchasing plan under
5.17this section the following fees:
5.18 (1) fees attributable to the costs of audits and other examinations of plan financial
5.19operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800,
5.20subpart 1, item F;
5.21 (2) an annual fee of $21,500, to be paid by June 15 of each calendar year, beginning
5.22in calendar year 2009; and
5.23 (3) for fiscal year 2009 only, a per-enrollee fee of 14.6 cents, based on the number of
5.24enrollees as of December 31, 2008.
5.25All fees collected under this paragraph shall be deposited in the state government special
5.26revenue fund.
5.27 Sec. 3. Minnesota Statutes 2010, section 256B.692, subdivision 5, is amended to read:
5.28 Subd. 5. County proposals. (a) On or before September 1, 1997, a county board
5.29that wishes to purchase or provide health care under this section must submit a preliminary
5.30proposal that substantially demonstrates the county's ability to meet all the requirements
5.31of this section in response to criteria for proposals issued by the department on or before
5.32July 1, 1997. Counties submitting preliminary proposals must establish a local planning
5.33process that involves input from medical assistance recipients, recipient advocates,
5.34providers and representatives of local school districts, labor, and tribal government to
5.35advise on the development of a final proposal and its implementation.
6.1(b) The county board must submit a final proposal on or before July 1, 1998, that
6.2demonstrates the ability to meet all the requirements of this section, including beginning
6.3enrollment on January 1, 1999, unless a delay has been granted under section
6.4subdivision 3a
6.5(c) After January 1, 1999, for a county in which the prepaid medical assistance
6.6program is in existence, the county board must submit a
6.7
6.8that meets the requirements of this section six months prior to the health plan contract
6.9termination date in order to begin enrollment after the termination. Nothing in this section
6.10shall impede or delay implementation or continuation of the prepaid medical assistance
6.11program in counties for which the board does not submit a proposal, or submits a proposal
6.12that is not in compliance with this section.
6.13(d) The commissioner is not required to terminate contracts for the prepaid medical
6.14assistance program that begin on or after September 1, 1997, in a county for which a
6.15county board has submitted a proposal under this paragraph, until two years have elapsed
6.16from the date of initial enrollment in the prepaid medical assistance program.
6.17 Sec. 4. Minnesota Statutes 2010, section 256B.692, subdivision 7, is amended to read:
6.18 Subd. 7. Dispute resolution. In the event the commissioner rejects a proposal
6.19under subdivision 6, the county board may request the
6.20three-person mediation panel. The commissioner shall resolve all disputes
6.21
6.22panel shall be composed of one designee of the president of the Association of Minnesota
6.23Counties, one designee of the commissioner of human services, and one person selected
6.24jointly by the designee of the commissioner of human services and the designee of
6.25the Association of Minnesota Counties. Within a reasonable period of time before the
6.26hearing, the panelists must be provided all documents and information relevant to the
6.27mediation. The parties to the mediation must be given 30 days' notice of a hearing before
6.28the mediation panel.
6.29 Sec. 5. Minnesota Statutes 2010, section 256B.694, is amended to read:
6.30256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
6.31CONTRACT.
6.32 (a) Notwithstanding section
6.33the commissioner of human services shall approve a county-based purchasing health
6.34plan proposal, submitted on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena
7.1Counties, that requires county-based purchasing on a single-plan basis contract if the
7.2implementation of the single-plan purchasing proposal does not limit an enrollee's
7.3provider choice or access to services and all other requirements applicable to health plan
7.4purchasing are satisfied. The commissioner shall continue to use single-health plan,
7.5county-based purchasing arrangements for medical assistance and general assistance
7.6medical care programs and products for the counties that were in single-health plan,
7.7county-based purchasing arrangements on March 1, 2008. This paragraph does not require
7.8the commissioner to terminate an existing contract with a noncounty-based purchasing
7.9plan that had enrollment in a medical assistance program or product in these counties on
7.10March 1, 2008. This paragraph expires on December 31, 2010, or the effective date
7.11of a new contract for medical assistance and general assistance medical care managed
7.12care programs entered into at the conclusion of the commissioner's next scheduled
7.13reprocurement process for the county-based purchasing entities covered by this paragraph,
7.14whichever is later.
7.15 (b) At the request of a county or group of counties, the commissioner shall
7.16
7.17purchasing plans, or with other qualified health plans that have coordination arrangements
7.18with counties, to serve persons
7.19Minnesota health care programs in order to promote better coordination or integration
7.20of health care services, social services and other community-based services, provided
7.21that all requirements applicable to health plan purchasing, including those in section
7.23the requirements in paragraph (a).
7.26 Section 1. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
7.27subdivision to read:
7.28 Subd. 8. Rural demonstration projects. For demonstration projects serving
7.29rural areas, the commissioner shall consult with rural hospitals, primary care providers,
7.30county boards, health plans, and other key stakeholders primarily domiciled in the
7.31service area regarding the development and approval of alternative rural health care
7.32delivery demonstration projects under this section. In addition to organizations eligible
7.33to establish a demonstration project under subdivision 1, a rural demonstration project
7.34may be established by a county public health or social services agency or a county-based
7.35purchasing plan. In a rural area where multiple, competing provider-based demonstration
8.1projects are not possible, the commissioner shall not approve more than one demonstration
8.2project to serve the primary geographic area and shall follow the applicable procedures
8.3and requirements in section 256B.692 regarding participation of county boards in
8.4reviewing and approving demonstration project proposals.
8.8 Section 1. REDUCTION OF STATE-MANDATED ADMINISTRATIVE
8.9REPORTS.
8.10(a) The commissioner of management and budget shall convene a report reduction
8.11working group of persons designated by the commissioners of health, human services, and
8.12commerce to eliminate redundant, unnecessary, obsolete, and low-priority state-mandated
8.13administrative reports required of health plans and county-based purchasing plans
8.14that serve persons enrolled in Minnesota health care programs. The commissioner of
8.15management and budget and the report reduction working group shall develop a plan to
8.16oversee the report reduction activities of the individual state agencies and coordinate the
8.17activities of multiple state agencies to consolidate reports or eliminate redundant reports
8.18required by more than one state agency on the same or a similar topic.
8.19(b) The commissioners of health, human services, and commerce shall reduce,
8.20eliminate, or consolidate state-mandated reports according to the plan developed by the
8.21commissioner of management and budget through the report reduction working group.
8.22In addition to other report reduction actions the commissioners or the working group
8.23may undertake, the commissioners shall:
8.24(1) collect encounter data, including provider payment data if collected, in a
8.25consolidated report provided to a single state agency, with the data collected by that state
8.26agency to be shared with other state agencies who need the data;
8.27(2) collect only one provider network report annually through a single state agency,
8.28with the data collected by that state agency to be shared with other state agencies who
8.29need the data;
8.30(3) collect only one standard financial report through a single state agency, with
8.31the data collected by that state agency to be shared with other state agencies who need
8.32the data. Data collected must be of a nature and in a format to allow comparison of the
8.33cost-effectiveness of fee-for-service payment systems and prepaid programs administered
8.34by health plans and county-based purchasing plans;
9.1(4) consolidate and simplify reports and documentation requirements relating to
9.2member communications and marketing materials, and establish a single review process
9.3for all programs, products, and agencies in order to ensure uniform and consistent
9.4regulation of health plan contracts;
9.5(5) consolidate state regulation and oversight of health plans and county-based
9.6purchasing plans so that activities of multiple agencies are administered through an
9.7efficient and uniform multiagency process of oversight and audits, with consistent
9.8standards, measures, and definitions for state oversight of quality, utilization management,
9.9care management, delegation accountability, access to care, appeals and grievances, and
9.10financial management;
9.11(6) establish uniform requirements and procedures for denial, termination, or
9.12reduction of services, and member appeals and grievances, and align state requirements
9.13and procedures with federal requirements and procedures;
9.14(7) reform the state's performance improvement projects, requirements, and
9.15procedures to be more flexible and efficient, and to place greater focus on measuring
9.16improvement of outcomes and less on mandating detailed or prescriptive requirements for
9.17specific performance improvement projects or activities;
9.18(8) new reporting requirements or ad hoc report requests shall be established by a
9.19state agency only:
9.20(i) if required by a federal agency;
9.21(ii) if needed for a state regulatory audit or corrective action plan; or
9.22(iii) after the completion of a review and analysis, and the development of
9.23recommendations by the commissioner of management and budget, in consultation
9.24with the report reduction working group, regarding the necessity, importance, and
9.25administrative cost of the new report, and after completing a review to determine
9.26whether the information sought can be obtained through another available state or federal
9.27report. The results of the review, analysis, and recommendations of the commissioner of
9.28management and budget must be provided to health plans and county-based purchasing
9.29plans for review and comment at least 60 days before a new report or requirement is
9.30established; and
9.31(9) to the extent possible, all state agencies shall use the procedures, reports,
9.32and audits of the Centers for Medicare and Medicaid Services instead of requiring an
9.33additional state-mandated report on the same or a similar topic.
9.34(c) By January 15, 2012, the commissioner of management and budget shall provide
9.35a report on the activities and results of the report reduction project to the chairs and
9.36ranking minority members of the legislative committees of the house of representatives
10.1and senate with jurisdiction over health plans or county-based purchasing payments,
10.2regulations, and performance. The report must include:
10.3(1) a timetable for report reduction actions already taken or planned by the
10.4commissioners or the report reduction working group;
10.5(2) the specific reports that have been or will be eliminated or consolidated;
10.6(3) the amount of money that will be saved through reductions in administrative
10.7costs of health plans and county-based purchasing plans as a result of the report reduction
10.8project; and
10.9(4) proposed legislation for changes to laws or rules that are needed to allow state
10.10agencies to further reduce, consolidate, or eliminate reports when the changes cannot
10.11be made administratively.
