Bill Text: MN HF2941 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Medical assistance enrollee adults without children coordinated care system established.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-03-20 - Introduction and first reading, referred to Health and Human Services Reform [HF2941 Detail]
Download: Minnesota-2011-HF2941-Introduced.html
1.2relating to human services; establishing a coordinated care system for medical
1.3assistance enrollees who are adults without children;proposing coding for new
1.4law in Minnesota Statutes, chapter 256B.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [256B.85] COORDINATED CARE FOR ADULTS WITHOUT
1.7CHILDREN.
1.8 Subdivision 1. Definitions. (a) For purposes of this section, the following definitions
1.9apply.
1.10(b) "Eligible enrollees" means adults without children eligible for medical assistance
1.11under section 256B.055, subdivision 15, with incomes that do not exceed 75 percent
1.12of the federal poverty guidelines.
1.13(c) "Federally qualified health center" has the meaning provided in section 145.9269,
1.14subdivision 1.
1.15 Subd. 2. Suspension. The commissioner, effective January 1, 2013, shall suspend
1.16the use of managed care and county-based purchasing plans under sections 256B.69 and
1.17256B.692, to deliver medical assistance services to adults without children eligible under
1.18section 256B.055, subdivision 15. The commissioner shall reinstate service delivery
1.19through managed care and county-based purchasing plans only if authorized by state law.
1.20 Subd. 3. Care coordination through fee-for-service. (a) Effective January 1,
1.212013, and until federal approval is received for a primary care case management system,
1.22the commissioner shall deliver services to eligible enrollees through a fee-for-service
1.23system. The commissioner shall coordinate care delivery under this system through the
2.1use of health care homes certified under section 256B.0751, federally qualified health
2.2centers, and other primary care providers.
2.3(b) Effective upon federal approval, but not earlier than January 1, 2013, the
2.4commissioner shall deliver services to eligible enrollees through a fee-for-service
2.5primary care case management system, as authorized under United States Code, title 42,
2.6section 1396u-2. The primary care case management system must incorporate the use of
2.7health care homes, federally qualified health centers, and other primary care providers,
2.8as specified in paragraph (a), and must include case management for human services
2.9and housing, as well as for health care needs. The commissioner shall require eligible
2.10enrollees to select a health care home, federally qualified health center, or other primary
2.11care provider from which to receive covered services, case management, and other care
2.12coordination.
2.13 Subd. 4. Coordinated care system. (a) Effective January 1, 2014, or upon federal
2.14approval, whichever is later, the commissioner shall deliver services to eligible enrollees
2.15through a coordinated care system. The coordinated care system must:
2.16(1) allow coordinated care providers to enter into risk/gain sharing contracts to
2.17provide and coordinate health care, human services, and housing for eligible enrollees;
2.18(2) require eligible enrollees to agree to receive all nonemergency services covered
2.19under the contract from the coordinated care provider or through referral;
2.20(3) make payment under risk/gain sharing contracts dependent upon a comparison
2.21of the cost of services provided to eligible enrollees with the coordinated care provider's
2.22per-member, per-month, risk-adjusted, cost of care benchmark, and the extent to which the
2.23coordinated care provider meets quality standards;
2.24(4) set limits on provider risk under a contract that are appropriate to the size and
2.25revenues of the provider and other factors; and
2.26(5) provide appeal mechanisms for both coordinated care providers and eligible
2.27enrollees.
2.28(b) A coordinated care provider may include the following groups of providers and
2.29suppliers, if they have established a mechanism for shared governance:
2.30(1) professionals in group practice arrangements;
2.31(2) networks of individual practices of professionals;
2.32(3) partnerships or joint venture arrangements between hospitals and health care
2.33professionals;
2.34(4) hospitals employing professionals;
2.35(5) human service and housing providers; and
3.1(6) other providers of services and supplies that the commissioner determines are
3.2appropriate and that are coordinated by a primary care provider, federally qualified health
3.3center, health care home, or other coordinated care providers.
3.4 Subd. 5. Plan for coordinated care system; advisory group. (a) The commissioner
3.5shall present to the legislature by December 15, 2012, an implementation plan and draft
3.6legislation to deliver care beginning January 1, 2014, to eligible enrollees through
3.7a coordinated care system. In developing this plan, the commissioner shall consider
3.8any available findings and results from the health care delivery demonstration project
3.9authorized under section 256B.0755, and the Hennepin County pilot program authorized
3.10under section 256B.0756, and shall consult with the advisory group established in
3.11paragraph (b).
3.12(b) The commissioner shall establish an advisory group comprised of health care
3.13providers, consumer representatives, and human service and housing providers, to assist
3.14the commissioner in developing the plan and draft legislation required by paragraph (a).
1.3assistance enrollees who are adults without children;proposing coding for new
1.4law in Minnesota Statutes, chapter 256B.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [256B.85] COORDINATED CARE FOR ADULTS WITHOUT
1.7CHILDREN.
1.8 Subdivision 1. Definitions. (a) For purposes of this section, the following definitions
1.9apply.
1.10(b) "Eligible enrollees" means adults without children eligible for medical assistance
1.11under section 256B.055, subdivision 15, with incomes that do not exceed 75 percent
1.12of the federal poverty guidelines.
1.13(c) "Federally qualified health center" has the meaning provided in section 145.9269,
1.14subdivision 1.
1.15 Subd. 2. Suspension. The commissioner, effective January 1, 2013, shall suspend
1.16the use of managed care and county-based purchasing plans under sections 256B.69 and
1.17256B.692, to deliver medical assistance services to adults without children eligible under
1.18section 256B.055, subdivision 15. The commissioner shall reinstate service delivery
1.19through managed care and county-based purchasing plans only if authorized by state law.
1.20 Subd. 3. Care coordination through fee-for-service. (a) Effective January 1,
1.212013, and until federal approval is received for a primary care case management system,
1.22the commissioner shall deliver services to eligible enrollees through a fee-for-service
1.23system. The commissioner shall coordinate care delivery under this system through the
2.1use of health care homes certified under section 256B.0751, federally qualified health
2.2centers, and other primary care providers.
2.3(b) Effective upon federal approval, but not earlier than January 1, 2013, the
2.4commissioner shall deliver services to eligible enrollees through a fee-for-service
2.5primary care case management system, as authorized under United States Code, title 42,
2.6section 1396u-2. The primary care case management system must incorporate the use of
2.7health care homes, federally qualified health centers, and other primary care providers,
2.8as specified in paragraph (a), and must include case management for human services
2.9and housing, as well as for health care needs. The commissioner shall require eligible
2.10enrollees to select a health care home, federally qualified health center, or other primary
2.11care provider from which to receive covered services, case management, and other care
2.12coordination.
2.13 Subd. 4. Coordinated care system. (a) Effective January 1, 2014, or upon federal
2.14approval, whichever is later, the commissioner shall deliver services to eligible enrollees
2.15through a coordinated care system. The coordinated care system must:
2.16(1) allow coordinated care providers to enter into risk/gain sharing contracts to
2.17provide and coordinate health care, human services, and housing for eligible enrollees;
2.18(2) require eligible enrollees to agree to receive all nonemergency services covered
2.19under the contract from the coordinated care provider or through referral;
2.20(3) make payment under risk/gain sharing contracts dependent upon a comparison
2.21of the cost of services provided to eligible enrollees with the coordinated care provider's
2.22per-member, per-month, risk-adjusted, cost of care benchmark, and the extent to which the
2.23coordinated care provider meets quality standards;
2.24(4) set limits on provider risk under a contract that are appropriate to the size and
2.25revenues of the provider and other factors; and
2.26(5) provide appeal mechanisms for both coordinated care providers and eligible
2.27enrollees.
2.28(b) A coordinated care provider may include the following groups of providers and
2.29suppliers, if they have established a mechanism for shared governance:
2.30(1) professionals in group practice arrangements;
2.31(2) networks of individual practices of professionals;
2.32(3) partnerships or joint venture arrangements between hospitals and health care
2.33professionals;
2.34(4) hospitals employing professionals;
2.35(5) human service and housing providers; and
3.1(6) other providers of services and supplies that the commissioner determines are
3.2appropriate and that are coordinated by a primary care provider, federally qualified health
3.3center, health care home, or other coordinated care providers.
3.4 Subd. 5. Plan for coordinated care system; advisory group. (a) The commissioner
3.5shall present to the legislature by December 15, 2012, an implementation plan and draft
3.6legislation to deliver care beginning January 1, 2014, to eligible enrollees through
3.7a coordinated care system. In developing this plan, the commissioner shall consider
3.8any available findings and results from the health care delivery demonstration project
3.9authorized under section 256B.0755, and the Hennepin County pilot program authorized
3.10under section 256B.0756, and shall consult with the advisory group established in
3.11paragraph (b).
3.12(b) The commissioner shall establish an advisory group comprised of health care
3.13providers, consumer representatives, and human service and housing providers, to assist
3.14the commissioner in developing the plan and draft legislation required by paragraph (a).
