Bill Text: MN SF1145 | 2011-2012 | 87th Legislature | Introduced
Bill Title: State health care programs contract authority with third-party administrators to provide medical assistance (MA) benefits
Sponsorship: Moderate Partisan Bill (Republican 4-1)
Status: (Introduced - Dead) 2011-04-11 - Referred to Health and Human Services [SF1145 Detail]
Download: Minnesota-2011-SF1145-Introduced.html
1.2relating to human services; permitting the state to contract with third-party
1.3administrators to provide medical assistance benefits; requiring use of a
1.4competitive request for proposal process; repealing mandatory participation by
1.5health maintenance organizations;amending Minnesota Statutes 2010, sections
1.6256B.0644; 256B.69, subdivisions 2, 5; repealing Minnesota Statutes 2010,
1.7section 62D.04, subdivision 5.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2010, section 256B.0644, is amended to read:
1.10256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
1.11PROGRAMS.
1.12 (a) A vendor of medical care, as defined in section256B.02, subdivision 7 , and a
1.13health maintenance organization, as defined in chapter 62D, must participate as a provider
1.14or contractor in the medical assistance program, general assistance medical care program,
1.15and MinnesotaCare as a condition of participating as a provider in health insurance plans
1.16and programs or contractor for state employees established under section43A.18 , the
1.17public employees insurance program under section43A.316 , for health insurance plans
1.18offered to local statutory or home rule charter city, county, and school district employees,
1.19the workers' compensation system under section176.135 , and insurance plans provided
1.20through the Minnesota Comprehensive Health Association under sections62E.01 to
1.2162E.19
. The limitations on insurance plans offered to local government employees shall
1.22not be applicable in geographic areas where provider participation is limited by managed
1.23care contracts with the Department of Human Services. For purposes of this section, a
1.24health maintenance organization, as defined in chapter 62D, is not a vendor of medical
1.25care.
2.1 (b)For providers other than health maintenance organizations, Participation in the
2.2medical assistance program means that:
2.3 (1) the provider accepts new medical assistance, general assistance medical care,
2.4and MinnesotaCare patients;
2.5 (2) for providers other than dental service providers, at least 20 percent of the
2.6provider's patients are covered by medical assistance, general assistance medical care,
2.7and MinnesotaCare as their primary source of coverage; or
2.8 (3) for dental service providers, at least ten percent of the provider's patients are
2.9covered by medical assistance, general assistance medical care, and MinnesotaCare as
2.10their primary source of coverage, or the provider accepts new medical assistance and
2.11MinnesotaCare patients who are children with special health care needs. For purposes
2.12of this section, "children with special health care needs" means children up to age 18
2.13who: (i) require health and related services beyond that required by children generally;
2.14and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
2.15condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
2.16cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
2.17neurological diseases; visual impairment or deafness; Down syndrome and other genetic
2.18disorders; autism; fetal alcohol syndrome; and other conditions designated by the
2.19commissioner after consultation with representatives of pediatric dental providers and
2.20consumers.
2.21 (c) Patients seen on a volunteer basis by the provider at a location other than
2.22the provider's usual place of practice may be considered in meeting the participation
2.23requirement in this section. The commissioner shall establish participation requirements
2.24for health maintenance organizations. The commissioner shall provide lists of participating
2.25medical assistance providers on a quarterly basis to the commissioner of management and
2.26budget, the commissioner of labor and industry, and the commissioner of commerce. Each
2.27of the commissioners shall develop and implement procedures to exclude as participating
2.28providers in the program or programs under their jurisdiction those providers who do
2.29not participate in the medical assistance program. The commissioner of management
2.30and budget shall implement this section through contracts with participating health and
2.31dental carriers.
2.32(d) For purposes of paragraphs (a) and (b), participation in the general assistance
2.33medical care program applies only to pharmacy providers.
2.34EFFECTIVE DATE.This section is effective for medical assistance, general
2.35assistance medical care, and MinnesotaCare plan years beginning on or after January
2.361, 2012.
3.1 Sec. 2. Minnesota Statutes 2010, section 256B.69, subdivision 2, is amended to read:
3.2 Subd. 2. Definitions. For the purposes of this section, the following terms have
3.3the meanings given.
3.4(a) "Commissioner" means the commissioner of human services. For the
3.5remainder of this section, the commissioner's responsibilities for methods and policies
3.6for implementing the project will be proposed by the project advisory committees and
3.7approved by the commissioner.
3.8(b) "Demonstration provider" means a health maintenance organization, community
3.9integrated service network,or accountable provider network authorized and operating
3.10under chapter 62D, 62N, or 62T, or vendor of risk management services as defined in
3.11section 60A.23, subdivision 8, that participates in the demonstration project according
3.12to criteria, standards, methods, and other requirements established for the project and
3.13approved by the commissioner. For purposes of this section, a county board, or group of
3.14county boards operating under a joint powers agreement, is considered a demonstration
3.15provider if the county or group of county boards meets the requirements of section
3.16256B.692
. Notwithstanding the above, Itasca County may continue to participate as a
3.17demonstration provider until July 1, 2004.
3.18(c) "Eligible individuals" means those persons eligible for medical assistance
3.19benefits as defined in sections256B.055 ,
256B.056 , and
256B.06 .
3.20(d) "Limitation of choice" means suspending freedom of choice while allowing
3.21eligible individuals to choose among the demonstration providers.
3.22EFFECTIVE DATE.This section is effective for demonstration project years
3.23beginning on or after January 1, 2012.
3.24 Sec. 3. Minnesota Statutes 2010, section 256B.69, subdivision 5, is amended to read:
3.25 Subd. 5. Prospective per capita payment. The commissioner shall establish the
3.26method and amount of payments for services. The commissioner shall annually contract
3.27with demonstration providers to provide services consistent with these established
3.28methods and amounts for payment. The commissioner shall enter into contracts with one
3.29or more demonstration providers on the basis of a request for proposal process as defined
3.30in section 16C.02, subdivision 12. The commissioner need not enter into a contract with
3.31each entity that submits a proposal.
3.32If allowed by the commissioner, a demonstration provider may contract with
3.33an insurer, health care provider, nonprofit health service plan corporation, or the
3.34commissioner, to provide insurance or similar protection against the cost of care provided
3.35by the demonstration provider or to provide coverage against the risks incurred by
4.1demonstration providers under this section. The recipients enrolled with a demonstration
4.2provider are a permissible group under group insurance laws and chapter 62C, the
4.3Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer
4.4or corporation may make benefit payments to a demonstration provider for services
4.5rendered or to be rendered to a recipient. Any insurer or nonprofit health service plan
4.6corporation licensed to do business in this state is authorized to provide this insurance or
4.7similar protection.
4.8Payments to providers participating in the project are exempt from the requirements
4.9of sections256.966 and
256B.03, subdivision 2 . The commissioner shall complete
4.10development of capitation rates for payments before delivery of services under this section
4.11is begun. For payments made during calendar year 1990 and later years, the commissioner
4.12shall contract with an independent actuary to establish prepayment rates.
4.13By January 15, 1996, the commissioner shall report to the legislature on the
4.14methodology used to allocate to participating counties available administrative
4.15reimbursement for advocacy and enrollment costs. The report shall reflect the
4.16commissioner's judgment as to the adequacy of the funds made available and of the
4.17methodology for equitable distribution of the funds. The commissioner must involve
4.18participating counties in the development of the report.
4.19Beginning July 1, 2004, the commissioner may include payments for elderly waiver
4.20services and 180 days of nursing home care in capitation payments for the prepaid medical
4.21assistance program for recipients age 65 and older. Payments for elderly waiver services
4.22shall be made no earlier than the month following the month in which services were
4.23received.
4.24EFFECTIVE DATE.This section is effective for demonstration project years
4.25beginning on or after January 1, 2012.
4.26 Sec. 4. REPEALER; MANDATORY HMO PARTICIPATION AS PROVIDER IN
4.27PUBLIC PROGRAMS.
4.28Minnesota Statutes 2010, section 62D.04, subdivision 5, is repealed effective
4.29January 1, 2012.
1.3administrators to provide medical assistance benefits; requiring use of a
1.4competitive request for proposal process; repealing mandatory participation by
1.5health maintenance organizations;amending Minnesota Statutes 2010, sections
1.6256B.0644; 256B.69, subdivisions 2, 5; repealing Minnesota Statutes 2010,
1.7section 62D.04, subdivision 5.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2010, section 256B.0644, is amended to read:
1.10256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
1.11PROGRAMS.
1.12 (a) A vendor of medical care, as defined in section
1.13
1.14or contractor in the medical assistance program, general assistance medical care program,
1.15and MinnesotaCare as a condition of participating as a provider in health insurance plans
1.16and programs or contractor for state employees established under section
1.17public employees insurance program under section
1.18offered to local statutory or home rule charter city, county, and school district employees,
1.19the workers' compensation system under section
1.20through the Minnesota Comprehensive Health Association under sections
1.22not be applicable in geographic areas where provider participation is limited by managed
1.23care contracts with the Department of Human Services. For purposes of this section, a
1.24health maintenance organization, as defined in chapter 62D, is not a vendor of medical
1.25care.
2.1 (b)
2.2medical assistance program means that:
2.3 (1) the provider accepts new medical assistance, general assistance medical care,
2.4and MinnesotaCare patients;
2.5 (2) for providers other than dental service providers, at least 20 percent of the
2.6provider's patients are covered by medical assistance, general assistance medical care,
2.7and MinnesotaCare as their primary source of coverage; or
2.8 (3) for dental service providers, at least ten percent of the provider's patients are
2.9covered by medical assistance, general assistance medical care, and MinnesotaCare as
2.10their primary source of coverage, or the provider accepts new medical assistance and
2.11MinnesotaCare patients who are children with special health care needs. For purposes
2.12of this section, "children with special health care needs" means children up to age 18
2.13who: (i) require health and related services beyond that required by children generally;
2.14and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
2.15condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
2.16cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
2.17neurological diseases; visual impairment or deafness; Down syndrome and other genetic
2.18disorders; autism; fetal alcohol syndrome; and other conditions designated by the
2.19commissioner after consultation with representatives of pediatric dental providers and
2.20consumers.
2.21 (c) Patients seen on a volunteer basis by the provider at a location other than
2.22the provider's usual place of practice may be considered in meeting the participation
2.23requirement in this section. The commissioner shall establish participation requirements
2.24for health maintenance organizations. The commissioner shall provide lists of participating
2.25medical assistance providers on a quarterly basis to the commissioner of management and
2.26budget, the commissioner of labor and industry, and the commissioner of commerce. Each
2.27of the commissioners shall develop and implement procedures to exclude as participating
2.28providers in the program or programs under their jurisdiction those providers who do
2.29not participate in the medical assistance program. The commissioner of management
2.30and budget shall implement this section through contracts with participating health and
2.31dental carriers.
2.32(d) For purposes of paragraphs (a) and (b), participation in the general assistance
2.33medical care program applies only to pharmacy providers.
2.34EFFECTIVE DATE.This section is effective for medical assistance, general
2.35assistance medical care, and MinnesotaCare plan years beginning on or after January
2.361, 2012.
3.1 Sec. 2. Minnesota Statutes 2010, section 256B.69, subdivision 2, is amended to read:
3.2 Subd. 2. Definitions. For the purposes of this section, the following terms have
3.3the meanings given.
3.4(a) "Commissioner" means the commissioner of human services. For the
3.5remainder of this section, the commissioner's responsibilities for methods and policies
3.6for implementing the project will be proposed by the project advisory committees and
3.7approved by the commissioner.
3.8(b) "Demonstration provider" means a health maintenance organization, community
3.9integrated service network,
3.10under chapter 62D, 62N, or 62T, or vendor of risk management services as defined in
3.11section 60A.23, subdivision 8, that participates in the demonstration project according
3.12to criteria, standards, methods, and other requirements established for the project and
3.13approved by the commissioner. For purposes of this section, a county board, or group of
3.14county boards operating under a joint powers agreement, is considered a demonstration
3.15provider if the county or group of county boards meets the requirements of section
3.17demonstration provider until July 1, 2004.
3.18(c) "Eligible individuals" means those persons eligible for medical assistance
3.19benefits as defined in sections
3.20(d) "Limitation of choice" means suspending freedom of choice while allowing
3.21eligible individuals to choose among the demonstration providers.
3.22EFFECTIVE DATE.This section is effective for demonstration project years
3.23beginning on or after January 1, 2012.
3.24 Sec. 3. Minnesota Statutes 2010, section 256B.69, subdivision 5, is amended to read:
3.25 Subd. 5. Prospective per capita payment. The commissioner shall establish the
3.26method and amount of payments for services. The commissioner shall annually contract
3.27with demonstration providers to provide services consistent with these established
3.28methods and amounts for payment. The commissioner shall enter into contracts with one
3.29or more demonstration providers on the basis of a request for proposal process as defined
3.30in section 16C.02, subdivision 12. The commissioner need not enter into a contract with
3.31each entity that submits a proposal.
3.32If allowed by the commissioner, a demonstration provider may contract with
3.33an insurer, health care provider, nonprofit health service plan corporation, or the
3.34commissioner, to provide insurance or similar protection against the cost of care provided
3.35by the demonstration provider or to provide coverage against the risks incurred by
4.1demonstration providers under this section. The recipients enrolled with a demonstration
4.2provider are a permissible group under group insurance laws and chapter 62C, the
4.3Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer
4.4or corporation may make benefit payments to a demonstration provider for services
4.5rendered or to be rendered to a recipient. Any insurer or nonprofit health service plan
4.6corporation licensed to do business in this state is authorized to provide this insurance or
4.7similar protection.
4.8Payments to providers participating in the project are exempt from the requirements
4.9of sections
4.10development of capitation rates for payments before delivery of services under this section
4.11is begun. For payments made during calendar year 1990 and later years, the commissioner
4.12shall contract with an independent actuary to establish prepayment rates.
4.13By January 15, 1996, the commissioner shall report to the legislature on the
4.14methodology used to allocate to participating counties available administrative
4.15reimbursement for advocacy and enrollment costs. The report shall reflect the
4.16commissioner's judgment as to the adequacy of the funds made available and of the
4.17methodology for equitable distribution of the funds. The commissioner must involve
4.18participating counties in the development of the report.
4.19Beginning July 1, 2004, the commissioner may include payments for elderly waiver
4.20services and 180 days of nursing home care in capitation payments for the prepaid medical
4.21assistance program for recipients age 65 and older. Payments for elderly waiver services
4.22shall be made no earlier than the month following the month in which services were
4.23received.
4.24EFFECTIVE DATE.This section is effective for demonstration project years
4.25beginning on or after January 1, 2012.
4.26 Sec. 4. REPEALER; MANDATORY HMO PARTICIPATION AS PROVIDER IN
4.27PUBLIC PROGRAMS.
4.28Minnesota Statutes 2010, section 62D.04, subdivision 5, is repealed effective
4.29January 1, 2012.
