Bill Text: MN SF654 | 2013-2014 | 88th Legislature | Engrossed
Bill Title: Miscellaneous health care policy and medical assistance (MA) provisions modifications
Sponsorship: Partisan Bill (Democrat 2)
Status: (Passed) 2013-05-20 - Secretary of State Chapter 81 [SF654 Detail]
Download: Minnesota-2013-SF654-Engrossed.html
1.2relating to human services; modifying provisions related to health care and
1.3medical assistance;amending Minnesota Statutes 2012, sections 62J.495,
1.4subdivision 15; 256.01, subdivision 34; 256.962, subdivision 8; 256B.0625,
1.5subdivisions 8, 8a, 8b, 17, 18e, 18f, 25; 256B.0755, subdivision 7; repealing
1.6Minnesota Rules, part 9505.0315, subpart 7, item D.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2012, section 62J.495, subdivision 15, is amended to read:
1.9 Subd. 15. Appeals review process. (a) Upon receipt of an appeal notice
1.10satisfying subdivision 14, the commissioner shall review the appeal and issue a written
1.11appeal determination on each appealed item with 90 days. Upon mutual agreement, the
1.12commissioner and the provider may extend the time for issuing a determination for a
1.13specified period. The commissioner shall notify the providerby first class mail of the
1.14appeal determination. The appeal determination takes effect upon the date of issuance
1.15specified in the determination.
1.16(b) In reviewing the appeal, the commissioner may request additional written or oral
1.17information from the provider.
1.18(c) The provider has the right to present information by telephone, in writing, or
1.19in person concerning the appeal to the commissioner prior to the issuance of the appeal
1.20determination within 30 days of the date the appeal was received by the commissioner.
1.21The provider must request an in-person conference in writing, separate from the appeal
1.22letter. Statements made during the review process are not admissible in a contested case
1.23hearing absent an express stipulation by the parties to the contested case.
1.24(d) For an appeal item on which the provider disagrees with the appeal determination,
1.25the provider may file with the commissioner a written demand for a contested case
2.1hearing to determine the proper resolution of specified appeal items. The demand must
2.2be postmarked or received by the commissioner within 30 days of the date of issuance
2.3specified in the determination. A contested case demand for an appeal item nullifies
2.4the written appeal determination issued by the commissioner for that appeal item. The
2.5commissioner shall refer any contested case demand to the Office of the Attorney General.
2.6(e) A contested case hearing must be heard by an administrative law judge according
2.7to sections14.48 to
14.56 . In any proceeding under this section, the appealing party must
2.8demonstrate by a preponderance of the evidence that the Minnesota electronic health
2.9record incentives program eligibility determination is incorrect.
2.10(f) Regardless of any appeal, the Minnesota electronic health record incentives
2.11program eligibility determination must remain in effect until final resolution of the appeal.
2.12(g) The commissioner has discretion to issue to the provider a proposed resolution
2.13for specified appeal items upon a request from the provider filed separately from the
2.14notice of appeal. The proposed resolution is final upon written acceptance by the provider
2.15within 30 days of the date the proposed resolution was mailed to or personally received by
2.16the provider, whichever is earlier.
2.17 Sec. 2. Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:
2.18 Subd. 34. Federal administrative reimbursement dedicated. Federal
2.19administrative reimbursement resulting from the following activities is appropriated to the
2.20commissioner for the designated purposes:
2.21(1) reimbursement for the Minnesota senior health options project; and
2.22(2) reimbursement related to prior authorization, review of medical necessity, and
2.23inpatient admission certification by a professional review organization. A portion of
2.24these funds must be used for activities to decrease unnecessary pharmaceutical costs in
2.25medical assistance.
2.26 Sec. 3. Minnesota Statutes 2012, section 256.962, subdivision 8, is amended to read:
2.27 Subd. 8. Eligibilityend review dates. The commissioner shall develop and
2.28implement a process by January 1, 2013, to provide eligibilityend review dates upon
2.29request from the managed care and county-based purchasing plans for medical assistance
2.30and MinnesotaCare enrollees.
2.31 Sec. 4. Minnesota Statutes 2012, section 256B.0625, subdivision 8, is amended to read:
3.1 Subd. 8. Physical therapy. (a) Medical assistance covers physical therapy and
3.2related services. Specialized maintenance therapy is covered for recipients age 20 and
3.3under.
3.4(b)Authorization by the commissioner is required to provide medically necessary
3.5services to a recipient. Services provided by a physical therapy assistant shall be
3.6reimbursed at the same rate as services performed by a physical therapist when the
3.7services of the physical therapy assistant are provided under the direction of a physical
3.8therapist who is on the premises. Services provided by a physical therapy assistant that
3.9are provided under the direction of a physical therapist who is not on the premises shall
3.10be reimbursed at 65 percent of the physical therapist rate.
3.11 Sec. 5. Minnesota Statutes 2012, section 256B.0625, subdivision 8a, is amended to read:
3.12 Subd. 8a. Occupational therapy. (a) Medical assistance covers occupational
3.13therapy and related services. Specialized maintenance therapy is covered for recipients
3.14age 20 and under.
3.15(b)Authorization by the commissioner is required to provide medically necessary
3.16services to a recipient. Services provided by an occupational therapy assistant shall be
3.17reimbursed at the same rate as services performed by an occupational therapist when the
3.18services of the occupational therapy assistant are provided under the direction of the
3.19occupational therapist who is on the premises. Services provided by an occupational
3.20therapy assistant that are provided under the direction of an occupational therapist who is
3.21not on the premises shall be reimbursed at 65 percent of the occupational therapist rate.
3.22 Sec. 6. Minnesota Statutes 2012, section 256B.0625, subdivision 8b, is amended to read:
3.23 Subd. 8b. Speech-language pathology and audiology services. (a) Medical
3.24assistance covers speech-language pathology and related services. Specialized
3.25maintenance therapy is covered for recipients age 20 and under.
3.26(b)Authorization by the commissioner is required to provide medically necessary
3.27speech-language pathology services to a recipient.
3.28(c) Medical assistance covers audiology services and related services. Services
3.29provided by a person who has been issued a temporary registration under section148.5161
3.30shall be reimbursed at the same rate as services performed by a speech-language pathologist
3.31or audiologist as long as the requirements of section148.5161, subdivision 3 , are met.
3.32 Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 17, is amended to read:
4.1 Subd. 17. Transportation costs. (a) Medical assistance covers medical
4.2transportation costs incurred solely for obtaining emergency medical care or transportation
4.3costs incurred by eligible persons in obtaining emergency or nonemergency medical
4.4care when paid directly to an ambulance company, common carrier, or other recognized
4.5providers of transportation services. Medical transportation must be provided by:
4.6(1) an ambulance, as defined in section144E.001, subdivision 2 ;
4.7(2) special transportation; or
4.8(3) common carrier including, but not limited to, bus, taxicab, other commercial
4.9carrier, or private automobile.
4.10(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
4.11part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
4.12would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
4.13transportation, or private automobile.
4.14The commissioner may use an order by the recipient's attending physician to certify that
4.15the recipient requires special transportation services. Special transportation providers shall
4.16perform driver-assisted services for eligible individuals. Driver-assisted service includes
4.17passenger pickup at and return to the individual's residence or place of business, assistance
4.18with admittance of the individual to the medical facility, and assistance in passenger
4.19securement or in securing of wheelchairs or stretchers in the vehicle. Special transportation
4.20providers must obtain written documentation from the health care service provider who
4.21is serving the recipient being transported, identifying the time that the recipient arrived.
4.22Special transportation providers may not bill for separate base rates for the continuation of
4.23a trip beyond the original destination. Special transportation providers must take recipients
4.24to thenearest appropriate health care provider, using the most direct route, and must not
4.25exceed 30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty
4.26care provider, unless the recipient receives authorization from the local agency. The
4.27minimum medical assistance reimbursement rates for special transportation services are:
4.28(1)(i) $17 for the base rate and $1.35 per mile for special transportation services to
4.29eligible persons who need a wheelchair-accessible van;
4.30(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
4.31eligible persons who do not need a wheelchair-accessible van; and
4.32(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
4.33special transportation services to eligible persons who need a stretcher-accessible vehicle;
4.34(2) the base rates for special transportation services in areas defined under RUCA
4.35to be super rural shall be equal to the reimbursement rate established in clause (1) plus
4.3611.3 percent; and
5.1(3) for special transportation services in areas defined under RUCA to be rural
5.2or super rural areas:
5.3(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
5.4percent of the respective mileage rate in clause (1); and
5.5(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
5.6112.5 percent of the respective mileage rate in clause (1).
5.7(c) For purposes of reimbursement rates for special transportation services under
5.8paragraph (b), the zip code of the recipient's place of residence shall determine whether
5.9the urban, rural, or super rural reimbursement rate applies.
5.10(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
5.11means a census-tract based classification system under which a geographical area is
5.12determined to be urban, rural, or super rural.
5.13(e) Effective for services provided on or after September 1, 2011, nonemergency
5.14transportation rates, including special transportation, taxi, and other commercial carriers,
5.15are reduced 4.5 percent. Payments made to managed care plans and county-based
5.16purchasing plans must be reduced for services provided on or after January 1, 2012,
5.17to reflect this reduction.
5.18 Sec. 8. Minnesota Statutes 2012, section 256B.0625, subdivision 18e, is amended to
5.19read:
5.20 Subd. 18e. Single administrative structure and delivery system. (a) The
5.21commissioner shall implement a single administrative structure and delivery system
5.22for nonemergency medical transportation, beginning July 1,2013 2014. The single
5.23administrative structure and delivery system must:
5.24(1) eliminate the distinction between access transportation services and special
5.25transportation services;
5.26(2) enable all medical assistance recipients to follow the same process to obtain
5.27nonemergency medical transportation, regardless of their level of need;
5.28(3) provide a single oversight framework for all providers of nonemergency medical
5.29transportation; and
5.30(4) provide flexibility in service delivery, recognizing that clients fall along a
5.31continuum of needs and resources.
5.32(b) The commissioner shall present to the legislature, by January 15,2013 2014, any
5.33draft legislation necessary to implement the single administrative structure and delivery
5.34system for nonemergency medical transportation.
6.1(c) In developing the single administrative structure and delivery system and
6.2the draft legislation, the commissioner shall consult with the Nonemergency Medical
6.3Transportation Advisory Committee.
6.4 Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 18f, is amended to
6.5read:
6.6 Subd. 18f. Enrollee assessment process. (a) The commissioner shall require that
6.7the administrator of nonemergency medical transportation adhere to the assessment
6.8process recommended by the Nonemergency Medical Transportation Advisory
6.9Committee. The commissioner, in consultation with the Nonemergency Medical
6.10Transportation Advisory Committee, shall develop and implement, by July 1, 2013 2014,
6.11a the comprehensive, statewide, standard assessment process for medical assistance
6.12enrollees seeking nonemergency medical transportation services recommended by the
6.13Nonemergency Medical Transportation Advisory Committee. The assessment process
6.14must identify a client's level of needs, abilities, and resources, and match the client with
6.15the mode of transportation in the client's service area that best meets those needs.
6.16(b) The assessment process must:
6.17(1) address mental health diagnoses when determining the most appropriate mode of
6.18transportation;
6.19(2) base decisions on clearly defined criteria that are available to clients, providers,
6.20and counties;
6.21(3) be standardized across the state and be aligned with other similar existing
6.22processes;
6.23(4) allow for extended periods of eligibility for certain types of nonemergency
6.24transportation when a client's condition is unlikely to change; and
6.25(5) increase the use of public transportation when appropriate and cost-effective,
6.26including offering monthly bus passes to clients.
6.27 Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 25, is amended to
6.28read:
6.29 Subd. 25. Prior authorization required. (a) The commissioner shall publish in
6.30the Minnesota health care programs provider manual and on the department's Web site a
6.31list of health services that require prior authorization,as well as the criteria and standards
6.32used to select health services on the list, and the criteria and standards used to determine
6.33whether certain providers must obtain prior authorization for their services. The list of
6.34services requiring prior authorization and the criteria and standards used to formulateit the
7.1list of services or the selection of providers for whom prior authorization is required are
7.2not subject to the requirements of sections14.001 to
14.69 . The commissioner's decision
7.3whether prior authorization is required for a health service or is required for a provider is
7.4not subject to administrative appeal. Use of criteria or standards to select providers for
7.5whom prior authorization is required shall not impede access to the service involved for any
7.6group of individuals with unique or special needs due to disability or functional condition.
7.7(b) The commissioner shall implement a modernized electronic system for providers
7.8to request prior authorization. The modernized electronic system must include at least the
7.9following functionalities:
7.10(1) authorizations are recipient-centric, not provider-centric;
7.11(2) adequate flexibility to support authorizations for an episode of care, continuous
7.12drug therapy, or for individual onetime services and allows an ordering and a rendering
7.13provider to both submit information into one request;
7.14(3) allows providers to review previous authorization requests and determine where
7.15a submitted request is within the authorization process;
7.16(4) supports automated workflows that allow providers to securely submit medical
7.17information that can be accessed by medical and pharmacy review vendors as well as
7.18department staff; and
7.19(5) supports development of automated clinical algorithms that can verify
7.20information and provide responses in real time.
7.21(c) The system described in paragraph (b) shall be completed by March 1, 2012. All
7.22authorization requests submitted on and after March 1, 2012, or upon completion of the
7.23modernized authorization system, whichever is later, must be submitted electronically by
7.24providers, except requests for drugs dispensed by an outpatient pharmacy, services that
7.25are provided outside of the state and surrounding local trade area, and services included
7.26on a service agreement.
7.27 Sec. 11. Minnesota Statutes 2012, section 256B.0755, subdivision 7, is amended to read:
7.28 Subd. 7. Expansion. The commissioner shallexplore the expansion of expand
7.29 the demonstration project to include additional medical assistance and MinnesotaCare
7.30enrollees, and shall seek participation of Medicare in demonstration projects. The
7.31commissioner shall seek to include participation of privately insured persons and Medicare
7.32recipients in the health care delivery demonstration. As part of the demonstration
7.33expansion, the commissioner may procure the services of the health care delivery systems
7.34authorized under this section by geographic area, to supplement or replace the services
7.35provided by managed care plans operating under section 256B.69.
8.1 Sec. 12. REPEALER.
8.2Minnesota Rules, part 9505.0315, subpart 7, item D, is repealed.
1.3medical assistance;amending Minnesota Statutes 2012, sections 62J.495,
1.4subdivision 15; 256.01, subdivision 34; 256.962, subdivision 8; 256B.0625,
1.5subdivisions 8, 8a, 8b, 17, 18e, 18f, 25; 256B.0755, subdivision 7; repealing
1.6Minnesota Rules, part 9505.0315, subpart 7, item D.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2012, section 62J.495, subdivision 15, is amended to read:
1.9 Subd. 15. Appeals review process. (a) Upon receipt of an appeal notice
1.10satisfying subdivision 14, the commissioner shall review the appeal and issue a written
1.11appeal determination on each appealed item with 90 days. Upon mutual agreement, the
1.12commissioner and the provider may extend the time for issuing a determination for a
1.13specified period. The commissioner shall notify the provider
1.14appeal determination. The appeal determination takes effect upon the date of issuance
1.15specified in the determination.
1.16(b) In reviewing the appeal, the commissioner may request additional written or oral
1.17information from the provider.
1.18(c) The provider has the right to present information by telephone, in writing, or
1.19in person concerning the appeal to the commissioner prior to the issuance of the appeal
1.20determination within 30 days of the date the appeal was received by the commissioner.
1.21The provider must request an in-person conference in writing, separate from the appeal
1.22letter. Statements made during the review process are not admissible in a contested case
1.23hearing absent an express stipulation by the parties to the contested case.
1.24(d) For an appeal item on which the provider disagrees with the appeal determination,
1.25the provider may file with the commissioner a written demand for a contested case
2.1hearing to determine the proper resolution of specified appeal items. The demand must
2.2be postmarked or received by the commissioner within 30 days of the date of issuance
2.3specified in the determination. A contested case demand for an appeal item nullifies
2.4the written appeal determination issued by the commissioner for that appeal item. The
2.5commissioner shall refer any contested case demand to the Office of the Attorney General.
2.6(e) A contested case hearing must be heard by an administrative law judge according
2.7to sections
2.8demonstrate by a preponderance of the evidence that the Minnesota electronic health
2.9record incentives program eligibility determination is incorrect.
2.10(f) Regardless of any appeal, the Minnesota electronic health record incentives
2.11program eligibility determination must remain in effect until final resolution of the appeal.
2.12(g) The commissioner has discretion to issue to the provider a proposed resolution
2.13for specified appeal items upon a request from the provider filed separately from the
2.14notice of appeal. The proposed resolution is final upon written acceptance by the provider
2.15within 30 days of the date the proposed resolution was mailed to or personally received by
2.16the provider, whichever is earlier.
2.17 Sec. 2. Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:
2.18 Subd. 34. Federal administrative reimbursement dedicated. Federal
2.19administrative reimbursement resulting from the following activities is appropriated to the
2.20commissioner for the designated purposes:
2.21(1) reimbursement for the Minnesota senior health options project; and
2.22(2) reimbursement related to prior authorization, review of medical necessity, and
2.23inpatient admission certification by a professional review organization. A portion of
2.24these funds must be used for activities to decrease unnecessary pharmaceutical costs in
2.25medical assistance.
2.26 Sec. 3. Minnesota Statutes 2012, section 256.962, subdivision 8, is amended to read:
2.27 Subd. 8. Eligibility
2.28implement a process by January 1, 2013, to provide eligibility
2.29request from the managed care and county-based purchasing plans for medical assistance
2.30and MinnesotaCare enrollees.
2.31 Sec. 4. Minnesota Statutes 2012, section 256B.0625, subdivision 8, is amended to read:
3.1 Subd. 8. Physical therapy. (a) Medical assistance covers physical therapy and
3.2related services. Specialized maintenance therapy is covered for recipients age 20 and
3.3under.
3.4(b)
3.5
3.6reimbursed at the same rate as services performed by a physical therapist when the
3.7services of the physical therapy assistant are provided under the direction of a physical
3.8therapist who is on the premises. Services provided by a physical therapy assistant that
3.9are provided under the direction of a physical therapist who is not on the premises shall
3.10be reimbursed at 65 percent of the physical therapist rate.
3.11 Sec. 5. Minnesota Statutes 2012, section 256B.0625, subdivision 8a, is amended to read:
3.12 Subd. 8a. Occupational therapy. (a) Medical assistance covers occupational
3.13therapy and related services. Specialized maintenance therapy is covered for recipients
3.14age 20 and under.
3.15(b)
3.16
3.17reimbursed at the same rate as services performed by an occupational therapist when the
3.18services of the occupational therapy assistant are provided under the direction of the
3.19occupational therapist who is on the premises. Services provided by an occupational
3.20therapy assistant that are provided under the direction of an occupational therapist who is
3.21not on the premises shall be reimbursed at 65 percent of the occupational therapist rate.
3.22 Sec. 6. Minnesota Statutes 2012, section 256B.0625, subdivision 8b, is amended to read:
3.23 Subd. 8b. Speech-language pathology and audiology services. (a) Medical
3.24assistance covers speech-language pathology and related services. Specialized
3.25maintenance therapy is covered for recipients age 20 and under.
3.26(b)
3.27
3.28
3.29provided by a person who has been issued a temporary registration under section
3.30shall be reimbursed at the same rate as services performed by a speech-language pathologist
3.31or audiologist as long as the requirements of section
3.32 Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 17, is amended to read:
4.1 Subd. 17. Transportation costs. (a) Medical assistance covers medical
4.2transportation costs incurred solely for obtaining emergency medical care or transportation
4.3costs incurred by eligible persons in obtaining emergency or nonemergency medical
4.4care when paid directly to an ambulance company, common carrier, or other recognized
4.5providers of transportation services. Medical transportation must be provided by:
4.6(1) an ambulance, as defined in section
4.7(2) special transportation; or
4.8(3) common carrier including, but not limited to, bus, taxicab, other commercial
4.9carrier, or private automobile.
4.10(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
4.11part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
4.12would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
4.13transportation, or private automobile.
4.14The commissioner may use an order by the recipient's attending physician to certify that
4.15the recipient requires special transportation services. Special transportation providers shall
4.16perform driver-assisted services for eligible individuals. Driver-assisted service includes
4.17passenger pickup at and return to the individual's residence or place of business, assistance
4.18with admittance of the individual to the medical facility, and assistance in passenger
4.19securement or in securing of wheelchairs or stretchers in the vehicle. Special transportation
4.20providers must obtain written documentation from the health care service provider who
4.21is serving the recipient being transported, identifying the time that the recipient arrived.
4.22Special transportation providers may not bill for separate base rates for the continuation of
4.23a trip beyond the original destination. Special transportation providers must take recipients
4.24to the
4.25exceed 30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty
4.26care provider, unless the recipient receives authorization from the local agency. The
4.27minimum medical assistance reimbursement rates for special transportation services are:
4.28(1)(i) $17 for the base rate and $1.35 per mile for special transportation services to
4.29eligible persons who need a wheelchair-accessible van;
4.30(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
4.31eligible persons who do not need a wheelchair-accessible van; and
4.32(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
4.33special transportation services to eligible persons who need a stretcher-accessible vehicle;
4.34(2) the base rates for special transportation services in areas defined under RUCA
4.35to be super rural shall be equal to the reimbursement rate established in clause (1) plus
4.3611.3 percent; and
5.1(3) for special transportation services in areas defined under RUCA to be rural
5.2or super rural areas:
5.3(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
5.4percent of the respective mileage rate in clause (1); and
5.5(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
5.6112.5 percent of the respective mileage rate in clause (1).
5.7(c) For purposes of reimbursement rates for special transportation services under
5.8paragraph (b), the zip code of the recipient's place of residence shall determine whether
5.9the urban, rural, or super rural reimbursement rate applies.
5.10(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
5.11means a census-tract based classification system under which a geographical area is
5.12determined to be urban, rural, or super rural.
5.13(e) Effective for services provided on or after September 1, 2011, nonemergency
5.14transportation rates, including special transportation, taxi, and other commercial carriers,
5.15are reduced 4.5 percent. Payments made to managed care plans and county-based
5.16purchasing plans must be reduced for services provided on or after January 1, 2012,
5.17to reflect this reduction.
5.18 Sec. 8. Minnesota Statutes 2012, section 256B.0625, subdivision 18e, is amended to
5.19read:
5.20 Subd. 18e. Single administrative structure and delivery system. (a) The
5.21commissioner shall implement a single administrative structure and delivery system
5.22for nonemergency medical transportation, beginning July 1,
5.23administrative structure and delivery system must:
5.24(1) eliminate the distinction between access transportation services and special
5.25transportation services;
5.26(2) enable all medical assistance recipients to follow the same process to obtain
5.27nonemergency medical transportation, regardless of their level of need;
5.28(3) provide a single oversight framework for all providers of nonemergency medical
5.29transportation; and
5.30(4) provide flexibility in service delivery, recognizing that clients fall along a
5.31continuum of needs and resources.
5.32(b) The commissioner shall present to the legislature, by January 15,
5.33
5.34system for nonemergency medical transportation.
6.1(c) In developing the single administrative structure and delivery system and
6.2the draft legislation, the commissioner shall consult with the Nonemergency Medical
6.3Transportation Advisory Committee.
6.4 Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 18f, is amended to
6.5read:
6.6 Subd. 18f. Enrollee assessment process. (a) The commissioner shall require that
6.7the administrator of nonemergency medical transportation adhere to the assessment
6.8process recommended by the Nonemergency Medical Transportation Advisory
6.9Committee. The commissioner
6.10
6.11
6.12enrollees seeking nonemergency medical transportation services recommended by the
6.13Nonemergency Medical Transportation Advisory Committee. The assessment process
6.14must identify a client's level of needs, abilities, and resources, and match the client with
6.15the mode of transportation in the client's service area that best meets those needs.
6.16(b) The assessment process must:
6.17(1) address mental health diagnoses when determining the most appropriate mode of
6.18transportation;
6.19(2) base decisions on clearly defined criteria that are available to clients, providers,
6.20and counties;
6.21(3) be standardized across the state and be aligned with other similar existing
6.22processes;
6.23(4) allow for extended periods of eligibility for certain types of nonemergency
6.24transportation when a client's condition is unlikely to change; and
6.25(5) increase the use of public transportation when appropriate and cost-effective,
6.26including offering monthly bus passes to clients.
6.27 Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 25, is amended to
6.28read:
6.29 Subd. 25. Prior authorization required. (a) The commissioner shall publish in
6.30the Minnesota health care programs provider manual and on the department's Web site a
6.31list of health services that require prior authorization,
6.32used to select health services on the list, and the criteria and standards used to determine
6.33whether certain providers must obtain prior authorization for their services. The list of
6.34services requiring prior authorization and the criteria and standards used to formulate
7.1list of services or the selection of providers for whom prior authorization is required are
7.2not subject to the requirements of sections
7.3whether prior authorization is required for a health service or is required for a provider is
7.4not subject to administrative appeal. Use of criteria or standards to select providers for
7.5whom prior authorization is required shall not impede access to the service involved for any
7.6group of individuals with unique or special needs due to disability or functional condition.
7.7(b) The commissioner shall implement a modernized electronic system for providers
7.8to request prior authorization. The modernized electronic system must include at least the
7.9following functionalities:
7.10(1) authorizations are recipient-centric, not provider-centric;
7.11(2) adequate flexibility to support authorizations for an episode of care, continuous
7.12drug therapy, or for individual onetime services and allows an ordering and a rendering
7.13provider to both submit information into one request;
7.14(3) allows providers to review previous authorization requests and determine where
7.15a submitted request is within the authorization process;
7.16(4) supports automated workflows that allow providers to securely submit medical
7.17information that can be accessed by medical and pharmacy review vendors as well as
7.18department staff; and
7.19(5) supports development of automated clinical algorithms that can verify
7.20information and provide responses in real time.
7.21(c) The system described in paragraph (b) shall be completed by March 1, 2012. All
7.22authorization requests submitted on and after March 1, 2012, or upon completion of the
7.23modernized authorization system, whichever is later, must be submitted electronically by
7.24providers, except requests for drugs dispensed by an outpatient pharmacy, services that
7.25are provided outside of the state and surrounding local trade area, and services included
7.26on a service agreement.
7.27 Sec. 11. Minnesota Statutes 2012, section 256B.0755, subdivision 7, is amended to read:
7.28 Subd. 7. Expansion. The commissioner shall
7.29 the demonstration project to include additional medical assistance and MinnesotaCare
7.30enrollees, and shall seek participation of Medicare in demonstration projects. The
7.31commissioner shall seek to include participation of privately insured persons and Medicare
7.32recipients in the health care delivery demonstration. As part of the demonstration
7.33expansion, the commissioner may procure the services of the health care delivery systems
7.34authorized under this section by geographic area, to supplement or replace the services
7.35provided by managed care plans operating under section 256B.69.
8.1 Sec. 12. REPEALER.
8.2Minnesota Rules, part 9505.0315, subpart 7, item D, is repealed.
