as introduced - 91st Legislature (2019 - 2020) Posted on 03/26/2020 01:11pm
A bill for an act
relating to health care; establishing a Primary Care Case Management program;
authorizing direct state payments to health care providers; proposing coding for
new law in Minnesota Statutes, chapter 256.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
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The Primary Care Case Management (PCCM)
program is established to achieve better health outcomes and reduce the cost of health care
for the state. The commissioner shall pay health care providers directly to provide services
for all medical assistance enrollees who are eligible under section 256B.055 and
MinnesotaCare enrollees eligible under section 256L.05. In counties where there is a
county-based purchasing system under section 256B.692, the commissioner shall have the
county-based purchaser administer the program and pay providers unless the counties request
that the commissioner take over the responsibility.
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(a) The commissioner of human services shall pay
licensed health care providers directly for all services provided to medical assistance enrollees
under section 256B.0625 and MinnesotaCare enrollees under section 256L.03.
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(b) Providers shall bill the state or the county-based purchaser directly for the services
they provide.
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(c) The commissioner shall not renew the state's contracts with managed care plans
under sections 256B.69 and 256L.12 for providing services to enrollees in the medical
assistance and MinnesotaCare programs.
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(a) In addition to paying providers under subdivision 2,
the commissioner shall use the PCCM program to pay primary care providers for coordinating
services for medical assistance and MinnesotaCare enrollees.
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Under the program, patients may choose a primary care provider to act as the enrollee's
case manager. Primary care physicians, nurses, and other qualified medical professionals
may provide primary care case management. Specialists who routinely provide care for
patients with specific or complex medical conditions may also be primary care providers
for purposes of case management.
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Primary care providers who offer PCCM services shall also receive a flat per-member,
per-month fee for performing care coordination services. The commissioner shall set case
management fees to reflect the variation in time and services required for a primary care
provider to coordinate care based on the complexity of a patient's health needs and
socioeconomic factors that lead to health disparities.
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(b) The primary care provider shall provide overall oversight of the enrollee's health and
coordinate with any other case manager of the enrollee as well as ensure 24-hour access to
health care, emergency treatment, and referrals.
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(c) The commissioner shall collaborate with community health clinics and social service
providers through planning and financing to provide outreach, medical care, and case
management services in the community for patients who, because of mental illness,
homelessness, or other circumstances, are unlikely to obtain needed care.
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(d) The commissioner shall collaborate with medical and social service providers through
planning and financing to reduce hospital readmissions by providing discharge planning
and services, including medical respite and transitional care for patients leaving medical
facilities and mental health and chemical dependency treatment programs.
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(a) For enrollees, the commissioner shall:
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(1) maintain a hotline and website to assist enrollees in locating providers;
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(2) provide a nurse consultation helpline 24 hours per day, seven days a week; and
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(3) contact enrollees based on claims data who have not had preventive visits and help
them select a primary care provider.
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(b) For providers, the commissioner shall:
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(1) review provider reimbursement rates to ensure reasonable and fair compensation;
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(2) ensure that providers are reimbursed on a timely basis; and
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(3) collaborate with providers to explore means of improving health care quality and
reducing costs.
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This section is effective the day following final enactment. Direct
payments to providers under the Primary Care Case Management program shall be effective
when the current contracts with managed care plans under Minnesota Statutes, sections
256B.69 and 256L.12, for medical assistance and MinnesotaCare services expire.
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