Minnesota Administrative Rules

4764.0030 CERTIFICATION AND RECERTIFICATION PROCEDURES.

Subpart 1.

Eligibility for certification.

A.

An eligible provider, supported by a care team and systems according to the requirements in part 4764.0040, may apply for certification as a health care home.

B.

A clinic will be certified only if all of the clinic's personal clinicians and local trade area clinicians meet the requirements for participation in the health care home. It is the clinic's responsibility to notify the department when a new clinician joins a certified clinic and intends to become a certified clinician. The clinic has 90 days from the date of hiring the new clinician or until its next annual anniversary date to apply for recertification, whichever is sooner. A clinic may operate as a certified clinic with the new clinician acting as though certified until the new clinician is certified. If the clinician chooses not to be certified, the clinic will no longer be certified, but the clinicians who were previously certified as part of the clinic will automatically hold an individual certification only.

Subp. 2.

Contents of application.

The applicant must submit the following to the commissioner:

A.

a completed self-assessment in a form prescribed by the commissioner which describes how the applicant meets the requirements in part 4764.0040;

B.

a completed and signed application form prescribed by the commissioner; and

C.

any other information required by the commissioner to show that the applicant meets the standards for certification or recertification.

Subp. 3.

On-site review and additional documentation.

The commissioner may conduct an on-site review and may request additional documentation to determine whether the applicant complies with certification or recertification requirements.

Subp. 4.

Completed application for certification.

An application for certification or recertification is complete when the commissioner has received all information in subpart 2; the on-site review, if any, has been completed; and the commissioner has received any additional documentation requested under subpart 3.

Subp. 5.

How to seek recertification.

To retain certification, a health care home must submit a letter of intent stating its desire to be recertified no later than 60 days before the one-year anniversary of its last certification or recertification and do the following:

A.

At the end of year one, an applicant must demonstrate:

(1)

the requirements for initial certification continue to be met; and

(2)

the requirements for the end of year one for each health care home standard in part 4764.0040 are met.

B.

At the end of year two and all subsequent years, unless the applicant obtains a variance for superior outcomes and continued progress on standards as provided in part 4764.0050, subpart 3, an applicant must demonstrate:

(1)

the requirements for initial certification and recertification at the end of year one continue to be met; and

(2)

the requirements for recertification at the end of year two in part 4764.0040, subpart 11, are met, including the requirement that the applicant's outcomes in its primary care services patient population achieve the benchmarks for patient health, patient experience, and cost-effectiveness established by the commissioner under subpart 6.

Subp. 6.

Benchmarks.

The commissioner must announce benchmarks for patient health, patient experience, and cost-effectiveness annually. The benchmarks must be based on one or more of the following factors:

A.

an improvement over time as reflected by a comparison of data measuring quality submitted by the health care home in the current year to data submitted in prior years;

B.

a comparison of data measuring quality submitted by the health care home to data submitted by other health care homes;

C.

standards established by state or federal law;

D.

best practices recommended by a scientifically based outcomes development organization;

E.

measures established by a national accrediting body or professional association; and

F.

additional measures that improve the quality or enhance the use of data currently being collected.

Subp. 7.

Notice of decision and timelines.

A.

The commissioner must notify an applicant in writing regarding whether the applicant is certified or recertified as a health care home within 90 days after receiving a completed application.

B.

If the commissioner certifies or recertifies the applicant as a health care home, the health care home is eligible for per-person care coordination payments under the care coordination payment system.

C.

If the commissioner denies the application for certification or recertification, the commissioner must notify the applicant in writing of the reasons for the denial. The applicant may file an appeal under part 4764.0060.

Statutory Authority:

MS s 256B.0751; 256B.0752; 256B.0753

History:

34 SR 591

Published Electronically:

January 13, 2010