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 orient new clinicians and staff to the health care home's care delivery approach.

Subp. 2.

Contents of application.

The eligible provider must submit the following to the commissioner:

A.

a completed self-assessment prescribed by the commissioner and made available on the Department of Health website that describes how the eligible provider meets the requirements in part 4764.0040;

B.

a completed application prescribed by the commissioner and made available on the Department of Health website; and

C.

any other information required by the commissioner to show that the eligible provider 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 eligible provider or health care home 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 indicate its intent to be recertified in the manner prescribed by the commissioner no later than 60 days before the three-year anniversary of its last certification or recertification and do the following:

A.

continue to meet the requirements for initial certification;

B.

meet the recertification requirements for each health care home standard in part 4764.0040, and the requirement that the health care home achieves outcomes in its primary care services patient population for patient health, patient experience, and cost-effectiveness as established by the commissioner under subpart 6; and

C.

continue to meet the requirements for level 2 and level 3 certification, if applicable.

Subp. 5a.

How to seek certification as a level 2 or level 3 health care home.

The eligible provider or health care home may indicate its intent to seek level 2 or level 3 certification at the time of certification or at any time following certification as a health care home in the manner prescribed by the commissioner. The eligible provider or health care home must demonstrate how they have met the level 2 or level 3 requirements according to part 4764.0040 and do the following:

A.

meet all foundational level certification and recertification requirements;

B.

address how the health care home is working to resolve any outstanding requirements and corrective action plans, if applicable; and

C.

if requested, participate in an on-site review and provide additional information or documentation necessary for the commissioner to make the determination that the health care home should be certified at level 2 or level 3.

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 eligible provider or health care home in writing regarding whether the eligible provider or health care home is certified or recertified as a health care home or certified at level 2 or level 3 within 90 days after receiving a completed application.

B.

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

Statutory Authority:

MS s 62U.03; 256B.0751; 256B.0752; 256B.0753

History:

34 SR 591; 47 SR 338

Published Electronically:

November 17, 2023