Bill Text: MN HF1121 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Autism spectrum disorder or other developmental conditions screening, diagnosis, and treatment for young children included in prepaid health plans.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2013-03-13 - Committee report, to pass and re-refer to Health and Human Services Policy [HF1121 Detail]
Download: Minnesota-2013-HF1121-Introduced.html
1.2relating to human services; modifying prepaid health plans to improve screening,
1.3diagnosis, and treatment of young children with autism spectrum disorder or other
1.4developmental conditions;amending Minnesota Statutes 2012, sections 256.01,
1.5by adding a subdivision; 256B.69, subdivisions 5a, 9, by adding a subdivision.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 256.01, is amended by adding a
1.8subdivision to read:
1.9 Subd. 35. Commissioner must annually report certain prepaid medical
1.10assistance plan data. The commissioner of education may share private or nonpublic
1.11data with the commissioner of human services to allow the commissioner of human
1.12services to annually report summary data, as defined in section 13.02, subdivision 19, by
1.13health plan, on the number of children and their native language and race who have been
1.14enrolled in managed care plans under section 256B.69, or county-based purchasing plans
1.15under section 256B.692, at least one year before enrolling in school and, once enrolled,
1.16who are referred by school staff for a diagnostic assessment due to possible functional
1.17deficits as compared to their peers. The commissioner of human services shall post the
1.18summary data for each of the managed care plans cited as well as the summary data and
1.19results of the initiative under section 256B.69, subdivision 32a, for each of the plans on
1.20the Department of Human Services public Web site by September 30 of each year. The
1.21commissioner of human services shall use this information to improve plan performance
1.22in early screening, diagnosis, and treatment for children under age three who are enrolled
1.23in managed care and county-based purchasing plans under prepaid medical assistance.
1.24The commissioners of human services and education must enter into a data-sharing
1.25agreement before sharing data under this subdivision.
2.1 Sec. 2. Minnesota Statutes 2012, section 256B.69, subdivision 5a, is amended to read:
2.2 Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
2.3and section256L.12 shall be entered into or renewed on a calendar year basis beginning
2.4January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
2.5renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
2.631, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
2.7issue separate contracts with requirements specific to services to medical assistance
2.8recipients age 65 and older.
2.9 (b) A prepaid health plan providing covered health services for eligible persons
2.10pursuant to chapters 256B and 256L is responsible for complying with the terms of its
2.11contract with the commissioner. Requirements applicable to managed care programs
2.12under chapters 256B and 256L established after the effective date of a contract with the
2.13commissioner take effect when the contract is next issued or renewed.
2.14 (c) Effective for services rendered on or after January 1, 2003, the commissioner
2.15shall withhold five percent of managed care plan payments under this section and
2.16county-based purchasing plan payments under section256B.692 for the prepaid medical
2.17assistance program pending completion of performance targets. Each performance target
2.18must be quantifiable, objective, measurable, and reasonably attainable, except in the case
2.19of a performance target based on a federal or state law or rule. Criteria for assessment
2.20of each performance target must be outlined in writing prior to the contract effective
2.21date. Clinical or utilization performance targets and their related criteria must consider
2.22evidence-based research and reasonable interventions when available or applicable to the
2.23populations served, and must be developed with input from external clinical experts
2.24and stakeholders, including managed care plans, county-based purchasing plans, and
2.25providers. The managed care or county-based purchasing plan must demonstrate,
2.26to the commissioner's satisfaction, that the data submitted regarding attainment of
2.27the performance target is accurate. The commissioner shall periodically change the
2.28administrative measures used as performance targets in order to improve plan performance
2.29across a broader range of administrative services. The performance targets must include
2.30measurement of plan efforts to contain spending on health care services and administrative
2.31activities. The commissioner may adopt plan-specific performance targets that take into
2.32account factors affecting only one plan, including characteristics of the plan's enrollee
2.33population. The withheld funds must be returned no sooner than July of the following
2.34year if performance targets in the contract are achieved. The commissioner may exclude
2.35special demonstration projects under subdivision 23.
3.1 (d) Effective for services rendered on or after January 1, 2009, through December
3.231, 2009, the commissioner shall withhold three percent of managed care plan payments
3.3under this section and county-based purchasing plan payments under section256B.692
3.4for the prepaid medical assistance program. The withheld funds must be returned no
3.5sooner than July 1 and no later than July 31 of the following year. The commissioner may
3.6exclude special demonstration projects under subdivision 23.
3.7(e) Effective for services provided on or after January 1, 2010, the commissioner
3.8shall require that managed care plans use the assessment and authorization processes,
3.9forms, timelines, standards, documentation, and data reporting requirements, protocols,
3.10billing processes, and policies consistent with medical assistance fee-for-service or the
3.11Department of Human Services contract requirements consistent with medical assistance
3.12fee-for-service or the Department of Human Services contract requirements for all
3.13personal care assistance services under section256B.0659 .
3.14(f) Effective for services rendered on or after January 1, 2010, through December
3.1531, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
3.16under this section and county-based purchasing plan payments under section256B.692
3.17for the prepaid medical assistance program. The withheld funds must be returned no
3.18sooner than July 1 and no later than July 31 of the following year. The commissioner may
3.19exclude special demonstration projects under subdivision 23.
3.20(g) Effective for services rendered on or after January 1, 2011, through December
3.2131, 2011, the commissioner shall include as part of the performance targets described in
3.22paragraph (c) a reduction in the health plan's emergency room utilization rate for state
3.23health care program enrollees by a measurable rate of five percent from the plan's utilization
3.24rate for state health care program enrollees for the previous calendar year. Effective for
3.25services rendered on or after January 1, 2012, the commissioner shall include as part of the
3.26performance targets described in paragraph (c) a reduction in the health plan's emergency
3.27department utilization rate for medical assistance and MinnesotaCare enrollees, as
3.28determined by the commissioner. For 2012, the reduction shall be based on the health plan's
3.29utilization in 2009. To earn the return of the withhold each subsequent year, the managed
3.30care plan or county-based purchasing plan must achieve a qualifying reduction of no less
3.31than ten percent of the plan's emergency department utilization rate for medical assistance
3.32and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions
3.3323 and 28, compared to the previous measurement year until the final performance target
3.34is reached. When measuring performance, the commissioner must consider the difference
3.35in health risk in a managed care or county-based purchasing plan's membership in the
4.1baseline year compared to the measurement year, and work with the managed care or
4.2county-based purchasing plan to account for differences that they agree are significant.
4.3The withheld funds must be returned no sooner than July 1 and no later than July 31
4.4of the following calendar year if the managed care plan or county-based purchasing plan
4.5demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
4.6was achieved. The commissioner shall structure the withhold so that the commissioner
4.7returns a portion of the withheld funds in amounts commensurate with achieved reductions
4.8in utilization less than the targeted amount.
4.9The withhold described in this paragraph shall continue for each consecutive contract
4.10period until the plan's emergency room utilization rate for state health care program
4.11enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical
4.12assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate
4.13with the health plans in meeting this performance target and shall accept payment
4.14withholds that may be returned to the hospitals if the performance target is achieved.
4.15(h) Effective for services rendered on or after January 1, 2012, the commissioner
4.16shall include as part of the performance targets described in paragraph (c) a reduction
4.17in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
4.18enrollees, as determined by the commissioner. To earn the return of the withhold each
4.19year, the managed care plan or county-based purchasing plan must achieve a qualifying
4.20reduction of no less than five percent of the plan's hospital admission rate for medical
4.21assistance and MinnesotaCare enrollees, excluding enrollees in programs described in
4.22subdivisions 23 and 28, compared to the previous calendar year until the final performance
4.23target is reached. When measuring performance, the commissioner must consider the
4.24difference in health risk in a managed care or county-based purchasing plan's membership
4.25in the baseline year compared to the measurement year, and work with the managed care
4.26or county-based purchasing plan to account for differences that they agree are significant.
4.27The withheld funds must be returned no sooner than July 1 and no later than July
4.2831 of the following calendar year if the managed care plan or county-based purchasing
4.29plan demonstrates to the satisfaction of the commissioner that this reduction in the
4.30hospitalization rate was achieved. The commissioner shall structure the withhold so that
4.31the commissioner returns a portion of the withheld funds in amounts commensurate with
4.32achieved reductions in utilization less than the targeted amount.
4.33The withhold described in this paragraph shall continue until there is a 25 percent
4.34reduction in the hospital admission rate compared to the hospital admission rates in
4.35calendar year 2011, as determined by the commissioner. The hospital admissions in this
4.36performance target do not include the admissions applicable to the subsequent hospital
5.1admission performance target under paragraph (i). Hospitals shall cooperate with the
5.2plans in meeting this performance target and shall accept payment withholds that may be
5.3returned to the hospitals if the performance target is achieved.
5.4(i) Effective for services rendered on or after January 1, 2012, the commissioner
5.5shall include as part of the performance targets described in paragraph (c) a reduction in
5.6the plan's hospitalization admission rates for subsequent hospitalizations within 30 days of
5.7a previous hospitalization of a patient regardless of the reason, for medical assistance and
5.8MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
5.9withhold each year, the managed care plan or county-based purchasing plan must achieve
5.10a qualifying reduction of the subsequent hospitalization rate for medical assistance and
5.11MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23
5.12and 28, of no less than five percent compared to the previous calendar year until the
5.13final performance target is reached.
5.14The withheld funds must be returned no sooner than July 1 and no later than July
5.1531 of the following calendar year if the managed care plan or county-based purchasing
5.16plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in
5.17the subsequent hospitalization rate was achieved. The commissioner shall structure the
5.18withhold so that the commissioner returns a portion of the withheld funds in amounts
5.19commensurate with achieved reductions in utilization less than the targeted amount.
5.20The withhold described in this paragraph must continue for each consecutive
5.21contract period until the plan's subsequent hospitalization rate for medical assistance and
5.22MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23
5.23and 28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar
5.24year 2011. Hospitals shall cooperate with the plans in meeting this performance target and
5.25shall accept payment withholds that must be returned to the hospitals if the performance
5.26target is achieved.
5.27(j) Effective for services rendered on or after January 1, 2011, through December 31,
5.282011, the commissioner shall withhold 4.5 percent of managed care plan payments under
5.29this section and county-based purchasing plan payments under section256B.692 for the
5.30prepaid medical assistance program. The withheld funds must be returned no sooner than
5.31July 1 and no later than July 31 of the following year. The commissioner may exclude
5.32special demonstration projects under subdivision 23.
5.33(k) Effective for services rendered on or after January 1, 2012, through December
5.3431, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
5.35under this section and county-based purchasing plan payments under section256B.692
5.36for the prepaid medical assistance program. The withheld funds must be returned no
6.1sooner than July 1 and no later than July 31 of the following year. The commissioner may
6.2exclude special demonstration projects under subdivision 23.
6.3(l) Effective for services rendered on or after January 1, 2013, through December 31,
6.42013, the commissioner shall withhold 4.5 percent of managed care plan payments under
6.5this section and county-based purchasing plan payments under section256B.692 for the
6.6prepaid medical assistance program. The withheld funds must be returned no sooner than
6.7July 1 and no later than July 31 of the following year. The commissioner may exclude
6.8special demonstration projects under subdivision 23.
6.9(m) Effective for services rendered on or after January 1, 2014, the commissioner
6.10shall withhold three percent of managed care plan payments under this section and
6.11county-based purchasing plan payments under section256B.692 for the prepaid medical
6.12assistance program. The withheld funds must be returned no sooner than July 1 and
6.13no later than July 31 of the following year. The commissioner may exclude special
6.14demonstration projects under subdivision 23.
6.15(n) A managed care plan or a county-based purchasing plan under section256B.692
6.16may include as admitted assets under section
62D.044 any amount withheld under this
6.17section that is reasonably expected to be returned.
6.18(o) Contracts between the commissioner and a prepaid health plan are exempt from
6.19the set-aside and preference provisions of section16C.16, subdivisions 6 , paragraph
6.20(a), and 7.
6.21(p) The return of the withhold under paragraphs (d), (f), and (j) to (m) is not subject
6.22to the requirements of paragraph (c).
6.23(q) Effective for services rendered on or after January 1, 2014, the commissioner
6.24shall withhold two percent of managed care plan payments under this section and
6.25county-based purchasing plan payments under section 256B.692, for the prepaid medical
6.26assistance program. The commissioner may exclude special demonstration projects under
6.27subdivisions 23 and 28. The withheld funds must be returned no sooner than July 1 and
6.28no later than July 31 of the following calendar year if the managed care plan or the
6.29county-based purchasing plan demonstrates to the satisfaction of the commissioner that
6.30performance targets established by the commissioner have been met. The commissioner
6.31must design the performance targets to improve:
6.32(1) early screening between the ages of one and three years;
6.33(2) referrals for assessment when a child is not meeting developmental milestones;
6.34and
6.35(3) treatment for identified plan enrollee children with autism spectrum disorder or
6.36other developmental conditions.
7.1The commissioner shall structure the withhold so that a portion of the withheld funds is
7.2returned in amounts commensurate with the degree of performance targets met.
7.3 Sec. 3. Minnesota Statutes 2012, section 256B.69, subdivision 9, is amended to read:
7.4 Subd. 9. Reporting. (a) Each demonstration provider shall submit information as
7.5required by the commissioner, including data required for assessing client satisfaction,
7.6quality of care, cost, and utilization of services for purposes of project evaluation. The
7.7commissioner shall also develop methods of data reporting and collection in order to
7.8provide aggregate enrollee information on encounters and outcomes to determine access
7.9and quality assurance. Required information shall be specified before the commissioner
7.10contracts with a demonstration provider.
7.11(b) Aggregate nonpersonally identifiable health plan encounter data, aggregate
7.12spending data for major categories of service as reported to the commissioners of
7.13health and commerce under section62D.08 , subdivision 3, clause (a), and criteria for
7.14service authorization and service use are public data that the commissioner shall make
7.15available and use in public reports. The commissioner shall require each health plan and
7.16county-based purchasing plan to provide:
7.17(1) encounter data for each service provided, using standard codes and unit of
7.18service definitions set by the commissioner, in a form that the commissioner can report by
7.19age, eligibility groups, and health plan, including data required for the initiative described
7.20in subdivision 32a related to early screening, diagnosis, and treatment of autism spectrum
7.21disorder and other developmental conditions; and
7.22(2) criteria, written policies, and procedures required to be disclosed under section
7.2362M.10
, subdivision 7, and Code of Federal Regulations, title 42, part 438.210 (b)(1),
7.24used for each type of service for which authorization is required.
7.25(c) Each demonstration provider shall report to the commissioner on the extent to
7.26which providers employed by or under contract with the demonstration provider use
7.27patient-centered decision-making tools or procedures designed to engage patients early
7.28in the decision-making process and the steps taken by the demonstration provider to
7.29encourage their use.
7.30 Sec. 4. Minnesota Statutes 2012, section 256B.69, is amended by adding a subdivision
7.31to read:
7.32 Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
7.33young children with autism spectrum disorder and other developmental conditions.
7.34The commissioner shall require managed care plans and county-based purchasing plans,
8.1as a condition of contract, to implement strategies to assure that young children between
8.2the ages of one and three years have periodic developmental screenings and that those who
8.3do not meet developmental milestones are provided a full assessment, including treatment
8.4recommendations, which will allow the child to improve functioning, demonstrated by
8.5assessments every six months, with the goal of meeting developmental milestones by age
8.6five. The plans must report the following data:
8.7(1) the age, native language, and race of each child screened;
8.8(2) the number of children screened who received a full diagnostic assessment to
8.9determine the treatment needs to improve the child's function;
8.10(3) the number of children who received treatments;
8.11(4) the types of treatments provided listed by billing code;
8.12(5) the amount of each treatment provided for each child over the plan year; and
8.13(6) the levels of improvement shown for each six-month period of treatment.
8.14The plans shall provide to the commissioner information on barriers to providing screening,
8.15diagnosis, and treatment of young children between the ages of one and three years.
1.3diagnosis, and treatment of young children with autism spectrum disorder or other
1.4developmental conditions;amending Minnesota Statutes 2012, sections 256.01,
1.5by adding a subdivision; 256B.69, subdivisions 5a, 9, by adding a subdivision.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 256.01, is amended by adding a
1.8subdivision to read:
1.9 Subd. 35. Commissioner must annually report certain prepaid medical
1.10assistance plan data. The commissioner of education may share private or nonpublic
1.11data with the commissioner of human services to allow the commissioner of human
1.12services to annually report summary data, as defined in section 13.02, subdivision 19, by
1.13health plan, on the number of children and their native language and race who have been
1.14enrolled in managed care plans under section 256B.69, or county-based purchasing plans
1.15under section 256B.692, at least one year before enrolling in school and, once enrolled,
1.16who are referred by school staff for a diagnostic assessment due to possible functional
1.17deficits as compared to their peers. The commissioner of human services shall post the
1.18summary data for each of the managed care plans cited as well as the summary data and
1.19results of the initiative under section 256B.69, subdivision 32a, for each of the plans on
1.20the Department of Human Services public Web site by September 30 of each year. The
1.21commissioner of human services shall use this information to improve plan performance
1.22in early screening, diagnosis, and treatment for children under age three who are enrolled
1.23in managed care and county-based purchasing plans under prepaid medical assistance.
1.24The commissioners of human services and education must enter into a data-sharing
1.25agreement before sharing data under this subdivision.
2.1 Sec. 2. Minnesota Statutes 2012, section 256B.69, subdivision 5a, is amended to read:
2.2 Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
2.3and section
2.4January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
2.5renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
2.631, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
2.7issue separate contracts with requirements specific to services to medical assistance
2.8recipients age 65 and older.
2.9 (b) A prepaid health plan providing covered health services for eligible persons
2.10pursuant to chapters 256B and 256L is responsible for complying with the terms of its
2.11contract with the commissioner. Requirements applicable to managed care programs
2.12under chapters 256B and 256L established after the effective date of a contract with the
2.13commissioner take effect when the contract is next issued or renewed.
2.14 (c) Effective for services rendered on or after January 1, 2003, the commissioner
2.15shall withhold five percent of managed care plan payments under this section and
2.16county-based purchasing plan payments under section
2.17assistance program pending completion of performance targets. Each performance target
2.18must be quantifiable, objective, measurable, and reasonably attainable, except in the case
2.19of a performance target based on a federal or state law or rule. Criteria for assessment
2.20of each performance target must be outlined in writing prior to the contract effective
2.21date. Clinical or utilization performance targets and their related criteria must consider
2.22evidence-based research and reasonable interventions when available or applicable to the
2.23populations served, and must be developed with input from external clinical experts
2.24and stakeholders, including managed care plans, county-based purchasing plans, and
2.25providers. The managed care or county-based purchasing plan must demonstrate,
2.26to the commissioner's satisfaction, that the data submitted regarding attainment of
2.27the performance target is accurate. The commissioner shall periodically change the
2.28administrative measures used as performance targets in order to improve plan performance
2.29across a broader range of administrative services. The performance targets must include
2.30measurement of plan efforts to contain spending on health care services and administrative
2.31activities. The commissioner may adopt plan-specific performance targets that take into
2.32account factors affecting only one plan, including characteristics of the plan's enrollee
2.33population. The withheld funds must be returned no sooner than July of the following
2.34year if performance targets in the contract are achieved. The commissioner may exclude
2.35special demonstration projects under subdivision 23.
3.1 (d) Effective for services rendered on or after January 1, 2009, through December
3.231, 2009, the commissioner shall withhold three percent of managed care plan payments
3.3under this section and county-based purchasing plan payments under section
3.5sooner than July 1 and no later than July 31 of the following year. The commissioner may
3.6exclude special demonstration projects under subdivision 23.
3.7(e) Effective for services provided on or after January 1, 2010, the commissioner
3.8shall require that managed care plans use the assessment and authorization processes,
3.9forms, timelines, standards, documentation, and data reporting requirements, protocols,
3.10billing processes, and policies consistent with medical assistance fee-for-service or the
3.11Department of Human Services contract requirements consistent with medical assistance
3.12fee-for-service or the Department of Human Services contract requirements for all
3.13personal care assistance services under section
3.14(f) Effective for services rendered on or after January 1, 2010, through December
3.1531, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
3.16under this section and county-based purchasing plan payments under section
3.18sooner than July 1 and no later than July 31 of the following year. The commissioner may
3.19exclude special demonstration projects under subdivision 23.
3.20(g) Effective for services rendered on or after January 1, 2011, through December
3.2131, 2011, the commissioner shall include as part of the performance targets described in
3.22paragraph (c) a reduction in the health plan's emergency room utilization rate for state
3.23health care program enrollees by a measurable rate of five percent from the plan's utilization
3.24rate for state health care program enrollees for the previous calendar year. Effective for
3.25services rendered on or after January 1, 2012, the commissioner shall include as part of the
3.26performance targets described in paragraph (c) a reduction in the health plan's emergency
3.27department utilization rate for medical assistance and MinnesotaCare enrollees, as
3.28determined by the commissioner. For 2012, the reduction shall be based on the health plan's
3.29utilization in 2009. To earn the return of the withhold each subsequent year, the managed
3.30care plan or county-based purchasing plan must achieve a qualifying reduction of no less
3.31than ten percent of the plan's emergency department utilization rate for medical assistance
3.32and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions
3.3323 and 28, compared to the previous measurement year until the final performance target
3.34is reached. When measuring performance, the commissioner must consider the difference
3.35in health risk in a managed care or county-based purchasing plan's membership in the
4.1baseline year compared to the measurement year, and work with the managed care or
4.2county-based purchasing plan to account for differences that they agree are significant.
4.3The withheld funds must be returned no sooner than July 1 and no later than July 31
4.4of the following calendar year if the managed care plan or county-based purchasing plan
4.5demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
4.6was achieved. The commissioner shall structure the withhold so that the commissioner
4.7returns a portion of the withheld funds in amounts commensurate with achieved reductions
4.8in utilization less than the targeted amount.
4.9The withhold described in this paragraph shall continue for each consecutive contract
4.10period until the plan's emergency room utilization rate for state health care program
4.11enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical
4.12assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate
4.13with the health plans in meeting this performance target and shall accept payment
4.14withholds that may be returned to the hospitals if the performance target is achieved.
4.15(h) Effective for services rendered on or after January 1, 2012, the commissioner
4.16shall include as part of the performance targets described in paragraph (c) a reduction
4.17in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
4.18enrollees, as determined by the commissioner. To earn the return of the withhold each
4.19year, the managed care plan or county-based purchasing plan must achieve a qualifying
4.20reduction of no less than five percent of the plan's hospital admission rate for medical
4.21assistance and MinnesotaCare enrollees, excluding enrollees in programs described in
4.22subdivisions 23 and 28, compared to the previous calendar year until the final performance
4.23target is reached. When measuring performance, the commissioner must consider the
4.24difference in health risk in a managed care or county-based purchasing plan's membership
4.25in the baseline year compared to the measurement year, and work with the managed care
4.26or county-based purchasing plan to account for differences that they agree are significant.
4.27The withheld funds must be returned no sooner than July 1 and no later than July
4.2831 of the following calendar year if the managed care plan or county-based purchasing
4.29plan demonstrates to the satisfaction of the commissioner that this reduction in the
4.30hospitalization rate was achieved. The commissioner shall structure the withhold so that
4.31the commissioner returns a portion of the withheld funds in amounts commensurate with
4.32achieved reductions in utilization less than the targeted amount.
4.33The withhold described in this paragraph shall continue until there is a 25 percent
4.34reduction in the hospital admission rate compared to the hospital admission rates in
4.35calendar year 2011, as determined by the commissioner. The hospital admissions in this
4.36performance target do not include the admissions applicable to the subsequent hospital
5.1admission performance target under paragraph (i). Hospitals shall cooperate with the
5.2plans in meeting this performance target and shall accept payment withholds that may be
5.3returned to the hospitals if the performance target is achieved.
5.4(i) Effective for services rendered on or after January 1, 2012, the commissioner
5.5shall include as part of the performance targets described in paragraph (c) a reduction in
5.6the plan's hospitalization admission rates for subsequent hospitalizations within 30 days of
5.7a previous hospitalization of a patient regardless of the reason, for medical assistance and
5.8MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
5.9withhold each year, the managed care plan or county-based purchasing plan must achieve
5.10a qualifying reduction of the subsequent hospitalization rate for medical assistance and
5.11MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23
5.12and 28, of no less than five percent compared to the previous calendar year until the
5.13final performance target is reached.
5.14The withheld funds must be returned no sooner than July 1 and no later than July
5.1531 of the following calendar year if the managed care plan or county-based purchasing
5.16plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in
5.17the subsequent hospitalization rate was achieved. The commissioner shall structure the
5.18withhold so that the commissioner returns a portion of the withheld funds in amounts
5.19commensurate with achieved reductions in utilization less than the targeted amount.
5.20The withhold described in this paragraph must continue for each consecutive
5.21contract period until the plan's subsequent hospitalization rate for medical assistance and
5.22MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23
5.23and 28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar
5.24year 2011. Hospitals shall cooperate with the plans in meeting this performance target and
5.25shall accept payment withholds that must be returned to the hospitals if the performance
5.26target is achieved.
5.27(j) Effective for services rendered on or after January 1, 2011, through December 31,
5.282011, the commissioner shall withhold 4.5 percent of managed care plan payments under
5.29this section and county-based purchasing plan payments under section
5.30prepaid medical assistance program. The withheld funds must be returned no sooner than
5.31July 1 and no later than July 31 of the following year. The commissioner may exclude
5.32special demonstration projects under subdivision 23.
5.33(k) Effective for services rendered on or after January 1, 2012, through December
5.3431, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
5.35under this section and county-based purchasing plan payments under section
6.1sooner than July 1 and no later than July 31 of the following year. The commissioner may
6.2exclude special demonstration projects under subdivision 23.
6.3(l) Effective for services rendered on or after January 1, 2013, through December 31,
6.42013, the commissioner shall withhold 4.5 percent of managed care plan payments under
6.5this section and county-based purchasing plan payments under section
6.6prepaid medical assistance program. The withheld funds must be returned no sooner than
6.7July 1 and no later than July 31 of the following year. The commissioner may exclude
6.8special demonstration projects under subdivision 23.
6.9(m) Effective for services rendered on or after January 1, 2014, the commissioner
6.10shall withhold three percent of managed care plan payments under this section and
6.11county-based purchasing plan payments under section
6.12assistance program. The withheld funds must be returned no sooner than July 1 and
6.13no later than July 31 of the following year. The commissioner may exclude special
6.14demonstration projects under subdivision 23.
6.15(n) A managed care plan or a county-based purchasing plan under section
6.17section that is reasonably expected to be returned.
6.18(o) Contracts between the commissioner and a prepaid health plan are exempt from
6.19the set-aside and preference provisions of section
6.20(a), and 7.
6.21(p) The return of the withhold under paragraphs (d), (f), and (j) to (m) is not subject
6.22to the requirements of paragraph (c).
6.23(q) Effective for services rendered on or after January 1, 2014, the commissioner
6.24shall withhold two percent of managed care plan payments under this section and
6.25county-based purchasing plan payments under section 256B.692, for the prepaid medical
6.26assistance program. The commissioner may exclude special demonstration projects under
6.27subdivisions 23 and 28. The withheld funds must be returned no sooner than July 1 and
6.28no later than July 31 of the following calendar year if the managed care plan or the
6.29county-based purchasing plan demonstrates to the satisfaction of the commissioner that
6.30performance targets established by the commissioner have been met. The commissioner
6.31must design the performance targets to improve:
6.32(1) early screening between the ages of one and three years;
6.33(2) referrals for assessment when a child is not meeting developmental milestones;
6.34and
6.35(3) treatment for identified plan enrollee children with autism spectrum disorder or
6.36other developmental conditions.
7.1The commissioner shall structure the withhold so that a portion of the withheld funds is
7.2returned in amounts commensurate with the degree of performance targets met.
7.3 Sec. 3. Minnesota Statutes 2012, section 256B.69, subdivision 9, is amended to read:
7.4 Subd. 9. Reporting. (a) Each demonstration provider shall submit information as
7.5required by the commissioner, including data required for assessing client satisfaction,
7.6quality of care, cost, and utilization of services for purposes of project evaluation. The
7.7commissioner shall also develop methods of data reporting and collection in order to
7.8provide aggregate enrollee information on encounters and outcomes to determine access
7.9and quality assurance. Required information shall be specified before the commissioner
7.10contracts with a demonstration provider.
7.11(b) Aggregate nonpersonally identifiable health plan encounter data, aggregate
7.12spending data for major categories of service as reported to the commissioners of
7.13health and commerce under section
7.14service authorization and service use are public data that the commissioner shall make
7.15available and use in public reports. The commissioner shall require each health plan and
7.16county-based purchasing plan to provide:
7.17(1) encounter data for each service provided, using standard codes and unit of
7.18service definitions set by the commissioner, in a form that the commissioner can report by
7.19age, eligibility groups, and health plan, including data required for the initiative described
7.20in subdivision 32a related to early screening, diagnosis, and treatment of autism spectrum
7.21disorder and other developmental conditions; and
7.22(2) criteria, written policies, and procedures required to be disclosed under section
7.24used for each type of service for which authorization is required.
7.25(c) Each demonstration provider shall report to the commissioner on the extent to
7.26which providers employed by or under contract with the demonstration provider use
7.27patient-centered decision-making tools or procedures designed to engage patients early
7.28in the decision-making process and the steps taken by the demonstration provider to
7.29encourage their use.
7.30 Sec. 4. Minnesota Statutes 2012, section 256B.69, is amended by adding a subdivision
7.31to read:
7.32 Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
7.33young children with autism spectrum disorder and other developmental conditions.
7.34The commissioner shall require managed care plans and county-based purchasing plans,
8.1as a condition of contract, to implement strategies to assure that young children between
8.2the ages of one and three years have periodic developmental screenings and that those who
8.3do not meet developmental milestones are provided a full assessment, including treatment
8.4recommendations, which will allow the child to improve functioning, demonstrated by
8.5assessments every six months, with the goal of meeting developmental milestones by age
8.6five. The plans must report the following data:
8.7(1) the age, native language, and race of each child screened;
8.8(2) the number of children screened who received a full diagnostic assessment to
8.9determine the treatment needs to improve the child's function;
8.10(3) the number of children who received treatments;
8.11(4) the types of treatments provided listed by billing code;
8.12(5) the amount of each treatment provided for each child over the plan year; and
8.13(6) the levels of improvement shown for each six-month period of treatment.
8.14The plans shall provide to the commissioner information on barriers to providing screening,
8.15diagnosis, and treatment of young children between the ages of one and three years.
