1.1Senator Drazkowski moved to amend
H.F. No. 2435, as amended pursuant to Rule 45,
1.2adopted by the Senate May 13, 2025, as follows (...):
1.3(The text of the amended House File is identical to
S.F. No. 2669.)
1.4Page 237, after line 12, insert:
1.5 "Sec. 16. Minnesota Statutes 2024, section 256B.69, subdivision 5a, is amended to read:
1.6 Subd. 5a.
Managed care contracts. (a) Managed care contracts under this section and
1.7section
256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
1.8may issue separate contracts with requirements specific to services to medical assistance
1.9recipients age 65 and older.
1.10 (b) A prepaid health plan providing covered health services for eligible persons pursuant
1.11to chapters
256B and
256L is responsible for complying with the terms of its contract with
1.12the commissioner. Requirements applicable to managed care programs under chapters
256B
1.13and
256L established after the effective date of a contract with the commissioner take effect
1.14when the contract is next issued or renewed.
1.15 (c) The commissioner shall withhold five percent of managed care plan payments under
1.16this section and county-based purchasing plan payments under section
256B.692 for the
1.17prepaid medical assistance program pending completion of performance targets. Each
1.18performance target must be quantifiable, objective, measurable, and reasonably attainable,
1.19except in the case of a performance target based on a federal or state law or rule.
Criteria
1.20for assessment of each performance target must be outlined in writing prior to the
contract
1.21effective date. Clinical or utilization performance targets and their related criteria
must
1.22consider evidence-based research and reasonable interventions when available or applicable
1.23to the populations served, and must be developed with input from external clinical
experts
1.24and stakeholders, including managed care plans, county-based purchasing plans, and
1.25providers. The managed care or county-based purchasing plan must demonstrate, to the
1.26commissioner's satisfaction, that the data submitted regarding attainment of the performance
1.27target is accurate. The commissioner shall periodically change the administrative
measures
1.28used as performance targets in order to improve plan performance across a broader
range
1.29of administrative services. The performance targets must include measurement of plan
1.30efforts to contain spending on health care services and administrative activities.
The
1.31commissioner may adopt plan-specific performance targets that take into account factors
1.32affecting only one plan, including characteristics of the plan's enrollee population.
The
1.33withheld funds must be returned no sooner than July of the following year if performance
2.1targets in the contract are achieved. The commissioner may exclude special demonstration
2.2projects under subdivision 23.
2.3(d) The commissioner shall require that managed care plans:
2.4(1) use the assessment and authorization processes, forms, timelines, standards,
2.5documentation, and data reporting requirements, protocols, billing processes, and
policies
2.6consistent with medical assistance fee-for-service or the Department of Human Services
2.7contract requirements for all personal care assistance services under section
256B.0659 and
2.8community first services and supports under section
256B.85;
2.9(2) by January 30 of each year that follows a rate increase for any aspect of services
2.10under section
256B.0659 or
256B.85, inform the commissioner and the chairs and ranking
2.11minority members of the legislative committees with jurisdiction over rates determined
2.12under section
256B.851 of the amount of the rate increase that is paid to each personal care
2.13assistance provider agency with which the plan has a contract; and
2.14(3) use a six-month timely filing standard and provide an exemption to the timely
filing
2.15timeliness for the resubmission of claims where there has been a denial, request for
more
2.16information, or system issue.
2.17(e) Effective for services rendered on or after January 1, 2013, through December
31,
2.182013, The commissioner shall withhold 4.5 percent of managed care plan payments under
2.19this section and county-based purchasing plan payments under section
256B.692 for the
2.20prepaid medical assistance program. The withheld funds must be returned no sooner
than
2.21July 1 and no later than July 31 of the following year. The commissioner may exclude
2.22special demonstration projects under subdivision 23.
2.23(f) Effective for services rendered on or after January 1, 2014, (e) The commissioner
2.24shall withhold three percent of managed care plan payments under this section and
2.25county-based purchasing plan payments under section
256B.692 for the prepaid medical
2.26assistance program. The withheld funds must be returned no sooner than July 1 and
no later
2.27than July 31 of the following year. The commissioner may exclude special demonstration
2.28projects under subdivision 23.
2.29(g) (f) A managed care plan or a county-based purchasing plan under section
256B.692
2.30may include as admitted assets under section
62D.044 any amount withheld under this
2.31section that is reasonably expected to be returned.
3.1(h) (g) Contracts between the commissioner and a prepaid health plan are exempt from
3.2the set-aside and preference provisions of section
16C.16, subdivisions 6, paragraph (a),
3.3and 7.
3.4(i) (h) The return of the withhold under
paragraphs paragraph (e)
and (f) is not subject
3.5to the requirements of paragraph (c).
3.6(j) (i) Managed care plans and county-based purchasing plans shall maintain current and
3.7fully executed agreements for all subcontractors, including bargaining groups, for
3.8administrative services that are expensed to the state's public health care programs.
3.9Subcontractor agreements determined to be material, as defined by the commissioner
after
3.10taking into account state contracting and relevant statutory requirements, must be
in the
3.11form of a written instrument or electronic document containing the elements of offer,
3.12acceptance, consideration, payment terms, scope, duration of the contract, and how
the
3.13subcontractor services relate to state public health care programs. Upon request,
the
3.14commissioner shall have access to all subcontractor documentation under this paragraph.
3.15Nothing in this paragraph shall allow release of information that is nonpublic data
pursuant
3.16to section
13.02.
3.17(j) Effective for services provided on or after January 1, 2026, through December
31,
3.182026, the commissioner shall withhold two percent of the capitation payment provided
to
3.19managed care plans under this section and county-based purchasing plans under section
3.20256B.692, for each medical assistance enrollee. The withheld funds must be returned
no
3.21sooner than July 1 and no later than July 31 of the following year for capitation
payments
3.22for enrollees for whom the plan submitted to the commissioner a verification of coverage
3.23form completed and signed by the enrollee. The verification of coverage form must
be
3.24developed by the commissioner and made available to managed care and county-based
3.25purchasing plans. The form must require the enrollee to provide the enrollee's name
and
3.26street address and the name of the managed care or county-based purchasing plan selected
3.27by or assigned to the enrollee. The form must include a signature block that allows
the
3.28enrollee to attest that the information provided is accurate; the enrollee is not
enrolled in,
3.29or has provided all requested information to the commissioner regarding the enrollee's
3.30participation in a group health plan, individual market plan, or medical assistance
plan in
3.31a different state; and the enrollee meets the applicable eligibility requirements
under section
3.32256B.056. A plan must request that all enrollees complete the verification of coverage
form,
3.33and must submit all completed forms to the commissioner by February 28, 2026. If a
3.34completed form for an enrollee is not received by the commissioner by that date:
3.35(1) the commissioner shall not return funds to the plan withheld for that enrollee;
4.1(2) the commissioner shall cease making capitation payments to the plan for that enrollee,
4.2effective for the April 2026 coverage month; and
4.3(3) the commissioner shall disenroll the enrollee from medical assistance, subject
to any
4.4enrollee appeal.
4.5(k) By January 1, 2027, and every two years thereafter, the commissioner must submit
4.6a report to the chairs and ranking minority members of the legislative committees
on health
4.7and human services finance and policy on the state's compliance with federal and state
4.8eligibility requirements for individuals enrolled in the medical assistance and MinnesotaCare
4.9programs. The report mandate under this paragraph is not subject to section 256.01,
4.10subdivision 42, and does not expire. The report must analyze:
4.11(1) the number of individuals that received benefits under the medical assistance
and
4.12MinnesotaCare programs that were ineligible for such benefits;
4.13(2) the amount of benefits provided to individuals under the medical assistance and
4.14MinnesotaCare programs that were ineligible for such benefits;
4.15(3) the commissioner's compliance with the redetermination of eligibility requirements
4.16in sections 256B.056, subdivisions 7 and 7a, and 256L.05, subdivision 3a; and
4.17(4) the number of enrollees disenrolled from the medical assistance program pursuant
4.18to paragraph (j), clause (3)."
4.19Pages 249 to 250, delete sections 22 to 26
4.20Renumber the sections in sequence and correct the internal references
4.21Amend the title accordingly
4.22The motion prevailed. #did not prevail. So the amendment was #not adopted.