Minnesota 2025-2026 Regular Session

Minnesota House Bill HF2955 Compare Versions

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1	1	1.1 A bill for an act
2	2	1.2 relating to human services; establishing a county-administered rural medical
3	3	1.3 assistance program; establishing payment, coverage, and eligibility requirements
4	4	1.4 for the CARMA program; directing the commissioner of human services to seek
5	5	1.5 federal waivers; amending Minnesota Statutes 2024, section 256B.69, subdivision
6	6	1.6 3a; proposing coding for new law in Minnesota Statutes, chapter 256B.
7	7	1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
8	8	1.8 Section 1. Minnesota Statutes 2024, section 256B.69, subdivision 3a, is amended to read:
9	9	1.9 Subd. 3a.County authority.(a) The commissioner, when implementing the medical
10	10	1.10assistance prepayment program within a county, must include the county board in the process
11	11	1.11of development, approval, and issuance of the request for proposals to provide services to
12	12	1.12eligible individuals within the proposed county. County boards must be given reasonable
13	13	1.13opportunity to make recommendations regarding the development, issuance, review of
14	14	1.14responses, and changes needed in the request for proposals. The commissioner must provide
15	15	1.15county boards the opportunity to review each proposal based on the identification of
16	16	1.16community needs under chapters 142F and 145A and county advocacy activities. If a county
17	17	1.17board finds that a proposal does not address certain community needs, the county board and
18	18	1.18commissioner shall continue efforts for improving the proposal and network prior to the
19	19	1.19approval of the contract. The county board shall make recommendations regarding the
20	20	1.20approval of local networks and their operations to ensure adequate availability and access
21	21	1.21to covered services. The provider or health plan must respond directly to county advocates
22	22	1.22and the state prepaid medical assistance ombudsperson regarding service delivery and must
23	23	1.23be accountable to the state regarding contracts with medical assistance funds. The county
24	24	1.24board may recommend a maximum number of participating health plans after considering
25	25	1Section 1.
26	26	REVISOR AGW/EN 25-0420903/24/25
27	27	State of Minnesota
28	28	This Document can be made available
29	29	in alternative formats upon request
30	30	HOUSE OF REPRESENTATIVES
31	31	H. F. No. 2955
32	32	NINETY-FOURTH SESSION
33	33	Authored by Backer, Bierman, Nadeau, Fischer and Huot04/01/2025
34	34	The bill was read for the first time and referred to the Committee on Health Finance and Policy 2.1the size of the enrolling population; ensuring adequate access and capacity; considering the
35	35	2.2client and county administrative complexity; and considering the need to promote the
36	36	2.3viability of locally developed health plans. The county board or a single entity representing
37	37	2.4a group of county boards and the commissioner shall mutually select health plans for
38	38	2.5participation at the time of initial implementation of the prepaid medical assistance program
39	39	2.6in that county or group of counties and at the time of contract renewal. The commissioner
40	40	2.7shall also seek input for contract requirements from the county or single entity representing
41	41	2.8a group of county boards at each contract renewal and incorporate those recommendations
42	42	2.9into the contract negotiation process.
43	43	2.10 (b) At the option of the county board, the board may develop contract requirements
44	44	2.11related to the achievement of local public health goals to meet the health needs of medical
45	45	2.12assistance enrollees. These requirements must be reasonably related to the performance of
46	46	2.13health plan functions and within the scope of the medical assistance benefit set. If the county
47	47	2.14board and the commissioner mutually agree to such requirements, the department shall
48	48	2.15include such requirements in all health plan contracts governing the prepaid medical
49	49	2.16assistance program in that county at initial implementation of the program in that county
50	50	2.17and at the time of contract renewal. The county board may participate in the enforcement
51	51	2.18of the contract provisions related to local public health goals.
52	52	2.19 (c) For counties in which a prepaid medical assistance program has not been established,
53	53	2.20the commissioner shall not implement that program if a county board submits an acceptable
54	54	2.21and timely preliminary and final proposal under section 256B.692, until county-based
55	55	2.22purchasing is no longer operational in that county. For counties in which a prepaid medical
56	56	2.23assistance program is in existence on or after September 1, 1997, the commissioner must
57	57	2.24terminate contracts with health plans according to section 256B.692, subdivision 5, if the
58	58	2.25county board submits and the commissioner accepts a preliminary and final proposal
59	59	2.26according to that subdivision. The commissioner is not required to terminate contracts that
60	60	2.27begin on or after September 1, 1997, according to section 256B.692 until two years have
61	61	2.28elapsed from the date of initial enrollment. This paragraph expires upon the effective date
62	62	2.29of paragraph (d).
63	63	2.30 (d) Effective January 1, 2027, for counties in which a prepaid medical assistance program
64	64	2.31is in existence on or after September 1, 1997, the commissioner must terminate contracts
65	65	2.32with health plans according to section 256B.692, subdivision 5, if the county board submits
66	66	2.33and the commissioner accepts a preliminary and final proposal according to that subdivision.
67	67	2.34 (d) (e) In the event that a county board or a single entity representing a group of county
68	68	2.35boards and the commissioner cannot reach agreement regarding: (i) the selection of
69	69	2Section 1.
70	70	REVISOR AGW/EN 25-0420903/24/25 3.1participating health plans in that county; (ii) contract requirements; or (iii) implementation
71	71	3.2and enforcement of county requirements including provisions regarding local public health
72	72	3.3goals, the commissioner shall resolve all disputes after taking into account the
73	73	3.4recommendations of a three-person mediation panel. The panel shall be composed of one
74	74	3.5designee of the president of the association of Minnesota counties, one designee of the
75	75	3.6commissioner of human services, and one person selected jointly by the designee of the
76	76	3.7commissioner of human services and the designee of the Association of Minnesota Counties.
77	77	3.8Within a reasonable period of time before the hearing, the panelists must be provided all
78	78	3.9documents and information relevant to the mediation. The parties to the mediation must be
79	79	3.10given 30 days' notice of a hearing before the mediation panel.
80	80	3.11 (e) (f) If a county which elects to implement county-based purchasing ceases to implement
81	81	3.12county-based purchasing, it is prohibited from assuming the responsibility of county-based
82	82	3.13purchasing for a period of five years from the date it discontinues purchasing.
83	83	3.14 (f) (g) The commissioner shall not require that contractual disputes between county-based
84	84	3.15purchasing entities and the commissioner be mediated by a panel that includes a
85	85	3.16representative of the Minnesota Council of Health Plans.
86	86	3.17 (g) (h) At the request of a county-purchasing entity, the commissioner shall adopt a
87	87	3.18contract reprocurement or renewal schedule under which all counties included in the entity's
88	88	3.19service area are reprocured or renewed at the same time.
89	89	3.20 (h) (i) The commissioner shall provide a written report under section 3.195 to the chairs
90	90	3.21of the legislative committees having jurisdiction over human services in the senate and the
91	91	3.22house of representatives describing in detail the activities undertaken by the commissioner
92	92	3.23to ensure full compliance with this section. The report must also provide an explanation for
93	93	3.24any decisions of the commissioner not to accept the recommendations of a county or group
94	94	3.25of counties required to be consulted under this section. The report must be provided at least
95	95	3.2630 days prior to the effective date of a new or renewed prepaid or managed care contract
96	96	3.27in a county.
97	97	3.28 EFFECTIVE DATE.This section is effective January 1, 2027.
98	98	3.29 Sec. 2. [256B.695] COUNTY-ADMINISTERED RURAL MEDICAL ASSISTANCE
99	99	3.30PROGRAM.
100	100	3.31 Subdivision 1.Definitions.(a) For the purposes of this section, the following terms have
101	101	3.32the meanings given.
102	102	3Sec. 2.
103	103	REVISOR AGW/EN 25-0420903/24/25 4.1 (b) "CARMA" means the county-administered rural medical assistance program
104	104	4.2established under this section.
105	105	4.3 (c) "Commissioner" means the commissioner of human services.
106	106	4.4 (d) "Eligible individual" means an individual who is:
107	107	4.5 (1) residing in a county administering CARMA; and
108	108	4.6 (2) eligible for medical assistance, MinnesotaCare, Minnesota Senior Health Options
109	109	4.7(MSHO), Minnesota Senior Care Plus (MSC+), or Special Needs Basic Care (SNBC).
110	110	4.8 (e) "Enrollee" means an individual enrolled in CARMA.
111	111	4.9 (f) "PMAP" means the prepaid medical assistance program under section 256B.69.
112	112	4.10 (g) "Rural county" has the meaning given to "rural area" in Code of Federal Regulations,
113	113	4.11title 42, section 438.52.
114	114	4.12 Subd. 2.Program established.A county-administered rural medical assistance program
115	115	4.13is established to:
116	116	4.14 (1) provide a county-owned and county-administered alternative to PMAP;
117	117	4.15 (2) facilitate integration of health care, public health, and social services to address
118	118	4.16health-related social needs in rural communities;
119	119	4.17 (3) account for the fewer enrollees and local providers of health care and community
120	120	4.18services in rural communities; and
121	121	4.19 (4) promote accountability for health outcomes, health equity, customer service,
122	122	4.20community outreach, and cost of care.
123	123	4.21 Subd. 3.County participation.Each county or group of counties authorized under
124	124	4.22section 256B.692 may administer CARMA for any or all eligible individuals as an alternative
125	125	4.23to PMAP, MinnesotaCare, MSHO, MSC+, or SNBC programs. Counties choosing and
126	126	4.24authorized to administer CARMA are exempt from the procurement process as required
127	127	4.25under section 256B.69.
128	128	4.26 Subd. 4.Oversight and regulation.CARMA is governed by sections 256B.69 and
129	129	4.27256B.692, unless otherwise provided for under this section. The commissioner must develop
130	130	4.28and implement a procurement process requiring applications from county-based purchasing
131	131	4.29plans interested in offering CARMA. The procurement process must require county-based
132	132	4.30purchasing plans to demonstrate compliance with federal and state regulatory requirements
133	133	4Sec. 2.
134	134	REVISOR AGW/EN 25-0420903/24/25 5.1and the ability to meet the goals of the program set forth in subdivision 2. The commissioner
135	135	5.2must review and approve or disapprove applications.
136	136	5.3 Subd. 5.CARMA enrollment.(a) Subject to paragraphs (d) and (e), eligible individuals
137	137	5.4must be automatically enrolled in CARMA, but may decline enrollment. Eligible individuals
138	138	5.5may enroll in fee-for-service medical assistance. Eligible individuals may change their
139	139	5.6CARMA elections on an annual basis.
140	140	5.7 (b) Eligible individuals must be able to enroll in CARMA through the selection process
141	141	5.8in accordance with the election period established in section 256B.69, subdivision 4,
142	142	5.9paragraph (e).
143	143	5.10 (c) Enrollees who were not previously enrolled in the medical assistance program or
144	144	5.11MinnesotaCare can change their selection once within the first year after enrollment in
145	145	5.12CARMA. Enrollees who were not previously in CARMA have 90 days to make a change
146	146	5.13and changes are allowed for additional special circumstances.
147	147	5.14 (d) The commissioner may offer a second health plan other than, and in addition to,
148	148	5.15CARMA to eligible individuals when another health plan is required by federal law or rule.
149	149	5.16The commissioner may offer a replacement plan to eligible individuals, as determined by
150	150	5.17the commissioner, when counties administering CARMA have their contract terminated
151	151	5.18for cause.
152	152	5.19 (e) The commissioner may, on a county-by-county basis, offer a health plan other than,
153	153	5.20and in addition to, CARMA to individuals who are eligible for both Medicare and medical
154	154	5.21assistance due to age or disability if the commissioner deems it necessary for enrollees to
155	155	5.22have another choice of health plan. Factors the commissioner must consider when
156	156	5.23determining if the other health plan is necessary include the number of available Medicare
157	157	5.24Advantage Plan options that are not special needs plans in the county, the size of the enrolling
158	158	5.25population, the additional administrative burden placed on providers and counties by multiple
159	159	5.26health plan options in a county, the need to ensure the viability and success of the CARMA
160	160	5.27program, and the impact to the medical assistance program.
161	161	5.28 (f) In counties where the commissioner is required by federal law or elects to offer a
162	162	5.29second health plan other than CARMA pursuant to paragraphs (d) and (e), eligible enrollees
163	163	5.30who do not select a health plan at the time of enrollment must automatically be enrolled in
164	164	5.31CARMA.
165	165	5.32 (g) This subdivision supersedes section 256B.694.
166	166	5Sec. 2.
167	167	REVISOR AGW/EN 25-0420903/24/25 6.1 Subd. 6.Benefits and services.(a) County entities administering CARMA must cover
168	168	6.2all benefits and services required to be covered by medical assistance under section
169	169	6.3256B.0625.
170	170	6.4 (b) County entities administering CARMA may include health-related social needs
171	171	6.5(HRSN) benefits as covered services under medical assistance as of January 1, 2030.
172	172	6.6Coverage for HRSN must be based on the assessed needs of housing, food, transportation,
173	173	6.7utilities, and interpersonal safety.
174	174	6.8 (c) County entities administering CARMA may reimburse enrollees directly for
175	175	6.9out-of-pocket costs incurred obtaining assessed HRSN services provided by nontraditional
176	176	6.10providers who are unable to accept payment via traditional health insurance methods.
177	177	6.11Enrollees must not be reimbursed for out-of-pocket costs paid to providers eligible to enroll.
178	178	6.12 Subd. 7.Payment.(a) The commissioner, in consultation with counties administering
179	179	6.13CARMA, must develop a mechanism for the payment of county entities administering
180	180	6.14CARMA. The payment mechanism must:
181	181	6.15 (1) be governed by contracts with terms, including but not limited to payment rates,
182	182	6.16amended on an as-needed basis;
183	183	6.17 (2) pay a full-risk monthly capitation payment for services included in CARMA, including
184	184	6.18the cost for administering CARMA benefits and services;
185	185	6.19 (3) include risk corridors based on minimum loss ratio, total cost of care, or other metrics;
186	186	6.20 (4) include a settle-up process tied to the risk corridor arrangement allowing a county
187	187	6.21entity administering CARMA to retain savings for reinvestment in health care activities
188	188	6.22and operations to protect against significant losses that a county entity administering CARMA
189	189	6.23or the state might realize, beginning no sooner than after the county-entity's third year of
190	190	6.24CARMA operations;
191	191	6.25 (5) include a collaborative rate-setting process accounting for CARMA experience,
192	192	6.26regional experience, and the Department of Human Services fee-for-service experience;
193	193	6.27and
194	194	6.28 (6) be exempt from section 256B.69, subdivisions 5a, paragraphs (c) and (f), and 5d,
195	195	6.29and payment for Medicaid services provided under section 256B.69, subdivision 28,
196	196	6.30paragraph (b), no sooner than three years after CARMA implementation.
197	197	6.31 (b) Payments for benefits and services under subdivision 6, paragraph (a), must not
198	198	6.32exceed payments that otherwise would have been paid to health plans under medical
199	199	6.33assistance for that county or region. Payments for HRSN benefits under subdivision 6,
200	200	6Sec. 2.
201	201	REVISOR AGW/EN 25-0420903/24/25 7.1paragraph (b), must be in addition to payments for benefits and services under subdivision
202	202	7.26, paragraph (a).
203	203	7.3 Subd. 8.Quality measures.(a) The commissioner and county entities administering
204	204	7.4CARMA must collaborate to establish quality measures for CARMA not to exceed the
205	205	7.5extent of quality measures required under sections 256B.69 and 256B.692. The measures
206	206	7.6must include:
207	207	7.7 (1) enrollee experience and outcomes;
208	208	7.8 (2) population health;
209	209	7.9 (3) health equity; and
210	210	7.10 (4) the value of health care spending.
211	211	7.11 (b) The commissioner and county entities administering CARMA must collaborate to
212	212	7.12define a quality improvement model for CARMA. The model must include a focus on
213	213	7.13locally specified measures based on the counties' unique needs. The locally specified
214	214	7.14measures for the county entity administering CARMA must be determined before the
215	215	7.15commissioner enters into any contract with the county entity.
216	216	7.16 Subd. 9.Data and systems integration.The commissioner and county entities
217	217	7.17administering CARMA must collaborate to:
218	218	7.18 (1) identify and address barriers that prevent county entities administering CARMA
219	219	7.19from reviewing individual enrollee eligibility information to identify eligibility and to help
220	220	7.20enrollees apply for other appropriate programs and resources;
221	221	7.21 (2) identify and address barriers preventing county entities administering CARMA from
222	222	7.22more readily communicating with and educating potential and current enrollees regarding
223	223	7.23other program opportunities, including helping enrollees apply for those programs and
224	224	7.24navigate transitions between programs;
225	225	7.25 (3) develop and test, in counties participating in CARMA, a universal public assistance
226	226	7.26application form to reduce the administrative barriers associated with applying for and
227	227	7.27participating in various public programs;
228	228	7.28 (4) identify and address regulatory and system barriers that may prohibit county entities
229	229	7.29administering CARMA, agencies, and other partners from working together to identify and
230	230	7.30address an individual's needs;
231	231	7.31 (5) facilitate greater interoperability between county entities administering CARMA,
232	232	7.32agencies, and other partners to send and receive the data necessary to support CARMA,
233	233	7Sec. 2.
234	234	REVISOR AGW/EN 25-0420903/24/25 8.1counties, and local health system efforts to improve the health and welfare of prospective
235	235	8.2and enrolled populations;
236	236	8.3 (6) support efforts of county entities administering CARMA to incorporate the necessary
237	237	8.4automation and interoperability to eliminate manual processes when related to the data
238	238	8.5exchanged; and
239	239	8.6 (7) support the creation and maintenance by county entities administering CARMA of
240	240	8.7an updated electronic inventory of community resources available to assist the enrollee in
241	241	8.8the enrollee's HRSN, including an electronic closed-loop referral system.
242	242	8.9 EFFECTIVE DATE.This section is effective January 1, 2027.
243	243	8.10 Sec. 3. REQUEST FOR FEDERAL WAIVER.
244	244	8.11 The commissioner of human services must seek all federal waivers and authority
245	245	8.12necessary to implement CARMA. Any part of the CARMA program that does not require
246	246	8.13federal approval shall have an effective date as specified in state law. The commissioner of
247	247	8.14human services shall notify the revisor of statutes when federal approval is obtained.
248	248	8.15 EFFECTIVE DATE.This section is effective the day following final enactment.
249	249	8Sec. 3.
250	250	REVISOR AGW/EN 25-0420903/24/25