1.1 A bill for an act
1.2 relating to human services; establishing a coordinated services organization
1.3 demonstration project; appropriating money; proposing coding for new law in
1.4 Minnesota Statutes, chapter 256B.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [256B.7705] COORDINATED SERVICES ORGANIZATION
1.7DEMONSTRATION PROJECT.
1.8 Subdivision 1.Purpose.The commissioner shall establish a demonstration project to
1.9test a provider-led coordinated service model, implemented by disability services providers
1.10for people with disabilities, that coordinates services across the continuum of covered
1.11services under medical assistance and Medicare, addresses health-related social needs, and
1.12prioritizes enrollee choice.
1.13 Subd. 2.Application.The commissioner shall develop a request for applications for
1.14participation in the coordinated services organization demonstration project. In developing
1.15the request for applications, the commissioner shall:
1.16 (1) identify, in consultation with interested parties, key indicators of well-being, quality,
1.17access, satisfaction, and other performance indicators;
1.18 (2) identify, in consultation with interested parties, indicators for measuring cost savings;
1.19 (3) establish quality standards for the coordinated service organization that are appropriate
1.20for the populations served;
1.21 (4) encourage the coordination of services across home and community-based services,
1.22crisis services, primary care, dental care, and pharmacy;
1Section 1.
25-04566 as introduced03/11/25 REVISOR AGW/HL
SENATE
STATE OF MINNESOTA
S.F. No. 2876NINETY-FOURTH SESSION
(SENATE AUTHORS: HOFFMAN, Abeler, Gruenhagen, Utke and Maye Quade)
OFFICIAL STATUSD-PGDATE
Introduction and first reading03/24/2025
Referred to Human Services 2.1 (5) allow flexibility in the application evaluation methodology to encourage applicants
2.2to propose innovation and disability services provider collaborations that may be customized
2.3for the special needs and barriers of patient populations receiving home and community-based
2.4waiver services and dual-eligible populations; and
2.5 (6) allow flexibility in the application evaluation methodology to facilitate the delivery
2.6of eligibility and claims data to the coordinated services organization, including collaborating
2.7on data use agreements with the Centers for Medicare & Medicaid Services for dual-eligible
2.8Medicare claims and eligibility data.
2.9 Subd. 3.Eligibility.(a) To be eligible to participate in the coordinated services
2.10organization demonstration project an applicant must demonstrate in its application that it
2.11will:
2.12 (1) include providers of home and community-based services and long-term services
2.13and supports;
2.14 (2) have partnership or joint venture arrangements between home and community-based
2.15providers and health care providers;
2.16 (3) have partnership or joint venture agreements with managed care plans serving people
2.17enrolled in special needs basic care programs to improve the coordination and integration
2.18of medical, behavioral health, and long-term services and supports for enrollees served by
2.19the coordinated services organization;
2.20 (4) have an established, nonprofit, shared governance structure;
2.21 (5) develop a process for enrollees to opt into the coordinated service organization and
2.22establish a mechanism to monitor enrollment;
2.23 (6) establish a process to ensure the quality of care and services provided;
2.24 (7) have the capacity to provide care coordination and population health activities for
2.25enrollees;
2.26 (8) have the capacity to provide community intervention programming, including
2.27upstream early identification and enhanced care to reduce preventable emergency department
2.28use, services to reduce avoidable hospitalization and readmission, transitions of care,
2.29enhanced primary care, medication therapy management, in-home technology, and specialized
2.30dental coordination and services;
2.31 (9) in cooperation with counties and community social service agencies, coordinate the
2.32delivery of health care services with existing social services programs;
2Section 1.
25-04566 as introduced03/11/25 REVISOR AGW/HL 3.1 (10) have a mechanism to ensure compliance with conflict-free case management
3.2requirements;
3.3 (11) have the ability to provide population health analysis, risk stratification, and quality
3.4and performance reporting to its participating providers for the purposes of meeting cost
3.5and quality measures; and
3.6 (12) adopt innovative and cost-effective methods of care delivery and coordination,
3.7which may include the use of telehealth, care coordinators, community health workers, and
3.8peer support.
3.9 (b) A successful applicant may contract with a third party, including for the administration
3.10of a payment system using the payment methods established by the commissioner for
3.11integrated health partnerships.
3.12 Subd. 4.Enrollment.(a) An individual is eligible to enroll with a coordinated services
3.13organization if the individual is either dually eligible for medical assistance and Medicare
3.14and eligible to receive waiver services under section 256B.49 or enrolled in medical
3.15assistance special needs basic care and receiving waiver services under section 256B.49.
3.16 (b) An individual eligible under paragraph (a) may enroll in a coordinated services
3.17organization if the organization and its participating providers serve the county in which
3.18the eligible individual resides.
3.19 Subd. 5.Accountability.(a) A coordinated services organization must accept
3.20responsibility for the quality of care and services based on standards established under
3.21subdivision 2 and the cost of care or utilization of services provided to its enrollees.
3.22Accountability standards must be appropriate to people with disabilities and specific
3.23subpopulations served.
3.24 (b) A coordinated services organization must demonstrate to the commissioner how it
3.25coordinates services affecting its enrollees' health, quality of care, and cost of care that are
3.26provided by other providers, county agencies, and other organizations in the local service
3.27area.
3.28 (c) After the expiration of an initial contract term under this section, the commissioner
3.29may evaluate additional activities for inclusion in coordinated services organization contracts.
3.30Additional activities the commissioner may include in the contract include but are not limited
3.31to long-term care consultation services assessments under section 256B.0911, community
3.32first services and supports consultative services under section 256B.85, waiver case
3Section 1.
25-04566 as introduced03/11/25 REVISOR AGW/HL 4.1management under sections 256B.092 and 256B.49, and financial management services
4.2under chapter 256B.
4.3 Subd. 6.Payments.(a) The commissioner shall establish a per member, per month
4.4population-based payment that reflects the ongoing activities, scope, and metrics of the
4.5coordinated services organization. The payment must be risk-adjusted to reflect varying
4.6levels of care and case management intensiveness for enrollees with chronic conditions,
4.7dependencies in activities of daily living, need for assistance due to behaviors, and other
4.8factors that recognize the medical complexity of the populations served. The payment must
4.9be paid at least on a quarterly basis.
4.10 (b) The commissioner shall collaborate with the coordinated services organization in
4.11developing a total cost of care risk-gain sharing payment model.
4.12 (c) The commissioner may include in the payment system incentive payments to the
4.13coordinated services organization that meet or exceed annual quality and performance targets
4.14realized through the coordination of care.
4.15 (d) The population-based payment must not duplicate services under already existing
4.16special need basic care coordination delegation agreements.
4.17 (e) The coordinated services organization must develop a value-based arrangement
4.18between the parties participating in its approved demonstration project, including the
4.19Department of Human Services, and establish a shared risk-savings distribution agreement
4.20among parties.
4.21 (f) The commissioner must continue to pay providers participating in an approved
4.22coordinated services organization demonstration project contractual or fee-for-service rates
4.23for individual services covered by medical assistance.
4.24 (g) A coordinated services organization receiving this payment must continue to meet
4.25cost and quality metrics under the program to maintain eligibility for the population-based
4.26payment.
4.27 Subd. 7.Federal approval.The commissioner shall apply for any federal approval
4.28required to implement this project and seek to maximize federal financial participation.
4.29 Subd. 8.Innovation grants.The commissioner shall, from within appropriations
4.30available for this purpose, establish coordinated service organization innovation and
4.31capacity-building grants. The commissioner shall award grants to assist approved coordinated
4.32services organizations in covering initial start-up costs and maximizing the coordination
4.33and integration of the organization and its partners.
4Section 1.
25-04566 as introduced03/11/25 REVISOR AGW/HL 5.1 Sec. 2. APPROPRIATION; COORDINATED SERVICE ORGANIZATION
5.2INNOVATION AND CAPACITY-BUILDING GRANTS.
5.3 $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
5.4fund to the commissioner of human services for coordinated service organization innovation
5.5and capacity-building grants under Minnesota Statutes, section 256B.7705. The commissioner
5.6must not award a grant exceeding $2,000,000 to a coordinated service organization during
5.7the biennium.
5Sec. 2.
25-04566 as introduced03/11/25 REVISOR AGW/HL