SF3612

Purpose

• Establishes the PatientCentered Care program to achieve better health outcomes, reduce overall health care costs for the state, and increase transparency and accountability in public health care programs.
• Requires the state to pay health care providers directly for services to Medical Assistance (MA) enrollees and MinnesotaCare enrollees, with the goal of simpler oversight and payment.
• Seeks to improve care coordination, accessibility, and data transparency in MA and MinnesotaCare.

Main Provisions (What the bill does)

• Direct payments to providers: The commissioner shall pay licensed health care providers directly for all services delivered to MA enrollees (under MA rules) and MinnesotaCare enrollees (under MinnesotaCare rules) on a fee-for-service basis.
• Administrative services organizations (ASOs): The commissioner may contract with ASOs to process claims, pay bills, and perform other administrative tasks, but ASOs may not bear financial risk and must be paid only for the administrative functions specified.
• County-Based Purchasing (CBP) as ASO option: Counties choosing a CBP system may form or participate in a new or existing CBP, which shall serve as the ASO unless a county requests the state take over.
• Care coordination: The department may contract with CBPs, counties, FQHCs, and community-based programs with interdisciplinary teams to provide care coordination services. Services include patient navigation, maintaining eligibility, transportation, interdisciplinary care planning, chronic disease management, specialist consultations, case management for serious mental illness and substance use disorders, discharge planning, medical respite, transitional care, behavioral health integration, and culturally competent outreach. Budgets for these programs are based on operating costs and community needs, not risk-based financial arrangements.
• Repeal of certain managed care contracts: The state shall not renew contracts with managed care plans or integrated health partnerships to provide MA and MinnesotaCare services.
• Definitions: Clarifies terms for Administrative Services Organization (ASO) and care coordination.
• Primary care payments: The state will provide flat care coordination payments to primary care providers designated by enrollees as their PCP, who will oversee the enrollee’s health and coordinate with case managers.
• Provider reimbursement and risk: Providers shall bill the state or county-based purchaser directly, and the state/county purchasers may not shift risk to providers or other entities. Reimbursement rates should be reasonable and timely, with efforts to improve care quality while reducing costs.
• Public outreach and enrollment: The bill allows grants to community health clinics, FQHCs, and CBPs to hire community health workers, nurses, or social workers to do outreach, help patients enroll in MA or MinnesotaCare, and coordinate care in the community.
• Duties to enrollees and providers: The commissioner must ensure timely, equitable access to medically necessary services; recruit a diverse, geographically distributed provider network; provide data analytics and utilization monitoring; maintain a hotline and a website; offer a 24/7 nurse consultation helpline; and proactively contact enrollees who have not had preventive visits.
• CBP option for service delivery: If counties elect CBP, they may provide these services with reimbursement through the Department of Human Services.
• Data transparency and access: All ASO contracts must comply with public access laws; no private entity shall claim proprietary rights over data from publicly funded programs. A publicly accessible data dashboard will present deidentified MA and MinnesotaCare data for research, oversight, and community engagement, updated quarterly, with an annual trend report.

Significant Changes to Law

• Moves from managed care and integrated health partnerships toward direct provider payments and county-based purchasing options acting as or coordinating as the ASO.
• Establishes a formal PatientCentered Care program with direct, fee-for-service payments to providers, rather than risk-based payment models.
• Introduces mandatory care coordination through interdisciplinary teams and CBPs/FQHCs/community-based programs, funded by budgets based on operations and community needs.
• Requires new data transparency measures, including public dashboards and annual reports, and restricts proprietary control over data from publicly funded programs.
• Repeals or replaces certain provisions related to MA and MinnesotaCare delivery through managed care/partnerships, and codes new authorities and processes in statute.

Implementation and Oversight Highlights

• The commissioner of human services will implement direct payment and care coordination structures, and may contract with ASOs and CBPs where appropriate.
• The bill calls for ongoing data transparency, including a quarterly updating dashboard and an annual report, to monitor usage, disparities, and trends.

Summary of Key Terminology (to aid search and understanding)

• PatientCentered Care program
• Medical Assistance (MA)
• MinnesotaCare
• Administrative Services Organization (ASO)
• care coordination
• county-based purchasing (CBP)
• Federally Qualified Health Centers (FQHCs)
• interdisciplinary teams
• primary care provider (PCP)
• fee-for-service
• direct payment
• grants
• public access to government records and data
• deidentified data
• data dashboard
• hotlines and nurse helpline
• mental illness and substance use disorders
• medical respite
• transitional care
• behavioral health integration

Relevant Terms PatientCentered Care program; direct payment; Medical Assistance; MinnesotaCare; Administrative Services Organization (ASO); care coordination; county-based purchasing (CBP); CBPs; FQHCs; interdisciplinary teams; primary care provider (PCP); fee-for-service; grants; public data/dashboard; deidentified data; public access to records; nurse helpline; 24/7 nurse consultation; medical respite; transitional care; behavioral health integration; mental illness; substance use disorders.