1.1    .................... moves to amend H. F. No. 3391, the second engrossment, as follows:
1.2Page 1, line 24, delete "require" and insert "encourage"
1.3Page 2, line 5, delete "complete" and insert "obtain"
1.4Page 2, line 7, delete ", or who are at risk of developing,"
1.5Page 2, line 11, delete "potential"
1.6Page 2, delete lines 29 to 34 and insert
1.7    "Subd. 2. Establishment of health care homes. The commissioners shall establish
1.8health care homes for state health care program enrollees who have complex or chronic
1.9health conditions. In establishing health care homes, the commissioners shall consider,
1.10and when appropriate, incorporate features of the medical home model developed for
1.11the provider-directed care coordination program authorized under section 256B.0625,
1.12subdivision 51. The commissioner shall study the feasibility of expanding health care
1.13homes to all enrollees and report to the Legislature by January 1, 2011."
1.14Page 3, line 24, delete "primary"
1.15Page 3, line 29, delete "and in health care home"
1.16Page 3, line 30, delete everything before "as"
1.17Page 4, delete lines 15 to 34 and insert
1.18    "Subd. 6. Comprehensive care plan. Health care homes must develop, maintain,
1.19and ensure the implementation of a comprehensive care plan for each enrollee who
1.20has a complex or chronic condition, based upon health history, tests, assessments, and
1.21other information. The comprehensive care plan must meet the criteria specified by the
1.22commissioners.
1.23    Subd. 7. Care coordinators. Health care homes must employ care coordinators
1.24to manage the care provided to patients with complex or chronic conditions. Care
1.25coordination includes:
2.1    (1) identifying patients with complex or chronic conditions eligible for care
2.2coordination;
2.3    (2) assisting primary care providers in care coordination and education;
2.4    (3) helping patients coordinate their care or access needed services, including
2.5preventative care;
2.6    (4) communicating the care needs and concerns of the patient to the health care home;
2.7    (5) collecting data on process and outcome measures;
2.8    (6) overseeing the development, maintenance, and implementation of care plans; and
2.9    (7) meeting other criteria as specified by the commissioner.
2.10    Subd. 8. Health care home collaborative. Health care homes must participate
2.11in the health care home collaborative defined in 256B.0754, subdivision 4, as required
2.12by the commissioners for certification."
2.13Page 5, line 10, delete everything after "fee."
2.14Page 5, line 11, delete "of $50 per person per month"
2.15Page 5, delete lines 16 to 18 and insert
2.16    "Subd. 3. Cost neutrality. If initial savings from implementation of health care
2.17homes are not sufficient to allow implementation of the care coordination fee in a
2.18cost-neutral manner, the commissioner shall reallocate costs within the health care system.
2.19EFFECTIVE DATE.Subdivisions 1 and 2 are effective July 1, 2009 or upon
2.20federal approval, whichever is later."
2.21Page 6, line 15, delete everything after "plans,"
2.22Page 6, line 16, delete everything before "and" and insert "organizations with
2.23expertise in care coordination models,"
2.24Page 7, delete section 6 and insert

2.25    "Sec. 6. Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision
2.26to read:
2.27    Subd. 29. Health care home model. (a) The commissioner shall require
2.28demonstration providers, as a condition of contract, to adopt by July 1, 2009, a health care
2.29home model for providing care to state health care program enrollees. The health care
2.30home model must meet the criteria specified in this section and section 256B.0752. The
2.31commissioner, in consultation with the commissioner of health, may waive or modify
2.32criteria for demonstration providers if the commissioners of health and human services
2.33determine that performance and quality standards would still be met.
2.34    (b) The commissioner, as a condition of contract, shall require demonstration
2.35providers, as part of their implementation of the health care home model, to pay providers
3.1a care coordination fee. The care coordination fee must meet the requirements of section
3.2256B.0753. Demonstration providers shall fund the care coordination fee through savings
3.3that result from implementation of the health care home model and, if necessary, through
3.4reductions in administrative costs and reallocation of other payment rates within its
3.5network. The commissioner shall not adjust current or future capitation rates for costs
3.6related to payment of the care coordination fee.
3.7    (c) The commissioners of health and human services shall require demonstration
3.8providers to: (1) collect from health care homes the data necessary to monitor
3.9implementation of the health care home model, measure and evaluate quality of care
3.10and outcomes, measure and evaluate patient experience, and determine cost savings
3.11from implementation of the health care home model; and (2) submit this data to
3.12the commissioners. The commissioners of health and human services shall provide
3.13demonstration providers and health care homes with practice profiles measuring
3.14utilization, cost, and quality. Before establishing or amending general standards for data
3.15collection under this paragraph, the commissioners must report the draft standards to the
3.16chairs and lead minority members of the legislative committees with jurisdiction over
3.17health care policy and finance. Standards for data collection are not subject to chapter 14,
3.18and section 14.386 does not apply.
3.19    (d) The commissioner shall study the feasibility and method of calculating savings
3.20from the use of health care homes, as required in 256B.0754, subdivision 6, paragraph
3.21b. The study must consider the methodology for distribution of savings. Under the
3.22methodology, the state must retain one-half of the savings, the demonstration providers
3.23may retain up to one-fourth of the savings, and at least one-fourth of the savings must be
3.24passed on to health care providers in the form of higher payment rates.
3.25    (e) Demonstration providers must encourage state health care program enrollees to
3.26complete an initial health assessment within three months from the time of enrollment, in
3.27order to identify individuals with complex or chronic health conditions, and to identify
3.28preventative health care needs.
3.29    (f) Beginning July 1, 2009, the commissioner shall require demonstration providers
3.30to require health care homes to develop, maintain and ensure the implementation of a
3.31comprehensive care plan, as defined in 256B.0752, Subdivision 6.
3.32    (g) Beginning July 1, 2009, the commissioner shall implement financial
3.33arrangements for demonstration providers to ensure that plans encourage each enrollee
3.34who has a complex or chronic condition to choose a certified primary care clinic or
3.35medical group to serve as a health care home."
3.36Page 50, line 11, delete everything after "(b)"
4.1Page 50, line 12, delete "per-month."
4.2Page 50, line 20, delete ", or are at risk of developing,"