1.1.................... moves to amend H.F. No. 3237, the first engrossment, as follows:
1.2Page 24, after line 29, insert:

1.3    "Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23,
1.4is amended to read:
1.5    Subd. 23. Alternative services; elderly and disabled persons. (a) The
1.6commissioner may implement demonstration projects to create alternative integrated
1.7delivery systems for acute and long-term care services to elderly persons and persons
1.8with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
1.9coordination, improve access to quality services, and mitigate future cost increases.
1.10The commissioner may seek federal authority to combine Medicare and Medicaid
1.11capitation payments for the purpose of such demonstrations and may contract with
1.12Medicare-approved special needs plans that are offered by a demonstration provider or
1.13by an entity that is directly or indirectly wholly owned or controlled by a demonstration
1.14provider to provide Medicaid services. Medicare funds and services shall be administered
1.15according to the terms and conditions of the federal contract and demonstration provisions.
1.16For the purpose of administering medical assistance funds, demonstrations under this
1.17subdivision are subject to subdivisions 1 to 22. The provisions of Minnesota Rules, parts
1.189500.1450 to 9500.1464, apply to these demonstrations, with the exceptions of parts
1.199500.1452 , subpart 2, item B; and 9500.1457, subpart 1, items B and C, which do not
1.20apply to persons enrolling in demonstrations under this section. All enforcement and
1.21rulemaking powers available under chapters 62D, 62M, and 62Q are hereby granted to the
1.22commissioner of health with respect to Medicare-approved special needs plans with which
1.23the commissioner contracts to provide Medicaid services under this section. An initial
1.24open enrollment period may be provided. Persons who disenroll from demonstrations
1.25under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464.
1.26When a person is enrolled in a health plan under these demonstrations and the health
1.27plan's participation is subsequently terminated for any reason, the person shall be
2.1provided an opportunity to select a new health plan and shall have the right to change
2.2health plans within the first 60 days of enrollment in the second health plan. Persons
2.3required to participate in health plans under this section who fail to make a choice of
2.4health plan shall not be randomly assigned to health plans under these demonstrations.
2.5Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
2.6subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
2.7the commissioner may contract with managed care organizations, including counties, to
2.8serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
2.9disabled persons only. For persons with a primary diagnosis of developmental disability,
2.10serious and persistent mental illness, or serious emotional disturbance, the commissioner
2.11must ensure that the county authority has approved the demonstration and contracting
2.12design. Enrollment in these projects for persons with disabilities shall be voluntary. The
2.13commissioner shall not implement any demonstration project under this subdivision for
2.14persons with a primary diagnosis of developmental disabilities, serious and persistent
2.15mental illness, or serious emotional disturbance, without approval of the county board of
2.16the county in which the demonstration is being implemented.
2.17    (b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
2.18to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
2.199525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
2.20under this section projects for persons with developmental disabilities. The commissioner
2.21may capitate payments for ICF/MR services, waivered services for developmental
2.22disabilities, including case management services, day training and habilitation and
2.23alternative active treatment services, and other services as approved by the state and by the
2.24federal government. Case management and active treatment must be individualized and
2.25developed in accordance with a person-centered plan. Costs under these projects may not
2.26exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
2.27and until four years after the pilot project implementation date, subcontractor participation
2.28in the long-term care developmental disability pilot is limited to a nonprofit long-term
2.29care system providing ICF/MR services, home and community-based waiver services,
2.30and in-home services to no more than 120 consumers with developmental disabilities in
2.31Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
2.32prior to expansion of the developmental disability pilot project. This paragraph expires
2.33four years after the implementation date of the pilot project.
2.34    (c) Before implementation of a demonstration project for disabled persons, the
2.35commissioner must provide information to appropriate committees of the house of
3.1representatives and senate and must involve representatives of affected disability groups
3.2in the design of the demonstration projects.
3.3    (d) A nursing facility reimbursed under the alternative reimbursement methodology
3.4in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
3.5provide services under paragraph (a). The commissioner shall amend the state plan and
3.6seek any federal waivers necessary to implement this paragraph.
3.7    (e) The commissioner, in consultation with the commissioners of commerce and
3.8health, may approve and implement programs for all-inclusive care for the elderly (PACE)
3.9according to federal laws and regulations governing that program and state laws or rules
3.10applicable to participating providers. The process for approval of these programs shall
3.11begin only after the commissioner receives grant money in an amount sufficient to cover
3.12the state share of the administrative and actuarial costs to implement the programs during
3.13state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
3.14account in the special revenue fund and are appropriated to the commissioner to be used
3.15solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
3.16not required to be licensed or certified as a health plan company as defined in section
3.1762Q.01, subdivision 4 . Persons age 55 and older who have been screened by the county
3.18and found to be eligible for services under the elderly waiver or community alternatives
3.19for disabled individuals or who are already eligible for Medicaid but meet level of
3.20care criteria for receipt of waiver services may choose to enroll in the PACE program.
3.21Medicare and Medicaid services will be provided according to this subdivision and
3.22federal Medicare and Medicaid requirements governing PACE providers and programs.
3.23PACE enrollees will receive Medicaid home and community-based services through the
3.24PACE provider as an alternative to services for which they would otherwise be eligible
3.25through home and community-based waiver programs and Medicaid State Plan Services.
3.26The commissioner shall establish Medicaid rates for PACE providers that do not exceed
3.27costs that would have been incurred under fee-for-service or other relevant managed care
3.28programs operated by the state.
3.29    (f) The commissioner shall seek federal approval to expand the Minnesota disability
3.30health options (MnDHO) program established under this subdivision in stages, first to
3.31regional population centers outside the seven-county metro area and then to all areas of
3.32the state. Until July 1, 2009, expansion for MnDHO projects that include home and
3.33community-based services is limited to the two projects and service areas in effect on
3.34March 1, 2006. Enrollment in integrated MnDHO programs that include home and
3.35community-based services shall remain voluntary. Costs for home and community-based
3.36services included under MnDHO must not exceed costs that would have been incurred
4.1under the fee-for-service program. Notwithstanding whether expansion occurs under
4.2this paragraph, in determining MnDHO payment rates and risk adjustment methods for
4.3contract years starting in 2012, the commissioner must consider the methods used to
4.4determine county allocations for home and community-based program participants. If
4.5necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs
4.6for home and community-based services, the commissioner shall achieve the reduction by
4.7maintaining the base rate for contract years 2010 and 2011 for services provided under the
4.8community alternatives for disabled individuals waiver at the same level as for contract
4.9year 2009. The commissioner may apply other reductions to MnDHO rates to implement
4.10decreases in provider payment rates required by state law. In developing program
4.11specifications for expansion of integrated programs, the commissioner shall involve and
4.12consult the state-level stakeholder group established in subdivision 28, paragraph (d),
4.13including consultation on whether and how to include home and community-based waiver
4.14programs. Plans for further expansion of MnDHO projects shall be presented to the chairs
4.15of the house of representatives and senate committees with jurisdiction over health and
4.16human services policy and finance by February 1, 2007.
4.17    (g) Notwithstanding section 256B.0261, health plans providing services under this
4.18section are responsible for home care targeted case management and relocation targeted
4.19case management. Services must be provided according to the terms of the waivers and
4.20contracts approved by the federal government."
4.21Renumber the sections in sequence and correct the internal references
4.22Amend the title accordingly