§ 256B.695 — COUNTY-ADMINISTERED RURAL MEDICAL ASSISTANCE PROGRAM

Minnesota § 256B.695

• Jurisdiction: Minnesota
• Part: PUBLIC WELFARE AND RELATED ACTIVITIES
• Ch. 256B: MEDICAL ASSISTANCE FOR NEEDY PERSONS

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Subdivision 1.Definitions.
(a) For the purposes of this section, the following terms have the meanings given.
(b) "CARMA" means the county-administered rural medical assistance program established under this section.
(c) "Commissioner" means the commissioner of human services.
(d) "Eligible individual" means an individual who is:
(1) residing in a county administering CARMA; and
(2) eligible for medical assistance, MinnesotaCare, Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus (MSC+), or Special Needs Basic Care (SNBC).
(e) "Enrollee" means an individual enrolled in CARMA.
(f) "PMAP" means the prepaid medical assistance program under section256B.69.
(g) "Rural county" has the meaning given to "rural area" in Code of Federal Regulations, title 42, section 438.52.

Subd. 2.Program established.
CARMA is established to:
(1) provide a county-owned and county-administered alternative to PMAP;
(2) facilitate integration of health care, public health, and social services to address health-related social needs in rural communities;
(3) account for the fewer enrollees and local providers of health care and community services in rural communities; and
(4) promote accountability for health outcomes, health equity, customer service, community outreach, and cost of care.

Subd. 3.County participation.
Each county or group of counties authorized under section256B.692may administer CARMA for any or all eligible individuals as an alternative to PMAP, MinnesotaCare, MSHO, MSC+, or SNBC programs. Counties choosing and authorized to administer CARMA are exempt from the procurement process as required under section256B.69.

Subd. 4.Oversight and regulation.
CARMA is governed by sections256B.69and256B.692, unless otherwise provided for under this section. The commissioner must develop and implement a procurement process requiring applications from county-based purchasing plans interested in offering CARMA. The procurement process must require county-based purchasing plans to demonstrate compliance with federal and state regulatory requirements and the ability to meet the goals of the program set forth in subdivision 2. The commissioner must review and approve or disapprove applications.

Subd. 5.CARMA enrollment.
(a) Subject to paragraphs (d) and (e), eligible individuals must be automatically enrolled in CARMA, but may decline enrollment. Eligible individuals may enroll in fee-for-service medical assistance. Eligible individuals may change their CARMA elections on an annual basis.
(b) Eligible individuals must be able to enroll in CARMA through the selection process in accordance with the election period established in section256B.69, subdivision 4, paragraph (e).
(c) Enrollees who were not previously enrolled in the medical assistance program or MinnesotaCare can change their selection once within the first year after enrollment in CARMA. Enrollees who were not previously enrolled in CARMA have 90 days to make a change and changes are allowed for additional special circumstances.
(d) The commissioner may offer a second health plan other than, and in addition to, CARMA to eligible individuals when another health plan is required by federal law or rule. The commissioner may offer a replacement plan to eligible individuals, as determined by the commissioner, when counties administering CARMA have their contract terminated for cause.
(e) The commissioner may, on a county-by-county basis, offer a health plan other than, and in addition to, CARMA to individuals who are eligible for both Medicare and medical assistance due to age or disability if the commissioner deems it necessary for enrollees to have another choice of health plan. Factors the commissioner must consider when determining if the other health plan is necessary include the number of available Medicare Advantage Plan options that are not special needs plans in the county, the size of the enrolling population, the additional administrative burden placed on providers and counties by multiple health plan options in a county, the need to ensure the viability and success of the CARMA program, and the impact to the medical assistance program.
(f) In counties where the commissioner is required by federal law or elects to offer a second health plan other than CARMA pursuant to paragraphs (d) and (e), eligible enrollees who do not select a health plan at the time of enrollment must automatically be enrolled in CARMA.
(g) This subdivision supersedes section256B.694.

Subd. 6.Benefits and services.
(a) Counties or groups of counties administering CARMA must cover all benefits and services required to be covered by medical assistance under section256B.0625.
(b) Counties or groups of counties administering CARMA may reimburse enrollees directly for out-of-pocket costs incurred obtaining assessed HRSN services provided by nontraditional providers who are unable to accept payment via traditional health insurance methods. Enrollees must not be reimbursed for out-of-pocket costs paid to providers eligible to enroll.

Subd. 7.Payment.
(a) The commissioner, in consultation with counties and groups of counties administering CARMA, must develop a mechanism for making payments to counties and groups of counties that administer CARMA. The payment mechanism must:
(1) be governed by contracts with terms, including but not limited to payment rates, amended on an as-needed basis;
(2) pay a full-risk monthly capitation payment for services included in CARMA, including the cost for administering CARMA benefits and services;
(3) include risk corridors based on minimum loss ratio, total cost of care, or other metrics;
(4) include a settle-up process tied to the risk corridor arrangement allowing a county or group of counties administering CARMA to retain savings for reinvestment in health care activities and operations to protect against significant losses that a county or group of counties administering CARMA or the state might realize, beginning no sooner than after a county's or group of counties' third year of CARMA operations;
(5) include a collaborative rate-setting process accounting for CARMA experience, regional experience, and the Department of Human Services fee-for-service experience; and
(6) be exempt from section256B.69, subdivisions 5a, paragraphs (c) and (f), and 5d, and payment for Medicaid services provided under section256B.69, subdivision 28, paragraph (b), no sooner than three years after CARMA implementation.
(b) Payments for benefits and services under subdivision 6, paragraph (a), must not exceed payments that otherwise would have been paid to health plans under medical assistance for that county or region.

Subd. 8.Quality measures.
(a) The commissioner and counties and groups of counties administering CARMA must collaborate to establish quality measures for CARMA not to exceed the extent of quality measures required under sections256B.69and256B.692. The measures must include:
(1) enrollee experience and outcomes;
(2) population health;
(3) health equity; and
(4) the value of health care spending.
(b) The commissioner and counties and groups of counties administering CARMA must collaborate to define a quality improvement model for CARMA. The model must include a focus on locally specified measures based on counties' unique needs. The locally specified measures for the county or group of counties administering CARMA must be determined before the commissioner enters into any contract with a county or group of counties.

Subd. 9.Data and systems integration.
The commissioner and counties and groups of counties administering CARMA must collaborate to:
(1) identify and address barriers that prevent counties and groups of counties administering CARMA from reviewing individual enrollee eligibility information to identify eligibility and to help enrollees apply for other appropriate programs and resources;
(2) identify and address barriers preventing counties and groups of counties administering CARMA from more readily communicating with and educating potential and current enrollees regarding other program opportunities, including helping enrollees apply for those programs and navigate transitions between programs;
(3) develop and test, in counties participating in CARMA, a universal public assistance application form to reduce the administrative barriers associated with applying for and participating in various public programs;
(4) identify and address regulatory and system barriers that may prohibit counties and groups of counties administering CARMA, agencies, and other partners from working together to identify and address an individual's needs;
(5) facilitate greater interoperability between counties and groups of counties administering CARMA, agencies, and other partners to send and receive the data necessary to support CARMA, counties, and local health system efforts to improve the health and welfare of prospective and enrolled populations;
(6) support efforts of counties and groups of counties administering CARMA to incorporate the necessary automation and interoperability to eliminate manual processes when related to the data exchanged; and
(7) support the creation and maintenance by counties and groups of counties administering CARMA of an updated electronic inventory of community resources available to assist the enrollee in the enrollee's HRSN, including an electronic closed-loop referral system.

Legislative History

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