HF3476

Purpose

• Establish a PatientCentered Care program to improve health outcomes, reduce overall health care costs for the state, and increase transparency and accountability in public health care programs.

Major Provisions

• Direct payments to providers: The state commissioner shall pay licensed health care providers directly for all services to medical assistance (MA) enrollees and MinnesotaCare enrollees, on a fee-for-service basis.
• Administrative services organizations (ASOs): The state may contract with ASOs to process claims, pay bills, and handle other administrative tasks, but ASOs cannot take on financial risk.
• County-based purchasing (CBP) option: Counties may form or join CBPs to administer the program, and the commissioner shall allow the CBP to serve as the ASO for the county unless the county requests the state to assume the role.
• Care coordination: The department may contract with CBPs, counties, Federally Qualified Health Centers (FQHCs), and community-based programs with interdisciplinary teams to provide care coordination. 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 and transitional care, behavioral health integration, and culturally competent outreach. Budgets for these programs shall be based on operating costs and community needs, not risk-based financial arrangements.
• Replacing or limiting managed care contracts: The state shall not renew contracts with certain managed care plans or integrated health partnerships to serve MA and MinnesotaCare enrollees under specified statutes.
• Definitions: Establish key terms—Administrative Services Organization (ASO), Care coordination, and related roles and responsibilities.
• Payment structure for providers: In addition to direct fee-for-service payments, the state will provide flat care coordination payments to primary care providers designated by enrollees as their primary care provider. The primary care provider oversees the enrollee’s health and coordinates with case managers.
• Provider reimbursement and oversight: The commissioner shall encourage collaboration with frontline providers to improve health care quality and control costs, ensure timely reimbursement, and make recommendations to legislative leaders about fair reimbursement rates.
• Community outreach and enrollment support: The department may fund community health clinics, FQHCs, and CBPs to hire community health workers, nurses, or social workers to conduct community outreach, assist with enrollment in MA or MinnesotaCare, and help patients access care.
• Enrollee supports and services: The department shall ensure medically necessary services are provided timely and equitably, recruit adequate, culturally competent providers, provide data analytics, maintain a hotline and a website to help enrollees locate providers, offer a 24/7 nurse consultation helpline, and actively contact enrollees with claims data who have not had preventive visits to help them choose a primary care provider.
• Data transparency and public reporting: All ASO contracts must comply with public access and data transparency laws. The department must create and maintain a publicly accessible data dashboard with deidentified MA and MinnesotaCare data, updated quarterly, plus an annual report on trends and disparities. Private entities cannot claim proprietary rights over data generated from publicly funded programs.

Significant Changes to Existing Law

• Establishes a new PatientCentered Care program that shifts some responsibilities from traditional managed care models to direct provider payments and new care coordination structures.
• Authorizes direct state payments to health care providers for MA and MinnesotaCare enrollees and creates a pathway for ASOs to handle administrative tasks without assuming financial risk.
• Enables counties to form or participate in county-based purchasing arrangements to support care delivery and administration.
• Replaces or limits existing managed care contracts and certain integrated health partnership arrangements for MA and MinnesotaCare enrollees.
• Requires a robust, transparent data infrastructure (public dashboards and annual reports) for monitoring use, outcomes, and disparities.

How It Would Work in Practice

• Providers would bill the state directly for services, with the state handling payments on a fee-for-service basis, while primary care practices receive additional flat payments for coordinating patient care.
• Care coordination teams drawn from physicians, nurses, community health workers, behavioral health professionals, and other licensed providers would work with patients to coordinate care, maintain eligibility, address transportation barriers, plan care, and connect patients to specialists and support services.
• County-based or community-based organizations would receive funding to conduct outreach, enroll patients, and help connect people to medical care.
• The state would avoid risk shifting to providers or other entities and would monitor costs and quality through data analytics, hotlines, and ongoing engagement with enrollees.
• Transparency requirements would ensure public access to data and regular reporting on trends, disparities, and program performance.

Relevant Changes to Law and Policy Context

• Repeals certain prior provisions related to MA/MinnesotaCare delivery models (e.g., specific sections of Minnesota Statutes 2024) and replaces them with the new PatientCentered Care framework.
• Requires ongoing evaluation of provider reimbursement fairness and timeliness, with mechanisms to keep costs in check while preserving access to care.

Relevant Terms - PatientCentered Care program - direct payment - Medical Assistance (MA) - MinnesotaCare - administrative services organization (ASO) - care coordination - county-based purchasing (CBP) - counties (as health purchasers) - FQHCs (Federally Qualified Health Centers) - community-based programs (CBPs) - interdisciplinary teams - primary care provider (PCP) - flat care coordination payments - fee-for-service - public access to government records - data dashboard - deidentified data - health analytics - nurse consultation helpline - care navigation - discharge planning - transitional care - behavioral health integration

Relevant Terms - MA (medical assistance) - MinnesotaCare - ASO - CBP - FQHC - care coordination - primary care provider (PCP) - fee-for-service - data dashboard - public records - deidentified data