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SF 1094

as introduced - 92nd Legislature (2021 - 2021) Posted on 02/16/2021 01:55pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health care; reducing the reimbursement rate for services delivered by
telemedicine; modifying the capitation rate to reflect the reduced reimbursement
rate for services delivered by telemedicine; amending Minnesota Statutes 2020,
sections 256B.0625, subdivision 3b; 256B.69, subdivision 31.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to
read:


Subd. 3b.

Telemedicine services.

(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week, except as provided
in paragraph (f). deleted text beginTelemedicinedeleted text end Servicesnew text begin delivered through telemedicinenew text end shall be paid at deleted text beginthe
full allowable
deleted text endnew text begin 90 percent of the reimbursementnew text end ratenew text begin paid for the same service delivered
through in-person contact
new text end.

(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
via telemedicine;

(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to telemedicine services.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:

(1) the type of service provided by telemedicine;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;

(5) the location of the originating site and the distant site;

(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.

(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, a community paramedic as defined
under section 144E.001, subdivision 5f, or a mental health practitioner defined under section
245.462, subdivision 17, or 245.4871, subdivision 26, working under the general supervision
of a mental health professional, and a community health worker who meets the criteria
under subdivision 49, paragraph (a); "health care provider" is defined under section 62A.671,
subdivision 3
; and "originating site" is defined under section 62A.671, subdivision 7.

(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:

(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and

(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.

Sec. 2.

Minnesota Statutes 2020, section 256B.69, subdivision 31, is amended to read:


Subd. 31.

Payment reduction.

(a) Beginning September 1, 2011, the commissioner
shall reduce payments and limit future rate increases paid to managed care plans and
county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved on a
statewide aggregate basis by program. The commissioner may use competitive bidding,
payment reductions, or other reductions to achieve the reductions and limits in this
subdivision.

(b) Beginning September 1, 2011, the commissioner shall reduce payments to managed
care plans and county-based purchasing plans as follows:

(1) 2.0 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;

(2) 2.82 percent for medical assistance families and children;

(3) 10.1 percent for medical assistance adults without children; and

(4) 6.0 percent for MinnesotaCare families and children.

(c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed care
plans and county-based purchasing plans for calendar year 2012 to a percentage of the rates
in effect on August 31, 2011, as follows:

(1) 98 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;

(2) 97.18 percent for medical assistance families and children;

(3) 89.9 percent for medical assistance adults without children; and

(4) 94 percent for MinnesotaCare families and children.

(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit the
maximum annual trend increases to rates paid to managed care plans and county-based
purchasing plans as follows:

(1) 7.5 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;

(2) 5.0 percent for medical assistance special needs basic care;

(3) 2.0 percent for medical assistance families and children;

(4) 3.0 percent for medical assistance adults without children;

(5) 3.0 percent for MinnesotaCare families and children; and

(6) 3.0 percent for MinnesotaCare adults without children.

(e) The commissioner may limit trend increases to less than the maximum. Beginning
July 1, 2014, the commissioner shall limit the maximum annual trend increases to rates paid
to managed care plans and county-based purchasing plans as follows for calendar years
2014 and 2015:

(1) 7.5 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;

(2) 5.0 percent for medical assistance special needs basic care;

(3) 2.0 percent for medical assistance families and children;

(4) 3.0 percent for medical assistance adults without children;

(5) 3.0 percent for MinnesotaCare families and children; and

(6) 4.0 percent for MinnesotaCare adults without children.

The commissioner may limit trend increases to less than the maximum. For calendar
year 2014, the commissioner shall reduce the maximum aggregate trend increases by
$47,000,000 in state and federal funds to account for the reductions in administrative
expenses in subdivision 5i.

new text begin (f) Beginning January 1, 2022, the commissioner shall reduce payments to managed
care plans and county-based purchasing plans by an amount that reflects the ten percent
reduction in the reimbursement rate for services delivered through telemedicine specified
in section 256B.0625, subdivision 3b, paragraph (a).
new text end