Recipient protections and continuity of care when a provider is subject to a serious operational event provided, complex transitions provided, and continuity period and transition payments provided.

A bill for an act

relating to human services; providing for recipient protections and continuity of

care when a provider is subject to a serious operational event; providing for complex

transitions; providing for a continuity period and transition payments for complex

transitions; amending Minnesota Statutes 2024, sections 256B.0651, subdivision

17; 256B.69, by adding a subdivision; 256B.85, subdivision 23a; proposing coding

for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

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[256B.045] RECIPIENT PROTECTIONS AND CONTINUITY OF CARE

WHEN A PROVIDER IS SUBJECT TO A SERIOUS OPERATIONAL EVENT.

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Subdivision 1.

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Definition.

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(a) For purposes of sections 256B.045 to 256B.047, the

following terms have the meanings given.

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(b) "Complex transition" means a provider termination, suspension, revocation, or closure

event that, without structured transition measures, would likely result in avoidable

hospitalization, institutionalization, serious clinical deterioration, or loss of housing or

placement for a recipient.

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(c) "Direct recipient care costs" means costs necessary to furnish covered services,

excluding owner distributions, dividends, related party profit, and other noncare financial

transfers.

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(d) "Lead agency" means a county, Tribe, or managed care organization.

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(e) "Recipient" means an enrollee, participant, resident, or other individual receiving

services under medical assistance.

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(f) "Serious operational event" means sanctions or termination actions affecting provider

participation or payments under section 256B.064, licensure loss or revocation, insolvency,

receivership, bankruptcy, abandonment, or inability of a provider to safely operate.

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Subd. 2.

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Provider duties.

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If a medical assistance service provider determines it is unable

to continue to provide services to a recipient due to a serious operational event, the provider

must:

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(1) when practicable, notify the recipient; the recipient's responsible party, if applicable;

the lead agency; and the commissioner 30 days before terminating services to the recipient;

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(2) assist the commissioner and lead agency in supporting the recipient in transitioning

to another provider of the recipient's choice; and

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(3) when practicable, provide each recipient with a copy of the relevant recipient bill of

rights or recipient protections, if applicable, at least 30 days before terminating services.

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Subd. 3.

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Commissioner's duties.

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(a) When a provider is subject to a serious operational

event, the commissioner or the commissioner's delegate must:

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(1) inform the appropriate ombudsperson's office, if applicable, and the lead agency for

each recipient currently receiving services; and

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(2) directly notify each recipient who receives services from the provider in order to

protect recipient welfare.

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(b) When a medical assistance service provider provides notice to the commissioner

under subdivision 2 that it is unable to continue to provide services to a recipient due to a

serious operational event, the commissioner must assist the provider and the lead agency

in supporting the recipient in transitioning to another provider of the recipient's choice.

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(c) The commissioner must ensure a recipient receives continuity of medically necessary

services and supports through a safe and orderly transition to appropriate receiving providers

when a serious operational event is designated as a complex transition under section

256B.046.

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Subd. 4.

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Lead agency duties.

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When a provider is subject to a serious operational event,

a lead agency must contact affected service recipients to ensure that each recipient:

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(1) is continuing to receive needed services; and

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(2) has been given free choice of provider if the recipient transfers to another service

provider.

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Sec. 2.

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[256B.046] COMPLEX TRANSITIONS.

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Subdivision 1.

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Complex transition designation.

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(a) The commissioner must designate

a serious operational event as a complex transition when:

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(1) a recipient is receiving long-term services and supports, including home and

community-based services;

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(2) a recipient is receiving behavioral health or substance use disorder treatment where

abrupt interruption of treatment creates a material risk;

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(3) a recipient is medically fragile and depends on life-sustaining treatment;

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(4) there is limited regional capacity, including limited culturally or linguistically

appropriate care; or

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(5) a recipient's placement stability is dependent upon continued service delivery.

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(b) The commissioner may establish objective thresholds to create a presumption of

complex transition based on the number of recipients affected by a serious operational event,

recipient acuity, service type, or unresolved discharge or placement barriers.

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Subd. 2.

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Complex transition operations plan.

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The commissioner must develop and

implement a written complex transition operations plan for each complex transition. The

plan must include:

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(1) recipient identification and acuity level;

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(2) stabilization actions to prevent gaps in care for high-risk recipients;

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(3) medical record, medication, and treatment plan continuity procedures;

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(4) receiving provider identification and capacity information;

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(5) transition timelines, transportation, and handoff procedures;

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(6) the communication plan for recipients, families, and guardians, including language

access; and

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(7) coordination with lead agencies, case managers, and ombudsperson offices, when

applicable.

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Subd. 3.

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Complex transition team.

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The commissioner may convene a complex transition

team that includes department staff, lead agencies, and other professionals, as necessary,

to ensure the safe transition of recipients from the provider that is unable to continue to

provide services to another provider.

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Subd. 4.

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Complex transition; legislative notice.

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The commissioner must notify the

chairs and ranking minority members of the legislative committees with jurisdiction over

human services policy and finance within ten days of designating a complex transition and

must provide a report within 90 days of recipient stabilization to identify systemic gaps and

make recommendations for systemic improvements.

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Sec. 3.

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[256B.047] CONTINUITY PERIOD AND TRANSITION PAYMENTS FOR

COMPLEX TRANSITIONS.

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Subdivision 1.

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Limited continuity period.

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A provider subject to a serious operational

event that is designated as a complex transition under section 256B.046 may continue to

provide services to high-risk recipients receiving long-term services and supports or hospice

care for up to 180 days after the date the serious operational event was designated a complex

transition. The continuity period under this subdivision does not reinstate provider

participation in medical assistance and does not limit the commissioner's sanction, exclusion,

recovery, licensing enforcement, or referral authority.

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Subd. 2.

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Good cause payment safeguards.

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When payment withholds or reductions

occur under section 256B.064, the commissioner may find good cause not to suspend

payments under Code of Federal Regulations, title 42, section 455.23(e) or (f), in order to

provide for continuity of care during complex transitions.

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Subd. 3.

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Transition payments.

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(a) If the commissioner does not suspend payments to

a provider sanctioned under section 256B.064 due to a determination of good cause, payments

to the provider must be limited to direct recipient care costs. A provider receiving payments

under this section must submit to independent financial monitoring and a prohibition on

financial distributions to owners.

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(b) When permitted by state and federal law, the amount of allowable transition payments

paid to a provider under this section are subtracted from the debts the provider owes to the

state.

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(c) The commissioner shall prioritize payment to alternative enrolled medical assistance

providers that assume responsibility for service provision, court-appointed receivers or

interim managers providing services, or substitute providers operating on site under an

approved transition plan.

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(d) Nothing in this section requires payments that are prohibited by federal law.

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Sec. 4.

Minnesota Statutes 2024, section 256B.0651, subdivision 17, is amended to read:

Subd. 17.

Recipient protection.

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(a)
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Providers of home care services must
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provide each

recipient with a copy of the home care bill of rights under section
144A.44
at least 30 days

prior to terminating services to a recipient, if the termination results from provider sanctions

under section
256B.064
, such as a payment withhold, a suspension of participation, or a

termination of participation. If a home care provider determines it is unable to continue

providing services to a recipient, the provider must notify the recipient, the recipient's

responsible party, and the commissioner 30 days prior to terminating services to the recipient

because of an action under section
256B.064
, and must assist the commissioner and lead

agency in supporting the recipient in transitioning to another home care provider of the

recipient's choice
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meet the recipient protection requirements under section 256B.045 when

subject to a serious operational event as defined in section 256B.045, subdivision 1
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.

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(b) In the event of a payment withhold from a home care provider, a suspension of

participation, or a termination of participation of a home care provider under section

256B.064
, the commissioner may inform the Office of Ombudsman for Long-Term Care

and the lead agencies for all recipients with active service agreements with the provider. At

the commissioner's request, the lead agencies must contact recipients to ensure that the

recipients are continuing to receive needed care, and that the recipients have been given

free choice of provider if they transfer to another home care provider. In addition, the

commissioner or the commissioner's delegate may directly notify recipients who receive

care from the provider that payments have been or will be withheld or that the provider's

participation in medical assistance has been or will be suspended or terminated, if the

commissioner determines that notification is necessary to protect the welfare of the recipients.

For purposes of this subdivision, "lead agencies" means counties, tribes, and managed care

organizations.

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Sec. 5.

Minnesota Statutes 2024, section 256B.69, is amended by adding a subdivision to

read:

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Subd. 38.

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Duties when a provider is no longer able to provide services.

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When a

provider is subject to a serious operational event in section 256B.045, managed care and

county-based purchasing plans must follow the complex transition operations plan developed

under section 256B.046, honor existing service authorizations when clinically appropriate

for continuity and safe transfer of services, and ensure timely contracting or single-case

arrangements to prevent service gaps.

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Sec. 6.

Minnesota Statutes 2024, section 256B.85, subdivision 23a, is amended to read:

Subd. 23a.

Sanctions; information for participants upon termination of services.

(a)

The commissioner may withhold payment from the provider or suspend or terminate the

provider enrollment number if the provider fails to comply fully with applicable laws or

rules. The provider has the right to appeal the decision of the commissioner under section

256B.064
.

(b) Notwithstanding subdivision 13, paragraph (e), if a participant employer fails to

comply fully with applicable laws or rules, the commissioner may disenroll the participant

from the budget model. A participant may appeal in writing to the department under section

256.045, subdivision 3
, to contest the department's decision to disenroll the participant from

the budget model.

(c) Agency-providers of CFSS services or FMS providers must
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provide each participant

with a copy of participant protections in subdivision 20c at least 30 days prior to terminating

services to a participant, if the termination results from sanctions under this subdivision or

section
256B.064
, such as a payment withhold or a suspension or termination of the provider

enrollment number. If a CFSS agency-provider, FMS provider, or consultation services

provider determines it is unable to continue providing services to a participant because of

an action under this subdivision or section
256B.064
, the agency-provider, FMS provider,

or consultation services provider must notify the participant, the participant's representative,

and the commissioner 30 days prior to terminating services to the participant, and must

assist the commissioner and lead agency in supporting the participant in transitioning to

another CFSS agency-provider, FMS provider, or consultation services provider of the

participant's choice
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meet the recipient protection requirements under section 256B.045 when

subject to a serious operational event as defined in section 256B.045, subdivision 1
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.

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(d) In the event the commissioner withholds payment from a CFSS agency-provider,

FMS provider, or consultation services provider, or suspends or terminates a provider

enrollment number of a CFSS agency-provider, FMS provider, or consultation services

provider under this subdivision or section
256B.064
, the commissioner may inform the

Office of Ombudsman for Long-Term Care and the lead agencies for all participants with

active service agreements with the agency-provider, FMS provider, or consultation services

provider. At the commissioner's request, the lead agencies must contact participants to

ensure that the participants are continuing to receive needed care, and that the participants

have been given free choice of agency-provider, FMS provider, or consultation services

provider if they transfer to another CFSS agency-provider, FMS provider, or consultation

services provider. In addition, the commissioner or the commissioner's delegate may directly

notify participants who receive care from the agency-provider, FMS provider, or consultation

services provider that payments have been or will be withheld or that the provider's

participation in medical assistance has been or will be suspended or terminated, if the

commissioner determines that the notification is necessary to protect the welfare of the

participants.

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