Minnesota Hospital Association

Policy & Advocacy

The Affordable Care Act (ACA) in Minnesota

Minnesota’s Reform Efforts

In 2008, the Minnesota Legislature passed a health care reform bill (S.F. 3780) that expanded access to health coverage for 12,000 Minnesotans, either through MinnesotaCare or through tax credits. The goal of the bill was to empower consumers with greater transparency around provider price and quality, better coordination of care through medical homes and to establish a framework for moving forward with payment reform solutions. Read about Minnesota’s health care reform journey.

Minnesota's Reform Timeline

Date

Description

Dec. 15, 2008

Commissioner of Human Services reports to Legislature with recommendations for a rate increase to long-term care employers for purchase of employee health insurance.

Jan. 1, 2009 or upon federal approval, whichever is later

MinnesotaCare expansions increasing income threshold for adults with no children to 250 percent of federal poverty guidelines, and allowing enrollees to remain on MinnesotaCare for an additional month after failing to submit renewal forms or make final month’s premium payment.

On or before Jan. 15, 2009

Commissioner of Health convenes first meeting of Health-Care Reform Review Council.

Jan. 15, 2009

Commissioner of Human Services shall report on ways to improve coordination between state health-care programs and social-service programs to identify and enroll MinnesotaCare-eligible residents.

Jan. 15, 2009

Commissioner of Health submits report to Health Care Access Commission regarding payment restructuring progress.

Jan. 15, 2009

Commissioner of Health makes recommendations to the Legislature for changes necessary in health licensure and regulation related to scope of practice of advanced practice nurses, physician assistants, and other health care professionals in the health-care home and primary-care delivery system.

Jan. 15, 2009

Commissioner of Health submits report and recommendations to the Legislature regarding affordability proposal for individuals with access to employer-subsidized health coverage.

April 1, 2009

Commissioner of Commerce makes form for opting out of Section 125 requirement available on its website.

July 1, 2009

Commissioner of Health awards grants to community-health boards for public health initiatives.

July 1, 2009

Employers with 11 or more FTEs must establish Section 125 plans or opt out.

July 1, 2009

Commissioners of Health and Human Services develop and implement certification standards for health-care homes for state health-care programs.

July 1, 2009

Commissioners of Health and Human Services establish a health-care home collaborative.

July 1, 2009

Commissioner of Human Services begins encouraging state health-care program enrollees with complex or chronic conditions to select primary care clinics with health-care home-certified clinicians.

July 1, 2009

Commissioner of Health establishes uniform definitions for baskets of care.

July 1, 2009

Commissioner of Health develops a system of quality incentive payments for providers.

July 1, 2009

Health plans and third-party administrators submit encounter data to Commissioner of Health.

July 1, 2009

Health plans and third-party administrators submit data on their contracted prices with providers to Commissioner of Health.

Oct. 15, 2009

Benefit Set Work Group submits report to Commissioner of Health on an initial essential benefit set and design.

Dec. 15, 2009

Commissioners of Health and Human Services report on implementation and administration of health-care home model for state health-care program enrollees.

Dec. 31, 2009

Commissioner of Health establishes quality measures for the baskets of care.

Jan. 15, 2010

Commissioner of Health reports on public health improvement program, including recommendations on sustainable funding source other than the Health Care Access Fund.

Jan. 1, 2010

Commissioner of Human Services develops payment system for care coordination fees.

Jan. 1, 2010

State employee insurance plans include options for high-deductible health plans.

Jan. 1, 2010

Hospitals and physician clinics submit standardized electronic information on outcomes and processes associated with patient care.

Jan. 1, 2010

Health plan companies required to use standardized quality measures developed by Commissioner of Health.

Jan. 1, 2010

Commissioner of Health develops plan to create transparent prices, encourage provider innovation and collaboration in cost-effective care delivery, reduce administrative burden on providers and plans associated with processing claims, and provide consumers with comparative information on health-care cost and quality.

Jan. 1, 2010

Health plans required to include health-care homes in provider networks.

Jan. 1, 2010

Health plans and third-party administrators submit encounter data to Commissioner of Health.

Jan. 1, 2010

Health plans and third-party administrators submit data on contracted prices with providers.

Jan. 1, 2010

Consumer Engagement Work Group makes recommendations to Commissioner of Health and Legislature.

Jan. 1, 2010

Health-care providers may establish package prices for baskets of care.

Jan. 1, 2010

Uniform Claims Review Process Work Group makes recommendations to Commissioner of Health regarding potential for reducing claims and adjudication costs by adopting more uniform payment methods.

Jan. 15, 2010

Commissioner of Health reports on recommendations of Essential Benefit Set Work Group to Legislature.

June 1, 2010

Commissioner of Health disseminates information to providers on their cost of care, resource use, quality of care, and the results of peer grouping.

June 22, 2010

Deadline for providers to review accuracy of Commissioner of Healths data based on cost of care, resource use, quality of care, and peer grouping.

July 1, 2010

Comparative price and quality information on baskets of care is published by Commissioner of Health for consumer use.

July 1, 2010

Commissioner of Finance implements quality incentive payment system for state employees.

July 1, 2010

Health plans required to pay care coordination fee for members enrolled in health-care homes.

July 1, 2010

Commissioner of Finance implements care coordination payments for participants in state employee insurance plan.

July 1, 2010

Health plans and third-party administrators submit encounter data to Commissioner of Health.

 

 

July 1, 2010

Commissioner of Human Services implements quality incentive payments for state health-care program enrollees.

July 1, 2010

Commissioner of Health establishes standards for measuring health outcomes and issues annual public reports on provider quality.

July 1, 2010 or upon federal approval, whichever is later

Commissioner of Human Services implements care coordination payment system.

July 1, 2010 or upon federal approval, whichever is later

Expansions of MinnesotaCare become effective allowing children to remain eligible for MinnesotaCare immediately after exceeding medical assistances income limits and increasing total family income limits to $57,500.

Sept. 1, 2010

Commissioner of Health publishes information on providers’ cost, quality, and peer grouping for public use.

Dec. 15, 2010

Commissioners of Health and Human Services report on implementation and administration of health-care home model for state health-care program enrollees.

Jan. 1, 2011

Commissioner of Human Services develops payment system to reward high- quality, low-cost providers; creates incentives for public health-care program enrollees to choose high-quality, low-cost providers; and fosters collaboration among providers to reduce cost shifting.

Jan. 1, 2011

Providers, group purchasers, prescribers, and dispensers of controlled substances must establish and maintain an electronic prescription program.

Jan. 1, 2011

Health plans and third-party administrators submit encounter data toCommissioner of Health.

Jan. 1, 2011

Health plans and third-party administrators submit data on contracted prices with providers.

 

 

Jan. 1, 2011

Commissioner of Finance, political subdivisions, and health plans develop incentives or products to encourage consumers to use high-quality, low-cost providers.

Jan. 1, 2011

Commissioner of Health reports to governor and Legislature on recommendations to encourage health plans to promote wide-spread adoption of insurance products that encourage the use of high-quality, low-cost providers.

Jan. 15, 2011

Commissioner of Health reports on public health improvement program and makes recommendations regarding whether future program funding should be distributed based on health disparities.

July 1, 2011

Health plans and third-party administrators submit encounter data toCommissioner of Health.

Sept. 1, 2011

Commissioner of Health publishes information on providers’ cost, quality, and peer grouping.

Dec.15, 2011

Commissioners of Health and Human Services report on implementation and administration of health-care home model for state health-care program enrollees.

Jan. 1, 2012

Health plans and third-party administrators submit encounter data toCommissioner of Health.

Jan. 15, 2012

Commissioner of Health reports on public health improvement program.

Jan. 1, 2012

Health plans and third-party administrators submit data on contracted prices with providers.

July 1, 2012

Health plans and third-party administrators submit encounter data toCommissioner of Health.

Sept. 1, 2012

Commissioner of Health publishes information on providers’ cost, quality, and peer grouping.

Dec. 15, 2012

Commissioners of Health and Human Services report on implementation and administration of health-care home model for state health-care program enrollees.

Federal Reform Timeline

Expected Chronology of Critical Steps in Implementation of the
Patient Protection and Affordable Care Act in Minnes0ta during 2011

Expected date
(2011)

Implementation Step

Comment

 

January 1

10% Medicare bonus for primary care and general surgeons


Bonus continues through 2015

 

January 1

Outpatient hospital rate cut by 0.25%

 

 

January 1

Medicare Advantage rates frozen

Freeze lasts for one year, deeper cuts in future

years

 

January

Stark exception for new physician-owned hospitals expires restrictions on grandfathered facilities begin

Element of MHA's current strategic plan.

 

January 5

Gov. Dayton signs executive order for early Medicaid enrollment


One of MHA's highest priorities according to

results from Board retreat. Association focus shifts to expediting implementation so enrollment

can begin as soon as possible.

 

January 7

CMS receives comments regarding proposed Medicaid RAC program

MHA submits comments urging revisions to

proposed rule that reflect lessons from Medicare

RAC program, protect providers costly duplication of audits by different contractors, and ensure ability of contractors to receive electronic information from providers' EMRs.

 

January 7

Proposed Value Based Purchasing program rules released

Comments due March 6; VBP demo for critical

access hospitals in 2012

 

January 17, 19

Institute of Medicine convenes hearings to take comments regarding upcoming studies of geographic disparities in Medicare payments and value index.


Together with Healthcare Quality Coalition, MHA

will assess need for additional comments and whether to submit them as a coalition, as individual organizations or both.

 

January 31

Comments regarding proposed

Medical Loss Ratio rules due

MHA expects to submit comments supporting

proposed allocation of medical and administrative expenses, and to request greater transparency of

data used in ratio calculation.

 

February 15

 

(or earlier)

CMS releases proposed shared

savings program (ACO) rules

Draft rules originally expected to be released in

September 2010 and continue to miss tentative deadlines

February 28

 

(or earlier)

CMS releases proposed readmission policy for high-risk population rules

Initial rules will apply to high-risk populations

with future rules to apply more broadly to

Medicare population; demos of readmissions policy for critical access hospitals required by ACA but on uncertain timeframe within CMS

March 1

 

(estimated)

CMS releases minimum standards, qualifications and duties for Health

Insurance Exchanges

Unclear when proposed rules will be released;

CMS provided guidance letter to states in 2010.

March 1

 

(estimated)

CMS releases proposed rules for

administrative simplification of eligibility verification and claims status

 

March 6

Comments regarding Value Based

Purchasing program proposed rules due

MHA intends to submit comments

March 23

Federal government begins making money available to help states pay for implementation of health insurance exchanges

Money available from 3/23/11 through 12/31/14

April 30

 

(or earlier)

IRS releases proposed community health needs assessment and related oversight provisions

Requirements do not apply to public hospitals;

community health needs assessment must be completed every three years.

May 1

 

(estimated)

Comments regarding proposed rules for administrative simplification of eligibility verification and claims status due

 

June 1

 

(or earlier)

MN expected to enact at least

authorizing legislation for development of Health Insurance Exchange development

In 2012, State must demonstrate significant

progress toward operational Exchange or federal government will operate Exchange; to meet that

deadline, legislature must act this session.

June 1

 

(estimate)

CMS releases final Medicaid RAC rule

 

June 30

 

(or earlier)

CMS releases proposed inpatient

PPS rule including distribution method for remaining $250 million for PPS hospitals in lowest per- beneficiary-spending counties

13 MN hospitals/health systems received a portion

of the initial $150 million. Critical access hospitals are not eligible for enhanced payments.

July 1

Administrative simplification of

eligibility verification and claims status due

Additional administrative simplification features

due in future

July 1

Redistribution of unused GME slots begins

Current formula appears to preclude MN from

gaining or losing slots; continued advocacy needed to allow MN to expand residencies

July 1

Medicaid adopts Medicare payment policy regarding health care acquired conditions

Effective date likely to be delayed since CMS has

conceded that problems exist within its data and methodology.

August 1

 

(or earlier)

Value based purchasing program performance standards announced


October 1

PPS inpatient payment rates cut

0.1%

 

October 1

First productivity adjustment (i.e., cut) to PPS rates

Estimate used by CBO was 1.3%, but CMS is not bound to follow that estimate. Productivity adjustment is in addition to other rate cuts in ACA and marketbasket update rules/policies. Similar productivity adjustment will be imposed for outpatient services in 2012.

October 1

Value based purchasing program's performance period begins

Quality and patient satisfaction scores from July

1, 2011 to June 30, 2012 will be used for calculating payments in federal fiscal year 2013, which beings Oct. 1, 2012.

October 1

Grants for training GME residents in preventive medicine specialties

Grants continue to 2015.

October 1

$200 million in grants available for wellness programs for employers with fewer than 100 employees


Possible source of extending MN's State Health

Improvement Grants expected to expire June 30,

2011

December 31

 

(or earlier)

CMS publishes core set of

Medicaid quality data for care delivered to adult enrollees.

 

December 31

 

(or earlier)

CMS solicits 8 or fewer states to

participate in Medicaid bundling demonstration

Demonstration begins in 2012.

December 31

 

(or earlier)

CMS releases draft plan to impose health care acquired condition payment policy for non-PPS hospitals

 

December 31

 

(or earlier)

CMS begins certification process forproviders seeking to become ACOs

Because proposed ACO rules have not been

released as of January 11, the certification process for providers might not begin until 2012.

December 31

 

(or earlier)

CMS solicits participants for

pediatric ACO demonstration program

Demonstration begins in 2012.

December 31

 

(or earlier)

Recommendations from CMS for comprehensive wage index reform

Unclear how new Congress will respond, although

unlikely to implement recommendations until after 2012 elections