MN HF4440

Amends Minnesota Statutes 2018, section 256B.69, subdivision 5a, to authorize the commissioner to withhold 5 percent of managed care plan and county-based purchasing plan capitation payments pending completion of performance targets.

Requires all performance targets to be quantifiable, objective, measurable, and reasonably attainable, with written assessment criteria established prior to contract effective dates; clinical and utilization targets must consider evidence-based research and be developed with input from external clinical experts and stakeholders.

Establishes specific performance targets including reducing emergency department utilization rates by 10 percent annually (toward a 25 percent overall reduction from 2009 baseline) and reducing hospital admission rates by 5 percent annually (toward a 25 percent overall reduction from 2011 baseline).

Requires withheld funds to be returned between July 1-31 of the following year if performance targets are achieved, with partial returns allowed for reductions less than targeted amounts; creates temporary 4.5 percent and 3 percent withholding rates for 2013 and 2014 respectively.

Effective January 1, 2021, establishes a 2 percent capitation withhold requiring enrollees to submit verification of coverage forms by February 28, 2021, with consequences including non-return of withheld funds, cessation of capitation payments, and disenrollment for enrollees without completed forms.