1.1    .................... moves to amend H. F. No. 2159 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. [256B.0751] CARE COORDINATION FOR CHILDREN WITH
1.4HIGH-COST MEDICAL CONDITIONS.
1.5    Subdivision 1. Care coordination required. (a) The commissioner of human
1.6services shall contract with the U special kids program to provide care coordination,
1.7beginning October 1, 2007, for medical assistance enrollees who are children with
1.8high-cost medical conditions, and to perform the other duties specified in this section.
1.9    (b) For purposes of this section, "care coordination" means collaboration with
1.10primary care physicians and specialists to manage care, development of medical
1.11management plans for recurrent acute illnesses, oversight and coordination of all aspects
1.12of care in partnership with families, organization of medical information into a summary
1.13of critical information, coordination and appropriate sequencing of tests and multiple
1.14appointments, information and assistance with accessing resources, and telephone triage
1.15for acute illnesses or problems.
1.16    Subd. 2. Referrals. The commissioner shall develop a mechanism to refer
1.17children to the U special kids program for care coordination. Beginning October 1, 2007,
1.18and subject to the limits on total program enrollment specified in subdivision 3, the
1.19commissioner shall refer to the U special kids program children who:
1.20    (1) incur medical expenses that exceed the qualifying level specified in subdivision 3;
1.21    (2) have medical conditions that involve four or more major systems; require
1.22multiple specialists; require use of technology such as G-tube, trach, central line, or
1.23oxygen; and require multiple medications; and
1.24    (3) do not have a medical case manager for cancer, organ transplantation, epilepsy,
1.25or bone marrow replacement.
2.1    Subd. 3. Qualifying level of medical expenses. (a) For the period October 1, 2007,
2.2through September 30, 2008, the commissioner shall refer children for care coordination
2.3under this section if they incurred medical expenses of $500,000 or more during the
2.4fiscal year ending June 30, 2007.
2.5    (b) For the period October 1, 2008, through September 30, 2009, the commissioner
2.6shall refer children for care coordination under this section if they incurred medical
2.7expenses of $400,000 or more during the fiscal year ending June 30, 2008.
2.8    (c) For the period October 1, 2009, through September 30, 2010, the commissioner
2.9shall refer children for care coordination under this section if they incurred medical
2.10expenses of $300,000 or more during the fiscal year ending June 30, 2009.
2.11    (d) Beginning October 1, 2010, the commissioner shall refer children for care
2.12coordination under this section if they incurred medical expenses of $250,000 or more
2.13during the previous fiscal year.
2.14    (e) The commissioner shall limit referrals to the extent necessary to ensure that
2.15total enrollment in the U special kids program does not exceed 100 children for the
2.16period October 1, 2007, through September 30, 2008, and does not exceed 150 children
2.17beginning October 1, 2008.
2.18    Subd. 4. Case management. Beginning October 1, 2007, the U special kids
2.19program shall coordinate all nonmedical case management services provided to children
2.20who are required to receive care coordination under this section. The program may
2.21require all nonmedical case managers, including, but not limited to, county case managers
2.22and case managers for children served under a home and community-based waiver,
2.23to submit care plans for approval, and to document client compliance with the care
2.24plans. The U special kids program, beginning October 1, 2008, may employ or contract
2.25with nonmedical case managers to provide all nonmedical case management services to
2.26children required to receive care coordination under this section. The commissioner shall
2.27reimburse the U special kids program for case management services through the medical
2.28assistance program.
2.29    Subd. 5. Statewide availability of care coordination. The U special kids program
2.30may contract with other entities to provide care coordination services as defined in
2.31subdivision 1, in order to ensure the availability of these services in all regions of the state.
2.32    Subd. 6. Advance practice nurse telephone triage system. The U special kids
2.33program shall establish and operate an advance practice nurse telephone triage system that
2.34is available statewide, 24 hours a day, seven days per week. The system must provide
3.1advance practice nurses with access to a Web-based information system to appropriately
3.2triage medical problems, manage care, and reduce unnecessary hospitalizations.
3.3    Subd. 7. Web-accessible database. The commissioner shall contract with an
3.4appropriate vendor to design, develop, and maintain an information management
3.5application and system that is secure and Web accessible for critical information
3.6summaries of children served by the U special kids program, to:
3.7    (1) allow effective communication and treatment integration between health care
3.8providers, patients and their families, case managers, advance practice nurses providing
3.9telephone triage services, and other persons or entities serving children enrolled in the U
3.10special kids program; and
3.11    (2) allow more effective program administration, financial management, and billing.
3.12Ownership of the information management application and system shall reside with the
3.13Department of Human Services. Data entry shall remain the responsibility of U special
3.14kids program case managers.
3.15    Subd. 8. Monitoring and evaluation. The commissioner shall monitor program
3.16outcomes and evaluate the extent to which referrals to the U special kids program have
3.17improved the quality and coordination of care and provided financial savings to the
3.18medical assistance program. The U special kids program shall submit to the commissioner,
3.19in the form and manner specified by the commissioner, all data and information necessary
3.20to monitor program outcomes and evaluate the program. The commissioner shall present a
3.21preliminary evaluation to the legislature by January 15, 2008, and a final evaluation to the
3.22legislature by January 15, 2010.

3.23    Sec. 2. [256B.0752] CARE COORDINATION FOR CHILDREN WITH
3.24HIGH-COST MENTAL HEALTH CONDITIONS.
3.25    Subdivision 1. Care coordination required. (a) The commissioner of human
3.26services shall contract with the U special kids program to provide care coordination,
3.27beginning October 1, 2007, for medical assistance enrollees who are children with
3.28high-cost mental health conditions and behavioral problems, and to perform the other
3.29duties specified in this section.
3.30    (b) For purposes of this section, "care coordination" means collaboration with
3.31primary care physicians and specialists to manage care, development of mental health
3.32management plans for recurrent mental health issues, oversight and coordination of all
3.33aspects of care in partnership with families, organization of medical, treatment, and
3.34therapy information into a summary of critical information, coordination and appropriate
4.1sequencing of evaluations and multiple appointments, information and assistance with
4.2accessing resources, and telephone triage for behavior or other problems.
4.3    Subd. 2. Referrals. The commissioner shall develop a mechanism to refer children
4.4to the program for care coordination. Beginning October 1, 2007, and subject to the limits
4.5on total program enrollment specified in subdivision 3, the commissioner shall refer to
4.6the U special kids program children who:
4.7    (1) incur mental health expenses that exceed the qualifying level specified in
4.8subdivision 3; and
4.9    (2) are currently receiving or at risk of needing inpatient mental health treatment,
4.10foster home care, or both.
4.11    Subd. 3. Qualifying level of medical expenses. (a) Beginning October 1, 2007, the
4.12commissioner shall refer children for care coordination under this section if they incurred
4.13medical and mental health expenses of $250,000 or more in the previous fiscal year.
4.14    (b) The commissioner shall limit referrals to the extent necessary to ensure that total
4.15enrollment in the U special kids program does not exceed 25 children for the period
4.16October 1, 2007, through September 30, 2008; does not exceed 75 children for the
4.17period October 1, 2008, through September 30, 2009; and does not exceed 125 children
4.18beginning October 1, 2009.
4.19    Subd. 4. Case management. The U special kids program, beginning October 1,
4.202007, shall coordinate all nonmedical case management services provided to children who
4.21are required to receive care coordination under this section. The program may require all
4.22nonmedical case managers, including but not limited to county case managers and case
4.23managers for children served under a home and community-based waiver, to submit care
4.24plans for approval, and to document client compliance with the care plans. The U special
4.25kids program, beginning October 1, 2008, may employ or contract with nonmedical case
4.26managers to provide all nonmedical case management services to children required to
4.27receive care coordination under this section. The commissioner shall reimburse the
4.28U special kids program for case management services through the medical assistance
4.29program.
4.30    Subd. 5. Statewide availability of care coordination. The program may contract
4.31with other entities to provide care coordination services as defined in subdivision 1, in
4.32order to ensure the availability of these services in all regions of the state.
4.33    Subd. 6. Monitoring and evaluation. The commissioner shall monitor program
4.34outcomes and shall evaluate the extent to which referrals to the U special kids program
4.35have improved the quality and coordination of care and provided financial savings to the
5.1medical assistance program. The U special kids program shall submit to the commissioner,
5.2in the form and manner specified by the commissioner, all data and information necessary
5.3to monitor program outcomes and evaluate the program. The commissioner shall present a
5.4preliminary evaluation to the legislature by January 15, 2008, and a final evaluation to the
5.5legislature by January 15, 2010.

5.6    Sec. 3. APPROPRIATION.
5.7    Subdivision 1. Care coordination for medical conditions. (a) $1,500,000 in fiscal
5.8year 2008 and $1,500,000 in fiscal year 2009 are appropriated from the general fund to the
5.9commissioner of human services for contracting for care coordination with the U special
5.10kids program under Minnesota Statutes, section 256B.0751.
5.11    (b) $500,000 in fiscal year 2008 and $500,000 in fiscal year 2009 are appropriated
5.12from the general fund to the commissioner of human services for the U special kids
5.13program to establish and administer an advance practice nurse telephone triage system
5.14under Minnesota Statutes, section 256B.0751, subdivision 6.
5.15    (c) $500,000 in fiscal year 2008 is appropriated from the general fund to the
5.16commissioner of human services to establish a Web-accessible database under Minnesota
5.17Statutes, section 256B.0751, subdivision 7.
5.18    (d) $500,000 in fiscal year 2008 and $750,000 in fiscal year 2009 are appropriated
5.19from the general fund to the commissioner of human services to reimburse the U special
5.20kids program for complementary alternative medicine treatment not covered under
5.21medical assistance.
5.22    Subd. 2. Care coordination for mental health conditions.
5.23    (a) $500,000 in fiscal year 2008 and $1,000,000 in fiscal year 2009 are appropriated
5.24from the general fund to the commissioner of human services for contracting for care
5.25coordination with the U special kids program under section 1. The base funding for this
5.26activity shall be $1,500,000 for fiscal years 2010 and beyond.
5.27    (b) $125,000 in fiscal year 2008 and $375,000 in fiscal year 2009 are appropriated
5.28from the general fund to the commissioner of human services for the U special kids
5.29program to cover complementary alternative medicine services and over-the-counter
5.30nutritional supplements not covered under medical assistance, subject to an annual limit of
5.31$5,000 per patient. The base funding for this activity shall be $625,000 for fiscal years
5.322010 and beyond."
5.33Amend the title accordingly