SF 2168

1st Unofficial Engrossment - 86th Legislature (2009 - 2010) Posted on 12/26/2012 11:17pm

1.1A bill for an act

1.2relating to health care; establishing mental health urgent care and consultation
1.3services; modifying the general assistance medical care program; requiring
1.4a report; appropriating money;amending Minnesota Statutes 2008, sections
1.5256.969, subdivision 27, by adding a subdivision; 256B.0625, subdivision 13f,
1.6by adding a subdivision; 256D.03, subdivisions 3a, 3b; 256D.06, subdivision 7;
1.7256L.05, subdivisions 1b, 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4;
1.8256L.17, subdivision 7; Minnesota Statutes 2009 Supplement, sections 256.969,
1.9subdivisions 2b, 3a; 256B.196, subdivision 2; 256B.199; 256D.03, subdivision
1.103; proposing coding for new law in Minnesota Statutes, chapters 245; 256D.
1.11BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.12ARTICLE 1

1.13HEALTH CARE PROGRAM MODIFICATION

1.14    Section 1. [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC
1.15CONSULTATION.
1.16    Subdivision 1. Mental health urgent care and psychiatric consultation. The
1.17commissioner shall include mental health urgent care and psychiatric consultation
1.18services as part of, but not limited to, the redesign of six community-based behavioral
1.19health hospitals and the Anoka-Metro Regional Treatment Center. These services must
1.20not duplicate existing services in the region, and must be implemented as specified in
1.21subdivisions 3 to 7.
1.22    Subd. 2. Definitions. For purposes of this section:
1.23(a) Mental health urgent care includes:
1.24(1) initial mental health screening;
1.25(2) mobile crisis assessment and intervention;
2.1(3) rapid access to psychiatry, including psychiatric evaluation, initial treatment,
2.2and short-term psychiatry;
2.3(4) nonhospital crisis stabilization residential beds; and
2.4(5) health care navigator services which include, but are not limited to, assisting
2.5uninsured individuals in obtaining health care coverage.
2.6(b) Psychiatric consultation services includes psychiatric consultation to primary
2.7care practitioners.
2.8    Subd. 3. Rapid access to psychiatry. The commissioner shall develop rapid access
2.9to psychiatric services based on the following criteria:
2.10(1) the individuals who receive the psychiatric services must be at risk of
2.11hospitalization and otherwise unable to receive timely services;
2.12(2) where clinically appropriate, the service may be provided via interactive video
2.13where the service is provided in conjunction with an emergency room, a local crisis
2.14service, or a primary care or behavioral care practitioner; and
2.15(3) the commissioner may integrate rapid access to psychiatry with the psychiatric
2.16consultation services in subdivision 4.
2.17    Subd. 4. Collaborative psychiatric consultation. (a) The commissioner shall
2.18establish a collaborative psychiatric consultation service based on the following criteria:
2.19(1) the service may be available via telephone, interactive video, e-mail, or other
2.20means of communication to emergency rooms, local crisis services, mental health
2.21professionals, and primary care practitioners, including pediatricians;
2.22(2) the service shall be provided by a multidisciplinary team including, at a
2.23minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical
2.24social worker;
2.25(3) the service shall include a triage-level assessment to determine the most
2.26appropriate response to each request, including appropriate referrals to other mental health
2.27professionals, as well as provision of rapid psychiatric access when other appropriate
2.28services are not available;
2.29(4) the first priority for this service is to provide the consultations required under
2.30section 256B.0625, subdivision 13j; and
2.31(5) the service must encourage use of cognitive and behavioral therapies and other
2.32evidence-based treatments in addition to or in place of medication, where appropriate.
2.33(b) The commissioner shall appoint an interdisciplinary work group to establish
2.34appropriate medication and psychotherapy protocols to guide the consultative process,
2.35including consultation with the Drug Utilization Review Board, as provided in section
2.36256B.0625, subdivision 13j.
3.1    Subd. 5. Phased availability. (a) The commissioner may phase in the availability
3.2of mental health urgent care services based on the limits of appropriations and the
3.3commissioner's determination of level of need and cost-effectiveness.
3.4(b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin
3.5and Ramsey Counties and children statewide who are affected by section 256B.0625,
3.6subdivision 13j, and must include tracking of costs for the services provided and
3.7associated impacts on utilization of inpatient, emergency room, and other services.
3.8    Subd. 6. Limited appropriations. The commissioner shall maximize use
3.9of available health care coverage for the services provided under this section. The
3.10commissioner's responsibility to provide these services for individuals without health care
3.11coverage must not exceed the appropriations for this section.
3.12    Subd. 7. Flexible implementation. To implement this section, the commissioner
3.13shall select the structure and funding method that is the most cost-effective for each county
3.14or group of counties. This may include grants, contracts, direct provision by state-operated
3.15services, and public-private partnerships. Where feasible, the commissioner shall make
3.16any grants under this section a part of the integrated adult mental health initiative grants
3.17under section 245.4661.

3.18    Sec. 2. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 2b, is
3.19amended to read:
3.20    Subd. 2b. Operating payment rates. In determining operating payment rates for
3.21admissions occurring on or after the rate year beginning January 1, 1991, and every two
3.22years after, or more frequently as determined by the commissioner, the commissioner shall
3.23obtain operating data from an updated base year and establish operating payment rates
3.24per admission for each hospital based on the cost-finding methods and allowable costs of
3.25the Medicare program in effect during the base year. Rates under the general assistance
3.26medical care, medical assistance, and MinnesotaCare programs shall not be rebased to
3.27more current data on January 1, 1997, January 1, 2005, for the first 24 months of the
3.28rebased period beginning January 1, 2009. For the first three six months of the rebased
3.29period beginning January 1, 2011, rates shall not be rebased at 74.25 percent of the full
3.30value of the rebasing percentage change. From April July 1, 2011, to March 31, 2012,
3.31rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change.
3.32Effective April 1, 2012, rates shall be rebased at full value. The base year operating
3.33payment rate per admission is standardized by the case mix index and adjusted by the
3.34hospital cost index, relative values, and disproportionate population adjustment. The
3.35cost and charge data used to establish operating rates shall only reflect inpatient services
4.1covered by medical assistance and shall not include property cost information and costs
4.2recognized in outlier payments.

4.3    Sec. 3. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is
4.4amended to read:
4.5    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
4.6assistance program must not be submitted until the recipient is discharged. However,
4.7the commissioner shall establish monthly interim payments for inpatient hospitals that
4.8have individual patient lengths of stay over 30 days regardless of diagnostic category.
4.9Except as provided in section 256.9693, medical assistance reimbursement for treatment
4.10of mental illness shall be reimbursed based on diagnostic classifications. Individual
4.11hospital payments established under this section and sections 256.9685, 256.9686, and
4.12256.9695 , in addition to third party and recipient liability, for discharges occurring during
4.13the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
4.14inpatient services paid for the same period of time to the hospital. This payment limitation
4.15shall be calculated separately for medical assistance and general assistance medical
4.16care services. The limitation on general assistance medical care shall be effective for
4.17admissions occurring on or after July 1, 1991. Services that have rates established under
4.18subdivision 11 or 12, must be limited separately from other services. After consulting with
4.19the affected hospitals, the commissioner may consider related hospitals one entity and
4.20may merge the payment rates while maintaining separate provider numbers. The operating
4.21and property base rates per admission or per day shall be derived from the best Medicare
4.22and claims data available when rates are established. The commissioner shall determine
4.23the best Medicare and claims data, taking into consideration variables of recency of the
4.24data, audit disposition, settlement status, and the ability to set rates in a timely manner.
4.25The commissioner shall notify hospitals of payment rates by December 1 of the year
4.26preceding the rate year. The rate setting data must reflect the admissions data used to
4.27establish relative values. Base year changes from 1981 to the base year established for the
4.28rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
4.29to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
4.301. The commissioner may adjust base year cost, relative value, and case mix index data
4.31to exclude the costs of services that have been discontinued by the October 1 of the year
4.32preceding the rate year or that are paid separately from inpatient services. Inpatient stays
4.33that encompass portions of two or more rate years shall have payments established based
4.34on payment rates in effect at the time of admission unless the date of admission preceded
4.35the rate year in effect by six months or more. In this case, operating payment rates for
5.1services rendered during the rate year in effect and established based on the date of
5.2admission shall be adjusted to the rate year in effect by the hospital cost index.
5.3    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
5.4payment, before third-party liability and spenddown, made to hospitals for inpatient
5.5services is reduced by .5 percent from the current statutory rates.
5.6    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
5.7admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
5.8before third-party liability and spenddown, is reduced five percent from the current
5.9statutory rates. Mental health services within diagnosis related groups 424 to 432, and
5.10facilities defined under subdivision 16 are excluded from this paragraph.
5.11    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
5.12fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
5.13inpatient services before third-party liability and spenddown, is reduced 6.0 percent
5.14from the current statutory rates. Mental health services within diagnosis related groups
5.15424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
5.16Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
5.17assistance does not include general assistance medical care. Payments made to managed
5.18care plans shall be reduced for services provided on or after January 1, 2006, to reflect
5.19this reduction.
5.20    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
5.21fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
5.22to hospitals for inpatient services before third-party liability and spenddown, is reduced
5.233.46 percent from the current statutory rates. Mental health services with diagnosis related
5.24groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
5.25paragraph. Payments made to managed care plans shall be reduced for services provided
5.26on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
5.27    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
5.28fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011,
5.29made to hospitals for inpatient services before third-party liability and spenddown, is
5.30reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis
5.31related groups 424 to 432 and facilities defined under subdivision 16 are excluded from
5.32this paragraph. Payments made to managed care plans shall be reduced for services
5.33provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.
5.34    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
5.35for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals
5.36for inpatient services before third-party liability and spenddown, is reduced 1.79 percent
6.1from the current statutory rates. Mental health services with diagnosis related groups
6.2424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
6.3Payments made to managed care plans shall be reduced for services provided on or after
6.4July 1, 2010 2011, to reflect this reduction.
6.5(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
6.6payment for fee-for-service admissions occurring on or after July 1, 2009, made to
6.7hospitals for inpatient services before third-party liability and spenddown, is reduced
6.8one percent from the current statutory rates. Facilities defined under subdivision 16 are
6.9excluded from this paragraph. Payments made to managed care plans shall be reduced for
6.10services provided on or after October 1, 2009, to reflect this reduction.
6.11EFFECTIVE DATE.This section is effective March 1, 2010.

6.12    Sec. 4. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
6.13to read:
6.14    Subd. 26a. Psychiatric and burn services payment adjustment on or after July
6.151, 2010. (a) For admissions occurring on or after July 1, 2010, the commissioner shall
6.16increase the total payment for medical assistance fee-for-service inpatient admissions for
6.17the diagnosis-related groups specified in paragraph (b) at any hospital that is a nonstate
6.18public Minnesota hospital and a Level I trauma center. The rate increases shall be
6.19established for each hospital by the commissioner at a level that uses each hospital's
6.20voluntary payments under paragraph (c) as the nonfederal share. For purposes of
6.21this subdivision, medical assistance does not include general assistance medical care.
6.22Payments to managed care health plans shall not be increased for payments under this
6.23subdivision.
6.24    (b) The rate increases provided in paragraph (a) apply to the following
6.25diagnosis-related groups or subgroups, or any subsequent designations of such groups
6.26or subgroups: 424 to 431, 433, 504 to 511, 521, and 523. These increases are only
6.27available to the extent that revenue is available from the counties under paragraph (c)
6.28for the nonfederal share.
6.29    (c) Effective July 15, 2010, in addition to any payment otherwise required under
6.30sections 256B.19, 256B.195, 256B.196, and 256B.199, the following government entities
6.31may make the following voluntary payments to the commissioner on an annual basis:
6.32    (1) Hennepin County, $7,000,000; and
6.33    (2) Ramsey County, $3,500,000.
7.1The amounts in this paragraph shall be part of the designated governmental unit's portion of
7.2the nonfederal share of medical assistance costs, including payments under subdivision 9.
7.3    (d) The commissioner may adjust the intergovernmental transfers under paragraph
7.4(c) and the payments under paragraph (a) based on the commissioner's determination of
7.5Medicare upper payment limits, hospital-specific charge limits, and any limits imposed
7.6by the federal government regarding the rate increase or the restriction in the American
7.7Resource and Recovery Act, Public Law 111-5, regarding increased local share.
7.8    (e) This section shall be implemented upon federal approval, retroactive to July 1,
7.92010, for services provided on or after that date.

7.10    Sec. 5. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:
7.11    Subd. 27. Quarterly payment adjustment. (a) In addition to any other payment
7.12under this section, the commissioner shall make the following payments effective July
7.131, 2007:
7.14    (1) for a hospital located in Minnesota and not eligible for payments under
7.15subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8
7.16percent of total patient days as of the base year in effect on July 1, 2005, a payment
7.17equal to 13 percent of the total of the operating and property payment rates, except that
7.18Hennepin County Medical Center and Regions Hospital shall not receive a payment
7.19under this subdivision;
7.20    (2) for a hospital located in Minnesota in a specified urban area outside of the
7.21seven-county metropolitan area and not eligible for payments under subdivision 20, with
7.22a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total
7.23patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent
7.24of the total of the operating and property payment rates. For purposes of this clause, the
7.25following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria,
7.26Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids,
7.27Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena;
7.28    (3) for a hospital located in Minnesota but not located in a specified urban area
7.29under clause (2), with a medical assistance inpatient utilization rate less than or equal to
7.3017.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment
7.31equal to four percent of the total of the operating and property payment rates. A hospital
7.32located in Woodbury and not in existence during the base year shall be reimbursed under
7.33this clause; and
7.34    (4) in addition to any payments under clauses (1) to (3), for a hospital located in
7.35Minnesota and not eligible for payments under subdivision 20 with a medical assistance
8.1inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect
8.2on July 1, 2005, a payment equal to eight percent of the total of the operating and property
8.3payment rates, and for a hospital located in Minnesota and not eligible for payments
8.4under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent
8.5of total patient days as of the base year in effect on July 1, 2005, a payment equal to
8.6nine percent of the total of the operating and property payment rates. After making any
8.7ratable adjustments required under paragraph (b), the commissioner shall proportionately
8.8reduce payments under clauses (2) and (3) by an amount needed to make payments under
8.9this clause.
8.10    (b) The state share of payments under paragraph (a) shall be equal to federal
8.11reimbursements to the commissioner to reimburse expenditures reported under section
8.12256B.199, paragraphs (a) to (d) . The commissioner shall ratably reduce or increase
8.13payments under this subdivision in order to ensure that these payments equal the amount
8.14of reimbursement received by the commissioner under section 256B.199, paragraphs (a)
8.15to (d) , except that payments shall be ratably reduced by an amount equivalent to the state
8.16share of a four percent reduction in MinnesotaCare and medical assistance payments for
8.17inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be equivalent
8.18to the state share of a three percent reduction in these payments. Effective for federal
8.19disproportionate share hospital funds earned on general assistance medical care payments
8.20for services rendered on or after March 1, 2010, to June 30, 2011, the amount of the three
8.21percent ratable reduction required under this paragraph shall be deposited in the account
8.22established in section 256D.032. Payments under this subdivision shall be further ratably
8.23reduced as follows: by $3,243,000 in fiscal year 2011; and by $2,495,000 in fiscal year
8.242012. These amounts shall be deposited in the account established in section 256D.032.
8.25    (c) The payments under paragraph (a) shall be paid quarterly based on each hospital's
8.26operating and property payments from the second previous quarter, beginning on July
8.2715, 2007, or upon federal approval of federal reimbursements under section 256B.199,
8.28paragraphs (a) to (d) , whichever occurs later.
8.29    (d) The commissioner shall not adjust rates paid to a prepaid health plan under
8.30contract with the commissioner to reflect payments provided in paragraph (a).
8.31    (e) The commissioner shall maximize the use of available federal money for
8.32disproportionate share hospital payments and shall maximize payments to qualifying
8.33hospitals. In order to accomplish these purposes, the commissioner may, in consultation
8.34with the nonstate entities identified in section 256B.199, paragraphs (a) to (d), adjust,
8.35on a pro rata basis if feasible, the amounts reported by nonstate entities under section
8.36256B.199, paragraphs (a) to (d), when application for reimbursement is made to the federal
9.1government, and otherwise adjust the provisions of this subdivision. The commissioner
9.2shall utilize a settlement process based on finalized data to maximize revenue under
9.3section 256B.199, paragraphs (a) to (d), and payments under this section.
9.4    (f) For purposes of this subdivision, medical assistance does not include general
9.5assistance medical care.
9.6EFFECTIVE DATE.This section is effective for services rendered on or after
9.7March 1, 2010.

9.8    Sec. 6. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to
9.9read:
9.10    Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and
9.11recommend drugs which require prior authorization. The Formulary Committee shall
9.12establish general criteria to be used for the prior authorization of brand-name drugs for
9.13which generically equivalent drugs are available, but the committee is not required to
9.14review each brand-name drug for which a generically equivalent drug is available.
9.15(b) Prior authorization may be required by the commissioner before certain
9.16formulary drugs are eligible for payment. The Formulary Committee may recommend
9.17drugs for prior authorization directly to the commissioner. The commissioner may also
9.18request that the Formulary Committee review a drug for prior authorization. Before the
9.19commissioner may require prior authorization for a drug:
9.20(1) the commissioner must provide information to the Formulary Committee on the
9.21impact that placing the drug on prior authorization may have on the quality of patient care
9.22and on program costs, information regarding whether the drug is subject to clinical abuse
9.23or misuse, and relevant data from the state Medicaid program if such data is available;
9.24(2) the Formulary Committee must review the drug, taking into account medical and
9.25clinical data and the information provided by the commissioner; and
9.26(3) the Formulary Committee must hold a public forum and receive public comment
9.27for an additional 15 days.
9.28The commissioner must provide a 15-day notice period before implementing the prior
9.29authorization.
9.30(c) Except as provided in subdivision 13j, prior authorization shall not be required or
9.31utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:
9.32(1) there is no generically equivalent drug available; and
9.33(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
9.34(3) the drug is part of the recipient's current course of treatment.
10.1This paragraph applies to any multistate preferred drug list or supplemental drug rebate
10.2program established or administered by the commissioner. Prior authorization shall
10.3automatically be granted for 60 days for brand name drugs prescribed for treatment of
10.4mental illness within 60 days of when a generically equivalent drug becomes available,
10.5provided that the brand name drug was part of the recipient's course of treatment at the
10.6time the generically equivalent drug became available.
10.7(d) Prior authorization shall not be required or utilized for any antihemophilic factor
10.8drug prescribed for the treatment of hemophilia and blood disorders where there is no
10.9generically equivalent drug available if the prior authorization is used in conjunction with
10.10any supplemental drug rebate program or multistate preferred drug list established or
10.11administered by the commissioner.
10.12(e) The commissioner may require prior authorization for brand name drugs
10.13whenever a generically equivalent product is available, even if the prescriber specifically
10.14indicates "dispense as written-brand necessary" on the prescription as required by section
10.15151.21, subdivision 2 .
10.16(f) Notwithstanding this subdivision, the commissioner may automatically require
10.17prior authorization, for a period not to exceed 180 days, for any drug that is approved by
10.18the United States Food and Drug Administration on or after July 1, 2005. The 180-day
10.19period begins no later than the first day that a drug is available for shipment to pharmacies
10.20within the state. The Formulary Committee shall recommend to the commissioner general
10.21criteria to be used for the prior authorization of the drugs, but the committee is not
10.22required to review each individual drug. In order to continue prior authorizations for a
10.23drug after the 180-day period has expired, the commissioner must follow the provisions
10.24of this subdivision.
10.25EFFECTIVE DATE.This section is effective March 1, 2010.

10.26    Sec. 7. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
10.27subdivision to read:
10.28    Subd. 13j. Antipsychotic and attention deficit disorder and attention deficit
10.29hyperactivity disorder medications. (a) The commissioner, in consultation with the
10.30Drug Utilization Review Board established in subdivision 13i and actively practicing
10.31pediatric mental health professionals, must:
10.32(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs
10.33and drugs used for attention deficit disorder or attention deficit hyperactivity disorder
10.34based on available medical, clinical, and safety data and research. The commissioner
10.35shall periodically review the list of medications and pediatric dose ranges and update
11.1the medications and doses listed as needed after consultation with the Drug Utilization
11.2Review Board;
11.3(2) identify situations where a collaborative psychiatric consultation and prior
11.4authorization should be required before the initiation or continuation of drug therapy
11.5in pediatric patients including, but not limited to, high-dose regimens, off-label use of
11.6prescription medication, a patient's young age, and lack of coordination among multiple
11.7prescribing providers; and
11.8(3) track prescriptive practices and the use of psychotropic medications in children
11.9with the goal of reducing the use of medication, where appropriate.
11.10(b) Effective July 1, 2011, the commissioner shall require prior authorization and
11.11a collaborative psychiatric consultation before an atypical antipsychotic and attention
11.12deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria
11.13identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric
11.14consultation must be completed before the identified medications are eligible for payment
11.15unless:
11.16(1) the patient has already been stabilized on the medication regimen; or
11.17(2) the prescriber indicates that the child is in crisis.
11.18If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed
11.19within 90 days for payment to continue.
11.20(c) For purposes of this subdivision, a collaborative psychiatric consultation must
11.21meet the criteria described in section 245.4862, subdivision 5.

11.22    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, is
11.23amended to read:
11.24    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
11.25subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
11.26services upper payment limit for nonstate government hospitals. The commissioner shall
11.27then determine the amount of a supplemental payment to Hennepin County Medical
11.28Center and Regions Hospital for these services that would increase medical assistance
11.29spending in this category to the aggregate upper payment limit for all nonstate government
11.30hospitals in Minnesota. In making this determination, the commissioner shall allot the
11.31available increases between Hennepin County Medical Center and Regions Hospital
11.32based on the ratio of medical assistance fee-for-service outpatient hospital payments to
11.33the two facilities. The commissioner shall adjust this allotment as necessary based on
11.34federal approvals, the amount of intergovernmental transfers received from Hennepin and
11.35Ramsey Counties, and other factors, in order to maximize the additional total payments.
12.1The commissioner shall inform Hennepin County and Ramsey County of the periodic
12.2intergovernmental transfers necessary to match federal Medicaid payments available
12.3under this subdivision in order to make supplementary medical assistance payments to
12.4Hennepin County Medical Center and Regions Hospital equal to an amount that when
12.5combined with existing medical assistance payments to nonstate governmental hospitals
12.6would increase total payments to hospitals in this category for outpatient services to
12.7the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
12.8receipt of these periodic transfers, the commissioner shall make supplementary payments
12.9to Hennepin County Medical Center and Regions Hospital.
12.10    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
12.11determine an upper payment limit for physicians affiliated with Hennepin County Medical
12.12Center and with Regions Hospital. The upper payment limit shall be based on the average
12.13commercial rate or be determined using another method acceptable to the Centers for
12.14Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
12.15Ramsey County of the periodic intergovernmental transfers necessary to match the federal
12.16Medicaid payments available under this subdivision in order to make supplementary
12.17payments to physicians affiliated with Hennepin County Medical Center and Regions
12.18Hospital equal to the difference between the established medical assistance payment for
12.19physician services and the upper payment limit. Upon receipt of these periodic transfers,
12.20the commissioner shall make supplementary payments to physicians of Hennepin Faculty
12.21Associates and HealthPartners.
12.22    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shall may
12.23make monthly voluntary intergovernmental transfers to the commissioner in the following
12.24amounts: $133,333 by not to exceed $12,000,000 per year from Hennepin County
12.25and $100,000 by $6,000,000 per year from Ramsey County. The commissioner shall
12.26increase the medical assistance capitation payments to Metropolitan Health Plan and
12.27HealthPartners by any licensed health plan under contract with the medical assistance
12.28program that agrees to make enhanced payments to Hennepin County Medical Center or
12.29Regions Hospital. The increase shall be in an amount equal to the annual value of the
12.30monthly transfers plus federal financial participation., with each health plan receiving its
12.31pro rata share of the increase based on the pro rata share of medical assistance admissions
12.32to Hennepin County Medical Center and Regions Hospital by those plans. Upon the
12.33request of the commissioner, health plans shall submit individual-level cost data for
12.34verification purposes. The commissioner may ratably reduce these payments on a pro rata
12.35basis in order to satisfy federal requirements for actuarial soundness. If payments are
12.36reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
13.1increased medical assistance capitation payments under the intergovernmental transfer
13.2described in this paragraph shall increase its medical assistance payments to Hennepin
13.3County Medical Center and Regions Hospital by the same amount as the increased
13.4payments received in the capitation payment described in this paragraph.
13.5    (d) The commissioner shall inform Hennepin County and Ramsey County on an
13.6ongoing basis of the need for any changes needed in the intergovernmental transfers
13.7in order to continue the payments under paragraphs (a) to (c), at their maximum level,
13.8including increases in upper payment limits, changes in the federal Medicaid match, and
13.9other factors.
13.10    (e) The payments in paragraphs (a) to (c) shall be implemented independently of
13.11each other, subject to federal approval and to the receipt of transfers under subdivision 3.
13.12EFFECTIVE DATE.This section is effective the day following final enactment.

13.13    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.199, is amended to read:
13.14256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
13.15    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
13.16for the expenditures in paragraphs (b) and (c).
13.17    (b) The commissioner shall apply for federal matching funds for certified public
13.18expenditures as follows:
13.19    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, and
13.20Regions Hospital, the University of Minnesota, and Fairview-University Medical Center
13.21shall report quarterly to the commissioner beginning June 1, 2007, payments made during
13.22the second previous quarter that may qualify for reimbursement under federal law;
13.23     (2) based on these reports, the commissioner shall apply for federal matching
13.24funds. These funds are appropriated to the commissioner for the payments under section
13.25256.969, subdivision 27 ; and
13.26     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
13.27the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
13.28hospital payment money expected to be available in the current federal fiscal year.
13.29    (c) The commissioner shall apply for federal matching funds for general assistance
13.30medical care expenditures as follows:
13.31    (1) for hospital services occurring on or after July 1, 2007, general assistance medical
13.32care expenditures for fee-for-service inpatient and outpatient hospital payments made by
13.33the department shall be used to apply for federal matching funds, except as limited below:
14.1    (i) only those general assistance medical care expenditures made to an individual
14.2hospital that would not cause the hospital to exceed its individual hospital limits under
14.3section 1923 of the Social Security Act may be considered; and
14.4    (ii) general assistance medical care expenditures may be considered only to the extent
14.5of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
14.6    (2) all hospitals must provide any necessary expenditure, cost, and revenue
14.7information required by the commissioner as necessary for purposes of obtaining federal
14.8Medicaid matching funds for general assistance medical care expenditures.
14.9    (d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
14.10apply for additional federal matching funds available as disproportionate share hospital
14.11payments under the American Recovery and Reinvestment Act of 2009. These funds shall
14.12be made available as the state share of payments under section 256.969, subdivision 28.
14.13The entities required to report certified public expenditures under paragraph (b), clause
14.14(1), shall report additional certified public expenditures as necessary under this paragraph.
14.15    (e) Effective July 15, 2010, in addition to any payment otherwise required under
14.16sections 256B.19, 256B.195, and 256B.196, the following government entities may make
14.17the following voluntary payments to the commissioner on an annual basis:
14.18    (1) Hennepin County, $6,200,000; and
14.19    (2) Ramsey County, $4,000,000.
14.20    (f) The sums in paragraph (e) shall be part of the designated governmental unit's
14.21portion of the nonfederal share of medical assistance costs.
14.22    (g) Effective July 15, 2010, the commissioner shall make the following Medicaid
14.23disproportionate share hospital payments to the hospitals on a monthly basis:
14.24    (1) to Hennepin County Medical Center, the amount of the transfer under paragraph
14.25(e), clause (1), plus any federal matching funds available to recognize higher medical
14.26assistance costs in institutions that provide high levels of charity care; and
14.27    (2) to Regions Hospital, the amount of the transfer under paragraph (e), clause (2),
14.28plus any federal matching funds available to recognize higher medical assistance costs in
14.29institutions that provide high levels of charity care.
14.30    (h) Effective July 15, 2010, after making the payments provided in paragraph
14.31(g), the commissioner shall make the increased payments provided in section 256.969,
14.32subdivision 26a.
14.33    (i) The commissioner shall make the payments under paragraphs (g) and (h) prior
14.34to making any other payments under this section, section 256.969, subdivision 27, or
14.35256B.195.
15.1    (j) The commissioner may adjust the intergovernmental transfers under paragraph
15.2(e) and the payments under paragraph (g) based on the commissioner's determination
15.3of Medicare upper payment limits, hospital-specific charge limits, and any limitations
15.4imposed by the federal government regarding the rate increase or the restriction in the
15.5American Resource and Recovery Act, Public Law 111-5, regarding increased local share.
15.6    (k) This section shall be implemented upon federal approval of the rate increase
15.7and a federal determination that the increased transfers do not violate the restriction in
15.8the American Resource and Recovery Act, Public Law 111-5, regarding the local share,
15.9retroactive to admissions occurring on or after July 15, 2010.

15.10    Sec. 10. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is
15.11amended to read:
15.12    Subd. 3. General assistance medical care; eligibility. (a) General assistance
15.13medical care may be paid for any person who is not eligible for medical assistance under
15.14chapter 256B, including eligibility for medical assistance based on a spenddown of excess
15.15income according to section 256B.056, subdivision 5, or MinnesotaCare for applicants
15.16and recipients defined in paragraph (c), except as provided in paragraph (d), and:
15.17    (1) who is receiving assistance under section 256D.05, except for families with
15.18children who are eligible under Minnesota family investment program (MFIP), or who is
15.19having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
15.20    (2) who is a resident of Minnesota; and
15.21    (i) who has gross countable income not in excess of 75 percent of the federal poverty
15.22guidelines for the family size, using a six-month budget period and whose equity in assets
15.23is not in excess of $1,000 per assistance unit. General assistance medical care is not
15.24available for applicants or enrollees who are otherwise eligible for medical assistance but
15.25fail to verify their assets. Enrollees who become eligible for medical assistance shall be
15.26terminated and transferred to medical assistance. Exempt assets, the reduction of excess
15.27assets, and the waiver of excess assets must conform to the medical assistance program in
15.28section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum
15.29amount of undistributed funds in a trust that could be distributed to or on behalf of the
15.30beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the
15.31terms of the trust, must be applied toward the asset maximum; or
15.32    (ii) who has gross countable income above 75 percent of the federal poverty
15.33guidelines but not in excess of 175 percent of the federal poverty guidelines for the family
15.34size, using a six-month budget period, whose equity in assets is not in excess of the limits
15.35in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization.
16.1    (b) The commissioner shall adjust the income standards under this section each July
16.21 by the annual update of the federal poverty guidelines following publication by the
16.3United States Department of Health and Human Services.
16.4    (c) Effective for applications and renewals processed on or after September 1, 2006,
16.5general assistance medical care may not be paid for applicants or recipients who are adults
16.6with dependent children under 21 whose gross family income is equal to or less than 275
16.7percent of the federal poverty guidelines who are not described in paragraph (f).
16.8    (d) Effective for applications and renewals processed on or after September 1,
16.92006, general assistance medical care may be paid for applicants and recipients who
16.10meet all eligibility requirements of paragraph (a), clause (2), item (i), for a temporary
16.11period beginning the date of application. Immediately following approval of general
16.12assistance medical care, enrollees shall be enrolled in MinnesotaCare under section
16.13256L.04, subdivision 7 , with covered services as provided in section 256L.03 for the rest
16.14of the six-month general assistance medical care eligibility period, until their six-month
16.15renewal. This paragraph does not apply to applicants and recipients who are exempt
16.16under paragraph (f).
16.17    (e) To be eligible for general assistance medical care following enrollment in
16.18MinnesotaCare as required by paragraph (d), an individual must complete a new
16.19application.
16.20    (f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are
16.21exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
16.22    (1) have applied for and are awaiting a determination of blindness or disability by
16.23the state medical review team or a determination of eligibility for Supplemental Security
16.24Income or Social Security Disability Insurance by the Social Security Administration;
16.25    (2) fail to meet the requirements of section 256L.09, subdivision 2;
16.26    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.;
16.27    (4) are classified as end-stage renal disease beneficiaries in the Medicare program;
16.28    (5) are enrolled in private health care coverage as defined in section 256B.02,
16.29subdivision 9;
16.30    (6) are eligible under paragraph (k);
16.31    (7) receive treatment funded pursuant to section 254B.02; or
16.32    (8) reside in the Minnesota sex offender program defined in chapter 246B.
16.33If an enrollee meets one of the categories described in this paragraph, the
16.34commissioner shall not require the enrollee to enroll in MinnesotaCare.
16.35    (g) For applications received on or after October 1, 2003, eligibility may begin no
16.36earlier than the date of application. For individuals eligible under paragraph (a), clause
17.1(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
17.2eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
17.3may reapply if there is a subsequent period of inpatient hospitalization.
17.4    (h) Beginning September 1, 2006, Minnesota health care program applications and
17.5renewals completed by recipients and applicants who are persons described in paragraph
17.6(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility
17.7by the county agency. If all other eligibility requirements of this subdivision are met,
17.8eligibility for general assistance medical care shall be available in any month during which
17.9MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
17.10notice of termination for eligibility for general assistance medical care shall be sent to
17.11an applicant or recipient. If all other eligibility requirements of this subdivision are
17.12met, eligibility for general assistance medical care shall be available until enrollment in
17.13MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).
17.14    (i) The date of an initial Minnesota health care program application necessary to
17.15begin a determination of eligibility shall be the date the applicant has provided a name,
17.16address, and Social Security number, signed and dated, to the county agency or the
17.17Department of Human Services. If the applicant is unable to provide a name, address,
17.18Social Security number, and signature when health care is delivered due to a medical
17.19condition or disability, a health care provider may act on an applicant's behalf to establish
17.20the date of an initial Minnesota health care program application by providing the county
17.21agency or Department of Human Services with provider identification and a temporary
17.22unique identifier for the applicant. The applicant must complete the remainder of the
17.23application and provide necessary verification before eligibility can be determined. The
17.24applicant must complete the application within the time periods required under the
17.25medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart
17.265, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining
17.27verification if necessary.
17.28    (j) County agencies are authorized to use all automated databases containing
17.29information regarding recipients' or applicants' income in order to determine eligibility for
17.30general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
17.31in order to determine eligibility and premium payments by the county agency.
17.32    (k) General assistance medical care is not available for a person in a correctional
17.33facility unless the person is detained by law for less than one year in a county correctional
17.34or detention facility as a person accused or convicted of a crime, or admitted as an
17.35inpatient to a hospital on a criminal hold order, and the person is a recipient of general
17.36assistance medical care at the time the person is detained by law or admitted on a criminal
18.1hold order and as long as the person continues to meet other eligibility requirements
18.2of this subdivision.
18.3    (l) General assistance medical care is not available for applicants or recipients who
18.4do not cooperate with the county agency to meet the requirements of medical assistance.
18.5    (m) In determining the amount of assets of an individual eligible under paragraph
18.6(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
18.7an asset excluded under paragraph (a), that was given away, sold, or disposed of for
18.8less than fair market value within the 60 months preceding application for general
18.9assistance medical care or during the period of eligibility. Any transfer described in this
18.10paragraph shall be presumed to have been for the purpose of establishing eligibility for
18.11general assistance medical care, unless the individual furnishes convincing evidence to
18.12establish that the transaction was exclusively for another purpose. For purposes of this
18.13paragraph, the value of the asset or interest shall be the fair market value at the time it
18.14was given away, sold, or disposed of, less the amount of compensation received. For any
18.15uncompensated transfer, the number of months of ineligibility, including partial months,
18.16shall be calculated by dividing the uncompensated transfer amount by the average monthly
18.17per person payment made by the medical assistance program to skilled nursing facilities
18.18for the previous calendar year. The individual shall remain ineligible until this fixed period
18.19has expired. The period of ineligibility may exceed 30 months, and a reapplication for
18.20benefits after 30 months from the date of the transfer shall not result in eligibility unless
18.21and until the period of ineligibility has expired. The period of ineligibility begins in the
18.22month the transfer was reported to the county agency, or if the transfer was not reported,
18.23the month in which the county agency discovered the transfer, whichever comes first. For
18.24applicants, the period of ineligibility begins on the date of the first approved application.
18.25    (n) When determining eligibility for any state benefits under this subdivision,
18.26the income and resources of all noncitizens shall be deemed to include their sponsor's
18.27income and resources as defined in the Personal Responsibility and Work Opportunity
18.28Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
18.29subsequently set out in federal rules.
18.30    (o) Undocumented noncitizens and nonimmigrants are ineligible for general
18.31assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
18.32in one or more of the classes listed in United States Code, title 8, section 1101, subsection
18.33(a), paragraph (15), and an undocumented noncitizen is an individual who resides in
18.34the United States without the approval or acquiescence of the United States Citizenship
18.35and Immigration Services.
19.1    (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for
19.2medical assistance due to the deeming of a sponsor's income and resources, is ineligible
19.3for general assistance medical care.
19.4    (q) Effective July 1, 2003, general assistance medical care emergency services end.
19.5(r) For the period beginning March 1, 2010, and ending July 1, 2011, the general
19.6assistance medical care program shall be administered according to section 256D.031,
19.7unless otherwise stated.
19.8EFFECTIVE DATE.This section is effective March 1, 2010.

19.9    Sec. 11. Minnesota Statutes 2008, section 256D.03, subdivision 3a, is amended to read:
19.10    Subd. 3a. Claims; assignment of benefits. (a) Claims must be filed pursuant to
19.11section 256D.16. General assistance medical care applicants and recipients must apply or
19.12agree to apply third party health and accident benefits to the costs of medical care. They
19.13must cooperate with the state in establishing paternity and obtaining third party payments.
19.14By accepting general assistance, a person assigns to the Department of Human Services
19.15all rights to medical support or payments for medical expenses from another person or
19.16entity on their own or their dependent's behalf and agrees to cooperate with the state in
19.17establishing paternity and obtaining third party payments. The application shall contain
19.18a statement explaining the assignment. Any rights or amounts assigned shall be applied
19.19against the cost of medical care paid for under this chapter. An assignment is effective on
19.20the date general assistance medical care eligibility takes effect.
19.21(b) Effective for general assistance medical care services rendered on or after
19.22March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under
19.23this subdivision shall be deposited in or credited to the account established in section
19.24256D.032.
19.25EFFECTIVE DATE.This section is effective March 1, 2010.

19.26    Sec. 12. Minnesota Statutes 2008, section 256D.03, subdivision 3b, is amended to read:
19.27    Subd. 3b. Cooperation. (a) General assistance or general assistance medical care
19.28applicants and recipients must cooperate with the state and local agency to identify
19.29potentially liable third-party payors and assist the state in obtaining third-party payments.
19.30Cooperation includes identifying any third party who may be liable for care and services
19.31provided under this chapter to the applicant, recipient, or any other family member for
19.32whom application is made and providing relevant information to assist the state in pursuing
19.33a potentially liable third party. General assistance medical care applicants and recipients
20.1must cooperate by providing information about any group health plan in which they may
20.2be eligible to enroll. They must cooperate with the state and local agency in determining
20.3if the plan is cost-effective. For purposes of this subdivision, coverage provided by the
20.4Minnesota Comprehensive Health Association under chapter 62E shall not be considered
20.5group health plan coverage or cost-effective by the state and local agency. If the plan is
20.6determined cost-effective and the premium will be paid by the state or local agency or is
20.7available at no cost to the person, they must enroll or remain enrolled in the group health
20.8plan. Cost-effective insurance premiums approved for payment by the state agency and
20.9paid by the local agency are eligible for reimbursement according to subdivision 6.
20.10(b) Effective for all premiums due on or after June 30, 1997, general assistance
20.11medical care does not cover premiums that a recipient is required to pay under a qualified
20.12or Medicare supplement plan issued by the Minnesota Comprehensive Health Association.
20.13General assistance medical care shall continue to cover premiums for recipients who are
20.14covered under a plan issued by the Minnesota Comprehensive Health Association on June
20.1530, 1997, for a period of six months following receipt of the notice of termination or
20.16until December 31, 1997, whichever is later.
20.17(c) Effective for general assistance medical care services rendered on or after
20.18March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under
20.19this subdivision shall be deposited in or credited to the account established in section
20.20256D.032.
20.21EFFECTIVE DATE.This section is effective March 1, 2010.

20.22    Sec. 13. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.
20.23    Subdivision 1. Eligibility. (a) Except as provided under subdivision 2, general
20.24assistance medical care may be paid for any individual who is not eligible for medical
20.25assistance under chapter 256B, including eligibility for medical assistance based on a
20.26spenddown of excess income according to section 256B.056, subdivision 5, and who:
20.27(1) is receiving assistance under section 256D.05, except for families with children
20.28who are eligible under the Minnesota family investment program (MFIP), or who is
20.29having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
20.30(2) is a resident of Minnesota and has gross countable income not in excess of 75
20.31percent of federal poverty guidelines for the family size, using a six-month budget period,
20.32and whose equity in assets is not in excess of $1,000 per assistance unit.
20.33Exempt assets, the reduction of excess assets, and the waiver of excess assets must
20.34conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d,
21.1except that the maximum amount of undistributed funds in a trust that could be distributed
21.2to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's
21.3discretion under the terms of the trust, must be applied toward the asset maximum.
21.4(b) The commissioner shall adjust the income standards under this section each July
21.51 by the annual update of the federal poverty guidelines following publication by the
21.6United States Department of Health and Human Services.
21.7    Subd. 2. Ineligible groups. (a) General assistance medical care may not be paid for
21.8an applicant or a recipient who:
21.9(1) is otherwise eligible for medical assistance but fails to verify their assets;
21.10(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;
21.11(3) is enrolled in private health coverage as defined in section 256B.02, subdivision
21.129;
21.13(4) is in a correctional facility, including an individual in a county correctional or
21.14detention facility as an individual accused or convicted of a crime, or admitted as an
21.15inpatient to a hospital on a criminal hold order;
21.16(5) resides in the Minnesota sex offender program defined in chapter 246B;
21.17(6) does not cooperate with the county agency to meet the requirements of medical
21.18assistance; or
21.19(7) does not cooperate with a county or state agency or the state medical review team
21.20in determining a disability or for determining eligibility for Supplemental Security Income
21.21or Social Security Disability Insurance by the Social Security Administration.
21.22(b) Undocumented noncitizens and nonimmigrants are ineligible for general
21.23assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
21.24in one or more of the classes listed in United States Code, title 8, section 1101, subsection
21.25(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the
21.26United States without approval or acquiescence of the United States Citizenship and
21.27Immigration Services.
21.28(c) Notwithstanding any other provision of law, a noncitizen who is ineligible for
21.29medical assistance due to the deeming of a sponsor's income and resources is ineligible for
21.30general assistance medical care.
21.31(d) General assistance medical care recipients who become eligible for medical
21.32assistance shall be terminated from general assistance medical care and transferred to
21.33medical assistance.
21.34    Subd. 3. Transitional MinnesotaCare. (a) Except as provided in paragraph (c),
21.35effective March 1, 2010, all applicants and recipients who meet the eligibility requirements
21.36in subdivision 1, paragraph (a), clause (2), and who are not described in subdivision 2
22.1shall be enrolled in MinnesotaCare under section 256L.04, subdivision 7, immediately
22.2following approval of general assistance medical care.
22.3(b) If all other eligibility requirements of this subdivision are met, general assistance
22.4medical care may be paid for individuals identified in paragraph (a) for a temporary
22.5period beginning the date of application. Eligibility for general assistance medical care
22.6shall continue until enrollment in MinnesotaCare is completed. Upon notification of
22.7eligibility for MinnesotaCare, notice of termination for eligibility for general assistance
22.8medical care shall be sent to the applicant or recipient. Once enrolled in MinnesotaCare,
22.9the MinnesotaCare-covered services as described in section 256L.03 shall apply for the
22.10remainder of the six-month general assistance medical care eligibility period until their
22.11six-month renewal.
22.12(c) This subdivision does not apply if the applicant or recipient:
22.13(1) has applied for and is awaiting a determination of blindness or disability by the
22.14state medical review team or a determination of eligibility for Supplemental Security
22.15Income or Social Security Disability Insurance by the Social Security Administration;
22.16(2) is homeless as defined by United States Code, title 42, section 11301, et seq.;
22.17(3) is classified as an end-stage renal disease beneficiary in the Medicare program;
22.18(4) receives treatment funded in section 254B.02; or
22.19(5) fails to meet the requirements of section 256L.09, subdivision 2.
22.20Applicants and recipients who meet any one of these criteria shall remain eligible for
22.21general assistance medical care and shall not be required to enroll in MinnesotaCare.
22.22(d) To be eligible for general assistance medical care following enrollment
22.23in MinnesotaCare as required in paragraph (a), an individual must complete a new
22.24application.
22.25    Subd. 4. Eligibility and enrollment procedures. (a) Eligibility for general
22.26assistance medical care shall begin no earlier than the date of application. The date of
22.27application shall be the date the applicant has provided a name, address, and Social
22.28Security number, signed and dated, to the county agency or the Department of Human
22.29Services. If the applicant is unable to provide a name, address, Social Security number,
22.30and signature when health care is delivered due to a medical condition or disability, a
22.31health care provider may act on an applicant's behalf to establish the date of an application
22.32by providing the county agency or Department of Human Services with provider
22.33identification and a temporary unique identifier for the applicant. The applicant must
22.34complete the remainder of the application and provide necessary verification before
22.35eligibility can be determined. The applicant must complete the application within the time
22.36periods required under the medical assistance program as specified in Minnesota Rules,
23.1parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the
23.2applicant in obtaining verification if necessary.
23.3    (b) County agencies are authorized to use all automated databases containing
23.4information regarding recipients' or applicants' income in order to determine eligibility for
23.5general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
23.6in order to determine eligibility and premium payments by the county agency.
23.7    (c) In determining the amount of assets of an individual eligible under subdivision 1,
23.8paragraph (a), clause (2), there shall be included any asset or interest in an asset, including
23.9an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or
23.10disposed of for less than fair market value within the 60 months preceding application for
23.11general assistance medical care or during the period of eligibility. Any transfer described
23.12in this paragraph shall be presumed to have been for the purpose of establishing eligibility
23.13for general assistance medical care, unless the individual furnishes convincing evidence to
23.14establish that the transaction was exclusively for another purpose. For purposes of this
23.15paragraph, the value of the asset or interest shall be the fair market value at the time it
23.16was given away, sold, or disposed of, less the amount of compensation received. For any
23.17uncompensated transfer, the number of months of ineligibility, including partial months,
23.18shall be calculated by dividing the uncompensated transfer amount by the average monthly
23.19per person payment made by the medical assistance program to skilled nursing facilities
23.20for the previous calendar year. The individual shall remain ineligible until this fixed period
23.21has expired. The period of ineligibility may exceed 30 months, and a reapplication for
23.22benefits after 30 months from the date of the transfer shall not result in eligibility unless
23.23and until the period of ineligibility has expired. The period of ineligibility begins in the
23.24month the transfer was reported to the county agency, or if the transfer was not reported,
23.25the month in which the county agency discovered the transfer, whichever comes first. For
23.26applicants, the period of ineligibility begins on the date of the first approved application.
23.27    (d) When determining eligibility for any state benefits under this subdivision,
23.28the income and resources of all noncitizens shall be deemed to include their sponsor's
23.29income and resources as defined in the Personal Responsibility and Work Opportunity
23.30Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
23.31subsequently set out in federal rules.
23.32    Subd. 5. General assistance medical care; services. (a) General assistance
23.33medical care covers:
23.34    (1) inpatient hospital services within the limitations described in subdivision 10;
23.35    (2) outpatient hospital services;
23.36    (3) services provided by Medicare-certified rehabilitation agencies;
24.1    (4) prescription drugs and other products recommended through the process
24.2established in section 256B.0625, subdivision 13;
24.3    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
24.4for diabetics to monitor blood sugar level;
24.5    (6) eyeglasses and eye examinations provided by a physician or optometrist;
24.6    (7) hearing aids;
24.7    (8) prosthetic devices;
24.8    (9) laboratory and x-ray services;
24.9    (10) physicians' services;
24.10    (11) medical transportation except special transportation;
24.11    (12) chiropractic services as covered under the medical assistance program;
24.12    (13) podiatric services;
24.13    (14) dental services as covered under the medical assistance program;
24.14    (15) mental health services covered under chapter 256B;
24.15    (16) prescribed medications for persons who have been diagnosed as mentally ill as
24.16necessary to prevent more restrictive institutionalization;
24.17    (17) medical supplies and equipment, and Medicare premiums, coinsurance, and
24.18deductible payments;
24.19    (18) medical equipment not specifically listed in this paragraph when the use of
24.20the equipment will prevent the need for costlier services that are reimbursable under
24.21this subdivision;
24.22    (19) services performed by a certified pediatric nurse practitioner, a certified family
24.23nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
24.24nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
24.25practitioner in independent practice, if (1) the service is otherwise covered under this
24.26chapter as a physician service, (2) the service provided on an inpatient basis is not included
24.27as part of the cost for inpatient services included in the operating payment rate, and (3) the
24.28service is within the scope of practice of the nurse practitioner's license as a registered
24.29nurse, as defined in section 148.171;
24.30    (20) services of a certified public health nurse or a registered nurse practicing in
24.31a public health nursing clinic that is a department of, or that operates under the direct
24.32authority of, a unit of government, if the service is within the scope of practice of the
24.33public health nurse's license as a registered nurse, as defined in section 148.171;
24.34    (21) telemedicine consultations, to the extent they are covered under section
24.35256B.0625, subdivision 3b;
25.1    (22) care coordination and patient education services provided by a community
25.2health worker according to section 256B.0625, subdivision 49; and
25.3    (23) regardless of the number of employees that an enrolled health care provider
25.4may have, sign language interpreter services when provided by an enrolled health care
25.5provider during the course of providing a direct, person-to-person-covered health care
25.6service to an enrolled recipient who has a hearing loss and uses interpreting services.
25.7(b) Sex reassignment surgery is not covered under this section.
25.8(c) Drug coverage is covered in accordance with section 256D.03, subdivision 4,
25.9paragraph (d).
25.10(d) The following co-payments shall apply for services provided:
25.11(1) $25 for nonemergency visits to a hospital-based emergency room; and
25.12(2) $3 per brand-name drug prescription, subject to a $7 per month maximum for
25.13prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when
25.14used for the treatment of mental illness.
25.15(e) Co-payments shall be limited to one per day per provider for nonemergency
25.16visits to a hospital-based emergency room. Recipients of general assistance medical care
25.17are responsible for all co-payments in this subdivision. Reimbursement for prescription
25.18drugs shall be reduced by the amount of the co-payment until the recipient has reached the
25.19$7 per month maximum for prescription drug co-payments. The provider shall collect
25.20the co-payment from the recipient. Providers may not deny services to recipients who
25.21are unable to pay the co-payment.
25.22(f) Chemical dependency services that are reimbursed under chapter 254B shall not
25.23be reimbursed under general assistance medical care.
25.24(g) Inpatient hospital services that are provided in community behavioral health
25.25hospitals operated by state-operated services shall not be reimbursed under general
25.26assistance medical care.
25.27    Subd. 6. Coordinated care delivery option. (a) A county or group of counties may
25.28elect to provide health care services to individuals who are eligible for general assistance
25.29medical care under this section and who reside within the county or counties through
25.30a coordinated care delivery option. The health care services provided by the county
25.31must include the services described in subdivision 5 with the exception of outpatient
25.32prescription drug coverage but including drugs administered in an outpatient setting.
25.33Counties that elect to provide health care services through this option must ensure that
25.34the requirements of this subdivision are met. Upon electing to provide services through
25.35this option, the county accepts the financial risk of the delivery of the health care services
25.36described in this subdivision to general assistance medical care recipients residing in
26.1the county for the period beginning July 1, 2010, and ending July 1, 2011, for the fixed
26.2payments described in subdivision 10.
26.3(b) A county that elects to provide services through this option must provide to
26.4the commissioner the following:
26.5(1) the names of the county or counties that are electing to provide services through
26.6the county care delivery option; and
26.7(2) the geographic area to be served.
26.8(c) The county may contract with a managed care plan, an integrated delivery
26.9system, a physician-hospital organization, or an academic health center to administer
26.10the delivery of services through this option. Any county providing general assistance
26.11medical care services through a county-based purchasing plan in accordance with section
26.12256B.692 may continue to provide services through the county-based purchasing plan.
26.13Payments to the county-based purchasing plan for the period beginning July 1, 2010, and
26.14ending July 1, 2011, shall be paid according to subdivision 10.
26.15(d) A county must demonstrate the ability to:
26.16(1) provide the covered services required under this subdivision to recipients
26.17residing within the county;
26.18(2) provide a system for advocacy, consumer protection, and complaints and appeals
26.19that is independent of care providers or other risk bearers and complies with section
26.20256B.69;
26.21(3) establish a process to monitor enrollment and ensure the quality of care provided;
26.22and
26.23(4) coordinate the delivery of health care services with existing homeless prevention,
26.24supportive housing, and rent subsidy programs and funding administered by the Minnesota
26.25Housing Finance Agency under chapter 462A.
26.26(e) The commissioner may require the county to provide the commissioner with data
26.27necessary for assessing enrollment, quality of care, cost, and utilization of services.
26.28(f) A county that elects to provide services through this option shall be considered to
26.29be a prepaid health plan for purposes of section 256.045.
26.30(g) The state shall not be liable for the payment of any cost or obligation incurred
26.31by the county or a participating provider.
26.32    Subd. 7. Health care home designation. The commissioner or a county may
26.33require a recipient to designate a primary care provider or a primary care clinic that is
26.34certified as a health care home under section 256B.0751.
26.35    Subd. 8. Payments; fee-for-service rate for the period between March 1,
26.362010, and July 1, 2010. (a) Effective for services provided on or after March 1, 2010,
27.1and before July 1, 2010, the payment rates for all covered services provided to general
27.2assistance medical care recipients, with the exception of outpatient prescription drug
27.3coverage, shall be 50 percent of the general assistance medical care payment rate in effect
27.4on February 28, 2010.
27.5(b) Outpatient prescription drug coverage provided on or after March 1, 2010, and
27.6before July 1, 2010, shall be paid on a fee-for-service basis in accordance with section
27.7256B.0625, subdivision 13e.
27.8    Subd. 9. Payments; fee-for-service rates for the period between July 1, 2010,
27.9and July 1, 2011. (a) Effective for services provided on or after July 1, 2010, and before
27.10July 1, 2011, to general assistance medical care recipients residing in counties that are
27.11not served through the coordinated care delivery option, payments shall be made by the
27.12commissioner to providers at rates described in this subdivision.
27.13(b) For inpatient hospital admissions provided on or after July 1, 2010, and before
27.14July 1, 2011, the payment rate shall be:
27.15(1) 70 percent of the general assistance medical care rate in effect on February
27.1628, 2010, if the inpatient hospital services were provided in a hospital where the
27.17fee-for-service inpatient and outpatient hospital general assistance medical care payments
27.18to the hospital for admissions provided in calendar year 2007 totaled $1,000,000 or more
27.19or the hospital's fee-for-service inpatient and outpatient hospital general assistance medical
27.20care payments received for calendar year 2007 admissions was one percent or more of the
27.21hospital's net patient revenue received for services provided in calendar year 2007; or
27.22(2) 40 percent of the general assistance medical care rate in effect on February 28,
27.232010, if the inpatient hospital services were provided by a hospital that does not meet the
27.24criteria described in clause (1).
27.25(c) Effective for services other than inpatient hospital services and outpatient
27.26prescription drug coverage provided on or after July 1, 2010, and before July 1, 2011,
27.27the payment rate shall begin at 50 percent of the general assistance medical care rate
27.28in effect on February 28, 2010.
27.29(d) Outpatient prescription drug coverage provided on or after July 1, 2010, and
27.30before July 1, 2011, shall be paid on a fee-for-service basis in accordance with section
27.31256B.0625, subdivision 13e.
27.32(e) The commissioner may adjust the rates paid under paragraphs (b) and (c) on a
27.33quarterly basis to ensure that the total aggregate amount paid out for services provided
27.34on a fee-for-service basis beginning March 1, 2010, and ending June 30, 2011, does not
27.35exceed the appropriation from the general assistance medical care account established in
27.36section 256D.032 for the general assistance medical care program.
28.1    Subd. 10. Payments; rate setting for the coordinated care delivery option. (a)
28.2Effective for general assistance medical care services, with the exception of outpatient
28.3prescription drug coverage, provided on or after July 1, 2010, and before July 1, 2011,
28.4to recipients residing in counties that have elected to provide services through the
28.5coordinated delivery care option, the commissioner shall establish quarterly prospective
28.6fixed payments to the county. The payments must not exceed 60 percent of the county's
28.7general assistance medical care county allocation amount as determined in paragraph (b).
28.8These payments must not be used by the county to pay MinnesotaCare premiums for
28.9general assistance medical care recipients or MinnesotaCare enrollees.
28.10(b) For each county that elects to provide services in accordance with subdivision
28.117, the commissioner shall determine a general assistance medical care county allocation
28.12amount that equals the total general assistance medical care payments made for recipients
28.13residing within the county in fiscal year 2009 for all covered general assistance medical
28.14care services with the exception of outpatient prescription drug coverage.
28.15(c) Outpatient prescription drug coverage provided on or after July 1, 2010,
28.16and before July 1, 2011, shall be paid on a fee-for-service basis according to section
28.17256B.0625, subdivision 13e.
28.18    Subd. 11. Veterans medical review team. (a) To ensure the timely processing of
28.19determinations of service-connected disabilities among veterans enrolled in the temporary
28.20general assistance medical care program, the commissioner shall review all medical
28.21evidence submitted by enrollees with a referral and seek additional information from
28.22providers, applicants, and enrollees to support the determination of a service-connected
28.23disability when necessary. Service-connected disability shall be determined according to
28.24the regulations and policies of the United States Department of Veterans Affairs.
28.25(b) Prior to a denial or withdrawal of a requested determination of service-connected
28.26disability due to insufficient evidence, the commissioner shall:
28.27(1) ensure that the missing evidence is necessary and appropriate to a determination
28.28of service-connected disability; and
28.29(2) assist applicants and enrollees to obtain the evidence, including, but not limited
28.30to, medical examinations and electronic medical records.
28.31(c) The commissioner shall provide the chairs of the legislative committees with
28.32jurisdiction over health and human services finance and veterans affairs finance the
28.33following information on the activities of the veterans medical review team by August 1,
28.342010, and provide an update by January 1, 2011:
28.35(1) the number of applications to the veterans medical review team that were denied,
28.36approved, or withdrawn;
29.1(2) the average length of time from receipt of the application to a decision;
29.2(3) the number of appeals and appeal results;
29.3(4) for applicants, their age, health coverage at the time of application,
29.4hospitalization history within three months of application, and whether an application for
29.5service-connected veterans benefits is pending; and
29.6(5) specific information on the medical certification, licensure, or other credentials
29.7of the person or persons performing the medical review determinations and length of
29.8time in that position.
29.9EFFECTIVE DATE.This section is effective for services rendered on or after
29.10March 1, 2010, and before July 1, 2011.

29.11    Sec. 14. [256D.032] GENERAL ASSISTANCE MEDICAL CARE ACCOUNT.
29.12The general assistance medical care account is created in the special revenue fund.
29.13Money deposited into the account is subject to appropriation by the legislature.
29.14EFFECTIVE DATE.This section is effective March 1, 2010.

29.15    Sec. 15. Minnesota Statutes 2008, section 256D.06, subdivision 7, is amended to read:
29.16    Subd. 7. SSI conversions and back claims. (a) The commissioner of human
29.17services shall contract with agencies or organizations capable of ensuring that clients who
29.18are presently receiving assistance under sections 256D.01 to 256D.21, and who may be
29.19eligible for benefits under the federal Supplemental Security Income program, apply and,
29.20when eligible, are converted to the federal income assistance program and made eligible
29.21for health care benefits under the medical assistance program. The commissioner shall
29.22ensure that money owing to the state under interim assistance agreements is collected.
29.23(b) The commissioner shall also directly or through contract implement procedures
29.24for collecting federal Medicare and medical assistance funds for which clients converted
29.25to SSI are retroactively eligible.
29.26(c) The commissioner shall contract with agencies to ensure implementation of
29.27this section. County contracts with providers for residential services shall include the
29.28requirement that providers screen residents who may be eligible for federal benefits and
29.29provide that information to the local agency. The commissioner shall modify the MAXIS
29.30computer system to provide information on clients who have been on general assistance
29.31for two years or longer. The list of clients shall be provided to local services for screening
29.32under this section.
30.1(d) Effective for general assistance medical care services rendered on or after
30.2March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under
30.3this subdivision shall be deposited in or credited to the account established in section
30.4256D.032.
30.5EFFECTIVE DATE.This section is effective March 1, 2010.

30.6    Sec. 16. Minnesota Statutes 2008, section 256L.05, subdivision 1b, is amended to read:
30.7    Subd. 1b. MinnesotaCare enrollment by county agencies. Beginning September
30.81, 2006, county agencies shall enroll single adults and households with no children
30.9formerly enrolled in general assistance medical care in MinnesotaCare according to
30.10section 256D.03, subdivision 3, or 256D.031. County agencies shall perform all duties
30.11necessary to administer the MinnesotaCare program ongoing for these enrollees, including
30.12the redetermination of MinnesotaCare eligibility at renewal.
30.13EFFECTIVE DATE.This section is effective March 1, 2010.

30.14    Sec. 17. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
30.15    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
30.16first day of the month following the month in which eligibility is approved and the first
30.17premium payment has been received. As provided in section 256B.057, coverage for
30.18newborns is automatic from the date of birth and must be coordinated with other health
30.19coverage. The effective date of coverage for eligible newly adoptive children added to a
30.20family receiving covered health services is the month of placement. The effective date
30.21of coverage for other new members added to the family is the first day of the month
30.22following the month in which the change is reported. All eligibility criteria must be met
30.23by the family at the time the new family member is added. The income of the new family
30.24member is included with the family's gross income and the adjusted premium begins in
30.25the month the new family member is added.
30.26(b) The initial premium must be received by the last working day of the month for
30.27coverage to begin the first day of the following month.
30.28(c) Benefits are not available until the day following discharge if an enrollee is
30.29hospitalized on the first day of coverage.
30.30(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
30.31256L.18 are secondary to a plan of insurance or benefit program under which an eligible
30.32person may have coverage and the commissioner shall use cost avoidance techniques to
30.33ensure coordination of any other health coverage for eligible persons. The commissioner
31.1shall identify eligible persons who may have coverage or benefits under other plans of
31.2insurance or who become eligible for medical assistance.
31.3(e) The effective date of coverage for single adults and households with no children
31.4formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
31.5according to section 256D.03, subdivision 3, or 256D.031, is the first day of the month
31.6following the last day of general assistance medical care coverage.
31.7EFFECTIVE DATE.This section is effective March 1, 2010.

31.8    Sec. 18. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
31.9    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility
31.10must be renewed every 12 months. The 12-month period begins in the month after the
31.11month the application is approved.
31.12    (b) Each new period of eligibility must take into account any changes in
31.13circumstances that impact eligibility and premium amount. An enrollee must provide all
31.14the information needed to redetermine eligibility by the first day of the month that ends
31.15the eligibility period. If there is no change in circumstances, the enrollee may renew
31.16eligibility at designated locations that include community clinics and health care providers'
31.17offices. The designated sites shall forward the renewal forms to the commissioner. The
31.18commissioner may establish criteria and timelines for sites to forward applications to the
31.19commissioner or county agencies. The premium for the new period of eligibility must be
31.20received as provided in section 256L.06 in order for eligibility to continue.
31.21    (c) For single adults and households with no children formerly enrolled in general
31.22assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
31.23subdivision 3 , or 256D.031, the first period of eligibility begins the month the enrollee
31.24submitted the application or renewal for general assistance medical care.
31.25    (d) An enrollee who fails to submit renewal forms and related documentation
31.26necessary for verification of continued eligibility in a timely manner shall remain eligible
31.27for one additional month beyond the end of the current eligibility period before being
31.28disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
31.29additional month.

31.30    Sec. 19. Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read:
31.31    Subd. 6. Exception for certain adults. Single adults and households with
31.32no children formerly enrolled in general assistance medical care and enrolled in
31.33MinnesotaCare according to section 256D.03, subdivision 3, or 256D.031, are eligible
31.34without meeting the requirements of this section until renewal.
32.1EFFECTIVE DATE.This section is effective March 1, 2010.

32.2    Sec. 20. Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read:
32.3    Subd. 4. Exception for transitioned adults. County agencies shall pay premiums
32.4for single adults and households with no children formerly enrolled in general assistance
32.5medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3,
32.6or 256D.031, until six-month renewal. The county agency has the option of continuing to
32.7pay premiums for these enrollees.
32.8EFFECTIVE DATE.This section is effective March 1, 2010.

32.9    Sec. 21. Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read:
32.10    Subd. 7. Exception for certain adults. Single adults and households with
32.11no children formerly enrolled in general assistance medical care and enrolled in
32.12MinnesotaCare according to section 256D.03, subdivision 3, or 256D.031, are exempt
32.13from the requirements of this section until renewal.
32.14EFFECTIVE DATE.This section is effective March 1, 2010.

32.15    Sec. 22. DRUG REBATE PROGRAM.
32.16The commissioner of human services shall continue to administer a drug rebate
32.17program for drugs purchased for persons eligible for the general assistance medical care
32.18program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph
32.19(cc), and 256D.03. The rebate revenues collected under the drug rebate program for
32.20persons eligible for the general assistance medical care program shall be deposited in the
32.21general assistance medical care account in the special revenue fund established under
32.22Minnesota Statutes, section 256D.032.
32.23EFFECTIVE DATE.This section is effective March 1, 2010, and expires June
32.2430, 2011.

32.25    Sec. 23. PROVIDER PARTICIPATION.
32.26For purposes of Minnesota Statutes, section 256B.0644, the reference to the general
32.27assistance medical care program shall include the temporary general assistance medical
32.28care program established under Minnesota Statutes, section 256D.031. In meeting the
32.29requirements of Minnesota Statutes, section 256B.0644, a provider must accept new
32.30patients regardless of the Minnesota health care program the patient is enrolled in and may
33.1not refuse to accept patients enrolled in one Minnesota health care program and continue
33.2to accept patients enrolled in other Minnesota health care programs.
33.3EFFECTIVE DATE.This section is effective March 1, 2010.

33.4    Sec. 24. TEMPORARY SUSPENSION.
33.5(a) For the period beginning March 1, 2010, to June 30, 2011, the commissioner
33.6of human services shall not implement or administer Minnesota Statutes 2008, section
33.7256D.03, subdivisions 6 and 9; Minnesota Statutes 2009 Supplement, section 256D.03,
33.8subdivision 4; or Minnesota Statutes 2008, section 256B.692; and Minnesota Statutes
33.92009 Supplement, section 256B.69, as they apply to the general assistance medical care
33.10program unless specifically continued in Minnesota Statutes, section 256D.031.
33.11(b) Notwithstanding paragraph (a), outpatient prescription drug coverage shall
33.12continue to be provided under Minnesota Statutes, section 256D.03.
33.13EFFECTIVE DATE.This section is effective March 1, 2010, and expires July 1,
33.142011.

33.15    Sec. 25. COORDINATED CARE DELIVERY ORGANIZATION
33.16DEMONSTRATION PROJECT.
33.17The commissioner of human services shall develop, and present to the legislature
33.18by December 15, 2010, a plan to establish a demonstration project to deliver inpatient
33.19hospital, primary care, and specialist services to general assistance medical care enrollees
33.20through coordinated care delivery organizations, beginning January 1, 2012. Each
33.21coordinated care delivery organization must deliver coordinated care through at least one
33.22hospital and one physician group practice, and may include counties and other health care
33.23providers. The coordinated care delivery organization must provide inpatient hospital,
33.24primary care, and specialist services to general assistance medical care enrollees eligible
33.25for the program under Minnesota Statutes, section 256D.03 or 256D.031. The coordinated
33.26care delivery organization must accept responsibility for the quality of care and must
33.27assume financial risk for the services provided. The plan must include:
33.28(1) financial incentives for coordinated care delivery organizations to reduce the
33.29growth in the volume and cost of services provided, while maintaining or improving
33.30the quality of care;
33.31(2) recommendations for the delivery of services not provided through a coordinated
33.32care delivery organization and coordination of outpatient and inpatient health care services;
34.1(3) recommendations as to the size and scope of the demonstration project and
34.2whether participation would be mandatory or voluntary for general assistance medical
34.3care enrollees; and
34.4(4) recommendations for managing financial risk within a coordinated care delivery
34.5organization.

34.6ARTICLE 2

34.7APPROPRIATIONS

34.8	Section 1. HEALTH AND HUMAN SERVICES APPROPRIATION.

34.9The sums shown in the columns marked "Appropriations" are added to or, if shown
34.10in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, as amended
34.11by Laws 2009, chapter 173, or other law to the agencies and for the purposes specified in
34.12this article. The appropriations are from the general fund, or another named fund, and are
34.13available for the fiscal years indicated for each purpose. The figures "2010" and "2011"
34.14used in this article mean that the addition to or subtraction from appropriations listed under
34.15them are available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively.
34.16"The first year" is fiscal year 2010. "The second year" is fiscal year 2011. "The biennium"
34.17is fiscal years 2010 and 2011. Supplemental appropriations and reductions for the fiscal
34.18year ending June 30, 2010, are effective the day following final enactment.

34.19				APPROPRIATIONS
34.20				Available for the Year
34.21				Ending June 30
34.22					2010		2011

34.23

Sec. 2. HUMAN SERVICES

34.24

Subdivision 1.Total Appropriation

$

(88,580,000)

$

27,041,000

34.25	Appropriations by Fund
34.26		2010	2011
34.27	General	(62,256,000)	(34,866,000)
34.28	Health Care Access	(68,568,000)	(185,157,000)
34.29	Special Revenue	42,244,000	247,064,000

34.30The amounts that may be spent for each
34.31purpose are specified in the following
34.32subdivisions.

34.33 34.34

Subd. 2.Children and Economic Assistance Grants

-0-

(9,939,000)

35.1The general fund appropriation to the
35.2commissioner of human services for children
35.3and community services grants in Laws
35.42009, chapter 79, article 13, section 3,
35.5subdivision 4, as amended by Laws 2009,
35.6chapter 173, article 2, section 1, subdivision
35.74, is reduced by $9,938,000 in fiscal year
35.82011. The general fund base for children
35.9and community service grants is increased
35.10by $9,938,000 per year for fiscal years 2012
35.11and 2013.

35.12 35.13

Subd. 3.Children and Economic Assistance Management

35.14

Children and Economic Assistance Operations

35.15	Appropriations by Fund
35.16	Special Revenue	29,000	-0-

35.17

Subd. 4.Basic Health Care Grants

35.18The amounts that may be spent from this
35.19appropriation for each purpose are as follows:

35.20

(a) MinnesotaCare Grants

(68,569,000)

(185,157,000)

35.21 35.22

(b) Medical Assistance Basic Health Care Grants - Families and Children

-0-

(4,070,000)

35.23 35.24

(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled

-0-

(6,470,000)

35.25

(d) General Assistance Medical Care Grants

35.26	Appropriations by Fund
35.27	General	(60,406,000)	-0-
35.28	Special Revenue	40,323,000	241,308,000

35.29For general assistance medical care grants
35.30under Minnesota Statutes, section 256D.031.
35.31The commissioner shall transfer $60,406,000
35.32on March 1, 2010, from the general fund to
35.33the fund established in Minnesota Statutes,
35.34section 256D.032. Any unexpended amount
36.1not used for general assistance medical care
36.2expenditures incurred before March 1, 2010,
36.3does not cancel and shall be transferred to
36.4the fund established in Minnesota Statutes,
36.5section 256D.032, by January 1, 2011.

36.6

Subd. 5.Health Care Management

36.7The amounts that may be spent from the
36.8appropriation for each purpose are as follows:

36.9

(a) Health Care Administration

36.10	Appropriations by Fund
36.11	General	(825,000)	(2,425,000)
36.12	Special Revenue	825,000	2,681,000

36.13$825,000 in fiscal year 2010 and $2,475,000
36.14in fiscal year 2011 from the special revenue
36.15fund are for administration of the general
36.16assistance medical care program under
36.17Minnesota Statutes, section 256D.031. For
36.18purposes of consistent cost allocation and
36.19accounting, the commissioner may transfer
36.20these amounts to the general fund. The
36.21commissioner shall transfer $825,000 in
36.22fiscal year 2010 and $2,475,000 in fiscal
36.23year 2011 from the general fund to the fund
36.24established in Minnesota Statutes, section
36.25256D.032.

36.26

(b) Health Care Operations

36.27	Appropriations by Fund
36.28	General	(1,025,000)	(3,075,000)
36.29	Special Revenue	1,067,000	3,075,000

36.30$1,025,000 in fiscal year 2010 and
36.31$3,075,000 in fiscal year 2011 from the
36.32special revenue fund are for operations of
36.33the general assistance medical care program
36.34under Minnesota Statutes, section 256D.031.
36.35For purposes of consistent cost allocation
37.1and accounting, the commissioner may
37.2transfer these amounts to the general fund.
37.3The commissioner shall transfer $1,025,000
37.4in fiscal year 2010 and $3,075,000 in fiscal
37.5year 2011 from the general fund to the fund
37.6established in Minnesota Statutes, section
37.7256D.032.

37.8

Subd. 6.Continuing Care Grants

37.9

Mental Health Grants

-0-

(9,938,000)

37.10The general fund appropriation to the
37.11commissioner of human services for adult
37.12mental health grants in Laws 2009, chapter
37.1379, article 13, section 3, subdivision 8, as
37.14amended by Laws 2009, chapter 173, article
37.152, section 1, subdivision 8, is reduced by
37.16$9,939,000 in fiscal year 2011. The general
37.17fund base for adult mental health grants is
37.18increased by $9,939,000 per year in fiscal
37.19years 2012 and 2013.

37.20

Subd. 7.Continuing Care Management

-0-

1,051,000

37.21

Subd. 8.Transfers

37.22(a) The commissioner of management and
37.23budget shall transfer $168,733,000 in fiscal
37.24year 2011 and $12,979,000 in fiscal year
37.252012, from the general fund to the fund
37.26established in Minnesota Statutes, section
37.27256D.032.
37.28(b) $19,877,000 shall be transferred in
37.29fiscal year 2011 from the general fund to
37.30the general assistance medical care account
37.31established in Minnesota Statutes, section
37.32256D.032.
37.33EFFECTIVE DATE.This article is effective March 1, 2010.