SF 2168

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/10/2010 07:57am

A bill for an act
relating to health care; establishing mental health urgent care and consultation
services; modifying the general assistance medical care program; appropriating
money; amending Minnesota Statutes 2008, sections 256.9657, subdivisions
2, 3; 256.969, subdivisions 21, 26, 27, by adding subdivisions; 256B.0625,
subdivision 13f, by adding a subdivision; 256B.69, by adding a subdivision;
256D.03, subdivisions 3a, 3b; 256D.06, subdivision 7; 256L.05, subdivisions
1b, 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4; 256L.17, subdivision
7; Minnesota Statutes 2009 Supplement, sections 256.969, subdivisions 2b, 3a,
30; 256B.195, subdivision 3; 256B.196, subdivision 2; 256B.199; 256D.03,
subdivision 3; proposing coding for new law in Minnesota Statutes, chapters
245; 256D.

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

ARTICLE 1

HEALTH CARE PROGRAM MODIFICATIONS

Section 1.

new text begin [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC
CONSULTATION.
new text end

new text begin Subdivision 1. new text end

new text begin Mental health urgent care and psychiatric consultation. new text end

new text begin The
commissioner shall include mental health urgent care and psychiatric consultation
services as part of, but not limited to, the redesign of six community-based behavioral
health hospitals and the Anoka-Metro Regional Treatment Center. These services must
not duplicate existing services in the region, and must be implemented as specified in
subdivisions 3 to 7.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For purposes of this section:
new text end

new text begin (a) Mental health urgent care includes:
new text end

new text begin (1) initial mental health screening;
new text end

new text begin (2) mobile crisis assessment and intervention;
new text end

new text begin (3) rapid access to psychiatry, including psychiatric evaluation, initial treatment,
and short-term psychiatry;
new text end

new text begin (4) nonhospital crisis stabilization residential beds; and
new text end

new text begin (5) health care navigator services which include, but are not limited to, assisting
uninsured individuals in obtaining health care coverage.
new text end

new text begin (b) Psychiatric consultation services includes psychiatric consultation to primary
care practitioners.
new text end

new text begin Subd. 3. new text end

new text begin Rapid access to psychiatry. new text end

new text begin The commissioner shall develop rapid access
to psychiatric services based on the following criteria:
new text end

new text begin (1) the individuals who receive the psychiatric services must be at risk of
hospitalization and otherwise unable to receive timely services;
new text end

new text begin (2) where clinically appropriate, the service may be provided via interactive video
where the service is provided in conjunction with an emergency room, a local crisis
service, or a primary care or behavioral care practitioner; and
new text end

new text begin (3) the commissioner may integrate rapid access to psychiatry with the psychiatric
consultation services in subdivision 4.
new text end

new text begin Subd. 4. new text end

new text begin Collaborative psychiatric consultation. new text end

new text begin (a) The commissioner shall
establish a collaborative psychiatric consultation service based on the following criteria:
new text end

new text begin (1) the service may be available via telephone, interactive video, e-mail, or other
means of communication to emergency rooms, local crisis services, mental health
professionals, and primary care practitioners, including pediatricians;
new text end

new text begin (2) the service shall be provided by a multidisciplinary team including, at a
minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical
social worker;
new text end

new text begin (3) the service shall include a triage-level assessment to determine the most
appropriate response to each request, including appropriate referrals to other mental health
professionals, as well as provision of rapid psychiatric access when other appropriate
services are not available;
new text end

new text begin (4) the first priority for this service is to provide the consultations required under
section 256B.0625, subdivision 13j; and
new text end

new text begin (5) the service must encourage use of cognitive and behavioral therapies and other
evidence-based treatments in addition to or in place of medication, where appropriate.
new text end

new text begin (b) The commissioner shall appoint an interdisciplinary work group to establish
appropriate medication and psychotherapy protocols to guide the consultative process,
including consultation with the Drug Utilization Review Board as provided in section
256B.0625, subdivision 13j.
new text end

new text begin Subd. 5. new text end

new text begin Phased availability. new text end

new text begin (a) The commissioner may phase in the availability
of mental health urgent care services based on the limits of appropriations and the
commissioner's determination of level of need and cost-effectiveness.
new text end

new text begin (b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin
and Ramsey Counties and children statewide who are affected by section 256B.0625,
subdivision 13j, and must include tracking of costs for the services provided and
associated impacts on utilization of inpatient, emergency room, and other services.
new text end

new text begin Subd. 6. new text end

new text begin Limited appropriations. new text end

new text begin The commissioner shall maximize use
of available health care coverage for the services provided under this section. The
commissioner's responsibility to provide these services for individuals without health care
coverage must not exceed the appropriations for this section.
new text end

new text begin Subd. 7. new text end

new text begin Flexible implementation. new text end

new text begin To implement this section, the commissioner
shall select the structure and funding method that is the most cost-effective for each county
or group of counties. This may include grants, contracts, direct provision by state-operated
services, and public-private partnerships. Where feasible, the commissioner shall make
any grants under this section a part of the integrated adult mental health initiative grants
under section 245.4661.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256.9657, subdivision 2, is amended to read:

Subd. 2.

Hospital surcharge.

(a) Effective October 1, 1992, each Minnesota
hospital except facilities of the federal Indian Health Service and regional treatment
centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
patient revenues excluding net Medicare revenues reported by that provider to the health
care cost information system according to the schedule in subdivision 4.

(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
percent.

(c) new text begin Effective March 1, 2010, to September 30, 2010, the surcharge under paragraph
(b) is increased to 3.95 percent. Effective October 1, 2010, to June 30, 2011, the surcharge
under paragraph (b) is increased to 3.06 percent. Notwithstanding section 256.9656,
money collected under this paragraph in excess of the amount collected under paragraph
(b) shall be deposited in the account established in section 256D.032.
new text end

new text begin (d) new text end Notwithstanding the Medicare cost finding and allowable cost principles, the
hospital surcharge is not an allowable cost for purposes of rate setting under sections
256.9685 to 256.9695.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256.9657, subdivision 3, is amended to read:

Subd. 3.

Surcharge on HMOs and community integrated service networks.

(a)
Effective October 1, 1992, each health maintenance organization with a certificate of
authority issued by the commissioner of health under chapter 62D and each community
integrated service network licensed by the commissioner under chapter 62N shall pay to
the commissioner of human services a surcharge equal to six-tenths of one percent of the
total premium revenues of the health maintenance organization or community integrated
service network as reported to the commissioner of health according to the schedule in
subdivision 4.

(b) new text begin Effective March 1, 2010, to June 30, 2011: (1) the surcharge under paragraph (a)
is increased to 4.0 percent; and (2) each county-based purchasing plan authorized under
section 256B.692 shall pay to the commissioner a surcharge equal to 4.0 percent of the
total premium revenues of the plan, as reported to the commissioner of health, according
to the payment schedule in subdivision 4. Notwithstanding section 256.9656, money
collected under this paragraph in excess of the amount collected under paragraph (a) shall
be deposited in the account established in section 256D.032.
new text end

new text begin (c) new text end For purposes of this subdivision, total premium revenue means:

(1) premium revenue recognized on a prepaid basis from individuals and groups
for provision of a specified range of health services over a defined period of time which
is normally one month, excluding premiums paid to a health maintenance organization
or community integrated service network from the Federal Employees Health Benefit
Program;

(2) premiums from Medicare wrap-around subscribers for health benefits which
supplement Medicare coverage;

(3) Medicare revenue, as a result of an arrangement between a health maintenance
organization or a community integrated service network and the Centers for Medicare
and Medicaid Services of the federal Department of Health and Human Services, for
services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited
from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social
Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and
1395w-24, respectively, as they may be amended from time to time; and

(4) medical assistance revenue, as a result of an arrangement between a health
maintenance organization or community integrated service network and a Medicaid state
agency, for services to a medical assistance beneficiary.

If advance payments are made under clause (1) or (2) to the health maintenance
organization or community integrated service network for more than one reporting period,
the portion of the payment that has not yet been earned must be treated as a liability.

deleted text begin (c) deleted text end new text begin (d) new text end When a health maintenance organization or community integrated service
network merges or consolidates with or is acquired by another health maintenance
organization or community integrated service network, the surviving corporation or the
new corporation shall be responsible for the annual surcharge originally imposed on
each of the entities or corporations subject to the merger, consolidation, or acquisition,
regardless of whether one of the entities or corporations does not retain a certificate of
authority under chapter 62D or a license under chapter 62N.

deleted text begin (d) deleted text end new text begin (e) new text end Effective July 1 of each year, the surviving corporation's or the new
corporation's surcharge shall be based on the revenues earned in the second previous
calendar year by all of the entities or corporations subject to the merger, consolidation,
or acquisition regardless of whether one of the entities or corporations does not retain a
certificate of authority under chapter 62D or a license under chapter 62N until the total
premium revenues of the surviving corporation include the total premium revenues of all
the merged entities as reported to the commissioner of health.

deleted text begin (e) deleted text end new text begin (f) new text end When a health maintenance organization or community integrated service
network, which is subject to liability for the surcharge under this chapter, transfers,
assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability
for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer
of the health maintenance organization or community integrated service network.

deleted text begin (f) deleted text end new text begin (g) new text end In the event a health maintenance organization or community integrated
service network converts its licensure to a different type of entity subject to liability
for the surcharge under this chapter, but survives in the same or substantially similar
form, the surviving entity remains liable for the surcharge regardless of whether one of
the entities or corporations does not retain a certificate of authority under chapter 62D
or a license under chapter 62N.

deleted text begin (g) deleted text end new text begin (h) new text end The surcharge assessed to a health maintenance organization or community
integrated service network ends when the entity ceases providing services for premiums
and the cessation is not connected with a merger, consolidation, acquisition, or conversion.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 4.

Minnesota Statutes 2009 Supplement, section 256.969, subdivision 2b, is
amended to read:

Subd. 2b.

Operating payment rates.

In determining operating payment rates for
admissions occurring on or after the rate year beginning January 1, 1991, and every two
years after, or more frequently as determined by the commissioner, the commissioner shall
obtain operating data from an updated base year and establish operating payment rates
per admission for each hospital based on the cost-finding methods and allowable costs of
the Medicare program in effect during the base year. Rates under the general assistance
medical care, medical assistance, and MinnesotaCare programs shall not be rebased to
more current data on January 1, 1997, January 1, 2005, for the first 24 months of the
rebased period beginning January 1, 2009. For the first deleted text begin three deleted text end new text begin six new text end months of the rebased
period beginning January 1, 2011, rates shall new text begin not new text end be rebased deleted text begin at 74.25 percent of the full
value of the rebasing percentage change deleted text end . From deleted text begin April deleted text end new text begin July new text end 1, 2011, to March 31, 2012,
rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change.
Effective April 1, 2012, rates shall be rebased at full value. The base year operating
payment rate per admission is standardized by the case mix index and adjusted by the
hospital cost index, relative values, and disproportionate population adjustment. The
cost and charge data used to establish operating rates shall only reflect inpatient services
covered by medical assistance and shall not include property cost information and costs
recognized in outlier payments.

Sec. 5.

Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is
amended to read:

Subd. 3a.

Payments.

(a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and
may merge the payment rates while maintaining separate provider numbers. The operating
and property base rates per admission or per day shall be derived from the best Medicare
and claims data available when rates are established. The commissioner shall determine
the best Medicare and claims data, taking into consideration variables of recency of the
data, audit disposition, settlement status, and the ability to set rates in a timely manner.
The commissioner shall notify hospitals of payment rates by December 1 of the year
preceding the rate year. The rate setting data must reflect the admissions data used to
establish relative values. Base year changes from 1981 to the base year established for the
rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
1. The commissioner may adjust base year cost, relative value, and case mix index data
to exclude the costs of services that have been discontinued by the October 1 of the year
preceding the rate year or that are paid separately from inpatient services. Inpatient stays
that encompass portions of two or more rate years shall have payments established based
on payment rates in effect at the time of admission unless the date of admission preceded
the rate year in effect by six months or more. In this case, operating payment rates for
services rendered during the rate year in effect and established based on the date of
admission shall be adjusted to the rate year in effect by the hospital cost index.

(b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.

(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.

(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.

(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, deleted text begin 2010 deleted text end new text begin 2011 new text end ,
made to hospitals for inpatient services before third-party liability and spenddown, is
reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis
related groups 424 to 432 and facilities defined under subdivision 16 are excluded from
this paragraph. Payments made to managed care plans shall be reduced for services
provided on or after July 1, 2009, through June 30, deleted text begin 2010 deleted text end new text begin 2011 new text end , to reflect this reduction.

(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, deleted text begin 2010 deleted text end new text begin 2011 new text end , made to hospitals
for inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, deleted text begin 2010 deleted text end new text begin 2011 new text end , to reflect this reduction.

(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.

new text begin (i) In order to offset the ratable reductions provided for in this subdivision, the total
payment rate for medical assistance fee-for-service admissions occurring on or after
March 1, 2010, to June 30, 2011, made to Minnesota hospitals for inpatient services
before third-party liability and spenddown, shall be increased by 14 percent from the
current statutory rates if the hospital is located in Hennepin or Ramsey County and 18
percent from the current statutory rates for all other Minnesota hospitals. For purposes
of this paragraph, medical assistance does not include general assistance medical care.
This increase shall be paid from the account established in section 256D.032. The
commissioner shall not adjust rates paid to a prepaid health plan under contract with
the commissioner to reflect payments provided in this paragraph. The commissioner
may utilize a settlement process to adjust rates in excess of the Medicare upper limits on
payments. The commissioner may ratably reduce payments under this paragraph in order
to comply with section 256B.195, subdivision 3, paragraph (f).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 6.

Minnesota Statutes 2008, section 256.969, subdivision 21, is amended to read:

Subd. 21.

Mental health or chemical dependency admissions; rates.

new text begin (a)
new text end Admissions under the general assistance medical care program occurring on or after
July 1, 1990, and admissions under medical assistance, excluding general assistance
medical care, occurring on or after July 1, 1990, and on or before September 30, 1992,
that are classified to a diagnostic category of mental health or chemical dependency
shall have rates established according to the methods of subdivision 14, except the per
day rate shall be multiplied by a factor of 2, provided that the total of the per day rates
shall not exceed the per admission rate. This methodology shall also apply when a hold
or commitment is ordered by the court for the days that inpatient hospital services are
medically necessary. Stays which are medically necessary for inpatient hospital services
and covered by medical assistance shall not be billable to any other governmental entity.
Medical necessity shall be determined under criteria established to meet the requirements
of section 256B.04, subdivision 15, or 256D.03, subdivision 7, paragraph (b).

new text begin (b) In order to ensure adequate access for the provision of mental health services
and to encourage broader delivery of these services outside the nonstate governmental
hospital setting, payment rates for medical assistance admissions occurring on or after
March 1, 2010, to June 30, 2011, at a Minnesota private, not-for-profit hospital above the
75th percentile of all Minnesota private, nonprofit hospitals for diagnosis-related groups
424 to 432 and 521 to 523 admissions paid by medical assistance for admissions occurring
in calendar year 2007, shall be increased for these diagnosis-related groups at a percentage
calculated to cost not more than a total of $40,000,000, including state and federal shares.
This increase shall be paid from the account established in section 256D.032. For
purposes of this paragraph, medical assistance does not include general assistance medical
care. The commissioner shall not adjust rates paid to a prepaid health plan under contract
with the commissioner to reflect payments provided in this paragraph. The commissioner
may utilize a settlement process to adjust rates in excess of the Medicare upper limits on
payments. The commissioner may ratably reduce payments under this paragraph in order
to comply with section 256B.195, subdivision 3, paragraph (f).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256.969, subdivision 26, is amended to read:

Subd. 26.

Greater Minnesota payment adjustment after June 30, 2001.

(a) For
admissions occurring after June 30, 2001, the commissioner shall pay fee-for-service
inpatient admissions for the diagnosis-related groups specified in paragraph (b) at hospitals
located outside of the seven-county metropolitan area at the higher of:

(1) the hospital's current payment rate for the diagnostic category to which the
diagnosis-related group belongs, exclusive of disproportionate population adjustments
received under subdivision 9 and hospital payment adjustments received under subdivision
23; or

(2) 90 percent of the average payment rate for that diagnostic category for hospitals
located within the seven-county metropolitan area, exclusive of disproportionate
population adjustments received under subdivision 9 and hospital payment adjustments
received under subdivisions 20 and 23.

(b) The payment increases provided in paragraph (a) apply to the following
diagnosis-related groups, as they fall within the diagnostic categories:

(1) 370 cesarean section with complicating diagnosis;

(2) 371 cesarean section without complicating diagnosis;

(3) 372 vaginal delivery with complicating diagnosis;

(4) 373 vaginal delivery without complicating diagnosis;

(5) 386 extreme immaturity and respiratory distress syndrome, neonate;

(6) 388 full-term neonates with other problems;

(7) 390 prematurity without major problems;

(8) 391 normal newborn;

(9) 385 neonate, died or transferred to another acute care facility;

(10) 425 acute adjustment reaction and psychosocial dysfunction;

(11) 430 psychoses;

(12) 431 childhood mental disorders; and

(13) 164-167 appendectomy.

new text begin For medical assistance admissions occurring on or after March 1, 2010, to June 30,
2011, the payment rate under paragraph (a), clause (2), shall be increased to 100 percent
from 90 percent, after application of the rate increase in subdivision 3a, paragraph (i). This
increase shall be paid from the account established in section 256D.032. For purposes
of this paragraph, medical assistance does not include general assistance medical care.
The commissioner shall not adjust rates paid to a prepaid health plan under contract with
the commissioner to reflect payments provided in this paragraph. The commissioner
may utilize a settlement process to adjust rates in excess of the Medicare upper limits on
payments. The commissioner may ratably reduce payments under this paragraph in order
to comply with section 256B.195, subdivision 3, paragraph (f).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 8.

Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:

new text begin Subd. 26a. new text end

new text begin Psychiatric and burn services payment adjustment on or after July
1, 2010. new text end

new text begin (a) For admissions occurring on or after July 1, 2010, the commissioner shall
increase the total payment for medical assistance fee-for-service inpatient admissions for
the diagnosis-related groups specified in paragraph (b) at any hospital that is a nonstate
public Minnesota hospital and a Level I trauma center. The rate increases shall be
established for each hospital by the commissioner at a level that uses each hospital's
voluntary payments under paragraph (c) as the nonfederal share. For purposes of
this subdivision, medical assistance does not include general assistance medical care.
Payments to managed care health plans shall not be increased for payments under this
subdivision.
new text end

new text begin (b) The rate increases provided in paragraph (a) apply to the following
diagnosis-related groups or subgroups, or any subsequent designations of such groups
or subgroups: 424 to 431, 433, 504 to 511, 521, and 523. These increases are only
available to the extent that revenue is available from the counties under paragraph (c)
for the nonfederal share.
new text end

new text begin (c) Effective July 15, 2010, in addition to any payment otherwise required under
sections 256B.19, 256B.195, 256B.196, and 256B.199, the following government entities
may make the following voluntary payments to the commissioner on an annual basis:
new text end

new text begin (1) Hennepin County, $7,000,000; and
new text end

new text begin (2) Ramsey County, $3,500,000.
new text end

new text begin The amounts in this paragraph shall be part of the designated governmental unit's portion of
the nonfederal share of medical assistance costs, including payments under subdivision 9.
new text end

new text begin (d) The commissioner may adjust the intergovernmental transfers under paragraph
(c) and the payments under paragraph (a) based on the commissioner's determination of
Medicare upper payment limits, hospital-specific charge limits, and any limits imposed
by the federal government regarding the rate increase or the restriction in the American
Resource and Recovery Act regarding increased local share.
new text end

new text begin (e) This section shall be implemented upon federal approval, retroactive to July 1,
2010, for services provided on or after that date.
new text end

Sec. 9.

Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:

Subd. 27.

Quarterly payment adjustment.

(a) In addition to any other payment
under this section, the commissioner shall make the following payments effective July
1, 2007:

(1) for a hospital located in Minnesota and not eligible for payments under
subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8
percent of total patient days as of the base year in effect on July 1, 2005, a payment
equal to 13 percent of the total of the operating and property payment rates new text begin , except that
Hennepin County Medical Center and Regions Hospital shall not receive a payment
under this subdivision new text end ;

(2) for a hospital located in Minnesota in a specified urban area outside of the
seven-county metropolitan area and not eligible for payments under subdivision 20, with
a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total
patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent
of the total of the operating and property payment rates. For purposes of this clause, the
following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria,
Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids,
Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena;

(3) for a hospital located in Minnesota but not located in a specified urban area
under clause (2), with a medical assistance inpatient utilization rate less than or equal to
17.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment
equal to four percent of the total of the operating and property payment rates. A hospital
located in Woodbury and not in existence during the base year shall be reimbursed under
this clause; and

(4) in addition to any payments under clauses (1) to (3), for a hospital located in
Minnesota and not eligible for payments under subdivision 20 with a medical assistance
inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect
on July 1, 2005, a payment equal to eight percent of the total of the operating and property
payment rates, and for a hospital located in Minnesota and not eligible for payments
under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent
of total patient days as of the base year in effect on July 1, 2005, a payment equal to
nine percent of the total of the operating and property payment rates. After making any
ratable adjustments required under paragraph (b), the commissioner shall proportionately
reduce payments under clauses (2) and (3) by an amount needed to make payments under
this clause.

(b) The state share of payments under paragraph (a) shall be equal to federal
reimbursements to the commissioner to reimburse expenditures reported under section
256B.199 new text begin , paragraphs (a) to (d) new text end . The commissioner shall ratably reduce or increase
payments under this subdivision in order to ensure that these payments equal the amount
of reimbursement received by the commissioner under section 256B.199 new text begin , paragraphs (a)
to (d) new text end , except that payments shall be ratably reduced by an amount equivalent to the state
share of a four percent reduction in MinnesotaCare and medical assistance payments for
inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be equivalent
to the state share of a three percent reduction in these payments. new text begin Effective for federal
disproportionate share hospital funds earned on general assistance medical care payments
for services rendered on or after March 1, 2010, to June 30, 2011, the amount of the three
percent ratable reduction required under this paragraph shall be deposited in the account
established in section 256D.032.
new text end

(c) The payments under paragraph (a) shall be paid quarterly based on each hospital's
operating and property payments from the second previous quarter, beginning on July
15, 2007, or upon federal approval of federal reimbursements under section 256B.199 new text begin ,
paragraphs (a) to (d) new text end , whichever occurs later.

(d) The commissioner shall not adjust rates paid to a prepaid health plan under
contract with the commissioner to reflect payments provided in paragraph (a).

(e) The commissioner shall maximize the use of available federal money for
disproportionate share hospital payments and shall maximize payments to qualifying
hospitals. In order to accomplish these purposes, the commissioner may, in consultation
with the nonstate entities identified in section 256B.199 new text begin , paragraphs (a) to (d) new text end , adjust,
on a pro rata basis if feasible, the amounts reported by nonstate entities under section
256B.199 new text begin , paragraphs (a) to (d), new text end when application for reimbursement is made to the federal
government, and otherwise adjust the provisions of this subdivision. The commissioner
shall utilize a settlement process based on finalized data to maximize revenue under
section 256B.199 new text begin , paragraphs (a) to (d), new text end and payments under this section.

(f) For purposes of this subdivision, medical assistance does not include general
assistance medical care.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for services rendered on or after
March 1, 2010.
new text end

Sec. 10.

Minnesota Statutes 2009 Supplement, section 256.969, subdivision 30,
is amended to read:

Subd. 30.

Payment rates for births.

(a) For admissions occurring on or after
October 1, 2009, the total operating and property payment rate, excluding disproportionate
population adjustment, for the following diagnosis-related groups, as they fall within
the diagnostic categories: (1) 371 cesarean section without complicating diagnosis; (2)
372 vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without
complicating diagnosis, shall be no greater than $3,528.

(b) The rates described in this subdivision do not include newborn care.

(c) Payments to managed care and county-based purchasing plans under section
256B.69, 256B.692, or 256L.12 shall be reduced for services provided on or after October
1, 2009, to reflect the adjustments in paragraph (a).

(d) Prior authorization shall not be required before reimbursement is paid for a
cesarean section delivery.

new text begin (e) In order to ensure adequate access for the provision of maternity services and
to encourage broader delivery of these services outside the nonstate governmental
hospital setting, and notwithstanding paragraph (a), payment rates for medical assistance
admissions occurring from March 1, 2010, to June 30, 2011, at a private, not-for-profit
hospital above the 65th percentile of all Minnesota private, nonprofit hospitals for
diagnosis-related groups 370 to 373 and 391 admissions paid by medical assistance for
admissions provided in calendar year 2007, shall be increased for these diagnosis-related
groups at a percentage calculated to cost not more than a total of $35,000,000, including
state and federal shares. This increase shall be paid from the account established in section
256D.032. For purposes of this paragraph, medical assistance does not include general
assistance medical care. The commissioner shall not adjust rates paid to a prepaid health
plan under contract with the commissioner to reflect payments provided in this paragraph.
The commissioner may utilize a settlement process to adjust rates in excess of the Medicare
upper limits on payments. The commissioner may ratably reduce payments under this
paragraph in order to comply with section 256B.195, subdivision 3, paragraph (f).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 11.

Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:

new text begin Subd. 31. new text end

new text begin Rate increase for hospitals in cities of the third class and fourth class.
new text end

new text begin Effective for services rendered on or after March 1, 2010, to June 30, 2011, payment rates
for medical assistance admissions, excluding general assistance medical care admissions,
at Minnesota hospitals with fewer than 500 medical assistance admissions during fiscal
year 2008 and located in cities of the third class or of the fourth class, as defined in
section 410.01, shall be increased by 27 percent. This increase shall be paid from the
account established in section 256D.032. The commissioner shall not adjust rates paid to a
prepaid health plan under contract with the commissioner to reflect payments provided
in this paragraph. The commissioner may utilize a settlement process to adjust rates in
excess of the Medicare upper limits on payments. The commissioner may ratably reduce
payments under this paragraph in order to comply with section 256B.195, subdivision 3,
paragraph (f).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 12.

Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to
read:

Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to
review each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain
formulary drugs are eligible for payment. The Formulary Committee may recommend
drugs for prior authorization directly to the commissioner. The commissioner may also
request that the Formulary Committee review a drug for prior authorization. Before the
commissioner may require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment
for an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior
authorization.

(c) new text begin Except as provided in subdivision 13j, new text end prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of treatment.

This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of
mental illness within 60 days of when a generically equivalent drug becomes available,
provided that the brand name drug was part of the recipient's course of treatment at the
time the generically equivalent drug became available.

(d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.

(e) The commissioner may require prior authorization for brand name drugs
whenever a generically equivalent product is available, even if the prescriber specifically
indicates "dispense as written-brand necessary" on the prescription as required by section
151.21, subdivision 2.

(f) Notwithstanding this subdivision, the commissioner may automatically require
prior authorization, for a period not to exceed 180 days, for any drug that is approved by
the United States Food and Drug Administration on or after July 1, 2005. The 180-day
period begins no later than the first day that a drug is available for shipment to pharmacies
within the state. The Formulary Committee shall recommend to the commissioner general
criteria to be used for the prior authorization of the drugs, but the committee is not
required to review each individual drug. In order to continue prior authorizations for a
drug after the 180-day period has expired, the commissioner must follow the provisions
of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 13.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 13j. new text end

new text begin Antipsychotic and attention deficit disorder and attention deficit
hyperactivity disorder medications. new text end

new text begin (a) The commissioner, in consultation with the
Drug Utilization Review Board established in subdivision 13i and actively practicing
pediatric mental health professionals, must:
new text end

new text begin (1) identify recommended pediatric dose ranges for atypical antipsychotic drugs
and drugs used for attention deficit disorder or attention deficit hyperactivity disorder
based on available medical, clinical, and safety data and research. The commissioner
shall periodically review the list of medications and pediatric dose ranges and update
the medications and doses listed as needed after consultation with the Drug Utilization
Review Board;
new text end

new text begin (2) identify situations where a collaborative psychiatric consultation and prior
authorization should be required before the initiation or continuation of drug therapy
in pediatric patients including, but not limited to, high-dose regimens, off-label use of
prescription medication, a patient's young age, and lack of coordination among multiple
prescribing providers; and
new text end

new text begin (3) track prescriptive practices and the use of psychotropic medications in children
with the goal of reducing the use of medication, where appropriate.
new text end

new text begin (b) Effective July 1, 2011, the commissioner shall require prior authorization and
a collaborative psychiatric consultation before an atypical antipsychotic and attention
deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria
identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric
consultation must be completed before the identified medications are eligible for payment
unless:
new text end

new text begin (1) the patient has already been stabilized on the medication regimen; or
new text end

new text begin (2) the prescriber indicates that the child is in crisis.
new text end

new text begin If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed
within 90 days for payment to continue.
new text end

new text begin (c) For purposes of this subdivision, a collaborative psychiatric consultation must
meet the criteria described in section 245.4862, subdivision 4.
new text end

Sec. 14.

Minnesota Statutes 2009 Supplement, section 256B.195, subdivision 3,
is amended to read:

Subd. 3.

Payments to certain safety net providers.

(a) Effective July 15, 2001, the
commissioner shall make the following payments to the hospitals indicated annually:

(1) to Hennepin County Medical Center, any federal matching funds available to
match the payments received by the medical center under subdivision 2, to increase
payments for medical assistance admissions and to recognize higher medical assistance
costs in institutions that provide high levels of charity care; and

(2) to Regions Hospital, any federal matching funds available to match the payments
received by the hospital under subdivision 2, to increase payments for medical assistance
admissions and to recognize higher medical assistance costs in institutions that provide
high levels of charity care.

(b) Effective July 15, 2001, the following percentages of the transfers under
subdivision 2 shall be retained by the commissioner for deposit each month into the
general fund:

(1) 18 percent, plus any federal matching funds, shall be allocated for the following
purposes:

(i) during the fiscal year beginning July 1, 2001, of the amount available under
this clause, 39.7 percent shall be allocated to make increased hospital payments under
section 256.969, subdivision 26; 34.2 percent shall be allocated to fund the amounts
due from small rural hospitals, as defined in section 144.148, for overpayments under
section 256.969, subdivision 5a, resulting from a determination that medical assistance
and general assistance payments exceeded the charge limit during the period from 1994 to
1997; and 26.1 percent shall be allocated to the commissioner of health for rural hospital
capital improvement grants under section 144.148; and

(ii) during fiscal years beginning on or after July 1, 2002, of the amount available
under this clause, 55 percent shall be allocated to make increased hospital payments under
section 256.969, subdivision 26, and 45 percent shall be allocated to the commissioner of
health for rural hospital capital improvement grants under section 144.148; and

(2) 11 percent shall be allocated to the commissioner of health to fund community
clinic grants under section 145.9268.

(c) This subdivision shall apply to fee-for-service payments only and shall not
increase capitation payments or payments made based on average rates. The allocation in
paragraph (b), clause (1), item (ii), to increase hospital payments under section 256.969,
subdivision 26, shall not limit payments under that section.

(d) Medical assistance rate or payment changes, including those required to obtain
federal financial participation under section 62J.692, subdivision 8, shall precede the
determination of intergovernmental transfer amounts determined in this subdivision.
Participation in the intergovernmental transfer program shall not result in the offset of
any health care provider's receipt of medical assistance payment increases other than
limits resulting from hospital-specific charge limits and limits on disproportionate share
hospital payments.

(e) Effective July 1, 2003, if the amount available for allocation under paragraph
(b) is greater than the amounts available during March 2003, after any increase in
intergovernmental transfers and payments that result from section 256.969, subdivision
3a, paragraph (c), are paid to the general fund, any additional amounts available under this
subdivision after reimbursement of the transfers under subdivision 2 shall be allocated to
increase medical assistance payments, subject to hospital-specific charge limits and limits
on disproportionate share hospital payments, as follows:

(1) if the payments under subdivision 5 are approved, the amount shall be paid to
the largest ten percent of hospitals as measured by 2001 payments for medical assistance,
general assistance medical care, and MinnesotaCare in the nonstate government hospital
category. Payments shall be allocated according to each hospital's proportionate share
of the 2001 payments; or

(2) if the payments under subdivision 5 are not approved, the amount shall be paid to
the largest ten percent of hospitals as measured by 2001 payments for medical assistance,
general assistance medical care, and MinnesotaCare in the nonstate government category
and to the largest ten percent of hospitals as measured by payments for medical assistance,
general assistance medical care, and MinnesotaCare in the nongovernment hospital
category. Payments shall be allocated according to each hospital's proportionate
share of the 2001 payments in their respective category of nonstate government and
nongovernment. The commissioner shall determine which hospitals are in the nonstate
government and nongovernment hospital categories.

new text begin (f) For federal fiscal years 2010 and 2011, payments under this subdivision shall
be made at no less than the federal fiscal year 2009 level.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 15.

Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2,
is amended to read:

Subd. 2.

Commissioner's duties.

(a) For the purposes of this subdivision and
subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
services upper payment limit for nonstate government hospitals. The commissioner shall
then determine the amount of a supplemental payment to Hennepin County Medical
Center and Regions Hospital for these services that would increase medical assistance
spending in this category to the aggregate upper payment limit for all nonstate government
hospitals in Minnesota. In making this determination, the commissioner shall allot the
available increases between Hennepin County Medical Center and Regions Hospital
based on the ratio of medical assistance fee-for-service outpatient hospital payments to
the two facilities. The commissioner shall adjust this allotment as necessary based on
federal approvals, the amount of intergovernmental transfers received from Hennepin and
Ramsey Counties, and other factors, in order to maximize the additional total payments.
The commissioner shall inform Hennepin County and Ramsey County of the periodic
intergovernmental transfers necessary to match federal Medicaid payments available
under this subdivision in order to make supplementary medical assistance payments to
Hennepin County Medical Center and Regions Hospital equal to an amount that when
combined with existing medical assistance payments to nonstate governmental hospitals
would increase total payments to hospitals in this category for outpatient services to
the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to Hennepin County Medical Center and Regions Hospital.

(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians affiliated with Hennepin County Medical
Center and with Regions Hospital. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
Ramsey County of the periodic intergovernmental transfers necessary to match the federal
Medicaid payments available under this subdivision in order to make supplementary
payments to physicians affiliated with Hennepin County Medical Center and Regions
Hospital equal to the difference between the established medical assistance payment for
physician services and the upper payment limit. Upon receipt of these periodic transfers,
the commissioner shall make supplementary payments to physicians of Hennepin Faculty
Associates and HealthPartners.

(c) Beginning January 1, 2010, Hennepin County and Ramsey County deleted text begin shall deleted text end new text begin may
new text end make monthly new text begin voluntary new text end intergovernmental transfers to the commissioner in deleted text begin the following deleted text end
amounts deleted text begin : $133,333 by deleted text end new text begin not to exceed $12,000,000 per year from new text end Hennepin County
and deleted text begin $100,000 by deleted text end new text begin $6,000,000 per year from new text end Ramsey County. The commissioner shall
increase the medical assistance capitation payments to deleted text begin Metropolitan Health Plan and
HealthPartners by deleted text end new text begin any licensed health plan under contract with the medical assistance
program that makes payments to Hennepin County Medical Center or Regions Hospital.
The increase shall be in new text end an amount equal to the annual value of the monthly transfers
plus federal financial participation new text begin , with each health plan receiving its pro rata share
of the increase based on the pro rata share of admissions to Hennepin County Medical
Center and Regions Hospital by those plans. Upon the request of the commissioner,
health plans shall submit individual-level cost data for verification purposes. The
commissioner may ratably reduce these payments on a pro rata basis in order to satisfy
federal requirements for actuarial soundness. If payments are reduced, transfers shall be
reduced accordingly. Any licensed health plan that receives increased medical assistance
capitation payments under the intergovernmental transfer described in this paragraph shall
increase its Minnesota health care program payments to Hennepin County Medical Center
and Regions Hospital by the same amount as the increased payments received in the
capitation payment described in this paragraph new text end .

(d) The commissioner shall inform Hennepin County and Ramsey County on an
ongoing basis of the need for any changes needed in the intergovernmental transfers
in order to continue the payments under paragraphs (a) to (c), at their maximum level,
including increases in upper payment limits, changes in the federal Medicaid match, and
other factors.

(e) The payments in paragraphs (a) to (c) shall be implemented independently of
each other, subject to federal approval and to the receipt of transfers under subdivision 3.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 16.

Minnesota Statutes 2009 Supplement, section 256B.199, is amended to read:

256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.

(a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
for the expenditures in paragraphs (b) and (c).

(b) The commissioner shall apply for federal matching funds for certified public
expenditures as follows:

(1) Hennepin County, Hennepin County Medical Center, Ramsey County, new text begin and
new text end Regions Hospital deleted text begin , the University of Minnesota, and Fairview-University Medical Center deleted text end
shall report quarterly to the commissioner beginning June 1, 2007, payments made during
the second previous quarter that may qualify for reimbursement under federal law;

(2) based on these reports, the commissioner shall apply for federal matching
funds. These funds are appropriated to the commissioner for the payments under section
256.969, subdivision 27; and

(3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.

(c) The commissioner shall apply for federal matching funds for general assistance
medical care expenditures as follows:

(1) for hospital services occurring on or after July 1, 2007, general assistance medical
care expenditures for fee-for-service inpatient and outpatient hospital payments made by
the department shall be used to apply for federal matching funds, except as limited below:

(i) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and

(ii) general assistance medical care expenditures may be considered only to the extent
of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and

(2) all hospitals must provide any necessary expenditure, cost, and revenue
information required by the commissioner as necessary for purposes of obtaining federal
Medicaid matching funds for general assistance medical care expenditures.

(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the American Recovery and Reinvestment Act of 2009. These funds shall
be made available as the state share of payments under section 256.969, subdivision 28.
The entities required to report certified public expenditures under paragraph (b), clause
(1), shall report additional certified public expenditures as necessary under this paragraph.

new text begin (e) Effective July 15, 2010, in addition to any payment otherwise required under
sections 256B.19, 256B.195, and 256B.196, the following government entities may make
the following voluntary payments to the commissioner on an annual basis:
new text end

new text begin (1) Hennepin County, $6,200,000; and
new text end

new text begin (2) Ramsey County, $4,000,000.
new text end

new text begin (f) The sums in paragraph (e) shall be part of the designated governmental unit's
portion of the nonfederal share of medical assistance costs.
new text end

new text begin (g) Effective July 15, 2010, the commissioner shall make the following Medicaid
disproportionate share hospital payments to the hospitals on a monthly basis:
new text end

new text begin (1) to Hennepin County Medical Center, the amount of the transfer under paragraph
(e), clause (1), plus any federal matching funds available to recognize higher medical
assistance costs in institutions that provide high levels of charity care; and
new text end

new text begin (2) to Regions Hospital, the amount of the transfer under paragraph (e), clause (2),
plus any federal matching funds available to recognize higher medical assistance costs in
institutions that provide high levels of charity care.
new text end

new text begin (h) Effective July 15, 2010, after making the payments provided in paragraph
(g), the commissioner shall make the increased payments provided in section 256.969,
subdivision 26a.
new text end

new text begin (i) The commissioner shall make the payments under paragraphs (g) and (h) prior
to making any other payments under this section, section 256.969, subdivision 27, or
256B.195.
new text end

new text begin (j) The commissioner may adjust the intergovernmental transfers under paragraph
(e) and the payments under paragraph (g) based on the commissioner's determination
of Medicare upper payment limits, hospital-specific charge limits, and any limitations
imposed by the federal government regarding the rate increase or the restriction in the
American Resource and Recovery Act regarding increased local share.
new text end

new text begin (k) This section shall be implemented upon federal approval of the rate increase and
a federal determination that the increased transfers do not violate the restriction in the
American Resource and Recovery Act regarding the local share, retroactive to admissions
occurring on or after July 15, 2010.
new text end

Sec. 17.

Minnesota Statutes 2008, section 256B.69, is amended by adding a
subdivision to read:

new text begin Subd. 5k. new text end

new text begin Temporary rate modifications. new text end

new text begin For services rendered effective May
1, 2010, to June 30, 2011, the total payment made to managed care plans under the
medical assistance program and under MinnesotaCare for families with children shall be
increased by 4.61 percent. This increase shall be paid from the account established in
section 256D.032.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 18.

Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is
amended to read:

Subd. 3.

General assistance medical care; eligibility.

(a) General assistance
medical care may be paid for any person who is not eligible for medical assistance under
chapter 256B, including eligibility for medical assistance based on a spenddown of excess
income according to section 256B.056, subdivision 5, or MinnesotaCare for applicants
and recipients defined in paragraph (c), except as provided in paragraph (d), and:

(1) who is receiving assistance under section 256D.05, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or

(2) who is a resident of Minnesota; and

(i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum
amount of undistributed funds in a trust that could be distributed to or on behalf of the
beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the
terms of the trust, must be applied toward the asset maximum; or

(ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the family
size, using a six-month budget period, whose equity in assets is not in excess of the limits
in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization.

(b) The commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.

(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (f).

(d) Effective for applications and renewals processed on or after September 1,
2006, general assistance medical care may be paid for applicants and recipients who
meet all eligibility requirements of paragraph (a), clause (2), item (i), for a temporary
period beginning the date of application. Immediately following approval of general
assistance medical care, enrollees shall be enrolled in MinnesotaCare under section
256L.04, subdivision 7, with covered services as provided in section 256L.03 for the rest
of the six-month general assistance medical care eligibility period, until their six-month
renewal. new text begin This paragraph does not apply to applicants and recipients who are exempt
under paragraph (f).
new text end

(e) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (d), an individual must complete a new
application.

(f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are
exempt from the MinnesotaCare enrollment requirements in this subdivision if they:

(1) have applied for and are awaiting a determination of blindness or disability by
the state medical review team or a determination of eligibility for Supplemental Security
Income or Social Security Disability Insurance by the Social Security Administration;

(2) fail to meet the requirements of section 256L.09, subdivision 2;

(3) are homeless as defined by United States Code, title 42, section 11301, et seq.;

(4) are classified as end-stage renal disease beneficiaries in the Medicare program;

(5) are enrolled in private health care coverage as defined in section 256B.02,
subdivision 9;

(6) are eligible under paragraph (k);

(7) receive treatment funded pursuant to section 254B.02; or

(8) reside in the Minnesota sex offender program defined in chapter 246B.

new text begin If an enrollee meets one of the categories described in this paragraph, the commissioner
shall not require the enrollee to enroll in MinnesotaCare.
new text end

(g) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.

(h) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).

(i) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
applicant must complete the application within the time periods required under the
medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart
5, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining
verification if necessary.

(j) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.

(k) General assistance medical care is not available for a person in a correctional
facility unless the person is detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order, and the person is a recipient of general
assistance medical care at the time the person is detained by law or admitted on a criminal
hold order and as long as the person continues to meet other eligibility requirements
of this subdivision.

(l) General assistance medical care is not available for applicants or recipients who
do not cooperate with the county agency to meet the requirements of medical assistance.

(m) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.

(n) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.

(o) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101, subsection
(a), paragraph (15), and an undocumented noncitizen is an individual who resides in
the United States without the approval or acquiescence of the United States Citizenship
and Immigration Services.

(p) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources, is ineligible
for general assistance medical care.

(q) Effective July 1, 2003, general assistance medical care emergency services end.

new text begin (r) For the period beginning March 1, 2010, and ending July 1, 2011, the general
assistance medical care program shall be administered according to section 256D.031,
unless otherwise stated.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 19.

Minnesota Statutes 2008, section 256D.03, subdivision 3a, is amended to read:

Subd. 3a.

Claims; assignment of benefits.

new text begin (a) new text end Claims must be filed pursuant to
section 256D.16. General assistance medical care applicants and recipients must apply or
agree to apply third party health and accident benefits to the costs of medical care. They
must cooperate with the state in establishing paternity and obtaining third party payments.
By accepting general assistance, a person assigns to the Department of Human Services
all rights to medical support or payments for medical expenses from another person or
entity on their own or their dependent's behalf and agrees to cooperate with the state in
establishing paternity and obtaining third party payments. The application shall contain
a statement explaining the assignment. Any rights or amounts assigned shall be applied
against the cost of medical care paid for under this chapter. An assignment is effective on
the date general assistance medical care eligibility takes effect.

new text begin (b) Effective for general assistance medical care services rendered on or after
March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under
this subdivision shall be deposited in or credited to the account established in section
256D.032.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 20.

Minnesota Statutes 2008, section 256D.03, subdivision 3b, is amended to read:

Subd. 3b.

Cooperation.

(a) General assistance or general assistance medical care
applicants and recipients must cooperate with the state and local agency to identify
potentially liable third-party payors and assist the state in obtaining third-party payments.
Cooperation includes identifying any third party who may be liable for care and services
provided under this chapter to the applicant, recipient, or any other family member for
whom application is made and providing relevant information to assist the state in pursuing
a potentially liable third party. General assistance medical care applicants and recipients
must cooperate by providing information about any group health plan in which they may
be eligible to enroll. They must cooperate with the state and local agency in determining
if the plan is cost-effective. For purposes of this subdivision, coverage provided by the
Minnesota Comprehensive Health Association under chapter 62E shall not be considered
group health plan coverage or cost-effective by the state and local agency. If the plan is
determined cost-effective and the premium will be paid by the state or local agency or is
available at no cost to the person, they must enroll or remain enrolled in the group health
plan. Cost-effective insurance premiums approved for payment by the state agency and
paid by the local agency are eligible for reimbursement according to subdivision 6.

(b) Effective for all premiums due on or after June 30, 1997, general assistance
medical care does not cover premiums that a recipient is required to pay under a qualified
or Medicare supplement plan issued by the Minnesota Comprehensive Health Association.
General assistance medical care shall continue to cover premiums for recipients who are
covered under a plan issued by the Minnesota Comprehensive Health Association on June
30, 1997, for a period of six months following receipt of the notice of termination or
until December 31, 1997, whichever is later.

new text begin (c) Effective for general assistance medical care services rendered on or after
March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under
this subdivision shall be deposited in or credited to the account established in section
256D.032.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 21.

new text begin [256D.031] GENERAL ASSISTANCE MEDICAL CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Eligibility. new text end

new text begin (a) Except as provided under subdivision 2, general
assistance medical care may be paid for any individual who is not eligible for medical
assistance under chapter 256B, including eligibility for medical assistance based on a
spenddown of excess income according to section 256B.056, subdivision 5, and who:
new text end

new text begin (1) is receiving assistance under section 256D.05, except for families with children
who are eligible under the Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
new text end

new text begin (2) is a resident of Minnesota and has gross countable income not in excess of 75
percent of federal poverty guidelines for the family size, using a six-month budget period,
and whose equity in assets is not in excess of $1,000 per assistance unit.
new text end

new text begin Exempt assets, the reduction of excess assets, and the waiver of excess assets must
conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d,
except that the maximum amount of undistributed funds in a trust that could be distributed
to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's
discretion under the terms of the trust, must be applied toward the asset maximum.
new text end

new text begin (b) The commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.
new text end

new text begin Subd. 2. new text end

new text begin Ineligible groups. new text end

new text begin (a) General assistance medical care may not be paid for
an applicant or a recipient who:
new text end

new text begin (1) is otherwise eligible for medical assistance but fails to verify their assets;
new text end

new text begin (2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;
new text end

new text begin (3) is enrolled in private health coverage as defined in section 256B.02, subdivision
9;
new text end

new text begin (4) is in a correctional facility, including an individual in a county correctional or
detention facility as an individual accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order;
new text end

new text begin (5) resides in the Minnesota sex offender program defined in chapter 246B;
new text end

new text begin (6) does not cooperate with the county agency to meet the requirements of medical
assistance; or
new text end

new text begin (7) does not cooperate with a county or state agency or the state medical review team
in determining a disability or for determining eligibility for Supplemental Security Income
or Social Security Disability Insurance by the Social Security Administration.
new text end

new text begin (b) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101, subsection
(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the
United States without approval or acquiescence of the United States Citizenship and
Immigration Services.
new text end

new text begin (c) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources is ineligible for
general assistance medical care.
new text end

new text begin (d) General assistance medical care recipients who become eligible for medical
assistance shall be terminated from general assistance medical care and transferred to
medical assistance.
new text end

new text begin Subd. 3. new text end

new text begin Transitional MinnesotaCare. new text end

new text begin (a) Except as provided in paragraph (c),
effective March 1, 2010, all applicants and recipients who meet the eligibility requirements
in subdivision 1, paragraph (a), clause (2), and who are not described in subdivision 2
shall be enrolled in MinnesotaCare under section 256L.04, subdivision 7, immediately
following approval of general assistance medical care.
new text end

new text begin (b) If all other eligibility requirements of this subdivision are met, general assistance
medical care may be paid for individuals identified in paragraph (a) for a temporary
period beginning the date of application. Eligibility for general assistance medical care
shall continue until enrollment in MinnesotaCare is completed. Upon notification of
eligibility for MinnesotaCare, notice of termination for eligibility for general assistance
medical care shall be sent to the applicant or recipient. Once enrolled in MinnesotaCare,
the MinnesotaCare-covered services as described in section 256L.03 shall apply for the
remainder of the six-month general assistance medical care eligibility period until their
six-month renewal.
new text end

new text begin (c) This subdivision does not apply if the applicant or recipient:
new text end

new text begin (1) has applied for and is awaiting a determination of blindness or disability by the
state medical review team or a determination of eligibility for Supplemental Security
Income or Social Security Disability Insurance by the Social Security Administration;
new text end

new text begin (2) is homeless as defined by United States Code, title 42, section 11301, et seq.;
new text end

new text begin (3) is classified as an end-stage renal disease beneficiary in the Medicare program;
new text end

new text begin (4) receives treatment funded in section 254B.02; or
new text end

new text begin (5) fails to meet the requirements of section 256L.09, subdivision 2.
new text end

new text begin Applicants and recipients who meet any one of these criteria shall remain eligible for
general assistance medical care and shall not be required to enroll in MinnesotaCare.
new text end

new text begin (d) To be eligible for general assistance medical care following enrollment
in MinnesotaCare as required in paragraph (a), an individual must complete a new
application.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility and enrollment procedures. new text end

new text begin (a) Eligibility for general
assistance medical care shall begin no earlier than the date of application. The date of
application shall be the date the applicant has provided a name, address, and Social
Security number, signed and dated, to the county agency or the Department of Human
Services. If the applicant is unable to provide a name, address, Social Security number,
and signature when health care is delivered due to a medical condition or disability, a
health care provider may act on an applicant's behalf to establish the date of an application
by providing the county agency or Department of Human Services with provider
identification and a temporary unique identifier for the applicant. The applicant must
complete the remainder of the application and provide necessary verification before
eligibility can be determined. The applicant must complete the application within the time
periods required under the medical assistance program as specified in Minnesota Rules,
parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the
applicant in obtaining verification if necessary.
new text end

new text begin (b) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.
new text end

new text begin (c) In determining the amount of assets of an individual eligible under subdivision 1,
paragraph (a), clause (2), there shall be included any asset or interest in an asset, including
an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or
disposed of for less than fair market value within the 60 months preceding application for
general assistance medical care or during the period of eligibility. Any transfer described
in this paragraph shall be presumed to have been for the purpose of establishing eligibility
for general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.
new text end

new text begin (d) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.
new text end

new text begin Subd. 5. new text end

new text begin General assistance medical care; services. new text end

new text begin (a) General assistance
medical care covers:
new text end

new text begin (1) inpatient hospital services within the limitations described in subdivision 10;
new text end

new text begin (2) outpatient hospital services;
new text end

new text begin (3) services provided by Medicare-certified rehabilitation agencies;
new text end

new text begin (4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;
new text end

new text begin (5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;
new text end

new text begin (6) eyeglasses and eye examinations provided by a physician or optometrist;
new text end

new text begin (7) hearing aids;
new text end

new text begin (8) prosthetic devices;
new text end

new text begin (9) laboratory and x-ray services;
new text end

new text begin (10) physicians' services;
new text end

new text begin (11) medical transportation except special transportation;
new text end

new text begin (12) chiropractic services as covered under the medical assistance program;
new text end

new text begin (13) podiatric services;
new text end

new text begin (14) dental services as covered under the medical assistance program;
new text end

new text begin (15) mental health services covered under chapter 256B;
new text end

new text begin (16) prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;
new text end

new text begin (17) medical supplies and equipment, and Medicare premiums, coinsurance, and
deductible payments;
new text end

new text begin (18) medical equipment not specifically listed in this paragraph when the use of
the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;
new text end

new text begin (19) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if: (i) the service is otherwise covered under this
chapter as a physician service, (ii) the service provided on an inpatient basis is not
included as part of the cost for inpatient services included in the operating payment rate,
and (iii) the service is within the scope of practice of the nurse practitioner's license as a
registered nurse, as defined in section 148.171;
new text end

new text begin (20) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;
new text end

new text begin (21) telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b;
new text end

new text begin (22) care coordination and patient education services provided by a community
health worker according to section 256B.0625, subdivision 49; and
new text end

new text begin (23) regardless of the number of employees that an enrolled health care provider
may have, sign language interpreter services when provided by an enrolled health care
provider during the course of providing a direct, person-to-person-covered health care
service to an enrolled recipient who has a hearing loss and uses interpreting services.
new text end

new text begin (b) Sex reassignment surgery is not covered under this section.
new text end

new text begin (c) Drug coverage is covered in accordance with section 256D.03, subdivision 4,
paragraph (d).
new text end

new text begin (d) The following co-payments shall apply for services provided:
new text end

new text begin (1) $25 for nonemergency visits to a hospital-based emergency room; and
new text end

new text begin (2) $3 per brand-name drug prescription, subject to a $7 per month maximum for
prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when
used for the treatment of mental illness.
new text end

new text begin (e) Co-payments shall be limited to one per day per provider for nonemergency
visits to a hospital-based emergency room. Recipients of general assistance medical care
are responsible for all co-payments in this subdivision. Reimbursement for prescription
drugs shall be reduced by the amount of the co-payment until the recipient has reached the
$7 per month maximum for prescription drug co-payments. The provider shall collect
the co-payment from the recipient. Providers may not deny services to recipients who
are unable to pay the co-payment.
new text end

new text begin (f) Chemical dependency services that are reimbursed under chapter 254B shall not
be reimbursed under general assistance medical care.
new text end

new text begin (g) Inpatient hospital services that are provided in community behavioral health
hospitals operated by state-operated services shall not be reimbursed under general
assistance medical care.
new text end

new text begin Subd. 6. new text end

new text begin Coordinated care delivery option. new text end

new text begin (a) A county or group of counties may
elect to provide health care services to individuals who are eligible for general assistance
medical care under this section and who reside within the county or counties through
a coordinated care delivery option. The health care services provided by the county
must include the services described in subdivision 5 with the exception of outpatient
prescription drug coverage but including drugs administered in an outpatient setting.
Counties that elect to provide health care services through this option must ensure that
the requirements of this subdivision are met. Upon electing to provide services through
this option, the county accepts the financial risk of the delivery of the health care services
described in this subdivision to general assistance medical care recipients residing in
the county for the period beginning July 1, 2010, and ending July 1, 2011, for the fixed
payments described in subdivision 10.
new text end

new text begin (b) A county that elects to provide services through this option must provide to
the commissioner the following:
new text end

new text begin (1) the names of the county or counties that are electing to provide services through
the county care delivery option; and
new text end

new text begin (2) the geographic area to be served.
new text end

new text begin (c) The county may contract with a managed care plan, an integrated delivery
system, a physician-hospital organization, or an academic health center to administer
the delivery of services through this option. Any county providing general assistance
medical care services through a county-based purchasing plan in accordance with section
256B.692 may continue to provide services through the county-based purchasing plan.
Payments to the county-based purchasing plan for the period beginning July 1, 2010, and
ending July 1, 2011, shall be paid according to subdivision 10.
new text end

new text begin (d) A county must demonstrate the ability to:
new text end

new text begin (1) provide the covered services required under this subdivision to recipients
residing within the county;
new text end

new text begin (2) provide a system for advocacy, consumer protection, and complaints and appeals
that is independent of care providers or other risk bearers and complies with section
256B.69;
new text end

new text begin (3) establish a process to monitor enrollment and ensure the quality of care provided;
and
new text end

new text begin (4) coordinate the delivery of health care services with existing homeless prevention,
supportive housing, and rent subsidy programs and funding administered by the Minnesota
Housing Finance Agency under chapter 462A.
new text end

new text begin (e) The commissioner may require the county to provide the commissioner with data
necessary for assessing enrollment, quality of care, cost, and utilization of services.
new text end

new text begin (f) A county that elects to provide services through this option shall be considered to
be a prepaid health plan for purposes of section 256.045.
new text end

new text begin (g) The state shall not be liable for the payment of any cost or obligation incurred
by the county or a participating provider.
new text end

new text begin Subd. 7. new text end

new text begin Health care home designation. new text end

new text begin The commissioner or a county may
require a recipient to designate a primary care provider or a primary care clinic that is
certified as a health care home under section 256B.0751.
new text end

new text begin Subd. 8. new text end

new text begin Payments; fee-for-service rate for the period between March 1,
2010, and July 1, 2010. new text end

new text begin (a) Effective for services provided on or after March 1, 2010,
and before July 1, 2010, the payment rates for all covered services provided to general
assistance medical care recipients, with the exception of outpatient prescription drug
coverage, shall be 50 percent of the general assistance medical care payment rate in effect
on February 28, 2010.
new text end

new text begin (b) Outpatient prescription drug coverage provided on or after March 1, 2010, and
before July 1, 2010, shall be paid on a fee-for-service basis in accordance with section
256B.0625, subdivision 13e.
new text end

new text begin Subd. 9. new text end

new text begin Payments; fee-for-service rates for the period between July 1, 2010,
and July 1, 2011. new text end

new text begin (a) Effective for services provided on or after July 1, 2010, and before
July 1, 2011, to general assistance medical care recipients residing in counties that are
not served through the coordinated care delivery option, payments shall be made by the
commissioner to providers at rates described in this subdivision.
new text end

new text begin (b) For inpatient hospital admissions provided on or after July 1, 2010, and before
July 1, 2011, the payment rate shall be:
new text end

new text begin (1) 69 percent of the general assistance medical care rate in effect on February
28, 2010, if the inpatient hospital services were provided in a hospital where the
fee-for-service inpatient and outpatient hospital general assistance medical care payments
to the hospital for admissions provided in calendar year 2007 totaled $1,000,000 or more
or the hospital's fee-for-service inpatient and outpatient hospital general assistance medical
care payments received for calendar year 2007 admissions was one percent or more of the
hospital's net patient revenue received for services provided in calendar year 2007; or
new text end

new text begin (2) 60 percent of the general assistance medical care rate in effect on February 28,
2010, if the inpatient hospital services were provided by a hospital that does not meet the
criteria described in clause (1).
new text end

new text begin (c) Effective for services other than inpatient hospital services and outpatient
prescription drug coverage provided on or after July 1, 2010, and before July 1, 2011,
the payment rate shall begin at 50 percent of the general assistance medical care rate
in effect on February 28, 2010.
new text end

new text begin (d) Outpatient prescription drug coverage provided on or after July 1, 2010, and
before July 1, 2011, shall be paid on a fee-for-service basis in accordance with section
256B.0625, subdivision 13e.
new text end

new text begin (e) The commissioner may adjust the rates paid under paragraphs (b) and (c) on a
quarterly basis to ensure that the total aggregate amount paid out for services provided
on a fee-for-service basis beginning March 1, 2010, and ending June 30, 2011, does not
exceed the appropriation from the general assistance medical care account established in
section 256D.032 for the general assistance medical care program.
new text end

new text begin Subd. 10. new text end

new text begin Payments; rate setting for the coordinated care delivery option. new text end

new text begin (a)
Effective for general assistance medical care services, with the exception of outpatient
prescription drug coverage, provided on or after July 1, 2010, and before July 1, 2011,
to recipients residing in counties that have elected to provide services through the
coordinated care delivery option, the commissioner shall establish quarterly prospective
fixed payments to the county. The payments must not exceed 60 percent of the county's
general assistance medical care county allocation amount as determined in paragraph (b).
These payments must not be used by the county to pay MinnesotaCare premiums for
general assistance medical care recipients or MinnesotaCare enrollees.
new text end

new text begin (b) For each county that elects to provide services in accordance with subdivision
7, the commissioner shall determine a general assistance medical care county allocation
amount that equals the total general assistance medical care payments made for recipients
residing within the county in fiscal year 2009 for all covered general assistance medical
care services with the exception of outpatient prescription drug coverage.
new text end

new text begin (c) Outpatient prescription drug coverage provided on or after July 1, 2010,
and before July 1, 2011, shall be paid on a fee-for-service basis according to section
256B.0625, subdivision 13e.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for services rendered on or after
March 1, 2010, and before July 1, 2011.
new text end

Sec. 22.

new text begin [256D.032] GENERAL ASSISTANCE MEDICAL CARE ACCOUNT.
new text end

new text begin The general assistance medical care account is created in the special revenue fund.
Money deposited into the account is subject to appropriation by the legislature.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 23.

Minnesota Statutes 2008, section 256D.06, subdivision 7, is amended to read:

Subd. 7.

SSI conversions and back claims.

(a) The commissioner of human
services shall contract with agencies or organizations capable of ensuring that clients who
are presently receiving assistance under sections 256D.01 to 256D.21, and who may be
eligible for benefits under the federal Supplemental Security Income program, apply and,
when eligible, are converted to the federal income assistance program and made eligible
for health care benefits under the medical assistance program. The commissioner shall
ensure that money owing to the state under interim assistance agreements is collected.

(b) The commissioner shall also directly or through contract implement procedures
for collecting federal Medicare and medical assistance funds for which clients converted
to SSI are retroactively eligible.

(c) The commissioner shall contract with agencies to ensure implementation of
this section. County contracts with providers for residential services shall include the
requirement that providers screen residents who may be eligible for federal benefits and
provide that information to the local agency. The commissioner shall modify the MAXIS
computer system to provide information on clients who have been on general assistance
for two years or longer. The list of clients shall be provided to local services for screening
under this section.

new text begin (d) Effective for general assistance medical care services rendered on or after
March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under
this subdivision shall be deposited in or credited to the account established in section
256D.032.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 24.

Minnesota Statutes 2008, section 256L.05, subdivision 1b, is amended to read:

Subd. 1b.

MinnesotaCare enrollment by county agencies.

Beginning September
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
section 256D.03, subdivision 3 new text begin , or 256D.031 new text end . County agencies shall perform all duties
necessary to administer the MinnesotaCare program ongoing for these enrollees, including
the redetermination of MinnesotaCare eligibility at renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 25.

Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and the first
premium payment has been received. As provided in section 256B.057, coverage for
newborns is automatic from the date of birth and must be coordinated with other health
coverage. The effective date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the month of placement. The effective date
of coverage for other new members added to the family is the first day of the month
following the month in which the change is reported. All eligibility criteria must be met
by the family at the time the new family member is added. The income of the new family
member is included with the family's gross income and the adjusted premium begins in
the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.

(c) Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.

(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.

(e) The effective date of coverage for single adults and households with no children
formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
according to section 256D.03, subdivision 3, new text begin or 256D.031, new text end is the first day of the month
following the last day of general assistance medical care coverage.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 26.

Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. The
commissioner may establish criteria and timelines for sites to forward applications to the
commissioner or county agencies. The premium for the new period of eligibility must be
received as provided in section 256L.06 in order for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3, new text begin or 256D.031, new text end the first period of eligibility begins the month the enrollee
submitted the application or renewal for general assistance medical care.

(d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period before being
disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
additional month.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 27.

Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read:

Subd. 6.

Exception for certain adults.

Single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, new text begin or 256D.031, new text end are eligible
without meeting the requirements of this section until renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 28.

Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read:

Subd. 4.

Exception for transitioned adults.

County agencies shall pay premiums
for single adults and households with no children formerly enrolled in general assistance
medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3,
new text begin or 256D.031, new text end until six-month renewal. The county agency has the option of continuing to
pay premiums for these enrollees.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 29.

Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read:

Subd. 7.

Exception for certain adults.

Single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, new text begin or 256D.031, new text end are exempt
from the requirements of this section until renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 30. new text begin DRUG REBATE PROGRAM.
new text end

new text begin The commissioner of human services shall continue to administer a drug rebate
program for drugs purchased for persons eligible for the general assistance medical care
program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph
(cc), and 256D.03. The rebate revenues collected under the drug rebate program for
persons eligible for the general assistance medical care program shall be deposited in the
general assistance medical care account in the special revenue fund established under
Minnesota Statutes, section 256D.032.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010, and expires June
30, 2011.
new text end

Sec. 31. new text begin PROVIDER PARTICIPATION.
new text end

new text begin For purposes of Minnesota Statutes, section 256B.0644, the reference to the general
assistance medical care program shall include the temporary general assistance medical
care program established under Minnesota Statutes, section 256D.031. In meeting the
requirements of Minnesota Statutes, section 256B.0644, a provider must accept new
patients regardless of the Minnesota health care program the patient is enrolled in and may
not refuse to accept patients enrolled in one Minnesota health care program and continue
to accept patients enrolled in other Minnesota health care programs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010.
new text end

Sec. 32. new text begin TEMPORARY SUSPENSION.
new text end

new text begin (a) For the period beginning March 1, 2010, to June 30, 2011, the commissioner
of human services shall not implement or administer Minnesota Statutes 2008, section
256D.03, subdivisions 6 and 9; Minnesota Statutes 2009 Supplement, section 256D.03,
subdivision 4; or Minnesota Statutes 2008, section 256B.692; and Minnesota Statutes
2009 Supplement, section 256B.69, as they apply to the general assistance medical care
program unless specifically continued in Minnesota Statutes, section 256D.031.
new text end

new text begin (b) Notwithstanding paragraph (a), outpatient prescription drug coverage shall
continue to be provided under Minnesota Statutes, section 256D.03.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2010, and expires July 1,
2011.
new text end

Sec. 33. new text begin MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION
ASSESSMENT MODIFICATION; TRANSFER.
new text end

new text begin Subdivision 1. new text end

new text begin Minnesota Comprehensive Health Association assessment
modification. new text end

new text begin For the purpose of the annual assessment allocation required in Minnesota
Statutes, section 62E.11, the Minnesota Comprehensive Health Association shall credit
$21,875,000 to HealthPartners' assessment for calendar year 2010 and $13,125,000 to
HealthPartners' assessment for calendar year 2011, upon receipt by the association of the
transfers specified in subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Transfer. new text end

new text begin $21,875,000 shall be transferred in fiscal year 2011 and
$13,125,000 in fiscal year 2012 from the general assistance medical care account
established in Minnesota Statutes, section 256D.032, to the commissioner of commerce
for disbursement upon receipt to the Minnesota Comprehensive Health Association, to
compensate for the loss in the association's assessments created by the credits specified in
subdivision 1.
new text end

ARTICLE 2

APPROPRIATIONS

Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATION. new text end

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

			new text begin APPROPRIATIONS new text end
			new text begin Available for the Year new text end
			new text begin Ending June 30 new text end
				new text begin 2010 new text end		new text begin 2011 new text end

Sec. 2. new text begin HUMAN SERVICES new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin (82,741,000) new text end

new text begin $ new text end

new text begin 165,372,000 new text end

new text begin Appropriations by Fund new text end
	new text begin 2010 new text end	new text begin 2011 new text end
new text begin General new text end	new text begin (62,256,000) new text end	new text begin (34,110,000) new text end
new text begin Health Care Access new text end	new text begin (68,568,000) new text end	new text begin (185,157,000) new text end
new text begin Special Revenue new text end	new text begin 48,053,000 new text end	new text begin 384,639,000 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end new text begin Children and Economic Assistance Grants new text end

new text begin -0- new text end

new text begin (14,121,000) new text end

new text begin The commissioner shall reduce the amount
allocated to children and community
services grants by $14,121,000. This is a
onetime reduction in fiscal year 2011. The
commissioner shall transfer $14,121,000 in
fiscal year 2011 from the general fund to
the fund established in Minnesota Statutes,
section 256D.032.
new text end

new text begin Subd. 3. new text end new text begin Children and Economic Assistance Management new text end

new text begin Children and Economic Assistance Operations new text end

new text begin Appropriations by Fund new text end
new text begin Special Revenue new text end	new text begin 29,000 new text end	new text begin -0- new text end

new text begin Subd. 4. new text end new text begin Basic Health Care Grants new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
new text end

new text begin (a) MinnesotaCare Grants new text end

new text begin (68,128,000) new text end

new text begin (179,051,000) new text end

new text begin Appropriations by Fund new text end
new text begin Health Care Access new text end	new text begin (68,568,000) new text end	new text begin (185,157,000) new text end
new text begin Special Revenue new text end	new text begin 440,000 new text end	new text begin 6,106,000 new text end

new text begin (b) Medical Assistance Basic Health Care Grants - Families and Children new text end

new text begin 3,074,000 new text end

new text begin 53,875,000 new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin -0- new text end	new text begin (4,070,000) new text end
new text begin Special Revenue new text end	new text begin 3,074,000 new text end	new text begin 57,945,000 new text end

new text begin (c) Medical Assistance Basic Health Care Grants - Elderly and Disabled new text end

new text begin 2,325,000 new text end

new text begin 41,314,000 new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin -0- new text end	new text begin (6,470,000) new text end
new text begin Special Revenue new text end	new text begin 2,325,000 new text end	new text begin 47,784,000 new text end

new text begin (d) General Assistance Medical Care Grants new text end

new text begin (20,083,000) new text end

new text begin 266,945,000 new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin (60,406,000) new text end	new text begin -0- new text end
new text begin Special Revenue new text end	new text begin 40,323,000 new text end	new text begin 266,945,000 new text end

new text begin For general assistance medical care grants
under Minnesota Statutes, section 256D.031.
The commissioner shall transfer $60,406,000
on March 1, 2010, from the general fund to
the fund established in Minnesota Statutes,
section 256D.032. Any unexpended amount
not used for general assistance medical care
expenditures incurred before March 1, 2010,
does not cancel and shall be transferred to
the fund established in Minnesota Statutes,
section 256D.032, by January 1, 2011.
new text end

new text begin Subd. 5. new text end new text begin Health Care Management new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Health Care Administration new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin (825,000) new text end	new text begin (2,425,000) new text end
new text begin Special Revenue new text end	new text begin 825,000 new text end	new text begin 2,784,000 new text end

new text begin $825,000 in fiscal year 2010 and $2,475,000
in fiscal year 2011 from the special revenue
fund are for administration of the general
assistance medical care program under
Minnesota Statutes, section 256D.031. For
purposes of consistent cost allocation and
accounting, the commissioner may transfer
these amounts to the general fund. The
commissioner shall transfer $825,000 in
fiscal year 2010 and $2,475,000 in fiscal
year 2011 from the general fund to the fund
established in Minnesota Statutes, section
256D.032.
new text end

new text begin (b) Health Care Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin (1,025,000) new text end	new text begin (3,075,000) new text end
new text begin Special Revenue new text end	new text begin 1,067,000 new text end	new text begin 3,075,000 new text end

new text begin $1,025,000 in fiscal year 2010 and
$3,075,000 in fiscal year 2011 from the
special revenue fund are for operations of
the general assistance medical care program
under Minnesota Statutes, section 256D.031.
For purposes of consistent cost allocation
and accounting, the commissioner may
transfer these amounts to the general fund.
The commissioner shall transfer $1,025,000
in fiscal year 2010 and $3,075,000 in fiscal
year 2011 from the general fund to the fund
established in Minnesota Statutes, section
256D.032.
new text end

new text begin Subd. 6. new text end new text begin Continuing Care Grants new text end

new text begin Mental Health Grants new text end

new text begin -0- new text end

new text begin (5,000,000) new text end

new text begin The commissioner shall reduce the amount
allocated to adult mental health grants by
$5,000,000. This is a onetime reduction in
fiscal year 2011. The commissioner shall
transfer $5,000,000 in fiscal year 2011 from
the general fund to the fund established in
Minnesota Statutes, section 256D.032.
new text end

new text begin Subd. 7. new text end new text begin Continuing Care Management new text end

new text begin -0- new text end

new text begin 1,051,000 new text end

new text begin Subd. 8. new text end new text begin Transfers new text end

new text begin (a) From March 1, 2010, until June 30, 2011,
the commissioner may transfer amounts
appropriated from the account created in
Minnesota Statutes, section 256D.032, to the
general fund to pay the hospital rate increases
under Minnesota Statutes, section 256.969,
from the medical assistance account.
new text end

new text begin (b) From May 1, 2010, until June 30, 2011,
the commissioner may transfer amounts
appropriated from the account created in
Minnesota Statutes, section 256D.032, to the
general fund or the health care access fund
to pay the managed care plan rate increases
under Minnesota Statutes, section 256B.69,
subdivision 5k, from the medical assistance
account.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This article is effective March 1, 2010.
new text end