HF 1166

2nd Engrossment - 87th Legislature (2011 - 2012) Posted on 03/15/2012 03:52pm

A bill for an act
relating to human services; changing medical assistance reimbursement
under other state health care programs; repealing mandatory participation by
health maintenance organizations; amending Minnesota Statutes 2010, section
256B.0644; repealing Minnesota Statutes 2010, section 62D.04, subdivision 5.

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

Section 1.

Minnesota Statutes 2010, section 256B.0644, is amended to read:

256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
PROGRAMS.

(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, deleted text begin and a
health maintenance organization, as defined in chapter 62D, deleted text end must participate as a provider
or contractor in the medical assistance program, general assistance medical care program,
and MinnesotaCare as a condition of participating as a provider in health insurance plans
and programs or contractor for state employees established under section 43A.18, the
public employees insurance program under section 43A.316, for health insurance plans
offered to local statutory or home rule charter city, county, and school district employees,
the workers' compensation system under section 176.135, and insurance plans provided
through the Minnesota Comprehensive Health Association under sections 62E.01 to
62E.19. The limitations on insurance plans offered to local government employees shall
not be applicable in geographic areas where provider participation is limited by managed
care contracts with the Department of Human Services. new text begin For purposes of this section, a
health maintenance organization, as defined in chapter 62D, is not a vendor of medical
care.
new text end

(b) deleted text begin For providers other than health maintenance organizations, deleted text end Participation in the
medical assistance program means that:

(1) the provider accepts new medical assistance, general assistance medical care,
and MinnesotaCare patients;

(2) for providers other than dental service providers, at least 20 percent of the
provider's patients are covered by medical assistance, general assistance medical care,
and MinnesotaCare as their primary source of coverage; or

(3) for dental service providers, at least ten percent of the provider's patients are
covered by medical assistance, general assistance medical care, and MinnesotaCare as
their primary source of coverage, or the provider accepts new medical assistance and
MinnesotaCare patients who are children with special health care needs. For purposes
of this section, "children with special health care needs" means children up to age 18
who: (i) require health and related services beyond that required by children generally;
and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
neurological diseases; visual impairment or deafness; Down syndrome and other genetic
disorders; autism; fetal alcohol syndrome; and other conditions designated by the
commissioner after consultation with representatives of pediatric dental providers and
consumers.

(c) Patients seen on a volunteer basis by the provider at a location other than
the provider's usual place of practice may be considered in meeting the participation
requirement in this section. The commissioner shall establish participation requirements
for health maintenance organizations. The commissioner shall provide lists of participating
medical assistance providers on a quarterly basis to the commissioner of management and
budget, the commissioner of labor and industry, and the commissioner of commerce. Each
of the commissioners shall develop and implement procedures to exclude as participating
providers in the program or programs under their jurisdiction those providers who do
not participate in the medical assistance program. The commissioner of management
and budget shall implement this section through contracts with participating health and
dental carriers.

(d) For purposes of paragraphs (a) and (b), participation in the general assistance
medical care program applies only to pharmacy providers.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for medical assistance and
MinnesotaCare plan years beginning on or after January 1, 2013.
new text end

Sec. 2. new text begin REPEALER; MANDATORY HMO PARTICIPATION AS PROVIDER IN
PUBLIC PROGRAMS.
new text end

new text begin Minnesota Statutes 2010, section 62D.04, subdivision 5, new text end new text begin is repealed effective
January 1, 2013.
new text end