SF 79

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health care; increasing eligibility for single adults and households
without children in MinnesotaCare; increasing inpatient hospital benefit limit in
MinnesotaCare; repealing the limited benefit set; amending Minnesota Statutes
2006, sections 256L.03, subdivisions 1, 3, 5; 256L.04, subdivision 7; repealing
Minnesota Statutes 2006, section 256L.035.

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

Section 1.

Minnesota Statutes 2006, section 256L.03, subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

deleted text begin For individuals under section 256L.04,
subdivision 7, with income no greater than 75 percent of the federal poverty guidelines
or for families with children under section 256L.04, subdivision 1, all subdivisions of
this section apply. deleted text end "Covered health services" means the health services reimbursed
under chapter 256B, with the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care services other than services
covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency
medical transportation services, personal care assistant and case management services,
nursing home or intermediate care facilities services, inpatient mental health services,
and chemical dependency services. Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments, psychological testing,
explanation of findings, mental health telemedicine, psychiatric consultation, medication
management by a physician, day treatment, partial hospitalization, and individual, family,
and group psychotherapy.

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in this section.

Sec. 2.

Minnesota Statutes 2006, section 256L.03, subdivision 3, is amended to read:

Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. deleted text begin Prior to July 1, 1997, the inpatient hospital benefit for adult
enrollees is subject to an annual benefit limit of $10,000. deleted text end The inpatient hospital benefit for
adult enrollees who qualify under section 256L.04, subdivision 7, or who qualify under
section 256L.04, subdivisions 1 and 2, with family gross income that exceeds deleted text begin 175 deleted text end new text begin 200 new text end
percent of the federal poverty guidelines and who are not pregnant, is subject to an annual
limit of deleted text begin $10,000 deleted text end new text begin $20,000 new text end .

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

Sec. 3.

Minnesota Statutes 2006, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21 deleted text begin in households with family income equal to or less than 175
percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
parents and relative caretakers of children under the age of 21 in households with family
income greater than 175 percent of the federal poverty guidelines for inpatient hospital
admissions occurring on or after January 1, 2001 deleted text end .

(c) Paragraph (a), clauses (1) to (4), do not apply to pregnant women and children
under the age of 21.

(d) Adult enrollees with family gross income that exceeds deleted text begin 175 deleted text end new text begin 200 new text end percent of the
federal poverty guidelines and who are not pregnant shall be financially responsible for
the coinsurance amount, if applicable, and amounts which exceed the deleted text begin $10,000 deleted text end new text begin $20,000 new text end
inpatient hospital benefit limit.

(e) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the deleted text begin $10,000 deleted text end new text begin $20,000 new text end annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

Sec. 4.

Minnesota Statutes 2006, section 256L.04, subdivision 7, is amended to read:

Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and households with no children who have gross family
incomes that are equal to or less than deleted text begin 175 deleted text end new text begin 200 new text end percent of the federal poverty guidelines.

Sec. 5. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256L.035, new text end new text begin is repealed.
new text end