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HF 1524

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:52am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to human services; offering supplemental hospital coverage under the
MinnesotaCare program; amending Minnesota Statutes 2008, sections 256L.03,
subdivisions 3, 5, by adding a subdivision; 256L.12, subdivision 6.

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

Section 1.

Minnesota Statutes 2008, 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. 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 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of $10,000new text begin , unless supplemental hospital coverage
has been purchased under subdivision 3b
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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision
to read:


new text begin Subd. 3b. new text end

new text begin Supplemental hospital coverage. new text end

new text begin (a) Effective January 1, 2010, or upon
federal approval, whichever is later, the commissioner shall offer all MinnesotaCare
applicants, and all enrollees during the open enrollment periods specified in paragraph
(b), the opportunity to purchase at full cost, supplemental hospital coverage to cover
inpatient hospital expenses in excess of the inpatient hospital annual limit established
under subdivision 3. Premiums for this coverage may vary only for age and shall be
collected by the commissioner using the procedures established for the sliding scale
premium determined under section 256L.15.
new text end

new text begin (b) The commissioner shall notify all persons submitting applications of the option to
purchase this coverage at the time of application. The commissioner shall provide persons
enrolled in MinnesotaCare on the effective date of this subdivision with the opportunity to
purchase this supplemental coverage during an initial open enrollment period. Following
this initial open enrollment period, the commissioner shall provide all enrollees with the
opportunity to purchase this supplemental coverage during an annual open enrollment
period during the month of November with coverage to take effect the following January 1.
new text end

Sec. 3.

Minnesota Statutes 2008, 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.

(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.

(d) Paragraph (a), clause (4), does not apply to mental health services.

(e) Adult enrollees with family gross income that exceeds 200 percent of the federal
poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1,
2009, and who are not pregnant shall be financially responsible for the coinsurance
amount, if applicable, and new text begin if supplemental hospital coverage has not been purchased under
subdivision 3b,
new text end amounts which exceed the $10,000 inpatient hospital benefit limit.

(f) 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 $10,000 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 4.

Minnesota Statutes 2008, section 256L.12, subdivision 6, is amended to read:


Subd. 6.

Co-payments and benefit limits.

Enrollees are responsible for all
co-payments in sections 256L.03, subdivision 5, and 256L.035, and shall pay co-payments
to the managed care plan or to its participating providers. The enrollee is also responsible
for payment of inpatient hospital charges which exceed the MinnesotaCare benefit limitnew text begin ,
unless supplemental hospital coverage has been purchased under subdivision 3b
new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end