HF 1873

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; changing MinnesotaCare
provisions to align with practice; amending Minnesota
Statutes 2004, sections 256.045, subdivision 3a;
256B.02, subdivision 12; 256B.056, subdivisions 5, 5a,
5b, 7, by adding subdivisions; 256B.057, subdivision
1; 256B.0644; 256D.045; 256L.01, subdivisions 4, 5;
256L.03, subdivision 1b; 256L.04, subdivision 2, by
adding subdivisions; 256L.05, subdivisions 3, 3a;
256L.07, subdivisions 1, 3, by adding a subdivision;
256L.15, subdivisions 2, 3; 549.02, by adding a
subdivision; 549.04.

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

Section 1.

Minnesota Statutes 2004, section 256.045,
subdivision 3a, is amended to read:

Subd. 3a.

Prepaid health plan appeals.

(a) All prepaid
health plans under contract to the commissioner under chapter
256B or 256D must provide for a complaint system according to
section 62D.11. When a prepaid health plan denies, reduces, or
terminates a health service or denies a request to authorize a
previously authorized health service, the prepaid health plan
must notify the recipient of the right to file a complaint or an
appeal. The notice must include the name and telephone number
of the ombudsman and notice of the recipient's right to request
a hearing under paragraph (b). deleted text begin When a complaint is filed, the
prepaid health plan must notify the ombudsman within three
working days. deleted text end Recipients may request the assistance of the
ombudsman in the complaint system process. The prepaid health
plan must issue a written resolution of the complaint to the
recipient within 30 days after the complaint is filed with the
prepaid health plan. A recipient is not required to exhaust the
complaint system procedures in order to request a hearing under
paragraph (b).

(b) Recipients enrolled in a prepaid health plan under
chapter 256B or 256D may contest a prepaid health plan's denial,
reduction, or termination of health services, a prepaid health
plan's denial of a request to authorize a previously authorized
health service, or the prepaid health plan's written resolution
of a complaint by submitting a written request for a hearing
according to subdivision 3. A state human services referee
shall conduct a hearing on the matter and shall recommend an
order to the commissioner of human services. The commissioner
need not grant a hearing if the sole issue raised by a recipient
is the commissioner's authority to require mandatory enrollment
in a prepaid health plan in a county where prepaid health plans
are under contract with the commissioner. The state human
services referee may order a second medical opinion from the
prepaid health plan or may order a second medical opinion from a
nonprepaid health plan provider at the expense of the prepaid
health plan. Recipients may request the assistance of the
ombudsman in the appeal process.

(c) In the written request for a hearing to appeal from a
prepaid health plan's denial, reduction, or termination of a
health service, a prepaid health plan's denial of a request to
authorize a previously authorized service, or the prepaid health
plan's written resolution to a complaint, a recipient may
request an expedited hearing. If an expedited appeal is
warranted, the state human services referee shall hear the
appeal and render a decision within a time commensurate with the
level of urgency involved, based on the individual circumstances
of the case.

Sec. 2.

Minnesota Statutes 2004, section 256B.02,
subdivision 12, is amended to read:

Subd. 12.

Third new text begin - new text end party payer.

"Third new text begin - new text end party payer" means a
person, entity, or agency or government program that has a
probable obligation to pay all or part of the costs of a medical
assistance recipient's health services. new text begin Third-party payer
includes an entity under contract with the recipient to cover
all or part of the recipient's medical costs.
new text end

Sec. 3.

Minnesota Statutes 2004, section 256B.056, is
amended by adding a subdivision to read:

new text begin Subd. 3d. new text end

new text begin Reduction of excess assets. new text end

new text begin Assets in excess
of the limits set forth in subdivisions 3 to 3c may be reduced
to allowable limits as follows:
new text end

new text begin (a) Assets may be reduced in any of the three calendar
months before the month of application in which the applicant
seeks coverage by:
new text end

new text begin (1) designating burial funds up to $1500 for each
applicant, spouse, and MA-eligible dependent child; and
new text end

new text begin (2) paying health service bills incurred in the retroactive
period for which the applicant seeks eligibility, starting with
the oldest bill. After assets are reduced to allowable limits,
eligibility begins with the next dollar of MA-covered health
services incurred in the retroactive period. Applicants
reducing assets under this subdivision who also have excess
income shall first spend excess assets to pay health service
bills and may meet the income spenddown on remaining bills.
new text end

new text begin (b) Assets may be reduced beginning the month of
application by:
new text end

new text begin (1) paying bills for health services that would otherwise
be paid by medical assistance; and
new text end

new text begin (2) using any means other than a transfer of assets for
less than fair market value as defined in section 256B.0595,
subdivision 1, paragraph (b).
new text end

Sec. 4.

Minnesota Statutes 2004, section 256B.056,
subdivision 5, is amended to read:

Subd. 5.

Excess income.

A person who has excess income
is eligible for medical assistance if the person has expenses
for medical care that are more than the amount of the person's
excess income, computed by deducting incurred medical expenses
from the excess income to reduce the excess to the income
standard specified in subdivision 5c. The person shall elect to
have the medical expenses deducted at the beginning of a
one-month budget period or at the beginning of a six-month
budget period. The commissioner shall allow persons eligible
for assistance on a one-month spenddown basis under this
subdivision to elect to pay the monthly spenddown amount in
advance of the month of eligibility to the state agency in order
to maintain eligibility on a continuous basis. If the recipient
does not pay the spenddown amount on or before the deleted text begin 20th deleted text end new text begin last
business day new text end of the month, the recipient is ineligible for this
option for the following month. The local agency shall code the
Medicaid Management Information System (MMIS) to indicate that
the recipient has elected this option. The state agency shall
convey recipient eligibility information relative to the
collection of the spenddown to providers through the Electronic
Verification System (EVS). A recipient electing advance payment
must pay the state agency the monthly spenddown amount on or
before new text begin noon on new text end the deleted text begin 20th deleted text end new text begin last business day new text end of the month in order
to be eligible for this option in the following month.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 5.

Minnesota Statutes 2004, section 256B.056,
subdivision 5a, is amended to read:

Subd. 5a.

Individuals on fixed or excluded income.

Recipients of medical assistance who receive only fixed unearned
or excluded income, when that income is excluded from
consideration as income or unvarying in amount and timing of
receipt throughout the year, shall report and verify their
income deleted text begin annually deleted text end new text begin every 12 months. The 12-month period begins
with the month of application new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 6.

Minnesota Statutes 2004, section 256B.056,
subdivision 5b, is amended to read:

Subd. 5b.

Individuals with low income.

Recipients of
medical assistance not residing in a long-term care facility who
have slightly fluctuating income which is below the medical
assistance income limit shall report and verify their income deleted text begin on
a semiannual basis deleted text end new text begin every six months. The six-month period
begins the month of application new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 7.

Minnesota Statutes 2004, section 256B.056,
subdivision 7, is amended to read:

Subd. 7.

Period of eligibility.

Eligibility is available
for the month of application and for three months prior to
application if the person was eligible in those prior
months. new text begin Eligibility for months prior to application is
determined independently from eligibility for the month of
application and future months. new text end A redetermination of eligibility
must occur every 12 months. new text begin The 12-month period begins with the
month of application.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 8.

Minnesota Statutes 2004, section 256B.056, is
amended by adding a subdivision to read:

new text begin Subd. 9. new text end

new text begin Notice. new text end

new text begin The state agency must be given notice
of monetary claims against a person, entity, or corporation that
may be liable to pay all or part of the cost of medical care
when the state agency has paid or becomes liable for the cost of
that care. Notice must be given according to paragraphs (a) to
(d).
new text end

new text begin (a) An applicant for medical assistance shall notify the
state or local agency of any possible claims when the applicant
submits the application. A recipient of medical assistance
shall notify the state or local agency of any possible claims
when those claims arise.
new text end

new text begin (b) A person providing medical care services to a recipient
of medical assistance shall notify the state agency when the
person has reason to believe that a third party may be liable
for payment of the cost of medical care.
new text end

new text begin (c) A party to a claim that may be assigned to the state
agency under this section shall notify the state agency of its
potential assignment claim in writing at each of the following
stages of a claim:
new text end

new text begin (1) when a claim is filed;
new text end

new text begin (2) when an action is commenced; and
new text end

new text begin (3) when a claim is concluded by payment, award, judgment,
settlement, or otherwise.
new text end

new text begin (d) Every party involved in any stage of a claim under this
subdivision is required to provide notice to the state agency at
that stage of the claim. However, when one of the parties to
the claim provides notice at that stage, every other party to
the claim is deemed to have provided the required notice for
that stage of the claim. If the required notice under this
paragraph is not provided to the state agency, all parties to
the claim are deemed to have failed to provide the required
notice. A party to the claim includes the injured person or the
person's legal representative, the plaintiff, the defendants, or
persons alleged to be responsible for compensating the injured
person or plaintiff, and any other party to the cause of action
or claim, regardless of whether the party knows the state agency
has a potential or actual assignment claim.
new text end

Sec. 9.

Minnesota Statutes 2004, section 256B.057,
subdivision 1, is amended to read:

Subdivision 1.

Infants and pregnant women.

(a) deleted text begin (1) deleted text end An
infant less than one year of age is eligible for medical
assistance if countable family income is equal to or less than
275 percent of the federal poverty guideline for the same family
size. A pregnant woman who has written verification of a
positive pregnancy test from a physician or licensed registered
nurse is eligible for medical assistance if countable family
income is equal to or less than deleted text begin 200 deleted text end new text begin 275 new text end percent of the federal
poverty guideline for the same family size. For purposes of
this subdivision, "countable family income" means the amount of
income considered available using the methodology of the AFDC
program under the state's AFDC plan as of July 16, 1996, as
required by the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (PRWORA), Public Law 104-193, except
for the earned income disregard and employment deductions.

deleted text begin (2) For applications processed within one calendar month
prior to the effective date, eligibility shall be determined by
applying the income standards and methodologies in effect prior
to the effective date for any months in the six-month budget
period before that date and the income standards and
methodologies in effect on the effective date for any months in
the six-month budget period on or after that date. The income
standards for each month shall be added together and compared to
the applicant's total countable income for the six-month budget
period to determine eligibility.
deleted text end

(b) deleted text begin (1) (Expired, 1Sp2003 c 14 art 12 s 19)
deleted text end

deleted text begin (2) For applications processed within one calendar month
prior to July 1, 2003, eligibility shall be determined by
applying the income standards and methodologies in effect prior
to July 1, 2003, for any months in the six-month budget period
before July 1, 2003, and the income standards and methodologies
in effect on the expiration date for any months in the six-month
budget period on or after July 1, 2003. The income standards
for each month shall be added together and compared to the
applicant's total countable income for the six-month budget
period to determine eligibility.
deleted text end

(c) deleted text begin Dependent care and child support paid under court order
shall be deducted from the countable income of pregnant
women. deleted text end new text begin An amount equal to the amount of earned income exceeding
275 percent of the federal poverty guideline plus the earned
income disregards and deductions of the AFDC program under the
state's AFDC plan as of July 16, 1996, as required by the
Personal Responsibility and Work Opportunity Reconciliation Act
of 1996 (PRWORA), Public Law 104-193, that exceeds 275 percent
of the federal poverty guideline will be deducted for pregnant
women and infants less than one year of age.
new text end

(d) An infant born on or after January 1, 1991, to a woman
who was eligible for and receiving medical assistance on the
date of the child's birth shall continue to be eligible for
medical assistance without redetermination until the child's
first birthday, as long as the child remains in the woman's
household.

new text begin EFFECTIVE DATE. new text end

new text begin The amendment to paragraph (a) is
effective retroactively from July 1, 2004, and the amendment to
paragraph (b) is effective retroactively from October 1, 2003.
new text end

Sec. 10.

Minnesota Statutes 2004, section 256B.0644, is
amended to read:

256B.0644 PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER
OTHER STATE HEALTH CARE PROGRAMS.

A vendor of medical care, as defined in section 256B.02,
subdivision 7, new text begin with the exception of a dental provider, new text end and a
health maintenance organization, as defined in chapter 62D, 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.
For providers other than health maintenance organizations,
participation in the medical assistance program means that deleted text begin (1)
deleted text end the provider accepts new medical assistance, general assistance
medical care, and MinnesotaCare patients deleted text begin or (2) for providers
other than dental service providers deleted text end , new text begin and new text end 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 deleted text begin , 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 deleted text end . 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 this participation requirement. 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 employee relations, 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 employee
relations shall implement this section through contracts with
participating health deleted text begin and dental deleted text end carriers.

Sec. 11.

Minnesota Statutes 2004, section 256D.045, is
amended to read:

256D.045 SOCIAL SECURITY NUMBER REQUIRED.

To be eligible for general assistance under sections
256D.01 to 256D.21, an individual must provide the individual's
Social Security number to the county agency or submit proof that
an application has been made. new text begin An individual who refuses to
provide a Social Security number because of a well-established
religious objection as described in Code of Federal Regulations,
title 42, section 435.910, may be eligible for general
assistance medical care under section 256D.03. new text end The provisions
of this section do not apply to the determination of eligibility
for emergency general assistance under section 256D.06,
subdivision 2. This provision applies to eligible children
under the age of 18 effective July 1, 1997.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 12.

Minnesota Statutes 2004, section 256L.01,
subdivision 4, is amended to read:

Subd. 4.

Gross individual or gross family income.

(a)
"Gross individual or gross family income" for nonfarm
self-employed means income calculated new text begin for the six-month period
of eligibility new text end using as the baseline the adjusted gross income
reported on the applicant's federal income tax form for the
previous year and adding back in reported depreciation,
carryover loss, and net operating loss amounts that apply to the
business in which the family is currently engaged.

(b) "Gross individual or gross family income" for farm
self-employed means income calculated new text begin for the six-month period
of eligibility new text end using as the baseline the adjusted gross income
reported on the applicant's federal income tax form for the
previous year and adding back in reported depreciation amounts
that apply to the business in which the family is currently
engaged.

(c) deleted text begin Applicants shall report the most recent financial
situation of the family if it has changed from the period of
time covered by the federal income tax form. The report may be
in the form of percentage increase or decrease deleted text end new text begin "Gross individual
or gross family income" means the total income for all family
members, calculated for the six-month period of eligibility new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 13.

Minnesota Statutes 2004, section 256L.01,
subdivision 5, is amended to read:

Subd. 5.

Income.

new text begin (a) new text end "Income" has the meaning given for
earned and unearned income for families and children in the
medical assistance program, according to the state's aid to
families with dependent children plan in effect as of July 16,
1996. The definition does not include medical assistance income
methodologies and deeming requirements. The earned income of
full-time and part-time students under age 19 is not counted as
income. Public assistance payments and supplemental security
income are not excluded income.

new text begin (b) For purposes of this subdivision, and unless otherwise
specified in this section, the commissioner shall use reasonable
methods to calculate gross earned and unearned income including,
but not limited to, projecting income based on income received
within the past 30 days, the last 90 days, or the last 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005.
new text end

Sec. 14.

Minnesota Statutes 2004, section 256L.03,
subdivision 1b, is amended to read:

Subd. 1b.

Pregnant women; eligibility for full medical
assistance services.

deleted text begin Beginning January 1, 1999, deleted text end A new text begin pregnant
new text end woman deleted text begin who is deleted text end enrolled in MinnesotaCare deleted text begin when her pregnancy is
diagnosed deleted text end is eligible for coverage of all services provided
under the medical assistance program according to chapter 256B
retroactive to the date deleted text begin the pregnancy is medically diagnosed deleted text end new text begin of
conception new text end . Co-payments totaling $30 or more, paid after the
date deleted text begin the pregnancy is diagnosed deleted text end new text begin of conception new text end , shall be refunded.

Sec. 15.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 1a. new text end

new text begin Social security number required. new text end

new text begin (a)
Individuals and families applying for MinnesotaCare coverage
must provide a Social Security number.
new text end

new text begin (b) The commissioner shall not deny eligibility to an
otherwise eligible applicant who has applied for a Social
Security number and is awaiting issuance of that Social Security
number.
new text end

new text begin (c) Newborns enrolled under section 256L.05, subdivision 3,
are exempt from the requirements of this subdivision.
new text end

new text begin (d) Individuals who refuse to provide a Social Security
number because of well-established religious objections are
exempt from the requirements of this subdivision. The term
"well-established religious objections" has the meaning given in
Code of Federal Regulations, title 42, section 435.910.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 16.

Minnesota Statutes 2004, section 256L.04,
subdivision 2, is amended to read:

Subd. 2.

Cooperation in establishing third-party
liability, paternity, and other medical support.

(a) To be
eligible for MinnesotaCare, individuals and families must
cooperate with the state agency to identify potentially liable
third-party payers and assist the state in obtaining third-party
payments. "Cooperation" includes, but is not limited
to, new text begin complying with the notice requirements in section 256B.056,
subdivision 9, new text end identifying any third party who may be liable for
care and services provided under MinnesotaCare to the enrollee,
providing relevant information to assist the state in pursuing a
potentially liable third party, and completing forms necessary
to recover third-party payments.

(b) A parent, guardian, relative caretaker, or child
enrolled in the MinnesotaCare program must cooperate with the
Department of Human Services and the local agency in
establishing the paternity of an enrolled child and in obtaining
medical care support and payments for the child and any other
person for whom the person can legally assign rights, in
accordance with applicable laws and rules governing the medical
assistance program. A child shall not be ineligible for or
disenrolled from the MinnesotaCare program solely because the
child's parent, relative caretaker, or guardian fails to
cooperate in establishing paternity or obtaining medical support.

Sec. 17.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 2a. new text end

new text begin Applications for other benefits. new text end

new text begin To be
eligible for MinnesotaCare, individuals and families must take
all necessary steps to obtain other benefits as described in
Code of Federal Regulations, title 42, section 435.608.
Applicants and enrollees must apply for other benefits within 30
days.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 18.

Minnesota Statutes 2004, 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 deleted text begin date of entry
into the family deleted text end new text begin month of placement or the month placement is
reported, whichever is later new text end . The effective date of coverage
for other new deleted text begin recipients deleted text end new text begin members new text end added to the family deleted text begin receiving
covered health services deleted text end is the first day of the month following
the month in which deleted text begin eligibility is approved or at renewal,
whichever the family receiving covered health services
prefers deleted text end new text begin the change is reported new text end . 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 19.

Minnesota Statutes 2004, section 256L.05,
subdivision 3a, is amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning January
1, 1999, 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) Beginning October 1, 2004, an enrollee's eligibility
must be renewed every six months. The first six-month period of
eligibility begins deleted text begin in the month after deleted text end the month the application
is deleted text begin approved deleted text end new text begin received by the commissioner new text end . 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.
The premium for the new period of eligibility must be received
as provided in section 256L.06 in order for eligibility to
continue.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 20.

Minnesota Statutes 2004, section 256L.07,
subdivision 1, is amended to read:

Subdivision 1.

General requirements.

(a) Children
enrolled in the original children's health plan as of September
30, 1992, children who enrolled in the MinnesotaCare program
after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross
incomes that are equal to or less than 150 percent of the
federal poverty guidelines are eligible without meeting the
requirements of subdivision 2 and the four-month requirement in
subdivision 3, as long as they maintain continuous coverage in
the MinnesotaCare program or medical assistance. Children who
apply for MinnesotaCare on or after the implementation date of
the employer-subsidized health coverage program as described in
Laws 1998, chapter 407, article 5, section 45, who have family
gross incomes that are equal to or less than 150 percent of the
federal poverty guidelines, must meet the requirements of
subdivision 2 to be eligible for MinnesotaCare.

(b) Families enrolled in MinnesotaCare under section
256L.04, subdivision 1, whose income increases above 275 percent
of the federal poverty guidelines, are no longer eligible for
the program and shall be disenrolled by the commissioner.
Individuals enrolled in MinnesotaCare under section 256L.04,
subdivision 7, whose income increases above 175 percent of the
federal poverty guidelines are no longer eligible for the
program and shall be disenrolled by the commissioner. For
persons disenrolled under this subdivision, MinnesotaCare
coverage terminates the last day of the calendar month following
the month in which the commissioner determines that the income
of a family or individual exceeds program income limits.

(c)(1) Notwithstanding paragraph (b), families enrolled in
MinnesotaCare under section 256L.04, subdivision 1, may remain
enrolled in MinnesotaCare if ten percent of their annual income
is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health
Association. Families who are no longer eligible for
MinnesotaCare under this subdivision shall be given an 18-month
notice period from the date that ineligibility is determined
before disenrollment. This clause expires February 1, 2004.

(2) Effective February 1, 2004, notwithstanding paragraph
(b), children may remain enrolled in MinnesotaCare if ten
percent of their deleted text begin annual deleted text end new text begin gross individual or gross new text end family income
new text begin as defined in section 256L.01, subdivision 4, new text end is less than the
deleted text begin annual deleted text end premium for a new text begin six-month new text end policy with a $500 deductible
available through the Minnesota Comprehensive Health
Association. Children who are no longer eligible for
MinnesotaCare under this clause shall be given a 12-month notice
period from the date that ineligibility is determined before
disenrollment. The premium for children remaining eligible
under this clause shall be the maximum premium determined under
section 256L.15, subdivision 2, paragraph (b).

(d) Effective July 1, 2003, notwithstanding paragraphs (b)
and (c), parents are no longer eligible for MinnesotaCare if
gross household income exceeds deleted text begin $50,000 deleted text end new text begin $25,000 for the six-month
period of eligibility new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 21.

Minnesota Statutes 2004, section 256L.07,
subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and
individuals enrolled in the MinnesotaCare program must have no
health coverage while enrolled or for at least four months prior
to application and renewal. Children enrolled in the original
children's health plan and children in families with income
equal to or less than 150 percent of the federal poverty
guidelines, who have other health insurance, are eligible if the
coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per
year; or

(3) lacks coverage because the child has exceeded the
maximum coverage for a particular diagnosis or the policy
excludes a particular diagnosis.

The commissioner may change this eligibility criterion for
sliding scale premiums in order to remain within the limits of
available appropriations. The requirement of no health coverage
does not apply to newborns.

(b) Medical assistance, general assistance medical care,
and the Civilian Health and Medical Program of the Uniformed
Service, CHAMPUS, or other coverage provided under United States
Code, title 10, subtitle A, part II, chapter 55, are not
considered insurance or health coverage for purposes of the
four-month requirement described in this subdivision.

(c) For purposes of this subdivision, Medicare Part A or B
coverage under title XVIII of the Social Security Act, United
States Code, title 42, sections 1395c to 1395w-4, is considered
health coverage. An applicant or enrollee may not refuse
Medicare coverage to establish eligibility for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or
general assistance medical care within one month of application
must meet the provisions of this subdivision and subdivision 2.

(e) deleted text begin Effective October 1, 2003, applicants who were
recipients of medical assistance and had deleted text end Cost-effective health
insurance deleted text begin which deleted text end new text begin that new text end was paid for by medical assistance deleted text begin are
exempt from deleted text end new text begin is not considered health coverage for purposes of
new text end the four-month requirement under this section new text begin , except if the
insurance continued after medical assistance no longer
considered it cost-effective or after medical assistance closed new text end .

Sec. 22.

Minnesota Statutes 2004, section 256L.07, is
amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Voluntary disenrollment for members of
military. new text end

new text begin Notwithstanding section 256L.05, subdivision 3b,
MinnesotaCare enrollees who are members of the military and
their families, who choose to voluntarily disenroll from the
program when one or more family members are called to active
duty, may reenroll during or following that member's tour of
active duty. Those individuals and families shall be considered
to have good cause for voluntary termination under section
256L.06, subdivision 3, paragraph (d). Income and asset
increases reported at the time of reenrollment shall be
disregarded. All provisions of sections 256L.01 to 256L.18,
shall apply to individuals and families enrolled under this
subdivision upon six-month renewal.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005.
new text end

Sec. 23.

Minnesota Statutes 2004, section 256L.15,
subdivision 2, is amended to read:

Subd. 2.

Sliding fee scale to determine percentage of
new text begin monthly new text end gross individual or family income.

(a) The commissioner
shall establish a sliding fee scale to determine the percentage
of new text begin monthly new text end gross individual or family income that households at
different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on
the enrollee's new text begin monthly new text end gross individual or family income. The
sliding fee scale must contain separate tables based on
enrollment of one, two, or three or more persons. The sliding
fee scale begins with a premium of 1.5 percent of new text begin monthly new text end gross
individual or family income for individuals or families with
incomes below the limits for the medical assistance program for
families and children in effect on January 1, 1999, and proceeds
through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8,
4.8, 5.9, 7.4, and 8.8 percent. These percentages are matched
to evenly spaced income steps ranging from the medical
assistance income limit for families and children in effect on
January 1, 1999, to 275 percent of the federal poverty
guidelines for the applicable family size, up to a family size
of five. The sliding fee scale for a family of five must be
used for families of more than five. Effective October 1, 2003,
the commissioner shall increase each percentage by 0.5
percentage points for enrollees with income greater than 100
percent but not exceeding 200 percent of the federal poverty
guidelines and shall increase each percentage by 1.0 percentage
points for families and children with incomes greater than 200
percent of the federal poverty guidelines. The sliding fee
scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income
after enrollment, premiums shall not be adjusted until
eligibility renewal.

(b)(1) Enrolled families whose gross annual income
increases above 275 percent of the federal poverty guideline
shall pay the maximum premium. This clause expires effective
February 1, 2004.

(2) Effective February 1, 2004, children in families whose
gross income is above 275 percent of the federal poverty
guidelines shall pay the maximum premium.

(3) The maximum premium is defined as a base charge for
one, two, or three or more enrollees so that if all
MinnesotaCare cases paid the maximum premium, the total revenue
would equal the total cost of MinnesotaCare medical coverage and
administration. In this calculation, administrative costs shall
be assumed to equal ten percent of the total. The costs of
medical coverage for pregnant women and children under age two
and the enrollees in these groups shall be excluded from the
total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or
more enrollees shall be three times the maximum premium for one.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon implementation of HealthMatch, whichever is later.
new text end

Sec. 24.

Minnesota Statutes 2004, section 256L.15,
subdivision 3, is amended to read:

Subd. 3.

Exceptions to sliding scale.

deleted text begin An annual premium
of $48 is required for all deleted text end Children in families with income at
or deleted text begin less than deleted text end new text begin below new text end 150 percent of new text begin the new text end federal poverty guidelines
new text begin pay a monthly premium of $4 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2006,
or upon implementation of HealthMatch, whichever is later.
new text end

Sec. 25.

Minnesota Statutes 2004, section 549.02, is
amended by adding a subdivision to read:

new text begin Subd. 3. new text end

new text begin Limitation. new text end

new text begin Notwithstanding subdivisions 1 and
2, where the state agency is named or intervenes as a party to
enforce the agency's rights under section 256B.056, the agency
shall not be liable for costs to any prevailing defendant.
new text end

Sec. 26.

Minnesota Statutes 2004, section 549.04, is
amended to read:

549.04 DISBURSEMENTS; TAXATION AND ALLOWANCE.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

In every action in a district
court, the prevailing party, including any public employee who
prevails in an action for wrongfully denied or withheld
employment benefits or rights, shall be allowed reasonable
disbursements paid or incurred, including fees and mileage paid
for service of process by the sheriff or by a private person.

new text begin Subd. 2. new text end

new text begin Limitation. new text end

new text begin Notwithstanding subdivision 1,
where the state agency is named or intervenes as a party to
enforce the agency's rights under section 256B.056, the agency
shall not be liable for disbursements to any prevailing
defendant.
new text end

Sec. 27. new text begin PLANNING PROCESS FOR MANAGED CARE.
new text end

new text begin The commissioner of human services shall develop a planning
process for the purposes of implementing at least one additional
managed care arrangement to provide medical assistance services,
excluding continuing care services, to recipients enrolled in
the medical assistance fee-for-service program, effective
January 1, 2007. This planning process shall include an
advisory committee composed of current fee-for-service
consumers, consumer advocates, and providers, as well as
representatives of health plans and other provider organizations
qualified to provide basic health care services to persons with
disabilities. The department shall seek any additional federal
authority necessary to provide basic health care services
through contracted managed care arrangements.
new text end