HF 1703

1st Committee Engrossment - 86th Legislature (2009 - 2010) Posted on 03/19/2013 07:28pm

A bill for an act
relating to human services; amending health care eligibility provisions for
medical assistance, MinnesotaCare, and general assistance medical care;
establishing a Drug Utilization Review Board; authorizing rulemaking; requiring
a report; amending Minnesota Statutes 2008, sections 62J.2930, subdivision
3; 245.494, subdivision 3; 256.015, subdivision 7; 256.969, subdivision 3a;
256B.037, subdivision 5; 256B.056, subdivisions 1c, 3c, 6; 256B.0625, by
adding subdivisions; 256B.094, subdivision 3; 256B.195, subdivisions 1, 2,
3; 256B.199; 256B.69, subdivision 5a; 256B.77, subdivision 13; 256D.03,
subdivision 3; 256L.01, by adding a subdivision; 256L.03, subdivision 5;
256L.15, subdivision 2; 507.092, by adding a subdivision; Laws 2005, First
Special Session chapter 4, article 8, sections 54; 61; 63; 66; 74; repealing
Minnesota Statutes 2008, sections 256B.031; 256L.01, subdivision 4; Laws
2005, First Special Session chapter 4, article 8, sections 21; 22; 23; 24.

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

Section 1.

Minnesota Statutes 2008, section 62J.2930, subdivision 3, is amended to
read:

Subd. 3.

Consumer information.

(a) The information clearinghouse or another
entity designated by the commissioner shall provide consumer information to health
plan company enrollees to:

(1) assist enrollees in understanding their rights;

(2) explain and assist in the use of all available complaint systems, including internal
complaint systems within health carriers, community integrated service networks, and
the Departments of Health and Commerce;

(3) provide information on coverage options in each region of the state;

(4) provide information on the availability of purchasing pools and enrollee
subsidies; and

(5) help consumers use the health care system to obtain coverage.

(b) The information clearinghouse or other entity designated by the commissioner
for the purposes of this subdivision shall not:

(1) provide legal services to consumers;

(2) represent a consumer or enrollee; or

(3) serve as an advocate for consumers in disputes with health plan companies.

(c) Nothing in this subdivision shall interfere with the ombudsman program
established under section deleted text begin 256B.031, subdivision 6 deleted text end new text begin 256B.69, subdivision 20 new text end , or other
existing ombudsman programs.

Sec. 2.

Minnesota Statutes 2008, section 245.494, subdivision 3, is amended to read:

Subd. 3.

Duties of the commissioner of human services.

The commissioner of
human services, in consultation with the Integrated Fund Task Force, shall:

(1) in the first quarter of 1994, in areas where a local children's mental health
collaborative has been established, based on an independent actuarial analysis, identify all
medical assistance and MinnesotaCare resources devoted to mental health services for
children in the target population including inpatient, outpatient, medication management,
services under the rehabilitation option, and related physician services in the total health
capitation of prepaid plans under contract with the commissioner to provide medical
assistance services under section 256B.69;

(2) assist each children's mental health collaborative to determine an actuarially
feasible operational target population;

(3) ensure that a prepaid health plan that contracts with the commissioner to provide
medical assistance or MinnesotaCare services shall pass through the identified resources
to a collaborative or collaboratives upon the collaboratives meeting the requirements
of section 245.4933 to serve the collaborative's operational target population. The
commissioner shall, through an independent actuarial analysis, specify differential rates
the prepaid health plan must pay the collaborative based upon severity, functioning, and
other risk factors, taking into consideration the fee-for-service experience of children
excluded from prepaid medical assistance participation;

(4) ensure that a children's mental health collaborative that enters into an agreement
with a prepaid health plan under contract with the commissioner shall accept medical
assistance recipients in the operational target population on a first-come, first-served basis
up to the collaborative's operating capacity or as determined in the agreement between
the collaborative and the commissioner;

(5) ensure that a children's mental health collaborative that receives resources passed
through a prepaid health plan under contract with the commissioner shall be subject to
the quality assurance standards, reporting of utilization information, standards set out in
sections 245.487 to 245.4889, and other requirements established in Minnesota Rules,
part 9500.1460;

(6) ensure that any prepaid health plan that contracts with the commissioner,
including a plan that contracts under section 256B.69, must enter into an agreement with
any collaborative operating in the same service delivery area that:

(i) meets the requirements of section 245.4933;

(ii) is willing to accept the rate determined by the commissioner to provide medical
assistance services; and

(iii) requests to contract with the prepaid health plan;

(7) ensure that no agreement between a health plan and a collaborative shall
terminate the legal responsibility of the health plan to assure that all activities under the
contract are carried out. The agreement may require the collaborative to indemnify the
health plan for activities that are not carried out;

(8) ensure that where a collaborative enters into an agreement with the commissioner
to provide medical assistance and MinnesotaCare services a separate capitation rate will
be determined through an independent actuarial analysis which is based upon the factors
set forth in clause (3) to be paid to a collaborative for children in the operational target
population who are eligible for medical assistance but not included in the prepaid health
plan contract with the commissioner;

(9) ensure that in counties where no prepaid health plan contract to provide medical
assistance or MinnesotaCare services exists, a children's mental health collaborative that
meets the requirements of section 245.4933 shall:

(i) be paid a capitated rate, actuarially determined, that is based upon the
collaborative's operational target population;

(ii) accept medical assistance or MinnesotaCare recipients in the operational target
population on a first-come, first-served basis up to the collaborative's operating capacity or
as determined in the contract between the collaborative and the commissioner; and

(iii) comply with quality assurance standards, reporting of utilization information,
standards set out in sections 245.487 to 245.4889, and other requirements established in
Minnesota Rules, part 9500.1460;

(10) subject to federal approval, in the development of rates for local children's
mental health collaboratives, the commissioner shall consider, and may adjust, trend and
utilization factors, to reflect changes in mental health service utilization and access;

(11) consider changes in mental health service utilization, access, and price, and
determine the actuarial value of the services in the maintenance of rates for local children's
mental health collaborative provided services, subject to federal approval;

(12) provide written notice to any prepaid health plan operating within the service
delivery area of a children's mental health collaborative of the collaborative's existence
within 30 days of the commissioner's receipt of notice of the collaborative's formation;

(13) ensure that in a geographic area where both a prepaid health plan including
those established under either section 256B.69 or 256L.12 and a local children's mental
health collaborative exist, medical assistance and MinnesotaCare recipients in the
operational target population who are enrolled in prepaid health plans will have the choice
to receive mental health services through either the prepaid health plan or the collaborative
that has a contract with the prepaid health plan, according to the terms of the contract;

(14) develop a mechanism for integrating medical assistance resources for mental
health service with MinnesotaCare and any other state and local resources available for
services for children in the operational target population, and develop a procedure for
making these resources available for use by a local children's mental health collaborative;

(15) gather data needed to manage mental health care including evaluation data and
data necessary to establish a separate capitation rate for children's mental health services
if that option is selected;

(16) by January 1, 1994, develop a model contract for providers of mental health
managed care that meets the requirements set out in sections 245.491 to 245.495 and
256B.69, and utilize this contract for all subsequent awards, and before January 1, 1995,
the commissioner of human services shall not enter into or extend any contract for any
prepaid plan that would impede the implementation of sections 245.491 to 245.495;

(17) develop revenue enhancement or rebate mechanisms and procedures to
certify expenditures made through local children's mental health collaboratives for
services including administration and outreach that may be eligible for federal financial
participation under medical assistance and other federal programs;

(18) ensure that new contracts and extensions or modifications to existing contracts
under section 256B.69 do not impede implementation of sections 245.491 to 245.495;

(19) provide technical assistance to help local children's mental health collaboratives
certify local expenditures for federal financial participation, using due diligence in order to
meet implementation timelines for sections 245.491 to 245.495 and recommend necessary
legislation to enhance federal revenue, provide clinical and management flexibility, and
otherwise meet the goals of local children's mental health collaboratives and request
necessary state plan amendments to maximize the availability of medical assistance for
activities undertaken by the local children's mental health collaborative;

(20) take all steps necessary to secure medical assistance reimbursement under the
rehabilitation option for family community support services and therapeutic support of
foster care and for individualized rehabilitation services;

(21) provide a mechanism to identify separately the reimbursement to a county
for child welfare targeted case management provided to children served by the local
collaborative for purposes of subsequent transfer by the county to the integrated fund;

(22) ensure that family members who are enrolled in a prepaid health plan and
whose children are receiving mental health services through a local children's mental
health collaborative file complaints about mental health services needed by the family
members, the commissioner shall comply with section deleted text begin 256B.031, subdivision 6 deleted text end new text begin 256B.69,
subdivision 20 new text end . A collaborative may assist a family to make a complaint; and

(23) facilitate a smooth transition for children receiving prepaid medical assistance
or MinnesotaCare services through a children's mental health collaborative who become
enrolled in a prepaid health plan.

Sec. 3.

Minnesota Statutes 2008, section 256.015, subdivision 7, is amended to read:

Subd. 7.

Cooperation new text begin with information requests new text end required.

new text begin (a) new text end Upon the request
of the deleted text begin Department deleted text end new text begin commissioner new text end of human services deleted text begin , deleted text end new text begin :
new text end

new text begin (1) new text end any state agency or third party payer shall cooperate deleted text begin with the department in deleted text end new text begin by new text end
furnishing information to help establish a third party liability deleted text begin . Upon the request of the
Department of Human Services or county child support or human service agencies deleted text end , new text begin as
required by the federal Deficit Reduction Act of 2005, Public Law 109-171;
new text end

new text begin (2) new text end any employer or third party payer shall cooperate deleted text begin in deleted text end new text begin by new text end furnishing new text begin a data file
containing new text end information about group health insurance deleted text begin plans deleted text end new text begin plan new text end or medical benefit deleted text begin plans
available to deleted text end new text begin plan coverage of new text end its employees new text begin or insureds within 60 days of the request new text end .

new text begin (b) new text end For purposes of section 176.191, subdivision 4, the deleted text begin Department deleted text end new text begin commissioner new text end
of labor and industry may allow the deleted text begin Department deleted text end new text begin commissioner new text end of human services and
county agencies direct access and data matching on information relating to workers'
compensation claims in order to determine whether the claimant has reported the fact of
a pending claim and the amount paid to or on behalf of the claimant to the deleted text begin Department deleted text end new text begin
commissioner new text end of human services.

new text begin (c) For the purpose of compliance with section 169.09, subdivision 13, and
federal requirements under Code of Federal Regulations, title 42, section 433.138(d)(4),
the commissioner of public safety shall provide accident data as requested by the
commissioner of human services. The disclosure shall not violate section 169.09,
subdivision 13, paragraph (d).
new text end

new text begin (d) new text end The deleted text begin Department deleted text end new text begin commissioner new text end of human services and county agencies shall
limit its use of information gained from agencies, third party payers, and employers to
purposes directly connected with the administration of its public assistance and child
support programs. The provision of information by agencies, third party payers, and
employers to the department under this subdivision is not a violation of any right of
confidentiality or data privacy.

Sec. 4.

Minnesota Statutes 2008, 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 deleted text begin July deleted text end new text begin August new text end 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, 2010, 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, 2010, 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, 2010, 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, 2010, to reflect this reduction.

Sec. 5.

Minnesota Statutes 2008, section 256B.037, subdivision 5, is amended to read:

Subd. 5.

Other contracts permitted.

Nothing in this section prohibits the
commissioner from contracting with an organization for comprehensive health services,
including dental services, under deleted text begin section 256B.031, deleted text end new text begin sections new text end 256B.035, 256B.69, or
256D.03, subdivision 4, paragraph (c).

Sec. 6.

Minnesota Statutes 2008, section 256B.056, subdivision 1c, is amended to read:

Subd. 1c.

Families with children income methodology.

(a)(1) [Expired, 1Sp2003
c 14 art 12 s 17]

(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 July 1, 2003, 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.

(3) For children ages one through 18 whose eligibility is determined under section
256B.057, subdivision 2, the following deductions shall be applied to income counted
toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
16, 1996: $90 work expense, dependent care, and child support paid under court order.
This clause is effective October 1, 2003.

(b) For families with children whose eligibility is determined using the standard
specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
earned income shall be disregarded for up to four months and the following deductions
shall be applied to each individual's income counted toward eligibility as allowed under
the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
under court order.

(c) If the four-month disregard in paragraph (b) has been applied to the wage
earner's income for four months, the disregard shall not be applied again until the wage
earner's income has not been considered in determining medical assistance eligibility for
12 consecutive months.

(d) 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 begin (e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
organization to or for the benefit of the child with a life-threatening illness must be
disregarded from income.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to read:

Subd. 3c.

Asset limitations for families and children.

A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one
person must not own more than $10,000 in total net assets. In addition to these maximum
amounts, an eligible individual or family may accrue interest on these amounts, but they
must be reduced to the maximum at the time of an eligibility redetermination. The value of
assets that are not considered in determining eligibility for medical assistance for families
and children is the value of those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business up to $200,000 are not
considered;

(3) one motor vehicle is excluded for each person of legal driving age who is
employed or seeking employment;

(4) deleted text begin one burial plot and all other burial expenses equal to the supplemental security
income program asset limit are not considered for each individual deleted text end new text begin assets designated as
burial expenses are excluded to the same extent they are excluded by the Supplemental
Security Income program new text end ;

(5) court-ordered settlements up to $10,000 are not considered;

(6) individual retirement accounts and funds are not considered; and

(7) assets owned by children are not considered.

Sec. 8.

Minnesota Statutes 2008, section 256B.056, subdivision 6, is amended to read:

Subd. 6.

Assignment of benefits.

To be eligible for medical assistance a person
must have applied or must agree to apply all proceeds received or receivable by the person
or the person's legal representative from any third party liable for the costs of medical
care. By accepting or receiving assistance, the person is deemed to have assigned the
person's rights to medical support and third party payments as required by title 19 of
the Social Security Act. Persons must cooperate with the state in establishing paternity
and obtaining third party payments. By accepting medical assistance, a person assigns
to the Department of Human Services all rights the person may have to medical support
or payments for medical expenses from any other 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. Any rights or amounts so assigned shall be applied against
the cost of medical care paid for under this chapter. Any assignment takes effect upon
the determination that the applicant is eligible for medical assistance and up to three
months prior to the date of application if the applicant is determined eligible for and
receives medical assistance benefits. The application must contain a statement explaining
this assignment. For the purposes of this section, "the Department of Human Services or
the state" includes prepaid health plans under contract with the commissioner according
to sections deleted text begin 256B.031, deleted text end 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12;
children's mental health collaboratives under section 245.493; demonstration projects for
persons with disabilities under section 256B.77; nursing facilities under the alternative
payment demonstration project under section 256B.434; and the county-based purchasing
entities under section 256B.692.

Sec. 9.

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

new text begin Subd. 13i. new text end

new text begin Drug Utilization Review Board; report. new text end

new text begin (a) A nine-member Drug
Utilization Review Board is established. The board must be comprised of at least three
but no more than four licensed physicians actively engaged in the practice of medicine
in Minnesota; at least three licensed pharmacists actively engaged in the practice of
pharmacy in Minnesota; and one consumer representative. The remainder must be made
up of health care professionals who are licensed in their field and have recognized
knowledge in the clinically appropriate prescribing, dispensing, and monitoring of covered
outpatient drugs. Members of the board must be appointed by the commissioner, shall
serve three-year terms, and may be reappointed by the commissioner. The board shall
annually elect a chair from among its members.
new text end

new text begin (b) The board must be staffed by an employee of the department who shall serve as
an ex officio nonvoting member of the board.
new text end

new text begin (c) The commissioner shall, with the advice of the board:
new text end

new text begin (1) implement a medical assistance retrospective and prospective drug utilization
review program as required by United States Code, title 42, section 1396r-8(g)(3);
new text end

new text begin (2) develop and implement the predetermined criteria and practice parameters for
appropriate prescribing to be used in retrospective and prospective drug utilization review;
new text end

new text begin (3) develop, select, implement, and assess interventions for physicians, pharmacists,
and patients that are educational and not punitive in nature;
new text end

new text begin (4) establish a grievance and appeals process for physicians and pharmacists under
this section;
new text end

new text begin (5) publish and disseminate educational information to physicians and pharmacists
regarding the board and the review program;
new text end

new text begin (6) adopt and implement procedures designed to ensure the confidentiality of any
information collected, stored, retrieved, assessed, or analyzed by the board, staff to
the board, or contractors to the review program that identifies individual physicians,
pharmacists, or recipients;
new text end

new text begin (7) establish and implement an ongoing process to:
new text end

new text begin (i) receive public comment regarding drug utilization review criteria and standards;
and
new text end

new text begin (ii) consider the comments along with other scientific and clinical information in
order to revise criteria and standards on a timely basis; and
new text end

new text begin (8) adopt any rules necessary to carry out this section.
new text end

new text begin (d) The board may establish advisory committees. The commissioner may contract
with appropriate organizations to assist the board in carrying out the board's duties.
The commissioner may enter into contracts for services to develop and implement a
retrospective and prospective review program.
new text end

new text begin (e) The board shall report to the commissioner annually on the date the drug
utilization review annual report is due to the Centers for Medicare and Medicaid Services.
This report must cover the preceding federal fiscal year. The commissioner shall make the
report available to the public upon request. The report must include information on the
activities of the board and the program; the effectiveness of implemented interventions;
administrative costs; and any fiscal impact resulting from the program. An honorarium
of $100 per meeting and reimbursement for mileage must be paid to each board member
in attendance.
new text end

new text begin (f) This subdivision is exempt from the provisions of section 15.059.
new text end

Sec. 10.

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

new text begin Subd. 53. new text end

new text begin Centers of excellence. new text end

new text begin For complex medical procedures with a high
degree of variation in outcomes, for which the Medicare program requires facilities
providing the services to meet certain criteria as a condition of coverage, the commissioner
may develop centers of excellence facility criteria in consultation with the Health Services
Policy Committee, section 256B.0625, subdivision 3c. The criteria must reflect facility
traits that have been linked to superior patient safety and outcomes for the procedures
in question, and must be based on the best available empirical evidence. For medical
assistance recipients enrolled on a fee-for-service basis, the commissioner may make
coverage for these procedures conditional upon the facility providing the services meeting
the specified criteria. Only facilities meeting the criteria may be reimbursed for the
procedures in question.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2009, or upon federal
approval, whichever is later.
new text end new text begin new text end

Sec. 11.

Minnesota Statutes 2008, section 256B.094, subdivision 3, is amended to read:

Subd. 3.

Coordination and provision of services.

(a) In a county or reservation
where a prepaid medical assistance provider has contracted under section deleted text begin 256B.031 or deleted text end
256B.69 to provide mental health services, the case management provider shall coordinate
with the prepaid provider to ensure that all necessary mental health services required
under the contract are provided to recipients of case management services.

(b) When the case management provider determines that a prepaid provider is not
providing mental health services as required under the contract, the case management
provider shall assist the recipient to appeal the prepaid provider's denial pursuant to
section 256.045, and may make other arrangements for provision of the covered services.

(c) The case management provider may bill the provider of prepaid health care
services for any mental health services provided to a recipient of case management
services which the county or tribal social services arranges for or provides and which are
included in the prepaid provider's contract, and which were determined to be medically
necessary as a result of an appeal pursuant to section 256.045. The prepaid provider
must reimburse the mental health provider, at the prepaid provider's standard rate for that
service, for any services delivered under this subdivision.

(d) If the county or tribal social services has not obtained prior authorization for
this service, or an appeal results in a determination that the services were not medically
necessary, the county or tribal social services may not seek reimbursement from the
prepaid provider.

Sec. 12.

Minnesota Statutes 2008, section 256B.195, subdivision 1, is amended to read:

Subdivision 1.

Federal approval required.

deleted text begin Sections deleted text end new text begin Section new text end 145.9268 deleted text begin , 256.969,
subdivision 26, deleted text end and this section are contingent on federal approval of the intergovernmental
transfers and payments to safety net hospitals and community clinics authorized under
this section. These sections are also contingent on current payment, by the government
entities, of intergovernmental transfers under section 256B.19 and this section.

Sec. 13.

Minnesota Statutes 2008, section 256B.195, subdivision 2, is amended to read:

Subd. 2.

Payments from governmental entities.

(a) In addition to any payment
required under section 256B.19, effective July 15, 2001, the following government entities
shall make the payments indicated deleted text begin before noon on the 15th of each month deleted text end new text begin annually new text end :

(1) Hennepin County, deleted text begin $2,000,000 deleted text end new text begin $24,000,000 new text end ; and

(2) Ramsey County, deleted text begin $1,000,000 deleted text end new text begin $12,000,000 new text end .

(b) These sums shall be part of the designated governmental unit's portion of the
nonfederal share of medical assistance costs. Of these payments, Hennepin County shall
pay 71 percent directly to Hennepin County Medical Center, and Ramsey County shall
pay 71 percent directly to Regions Hospital. The counties must provide certification to the
commissioner of payments to hospitals under this subdivision.

Sec. 14.

Minnesota Statutes 2008, 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 deleted text begin after
noon on the 15th of each month deleted text end new text begin annually new text end :

(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.

Sec. 15.

Minnesota Statutes 2008, 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, Regions
Hospital, the University of Minnesota, and Fairview-University Medical Center shall
report deleted text begin quarterly deleted text end new text begin annually new text end to the commissioner beginning June 1, 2007, payments made
during the deleted text begin second deleted text end previous deleted text begin quarter deleted text end new text begin calendar year new text end 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.

Sec. 16.

Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section for the
prepaid medical assistance and general assistance medical care programs pending
completion of performance targets. Each performance target must be quantifiable,
objective, measurable, and reasonably attainable, except in the case of a performance
target based on a federal or state law or rule. Criteria for assessment of each performance
target must be outlined in writing prior to the contract effective date. The managed
care plan must demonstrate, to the commissioner's satisfaction, that the data submitted
regarding attainment of the performance target is accurate. The commissioner shall
periodically change the administrative measures used as performance targets in order
to improve plan performance across a broader range of administrative services. The
performance targets must include measurement of plan efforts to contain spending
on health care services and administrative activities. The commissioner may adopt
plan-specific performance targets that take into account factors affecting only one plan,
including characteristics of the plan's enrollee population. The withheld funds must be
returned no sooner than July of the following year if performance targets in the contract
are achieved. The commissioner may exclude special demonstration projects under
subdivision 23. A managed care plan or a county-based purchasing plan under section
256B.692 may include as admitted assets under section 62D.044 any amount withheld
under this paragraph that is reasonably expected to be returned.

(d)(1) Effective for services rendered on or after January 1, 2009, the commissioner
shall withhold three percent of managed care plan payments under this section for the
prepaid medical assistance and general assistance medical care programs. The withheld
funds must be returned no sooner than July 1 and no later than July 31 of the following
year. The commissioner may exclude special demonstration projects under subdivision 23.

(2) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under
this paragraph. The return of the withhold under this paragraph is not subject to the
requirements of paragraph (c).

new text begin (e) Contracts between the commissioner and a prepaid health plan are exempt from
the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
(a), and 7.
new text end

Sec. 17.

Minnesota Statutes 2008, section 256B.77, subdivision 13, is amended to read:

Subd. 13.

Ombudsman.

Enrollees shall have access to ombudsman services
established in section deleted text begin 256B.031, subdivision 6 deleted text end new text begin 256B.69, subdivision 20 new text end , and advocacy
services provided by the ombudsman for mental health and developmental disabilities
established in sections 245.91 to 245.97. The managed care ombudsman and the
ombudsman for mental health and developmental disabilities shall coordinate services
provided to avoid duplication of services. For purposes of the demonstration project,
the powers and responsibilities of the Office of Ombudsman for Mental Health and
Developmental Disabilities, as provided in sections 245.91 to 245.97 are expanded
to include all eligible individuals, health plan companies, agencies, and providers
participating in the demonstration project.

Sec. 18.

Minnesota Statutes 2008, 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 deleted text begin as deleted text end new text begin for applicants
and recipients new text end defined in paragraph deleted text begin (b) deleted text end new text begin (c) new text end , except as provided in paragraph deleted text begin (c) deleted text end new text begin (d) new text end , 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; new text begin or new text end

(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 deleted text begin ; or deleted text end new text begin . new text end

deleted text begin (iii) deleted text end new text begin (b) new text end 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.

deleted text begin (b) deleted text end new text begin (c) new text end 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 deleted text begin (e) deleted text end new text begin (f) new text end .

deleted text begin (c) deleted text end new text begin (d) new text end 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.

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

deleted text begin (e) deleted text end new text begin (f) new text end Applicants and recipients eligible under paragraph (a), clause deleted text begin (1) deleted text end new text begin (2), item (i) new text end ,
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 deleted text begin (j) deleted text end new text begin (k) new text end ;

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

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

deleted text begin (f) deleted text end new text begin (g) new text end 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.

deleted text begin (g) deleted text end new text begin (h) new text end Beginning September 1, 2006, Minnesota health care program applications
and renewals completed by recipients and applicants who are persons described
in paragraph deleted text begin (c) deleted text end new text begin (d) new text end 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 deleted text begin (c) deleted text end new text begin (d) new text end , deleted text begin (e) deleted text end new text begin (f) new text end ,
and deleted text begin (f) deleted text end new text begin (g) new text end .

deleted text begin (h) deleted text end new text begin (i) new text end 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. new text begin
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. new text end The county agency must assist the applicant in obtaining
verification if necessary.

deleted text begin (i) deleted text end new text begin (j) new text end 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.

deleted text begin (j) deleted text end new text begin (k) new text end 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.

deleted text begin (k) deleted text end new text begin (l) new text end 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.

deleted text begin (l) deleted text end new text begin (m) new text end 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.

deleted text begin (m) deleted text end new text begin (n) new text end 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.

deleted text begin (n) deleted text end new text begin (o) new text end 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(a)(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.

deleted text begin (o) deleted text end new text begin (p) new text end 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.

deleted text begin (p) deleted text end new text begin (q) new text end Effective July 1, 2003, general assistance medical care emergency services
end.

Sec. 19.

Minnesota Statutes 2008, section 256L.01, is amended by adding a subdivision
to read:

new text begin Subd. 4a. new text end

new text begin Gross individual or gross family income. new text end

new text begin "Gross individual or gross
family income" means:
new text end

new text begin (1) for nonfarm self-employed, income calculated for the 12-month period of
eligibility using, as a baseline, the adjusted gross income reported on the applicant's federal
income tax form for the previous year and adding back in depreciation and carryover net
operating loss amounts that apply to the business in which the family is currently engaged;
new text end

new text begin (2) for farm self-employed, income calculated for the 12-month period of eligibility
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; and
new text end

new text begin (3) the total income for all family members, calculated for the 12-month period
of eligibility.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2009.
new text end

Sec. 20.

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 deleted text begin and
$3,000 per family deleted text end ;

(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 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.

Sec. 21.

Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:

Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
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 monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. Until
June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly 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. 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 be adjusted at the time the change in income is reported.

(b) Children in families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. 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.

(c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d) with the exception that children in families
with income at or below 150 percent of the federal poverty guidelines shall pay a monthly
premium of $4. For purposes of paragraph (d), "minimum" means a monthly premium
of $4.

(d) The following premium scale is established for individuals and families with
gross family incomes of deleted text begin 300 deleted text end new text begin 275 new text end percent of the federal poverty guidelines or less:

Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
0-45%	minimum
46-54%	new text begin $4 or new text end 1.1% new text begin of family income, whichever is greater new text end
55-81%	1.6%
82-109%	2.2%
110-136%	2.9%
137-164%	3.6%
165-191%	4.6%
192-219%	5.6%
220-248%	6.5%
deleted text begin 249-274% deleted text end new text begin 249-275% new text end	7.2%
deleted text begin 275-300% deleted text end	deleted text begin 8.0% deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 22.

Minnesota Statutes 2008, section 507.092, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Medical assistance liens; transfer on death deed. new text end

new text begin (a) In counties where
the district court has a probate division, actions to enforce a medical assistance lien or
claim against real property described in a transfer on death deed and any matter raised in
connection with enforcement shall be determined in the probate division. Notwithstanding
any other law to the contrary, the provisions of section 256B.15 shall apply to any
proceeding to enforce a medical assistance lien or claim under chapter 524 or 525. In other
counties, the district court shall have jurisdiction to determine any matter affecting real
property purporting to be transferred by a transfer on death deed.
new text end

new text begin (b) This provision is effective the day following final enactment retroactively from
August 1, 2008, and applies to instruments recorded on or after August 1, 2008, and to
claims, disputes, and other matters arising from or relating to such instruments, provided
however that no deed or other voluntary instrument may be refused recording on or after
August 1, 2008, for failure to comply with the requirements of this section or section
508.50 or 508A.50, as appropriate, if the deed or other voluntary instrument complies
with this section or the requirements of this section as it existed prior to the effective
date of this amendment.
new text end

Sec. 23.

Laws 2005, First Special Session chapter 4, article 8, section 54, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective August 1, deleted text begin 2007, or upon HealthMatch
implementation, whichever is later deleted text end new text begin 2009 new text end .

Sec. 24.

Laws 2005, First Special Session chapter 4, article 8, section 61, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective August 1, deleted text begin 2007, or upon HealthMatch
implementation, whichever is later deleted text end new text begin 2009 new text end .

Sec. 25.

Laws 2005, First Special Session chapter 4, article 8, section 63, the effective
date, is amended to read:

EFFECTIVE DATE.

This section is effective August 1, deleted text begin 2007, or upon HealthMatch
implementation, whichever is later deleted text end new text begin 2009 new text end .

Sec. 26.

Laws 2005, First Special Session chapter 4, article 8, section 66, the effective
date, is amended to read:

EFFECTIVE DATE.

Paragraph (a) is effective August 1, deleted text begin 2007, or upon
HealthMatch implementation, whichever is later deleted text end new text begin 2009 new text end , and paragraph (e) is effective
September 1, 2006.

Sec. 27.

Laws 2005, First Special Session chapter 4, article 8, section 74, the effective
date, is amended to read:

EFFECTIVE DATE.

The amendment to paragraph (a) changing gross family or
individual income to monthly gross family or individual income is effective August 1,
deleted text begin 2007, or upon implementation of HealthMatch, whichever is later deleted text end new text begin 2009 new text end . The amendment
to paragraph (a) related to premium adjustments and changes of income and the
amendment to paragraph (c) are effective September 1, 2005, or upon federal approval,
whichever is later. deleted text begin Prior to the implementation of HealthMatch, deleted text end The commissioner
shall implement this section to the fullest extent possible, including the use of manual
processing. deleted text begin Upon implementation of HealthMatch, the commissioner shall implement this
section in a manner consistent with the procedures and requirements of HealthMatch.
deleted text end

Sec. 28. new text begin REPEALER.
new text end

new text begin (a) Minnesota Statutes 2008, sections 256B.031; and 256L.01, subdivision 4, new text end new text begin are
repealed.
new text end

new text begin (b) new text end new text begin Laws 2005, First Special Session chapter 4, article 8, sections 21; 22; 23; and
24, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2009.
new text end