Minnesota Legislature
HF 745
as introduced - 92nd Legislature (2021 - 2022) Posted on 03/10/2021 12:49pm
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 02/04/2021 |
Current Version - as introduced
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A bill for an act
relating to health care; exempting medications for the prevention or treatment of
HIV from medical assistance and MinnesotaCare co-payments; amending
Minnesota Statutes 2020, sections 256B.0631, subdivision 1; 256L.03, subdivision
5.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2020, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:
(1) $3 per nonpreventive visit, except as provided in paragraph (b). 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 assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometrist;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription and $1 per generic drug prescription, subject
to a $12 per month maximum for prescription drug co-payments. No co-payments shall
apply to antipsychotic drugs when used for the treatment of mental illnessnew text begin . No co-payments
shall apply to medications when used for the prevention or treatment of the human
immunodeficiency virus (HIV)new text end ;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
Sec. 2.
Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 deleted text begin anddeleted text end new text begin ,new text end to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5new text begin , or to pre-exposure prophylaxis (PrEP) and postexposure
prophylaxis (PEP) medications when used for the prevention or treatment of the human
immunodeficiency virus (HIV)new text end .
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
Sec. 3. new text begin EFFECTIVE DATE.
new text end
new text begin
Sections 1 and 2 are effective January 1, 2022, subject to federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end