1.1                          A bill for an act 
  1.2             relating to human services; expanding eligibility for 
  1.3             the senior drug program; changing the senior drug 
  1.4             program to prescription drug program; requiring 
  1.5             information on prescription drug patient assistance 
  1.6             programs; amending Minnesota Statutes 1998, section 
  1.7             256.955, subdivisions 1 and 2; Minnesota Statutes 1999 
  1.8             Supplement, section 256.955, subdivisions 4, 7, 8, and 
  1.9             9; Laws 1997, chapter 225, article 4, section 4, as 
  1.10            amended. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1998, section 256.955, 
  1.13  subdivision 1, is amended to read: 
  1.14     Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  1.15  services shall establish and administer a ~~senior citizen~~ 
  1.16  prescription drug program.  Qualified ~~senior citizens~~ 
  1.17  individuals shall be eligible for prescription drug coverage 
  1.18  under the program beginning no later than January 1, 1999. 
  1.19     Sec. 2.  Minnesota Statutes 1998, section 256.955, 
  1.20  subdivision 2, is amended to read: 
  1.21     Subd. 2.  [DEFINITIONS.] (a) For purposes of this section, 
  1.22  the following definitions apply. 
  1.23     (b) "Health plan" has the meaning provided in section 
  1.24  62Q.01, subdivision 3. 
  1.25     (c) "Health plan company" has the meaning provided in 
  1.26  section 62Q.01, subdivision 4. 
  1.27     (d) "Qualified ~~senior citizen~~ individual" means a Medicare 
  1.28  enrollee, or an individual age 65 or older who is not a Medicare 
  2.1   enrollee, who: 
  2.2      (1) ~~is eligible as a qualified Medicare beneficiary~~ 
  2.3   ~~according to section 256B.057, subdivision 3 or 3a, or is~~ 
  2.4   ~~eligible under section 256B.057, subdivision 3 or 3a, and is~~ 
  2.5   ~~also eligible for medical assistance or general assistance~~ 
  2.6   ~~medical care with a spenddown as defined in section 256B.056,~~ 
  2.7   ~~subdivision 5.  Persons who are determined eligible for medical~~ 
  2.8   ~~assistance according to section 256B.0575, who are eligible for~~ 
  2.9   ~~medical assistance or general assistance medical care without a~~ 
  2.10  ~~spenddown, or who are enrolled in MinnesotaCare, are not~~ 
  2.11  ~~eligible for this program~~ has a household income that does not 
  2.12  exceed 300 percent of the federal poverty guidelines for family 
  2.13  size, using the income methodologies specified for aged, blind, 
  2.14  or disabled persons in section 256B.056, subdivision 1a; 
  2.15     (2) has assets that do not exceed $8,000 for a single 
  2.16  individual and $12,000 for a married couple or family of two or 
  2.17  more, as determined using the methodologies specified for aged, 
  2.18  blind, or disabled persons in section 256B.056, subdivision 1a; 
  2.19     ~~(2)~~ (3) is not enrolled in prescription drug coverage under 
  2.20  a health plan; 
  2.21     ~~(3)~~ (4) is not enrolled in prescription drug coverage under 
  2.22  a Medicare supplement plan, as defined in sections 62A.31 to 
  2.23  62A.44, or policies, contracts, or certificates that supplement 
  2.24  Medicare issued by health maintenance organizations or those 
  2.25  policies, contracts, or certificates governed by section 1833 or 
  2.26  1876 of the federal Social Security Act, United States Code, 
  2.27  title 42, section 1395, et seq., as amended; 
  2.28     ~~(4)~~ (5) has not had coverage described in clauses (2) and 
  2.29  (3) for at least four months prior to application for the 
  2.30  program; ~~and~~ 
  2.31     ~~(5)~~ (6) is a permanent resident of Minnesota as defined in 
  2.32  section 256L.09; and 
  2.33     (7) is not eligible for MinnesotaCare, for medical 
  2.34  assistance according to section 256B.0575, or for medical 
  2.35  assistance or general assistance medical care without a 
  2.36  spenddown. 
  3.1      Sec. 3.  Minnesota Statutes 1999 Supplement, section 
  3.2   256.955, subdivision 4, is amended to read: 
  3.3      Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
  3.4   MEDICAL ASSISTANCE.] Applications and information on the program 
  3.5   must be made available at county social service agencies, health 
  3.6   care provider offices, and agencies and organizations serving 
  3.7   senior citizens and persons with disabilities.  ~~Senior citizens~~ 
  3.8   Individuals shall submit applications and any information 
  3.9   specified by the commissioner as being necessary to verify 
  3.10  eligibility directly to the county social service agencies:  
  3.11     (1) beginning January 1, 1999, the county social service 
  3.12  agency shall determine medical assistance spenddown eligibility 
  3.13  of individuals who qualify for the ~~senior citizen~~ prescription 
  3.14  drug program ~~of individuals~~; and 
  3.15     (2) program payments will be used to reduce the spenddown 
  3.16  obligations of individuals who are determined to be eligible for 
  3.17  medical assistance with a spenddown as defined in section 
  3.18  256B.056, subdivision 5. 
  3.19  ~~Seniors~~ Qualified individuals who are eligible for medical 
  3.20  assistance with a spenddown shall be financially responsible for 
  3.21  the deductible amount up to the satisfaction of the spenddown.  
  3.22  No deductible applies once the spenddown has been met.  Payments 
  3.23  to providers for prescription drugs for persons eligible under 
  3.24  this subdivision shall be reduced by the deductible.  
  3.25     County social service agencies shall determine an 
  3.26  applicant's eligibility for the program within 30 days from the 
  3.27  date the application is received.  Eligibility begins the month 
  3.28  after approval. 
  3.29     Sec. 4.  Minnesota Statutes 1999 Supplement, section 
  3.30  256.955, subdivision 7, is amended to read: 
  3.31     Subd. 7.  [COST SHARING.] (a) Enrollees shall pay an annual 
  3.32  enrollment fee based on the following sliding scale.  
  3.33    Household income as percentage                Annual
  3.34    of the federal poverty guidelines         Enrollment fee
  3.35    120 percent or less                            $  0 
  3.36    121 percent to 150 percent                     $120 
  4.1     151 percent to 200 percent                     $360 
  4.2     201 percent to 250 percent                     $600 
  4.3     251 percent to 300 percent        full average per person 
  4.4                                       cost of coverage minus 
  4.5                                       the $420 annual deductible  
  4.6   Enrollees whose household incomes increase above 300 percent of 
  4.7   the federal poverty guidelines after initial program enrollment 
  4.8   may remain enrolled if they maintain continuous enrollment and 
  4.9   pay an annual enrollment fee equal to the full average per 
  4.10  person cost of coverage minus the $420 annual deductible. 
  4.11     (b) Program enrollees must satisfy a $420 annual 
  4.12  deductible, based upon expenditures for prescription drugs, to 
  4.13  be paid in $35 monthly increments. 
  4.14     Sec. 5.  Minnesota Statutes 1999 Supplement, section 
  4.15  256.955, subdivision 8, is amended to read: 
  4.16     Subd. 8.  [REPORT.] The commissioner shall annually report 
  4.17  to the legislature on the ~~senior citizen~~ prescription drug 
  4.18  program.  The report must include demographic information on 
  4.19  enrollees, per-prescription expenditures, total program 
  4.20  expenditures, hospital and nursing home costs avoided by 
  4.21  enrollees, any savings to medical assistance and Medicare 
  4.22  resulting from the provision of prescription drug coverage under 
  4.23  Medicare by health maintenance organizations, other public and 
  4.24  private options for drug assistance to the ~~senior~~ covered 
  4.25  population, any hardships caused by the annual enrollment fee 
  4.26  and deductible, and any recommendations for changes in 
  4.27  the ~~senior~~ prescription drug program. 
  4.28     Sec. 6.  Minnesota Statutes 1999 Supplement, section 
  4.29  256.955, subdivision 9, is amended to read: 
  4.30     Subd. 9.  [PROGRAM LIMITATION.] The commissioner shall 
  4.31  administer the ~~senior~~ prescription drug program so that the 
  4.32  costs total no more than funds appropriated plus the drug rebate 
  4.33  proceeds.  ~~Senior~~ Prescription drug program rebate revenues are 
  4.34  appropriated to the commissioner and shall be expended to 
  4.35  augment funding of the ~~senior~~ prescription drug program.  New 
  4.36  enrollment shall cease if the commissioner determines that, 
  4.37  given current enrollment, costs of the program will exceed 
  5.1   appropriated funds and rebate proceeds.  ~~This section shall be~~ 
  5.2   ~~repealed upon federal approval of the waiver to allow the~~ 
  5.3   ~~commissioner to provide prescription drug coverage for qualified~~ 
  5.4   ~~Medicare beneficiaries whose income is less than 150 percent of~~ 
  5.5   ~~the federal poverty guidelines.~~ 
  5.6      Sec. 7.  Laws 1997, chapter 225, article 4, section 4, as 
  5.7   amended by Laws 1999, chapter 245, article 4, section 104, is 
  5.8   amended to read: 
  5.9      Sec. 4.  [~~SENIOR~~ PRESCRIPTION DRUG PROGRAM.] 
  5.10     The commissioner shall report to the legislature the 
  5.11  estimated costs of the ~~senior~~ prescription drug program ~~without~~ 
  5.12  ~~funding caps~~.  The report shall be included as part of the 
  5.13  November and February forecasts. 
  5.14     The commissioner of finance shall annually reimburse the 
  5.15  general fund with health care access funds for the estimated 
  5.16  increased costs in the QMB/SLMB program directly associated with 
  5.17  the ~~senior~~ prescription drug program.  This reimbursement shall 
  5.18  sunset June 30, 2001. 
  5.19     Sec. 8.  [INFORMATION ON PRESCRIPTION DRUG PATIENT 
  5.20  ASSISTANCE PROGRAMS.] 
  5.21     The commissioner of human services must work with the board 
  5.22  of medical practice and the Pharmaceutical Research and 
  5.23  Manufacturers of America (PhRMA) to develop a strategy to 
  5.24  provide information on prescription drug patient assistance 
  5.25  programs offered by member companies of PhRMA to all physicians 
  5.26  in the state.  Any strategy developed must provide physicians 
  5.27  with regular updates on prescription drug patient assistance 
  5.28  programs and be implemented without cost to physicians or the 
  5.29  state. 
  5.30     Sec. 9.  [INSTRUCTION TO REVISOR.] 
  5.31     The revisor of statutes shall change the phrase "senior 
  5.32  citizen drug program" wherever it appears in the next edition of 
  5.33  Minnesota Statutes and Minnesota Rules to "prescription drug 
  5.34  program." 
  5.35     Sec. 10.  [APPROPRIATION.] 
  5.36     $....... is appropriated from the general fund to the 
  6.1   commissioner of human services for the fiscal year ending June 
  6.2   30, 2001, to fund the prescription drug program.