1.1                          A bill for an act 
  1.2             relating to human services; modifying date of 
  1.3             application for general assistance medical care; 
  1.4             reducing the co-payment for inpatient hospitalization 
  1.5             services under general assistance medical care; 
  1.6             amending Minnesota Statutes 2003 Supplement, section 
  1.7             256D.03, subdivisions 3, 4.  
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2003 Supplement, section 
  1.10  256D.03, subdivision 3, is amended to read: 
  1.11     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
  1.12  (a) General assistance medical care may be paid for any person 
  1.13  who is not eligible for medical assistance under chapter 256B, 
  1.14  including eligibility for medical assistance based on a 
  1.15  spenddown of excess income according to section 256B.056, 
  1.16  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
  1.17  except as provided in paragraph (c), and: 
  1.18     (1) who is receiving assistance under section 256D.05, 
  1.19  except for families with children who are eligible under 
  1.20  Minnesota family investment program (MFIP), or who is having a 
  1.21  payment made on the person's behalf under sections 256I.01 to 
  1.22  256I.06; or 
  1.23     (2) who is a resident of Minnesota; and 
  1.24     (i) who has gross countable income not in excess of 75 
  1.25  percent of the federal poverty guidelines for the family size, 
  1.26  using a six-month budget period and whose equity in assets is 
  2.1   not in excess of $1,000 per assistance unit.  Exempt assets, the 
  2.2   reduction of excess assets, and the waiver of excess assets must 
  2.3   conform to the medical assistance program in section 256B.056, 
  2.4   subdivision 3, with the following exception:  the maximum amount 
  2.5   of undistributed funds in a trust that could be distributed to 
  2.6   or on behalf of the beneficiary by the trustee, assuming the 
  2.7   full exercise of the trustee's discretion under the terms of the 
  2.8   trust, must be applied toward the asset maximum; or 
  2.9      (ii) who has gross countable income above 75 percent of the 
  2.10  federal poverty guidelines but not in excess of 175 percent of 
  2.11  the federal poverty guidelines for the family size, using a 
  2.12  six-month budget period, whose equity in assets is not in excess 
  2.13  of the limits in section 256B.056, subdivision 3c, and who 
  2.14  applies during an inpatient hospitalization.  
  2.15     (b) General assistance medical care may not be paid for 
  2.16  applicants or recipients who meet all eligibility requirements 
  2.17  of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 
  2.18  are adults with dependent children under 21 whose gross family 
  2.19  income is equal to or less than 275 percent of the federal 
  2.20  poverty guidelines. 
  2.21     (c) For applications received on or after October 1, 2003, 
  2.22  eligibility may begin no earlier than the date of application.  
  2.23  For individuals eligible under paragraph (a), clause (2), item 
  2.24  (i), a redetermination of eligibility must occur every 12 
  2.25  months.  Individuals are eligible under paragraph (a), clause 
  2.26  (2), item (ii), only during inpatient hospitalization but may 
  2.27  reapply if there is a subsequent period of inpatient 
  2.28  hospitalization.  Beginning January 1, 2000, Minnesota health 
  2.29  care program applications completed by recipients and applicants 
  2.30  who are persons described in paragraph (b), may be returned to 
  2.31  the county agency to be forwarded to the Department of Human 
  2.32  Services or sent directly to the Department of Human Services 
  2.33  for enrollment in MinnesotaCare.  If all other eligibility 
  2.34  requirements of this subdivision are met, eligibility for 
  2.35  general assistance medical care shall be available in any month 
  2.36  during which a MinnesotaCare eligibility determination and 
  3.1   enrollment are pending.  Upon notification of eligibility for 
  3.2   MinnesotaCare, notice of termination for eligibility for general 
  3.3   assistance medical care shall be sent to an applicant or 
  3.4   recipient.  If all other eligibility requirements of this 
  3.5   subdivision are met, eligibility for general assistance medical 
  3.6   care shall be available until enrollment in MinnesotaCare 
  3.7   subject to the provisions of paragraph (e). 
  3.8      (d) The date of an initial Minnesota health care program 
  3.9   application necessary to begin a determination of eligibility 
  3.10  shall be the date the applicant has provided a name, address, 
  3.11  and Social Security number, signed and dated, to the county 
  3.12  agency or the Department of Human Services.  If the applicant is 
  3.13  unable to provide a name, address, Social Security number, and 
  3.14  signature when health care is delivered due to a medical 
  3.15  condition or disability, a health care provider may act on an 
  3.16  applicant's behalf to establish the date of an initial Minnesota 
  3.17  health care program application by providing the county agency 
  3.18  or Department of Human Services with provider identification and 
  3.19  a temporary unique identifier for the applicant by the end of 
  3.20  the next business day.  The applicant must complete the 
  3.21  remainder of the application and provide necessary verification 
  3.22  before eligibility can be determined.  The county agency must 
  3.23  assist the applicant in obtaining verification if necessary.  
  3.24     (e) County agencies are authorized to use all automated 
  3.25  databases containing information regarding recipients' or 
  3.26  applicants' income in order to determine eligibility for general 
  3.27  assistance medical care or MinnesotaCare.  Such use shall be 
  3.28  considered sufficient in order to determine eligibility and 
  3.29  premium payments by the county agency. 
  3.30     (f) General assistance medical care is not available for a 
  3.31  person in a correctional facility unless the person is detained 
  3.32  by law for less than one year in a county correctional or 
  3.33  detention facility as a person accused or convicted of a crime, 
  3.34  or admitted as an inpatient to a hospital on a criminal hold 
  3.35  order, and the person is a recipient of general assistance 
  3.36  medical care at the time the person is detained by law or 
  4.1   admitted on a criminal hold order and as long as the person 
  4.2   continues to meet other eligibility requirements of this 
  4.3   subdivision.  
  4.4      (g) General assistance medical care is not available for 
  4.5   applicants or recipients who do not cooperate with the county 
  4.6   agency to meet the requirements of medical assistance.  
  4.7      (h) In determining the amount of assets of an individual 
  4.8   eligible under paragraph (a), clause (2), item (i), there shall 
  4.9   be included any asset or interest in an asset, including an 
  4.10  asset excluded under paragraph (a), that was given away, sold, 
  4.11  or disposed of for less than fair market value within the 60 
  4.12  months preceding application for general assistance medical care 
  4.13  or during the period of eligibility.  Any transfer described in 
  4.14  this paragraph shall be presumed to have been for the purpose of 
  4.15  establishing eligibility for general assistance medical care, 
  4.16  unless the individual furnishes convincing evidence to establish 
  4.17  that the transaction was exclusively for another purpose.  For 
  4.18  purposes of this paragraph, the value of the asset or interest 
  4.19  shall be the fair market value at the time it was given away, 
  4.20  sold, or disposed of, less the amount of compensation received.  
  4.21  For any uncompensated transfer, the number of months of 
  4.22  ineligibility, including partial months, shall be calculated by 
  4.23  dividing the uncompensated transfer amount by the average 
  4.24  monthly per person payment made by the medical assistance 
  4.25  program to skilled nursing facilities for the previous calendar 
  4.26  year.  The individual shall remain ineligible until this fixed 
  4.27  period has expired.  The period of ineligibility may exceed 30 
  4.28  months, and a reapplication for benefits after 30 months from 
  4.29  the date of the transfer shall not result in eligibility unless 
  4.30  and until the period of ineligibility has expired.  The period 
  4.31  of ineligibility begins in the month the transfer was reported 
  4.32  to the county agency, or if the transfer was not reported, the 
  4.33  month in which the county agency discovered the transfer, 
  4.34  whichever comes first.  For applicants, the period of 
  4.35  ineligibility begins on the date of the first approved 
  4.36  application. 
  5.1      (i) When determining eligibility for any state benefits 
  5.2   under this subdivision, the income and resources of all 
  5.3   noncitizens shall be deemed to include their sponsor's income 
  5.4   and resources as defined in the Personal Responsibility and Work 
  5.5   Opportunity Reconciliation Act of 1996, title IV, Public Law 
  5.6   104-193, sections 421 and 422, and subsequently set out in 
  5.7   federal rules. 
  5.8      (j) Undocumented noncitizens and nonimmigrants are 
  5.9   ineligible for general assistance medical care, except an 
  5.10  individual eligible under paragraph (a), clause (4), remains 
  5.11  eligible through September 30, 2003.  For purposes of this 
  5.12  subdivision, a nonimmigrant is an individual in one or more of 
  5.13  the classes listed in United States Code, title 8, section 
  5.14  1101(a)(15), and an undocumented noncitizen is an individual who 
  5.15  resides in the United States without the approval or 
  5.16  acquiescence of the Immigration and Naturalization Service. 
  5.17     (k) Notwithstanding any other provision of law, a 
  5.18  noncitizen who is ineligible for medical assistance due to the 
  5.19  deeming of a sponsor's income and resources, is ineligible for 
  5.20  general assistance medical care. 
  5.21     (l) Effective July 1, 2003, general assistance medical care 
  5.22  emergency services end.  
  5.23     Sec. 2.  Minnesota Statutes 2003 Supplement, section 
  5.24  256D.03, subdivision 4, is amended to read: 
  5.25     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
  5.26  (a)(i) For a person who is eligible under subdivision 3, 
  5.27  paragraph (a), clause (2), item (i), general assistance medical 
  5.28  care covers, except as provided in paragraph (c): 
  5.29     (1) inpatient hospital services; 
  5.30     (2) outpatient hospital services; 
  5.31     (3) services provided by Medicare certified rehabilitation 
  5.32  agencies; 
  5.33     (4) prescription drugs and other products recommended 
  5.34  through the process established in section 256B.0625, 
  5.35  subdivision 13; 
  5.36     (5) equipment necessary to administer insulin and 
  6.1   diagnostic supplies and equipment for diabetics to monitor blood 
  6.2   sugar level; 
  6.3      (6) eyeglasses and eye examinations provided by a physician 
  6.4   or optometrist; 
  6.5      (7) hearing aids; 
  6.6      (8) prosthetic devices; 
  6.7      (9) laboratory and X-ray services; 
  6.8      (10) physician's services; 
  6.9      (11) medical transportation except special transportation; 
  6.10     (12) chiropractic services as covered under the medical 
  6.11  assistance program; 
  6.12     (13) podiatric services; 
  6.13     (14) dental services and dentures, subject to the 
  6.14  limitations specified in section 256B.0625, subdivision 9; 
  6.15     (15) outpatient services provided by a mental health center 
  6.16  or clinic that is under contract with the county board and is 
  6.17  established under section 245.62; 
  6.18     (16) day treatment services for mental illness provided 
  6.19  under contract with the county board; 
  6.20     (17) prescribed medications for persons who have been 
  6.21  diagnosed as mentally ill as necessary to prevent more 
  6.22  restrictive institutionalization; 
  6.23     (18) psychological services, medical supplies and 
  6.24  equipment, and Medicare premiums, coinsurance and deductible 
  6.25  payments; 
  6.26     (19) medical equipment not specifically listed in this 
  6.27  paragraph when the use of the equipment will prevent the need 
  6.28  for costlier services that are reimbursable under this 
  6.29  subdivision; 
  6.30     (20) services performed by a certified pediatric nurse 
  6.31  practitioner, a certified family nurse practitioner, a certified 
  6.32  adult nurse practitioner, a certified obstetric/gynecological 
  6.33  nurse practitioner, a certified neonatal nurse practitioner, or 
  6.34  a certified geriatric nurse practitioner in independent 
  6.35  practice, if (1) the service is otherwise covered under this 
  6.36  chapter as a physician service, (2) the service provided on an 
  7.1   inpatient basis is not included as part of the cost for 
  7.2   inpatient services included in the operating payment rate, and 
  7.3   (3) the service is within the scope of practice of the nurse 
  7.4   practitioner's license as a registered nurse, as defined in 
  7.5   section 148.171; 
  7.6      (21) services of a certified public health nurse or a 
  7.7   registered nurse practicing in a public health nursing clinic 
  7.8   that is a department of, or that operates under the direct 
  7.9   authority of, a unit of government, if the service is within the 
  7.10  scope of practice of the public health nurse's license as a 
  7.11  registered nurse, as defined in section 148.171; and 
  7.12     (22) telemedicine consultations, to the extent they are 
  7.13  covered under section 256B.0625, subdivision 3b.  
  7.14     (ii) Effective October 1, 2003, for a person who is 
  7.15  eligible under subdivision 3, paragraph (a), clause (2), item 
  7.16  (ii), general assistance medical care coverage is limited to 
  7.17  inpatient hospital services, including physician services 
  7.18  provided during the inpatient hospital stay.  A ~~$1,000~~ $100 
  7.19  deductible is required for each inpatient hospitalization.  
  7.20     (b) Gender reassignment surgery and related services are 
  7.21  not covered services under this subdivision unless the 
  7.22  individual began receiving gender reassignment services prior to 
  7.23  July 1, 1995.  
  7.24     (c) In order to contain costs, the commissioner of human 
  7.25  services shall select vendors of medical care who can provide 
  7.26  the most economical care consistent with high medical standards 
  7.27  and shall where possible contract with organizations on a 
  7.28  prepaid capitation basis to provide these services.  The 
  7.29  commissioner shall consider proposals by counties and vendors 
  7.30  for prepaid health plans, competitive bidding programs, block 
  7.31  grants, or other vendor payment mechanisms designed to provide 
  7.32  services in an economical manner or to control utilization, with 
  7.33  safeguards to ensure that necessary services are provided.  
  7.34  Before implementing prepaid programs in counties with a county 
  7.35  operated or affiliated public teaching hospital or a hospital or 
  7.36  clinic operated by the University of Minnesota, the commissioner 
  8.1   shall consider the risks the prepaid program creates for the 
  8.2   hospital and allow the county or hospital the opportunity to 
  8.3   participate in the program in a manner that reflects the risk of 
  8.4   adverse selection and the nature of the patients served by the 
  8.5   hospital, provided the terms of participation in the program are 
  8.6   competitive with the terms of other participants considering the 
  8.7   nature of the population served.  Payment for services provided 
  8.8   pursuant to this subdivision shall be as provided to medical 
  8.9   assistance vendors of these services under sections 256B.02, 
  8.10  subdivision 8, and 256B.0625.  For payments made during fiscal 
  8.11  year 1990 and later years, the commissioner shall consult with 
  8.12  an independent actuary in establishing prepayment rates, but 
  8.13  shall retain final control over the rate methodology.  
  8.14     (d) Recipients eligible under subdivision 3, paragraph (a), 
  8.15  clause (2), item (i), shall pay the following co-payments for 
  8.16  services provided on or after October 1, 2003: 
  8.17     (1) $3 per nonpreventive visit.  For purposes of this 
  8.18  subdivision, a visit means an episode of service which is 
  8.19  required because of a recipient's symptoms, diagnosis, or 
  8.20  established illness, and which is delivered in an ambulatory 
  8.21  setting by a physician or physician ancillary, chiropractor, 
  8.22  podiatrist, nurse midwife, advanced practice nurse, audiologist, 
  8.23  optician, or optometrist; 
  8.24     (2) $25 for eyeglasses; 
  8.25     (3) $25 for nonemergency visits to a hospital-based 
  8.26  emergency room; 
  8.27     (4) $3 per brand-name drug prescription and $1 per generic 
  8.28  drug prescription, subject to a $20 per month maximum for 
  8.29  prescription drug co-payments.  No co-payments shall apply to 
  8.30  antipsychotic drugs when used for the treatment of mental 
  8.31  illness; and 
  8.32     (5) 50 percent coinsurance on basic restorative dental 
  8.33  services. 
  8.34     (e) Recipients of general assistance medical care are 
  8.35  responsible for all co-payments in this subdivision.  The 
  8.36  general assistance medical care reimbursement to the provider 
  9.1   shall be reduced by the amount of the co-payment, except that 
  9.2   reimbursement for prescription drugs shall not be reduced once a 
  9.3   recipient has reached the $20 per month maximum for prescription 
  9.4   drug co-payments.  The provider collects the co-payment from the 
  9.5   recipient.  Providers may not deny services to recipients who 
  9.6   are unable to pay the co-payment, except as provided in 
  9.7   paragraph (f). 
  9.8      (f) If it is the routine business practice of a provider to 
  9.9   refuse service to an individual with uncollected debt, the 
  9.10  provider may include uncollected co-payments under this 
  9.11  section.  A provider must give advance notice to a recipient 
  9.12  with uncollected debt before services can be denied. 
  9.13     (g) Any county may, from its own resources, provide medical 
  9.14  payments for which state payments are not made. 
  9.15     (h) Chemical dependency services that are reimbursed under 
  9.16  chapter 254B must not be reimbursed under general assistance 
  9.17  medical care. 
  9.18     (i) The maximum payment for new vendors enrolled in the 
  9.19  general assistance medical care program after the base year 
  9.20  shall be determined from the average usual and customary charge 
  9.21  of the same vendor type enrolled in the base year. 
  9.22     (j) The conditions of payment for services under this 
  9.23  subdivision are the same as the conditions specified in rules 
  9.24  adopted under chapter 256B governing the medical assistance 
  9.25  program, unless otherwise provided by statute or rule. 
  9.26     (k) Inpatient and outpatient payments shall be reduced by 
  9.27  five percent, effective July 1, 2003.  This reduction is in 
  9.28  addition to the five percent reduction effective July 1, 2003, 
  9.29  and incorporated by reference in paragraph (i).  
  9.30     (l) Payments for all other health services except 
  9.31  inpatient, outpatient, and pharmacy services shall be reduced by 
  9.32  five percent, effective July 1, 2003.  
  9.33     (m) Payments to managed care plans shall be reduced by five 
  9.34  percent for services provided on or after October 1, 2003. 
  9.35     (n) A hospital receiving a reduced payment as a result of 
  9.36  this section may apply the unpaid balance toward satisfaction of 
 10.1   the hospital's bad debts.