1.1                          A bill for an act 
  1.2             relating to health; expanding eligibility for the 
  1.3             MinnesotaCare program; modifying the financial 
  1.4             management provisions for MinnesotaCare; increasing 
  1.5             the MinnesotaCare provider reimbursement rate; 
  1.6             amending Minnesota Statutes 1995 Supplement, sections 
  1.7             256.9352, subdivision 3; and 256.9354, subdivision 5; 
  1.8             proposing coding for new law in Minnesota Statutes, 
  1.9             chapter 256. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 1995 Supplement, section 
  1.12  256.9354, subdivision 5, is amended to read: 
  1.13     Subd. 5.  [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO 
  1.14  CHILDREN.] (a) Beginning October 1, 1994, the definition of 
  1.15  "eligible persons" is expanded to include all individuals and 
  1.16  households with no children who have gross family incomes that 
  1.17  are equal to or less than 125 percent of the federal poverty 
  1.18  guidelines and who are not eligible for medical assistance 
  1.19  without a spenddown under chapter 256B.  
  1.20     (b) After October 1, 1995 Beginning July 1, 1996, the 
  1.21  commissioner of human services may shall expand the definition 
  1.22  of "eligible persons" to include all individuals and households 
  1.23  with no children who have gross family incomes that are equal to 
  1.24  or less than 135 150 percent of federal poverty guidelines and 
  1.25  are not eligible for medical assistance without a spenddown 
  1.26  under chapter 256B.  This expansion may must occur only 
  1.27  if unless the commissioner certifies that the financial 
  2.1   management requirements of section 256.9352, subdivision 3, can 
  2.2   cannot be met. 
  2.3      (c) The commissioners of health and human services, in 
  2.4   consultation with the legislative commission on health care 
  2.5   access, shall make preliminary recommendations to the 
  2.6   legislature by October 1, 1995, and final recommendations to the 
  2.7   legislature by February 1, 1996, on whether a further expansion 
  2.8   of the definition of "eligible persons" to include all 
  2.9   individuals and households with no children who have gross 
  2.10  family incomes that are equal to or less than 150 percent of 
  2.11  federal poverty guidelines and are not eligible for medical 
  2.12  assistance without a spenddown under chapter 256B would be 
  2.13  allowed under the financial management constraints outlined in 
  2.14  section 256.9352, subdivision 3.  
  2.15     (d) All eligible persons under paragraphs (a) and (b) are 
  2.16  eligible for coverage through the MinnesotaCare program but must 
  2.17  pay a premium as determined under sections 256.9357 and 
  2.18  256.9358.  Individuals and families whose income is greater than 
  2.19  the limits established under section 256.9358 may not enroll in 
  2.20  the MinnesotaCare program. 
  2.21     Sec. 2.  Minnesota Statutes 1995 Supplement, section 
  2.22  256.9352, subdivision 3, is amended to read: 
  2.23     Subd. 3.  [FINANCIAL MANAGEMENT.] (a) The commissioner 
  2.24  shall manage spending for the MinnesotaCare program in a manner 
  2.25  that maintains a minimum reserve equal to five percent of the 
  2.26  expected cost of state premium subsidies.  The commissioner must 
  2.27  make a quarterly assessment of the expected expenditures for the 
  2.28  covered services for the remainder of the current biennium and 
  2.29  for the following biennium.  The estimated expenditure, 
  2.30  including minimum reserve requirements, shall be compared to an 
  2.31  estimate of the revenues that will be deposited in the health 
  2.32  care access fund.  Based on this comparison, and after 
  2.33  consulting with the chairs of the house ways and means committee 
  2.34  and the senate finance committee, and the legislative commission 
  2.35  on health care access, the commissioner shall, as necessary, 
  2.36  make the adjustments specified in paragraph (b) to ensure that 
  3.1   expenditures remain within the limits of available revenues for 
  3.2   the remainder of the current biennium and for the following 
  3.3   biennium.  The commissioner shall not hire additional staff 
  3.4   using appropriations from the health care access fund until the 
  3.5   commissioner of finance makes a determination that the 
  3.6   adjustments implemented under paragraph (b) are sufficient to 
  3.7   allow MinnesotaCare expenditures to remain within the limits of 
  3.8   available revenues for the remainder of the current biennium and 
  3.9   for the following biennium. 
  3.10     (b) The adjustments the commissioner shall use must be 
  3.11  implemented in this order:  first, reduce MinnesotaCare provider 
  3.12  reimbursement rates as required under section 256.9370, 
  3.13  subdivision 2; second, stop enrollment of single adults and 
  3.14  households without children; second third, upon 45 days' notice, 
  3.15  stop coverage of single adults and households without children 
  3.16  already enrolled in the MinnesotaCare program; third fourth, 
  3.17  upon 90 days' notice, decrease the premium subsidy amounts by 
  3.18  ten percent for families with gross annual income above 200 
  3.19  percent of the federal poverty guidelines; fourth fifth, upon 90 
  3.20  days' notice, decrease the premium subsidy amounts by ten 
  3.21  percent for families with gross annual income at or below 200 
  3.22  percent; and fifth sixth, require applicants to be uninsured for 
  3.23  at least six months prior to eligibility in the MinnesotaCare 
  3.24  program.  If these measures are insufficient to limit the 
  3.25  expenditures to the estimated amount of revenue, the 
  3.26  commissioner shall further limit enrollment or decrease premium 
  3.27  subsidies. 
  3.28     The reserve referred to in this subdivision is appropriated 
  3.29  to the commissioner but may only be used upon approval of the 
  3.30  commissioner of finance, if estimated costs will exceed the 
  3.31  forecasted amount of available revenues after all adjustments 
  3.32  authorized under this subdivision have been made. 
  3.33     By February 1, 1995, the department of human services and 
  3.34  the department of health shall develop a plan to adjust benefit 
  3.35  levels, eligibility guidelines, or other steps necessary to 
  3.36  ensure that expenditures for the MinnesotaCare program are 
  4.1   contained within the two percent taxes imposed under section 
  4.2   295.52 and the gross premiums tax imposed under section 60A.15, 
  4.3   subdivision 1, paragraph (e), for fiscal year 1997.  
  4.4      (c) Notwithstanding paragraphs (a) and (b), the 
  4.5   commissioner shall proceed with the enrollment of single adults 
  4.6   and households without children in accordance with section 
  4.7   256.9354, subdivision 5, paragraph (a), even if the expenditures 
  4.8   do not remain within the limits of available revenues through 
  4.9   fiscal year 1997 to allow the departments of human services and 
  4.10  health to develop the plan required under paragraph (b). 
  4.11     Sec. 3.  [256.9370] [PROVIDER REIMBURSEMENT UNDER 
  4.12  MINNESOTACARE PROGRAM.] 
  4.13     Subdivision 1.  [RATE INCREASE.] Effective for services 
  4.14  provided on or after July 1, 1996, the commissioner shall 
  4.15  increase MinnesotaCare provider reimbursement rates for all 
  4.16  services covered by MinnesotaCare by 15 percent above the rates 
  4.17  in effect on June 30, 1996.  The commissioner shall adjust any 
  4.18  capitation rates developed for MinnesotaCare enrollees to 
  4.19  reflect this increase. 
  4.20     Subd. 2.  [COMPLIANCE WITH FINANCIAL MANAGEMENT 
  4.21  REQUIREMENTS.] The commissioner shall reduce the reimbursement 
  4.22  rates established under subdivision 1, including capitation 
  4.23  rates if applicable, as provided in section 256.9352, 
  4.24  subdivision 3, if this is necessary to comply with the financial 
  4.25  management requirements for the MinnesotaCare program.  The 
  4.26  commissioner may not reduce reimbursement rates to a level lower 
  4.27  than the rates in effect on June 30, 1996, and any reduction in 
  4.28  capitation rates must not reflect this limitation.