1.1                          A bill for an act 
  1.2             relating to human services; changing provisions in the 
  1.3             medical assistance prepayment demonstration project; 
  1.4             amending Minnesota Statutes 2000, sections 62Q.19, 
  1.5             subdivision 1; 256B.69, subdivision 4. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 2000, section 62Q.19, 
  1.8   subdivision 1, is amended to read: 
  1.9      Subdivision 1.  [DESIGNATION.] The commissioner shall 
  1.10  designate essential community providers.  The criteria for 
  1.11  essential community provider designation shall be the following: 
  1.12     (1) a demonstrated ability to integrate applicable 
  1.13  supportive and stabilizing services with medical care for 
  1.14  uninsured persons and high-risk and special needs populations as 
  1.15  defined in section 62Q.07, subdivision 2, paragraph (e), 
  1.16  underserved, and other special needs populations; and 
  1.17     (2) a commitment to serve low-income and underserved 
  1.18  populations by meeting the following requirements: 
  1.19     (i) has nonprofit status in accordance with chapter 317A; 
  1.20     (ii) has tax exempt status in accordance with the Internal 
  1.21  Revenue Service Code, section 501(c)(3); 
  1.22     (iii) charges for services on a sliding fee schedule based 
  1.23  on current poverty income guidelines; and 
  1.24     (iv) does not restrict access or services because of a 
  1.25  client's financial limitation; 
  2.1      (3) status as a local government unit as defined in section 
  2.2   62D.02, subdivision 11, a hospital district created or 
  2.3   reorganized under sections 447.31 to 447.37, an Indian tribal 
  2.4   government, an Indian health service unit, or a community health 
  2.5   board as defined in chapter 145A; 
  2.6      (4) a former state hospital that specializes in the 
  2.7   treatment of cerebral palsy, spina bifida, epilepsy, closed head 
  2.8   injuries, specialized orthopedic problems, and other disabling 
  2.9   conditions; or 
  2.10     (5) a rural hospital that has qualified for a sole 
  2.11  community hospital financial assistance grant in the past three 
  2.12  years under section 144.1484, subdivision 1.  For these rural 
  2.13  hospitals, the essential community provider designation applies 
  2.14  to all health services provided, including both inpatient and 
  2.15  outpatient services; or 
  2.16     (6) an alternative school authorized under sections 123A.05 
  2.17  to 123A.08 or under section 124D.68 and a charter school 
  2.18  authorized under section 124D.10.  For these schools the 
  2.19  essential community provider designation applies for mental 
  2.20  health services delivered by a licensed health care or social 
  2.21  services practitioner to a child currently enrolled in the 
  2.22  school. 
  2.23     Prior to designation, the commissioner shall publish the 
  2.24  names of all applicants in the State Register.  The public shall 
  2.25  have 30 days from the date of publication to submit written 
  2.26  comments to the commissioner on the application.  No designation 
  2.27  shall be made by the commissioner until the 30-day period has 
  2.28  expired. 
  2.29     The commissioner may designate an eligible provider as an 
  2.30  essential community provider for all the services offered by 
  2.31  that provider or for specific services designated by the 
  2.32  commissioner. 
  2.33     For the purpose of this subdivision, supportive and 
  2.34  stabilizing services include at a minimum, transportation, child 
  2.35  care, cultural, and linguistic services where appropriate. 
  2.36     Sec. 2.  Minnesota Statutes 2000, section 256B.69, 
  3.1   subdivision 4, is amended to read: 
  3.2      Subd. 4.  [LIMITATION OF CHOICE.] (a) The commissioner 
  3.3   shall develop criteria to determine when limitation of choice 
  3.4   may be implemented in the experimental counties.  The criteria 
  3.5   shall ensure that all eligible individuals in the county have 
  3.6   continuing access to the full range of medical assistance 
  3.7   services as specified in subdivision 6. 
  3.8      (b) The commissioner shall exempt the following persons 
  3.9   from participation in the project, in addition to those who do 
  3.10  not meet the criteria for limitation of choice:  (1) persons 
  3.11  eligible for medical assistance according to section 256B.055, 
  3.12  subdivision 1; (2) persons eligible for medical assistance due 
  3.13  to blindness or disability as determined by the social security 
  3.14  administration or the state medical review team, unless:  (i) 
  3.15  they are 65 years of age or older, or (ii) they reside in Itasca 
  3.16  county or they reside in a county in which the commissioner 
  3.17  conducts a pilot project under a waiver granted pursuant to 
  3.18  section 1115 of the Social Security Act; (3) recipients who 
  3.19  currently have private coverage through a health maintenance 
  3.20  organization; (4) recipients who are eligible for medical 
  3.21  assistance by spending down excess income for medical expenses 
  3.22  other than the nursing facility per diem expense; (5) recipients 
  3.23  who receive benefits under the Refugee Assistance Program, 
  3.24  established under United States Code, title 8, section 1522(e); 
  3.25  (6) children who are both determined to be severely emotionally 
  3.26  disturbed and receiving case management services according to 
  3.27  section 256B.0625, subdivision 20; and (7) adults who are both 
  3.28  determined to be seriously and persistently mentally ill and 
  3.29  received case management services according to section 
  3.30  256B.0625, subdivision 20.  Children under age 21 who are in 
  3.31  foster placement may enroll in the project on an elective 
  3.32  basis.  Individuals excluded under clauses (6) and (7) may 
  3.33  choose to enroll on an elective basis. 
  3.34     (c) When a child enrolled with a demonstration provider has 
  3.35  been identified as receiving mental health services in an 
  3.36  alternative school, the alternative school shall notify the 
  4.1   commissioner and the child's county of financial 
  4.2   responsibility.  The commissioner, in coordination with the 
  4.3   county, shall determine whether the child qualifies under 
  4.4   paragraph (b) for exclusion from participation in the 
  4.5   demonstration project.  If the child qualifies, the county shall 
  4.6   contact the child's parent or guardian and offer the option for 
  4.7   the child to be excluded from the demonstration project. 
  4.8      (d) The commissioner may allow persons with a one-month 
  4.9   spenddown who are otherwise eligible to enroll to voluntarily 
  4.10  enroll or remain enrolled, if they elect to prepay their monthly 
  4.11  spenddown to the state. 
  4.12     (e) Beginning on or after July 1, 1997, the commissioner 
  4.13  may require those individuals to enroll in the prepaid medical 
  4.14  assistance program who otherwise would have been excluded under 
  4.15  clauses (1) and (3) and under Minnesota Rules, part 9500.1452, 
  4.16  subpart 2, items H, K, and L. 
  4.17     (f) Before limitation of choice is implemented, eligible 
  4.18  individuals shall be notified and after notification, shall be 
  4.19  allowed to choose only among demonstration providers.  The 
  4.20  commissioner may assign an individual with private coverage 
  4.21  through a health maintenance organization, to the same health 
  4.22  maintenance organization for medical assistance coverage, if the 
  4.23  health maintenance organization is under contract for medical 
  4.24  assistance in the individual's county of residence.  After 
  4.25  initially choosing a provider, the recipient is allowed to 
  4.26  change that choice only at specified times as allowed by the 
  4.27  commissioner.  If a demonstration provider ends participation in 
  4.28  the project for any reason, a recipient enrolled with that 
  4.29  provider must select a new provider but may change providers 
  4.30  without cause once more within the first 60 days after 
  4.31  enrollment with the second provider. 
  4.32     Sec. 3.  [EFFECTIVE DATE.] 
  4.33     Sections 1 and 2 are effective the day following final 
  4.34  enactment.