1.1                          A bill for an act 
  1.2             relating to human services; providing coverage for 
  1.3             vision services under the MinnesotaCare limited 
  1.4             benefit set; amending Minnesota Statutes 2003 
  1.5             Supplement, section 256L.035. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 2003 Supplement, section 
  1.8   256L.035, is amended to read: 
  1.9      256L.035 [LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE 
  1.10  ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.] 
  1.11     (a) "Covered health services" for individuals under section 
  1.12  256L.04, subdivision 7, with income above 75 percent, but not 
  1.13  exceeding 175 percent, of the federal poverty guideline means: 
  1.14     (1) inpatient hospitalization benefits with a ten percent 
  1.15  co-payment up to $1,000 and subject to an annual limitation of 
  1.16  $10,000; 
  1.17     (2) physician services provided during an inpatient stay; 
  1.18  and 
  1.19     (3) physician services not provided during an inpatient 
  1.20  stay,; outpatient hospital services,; chiropractic services 
  1.21  ,; lab and diagnostic services,; vision services excluding the 
  1.22  dispensing, fitting, and adjustment of eyeglasses or contacts 
  1.23  and eye examinations to determine refractive state; and 
  1.24  prescription drugs,; subject to an aggregate cap of $2,000 per 
  1.25  calendar year and the following co-payments: 
  2.1      (i) $50 co-pay per emergency room visit; 
  2.2      (ii) $3 co-pay per prescription drug; and 
  2.3      (iii) $5 co-pay per nonpreventive physician and optometrist 
  2.4   visit. 
  2.5      For purposes of this subdivision, "a visit" means an 
  2.6   episode of service which is required because of a recipient's 
  2.7   symptoms, diagnosis, or established illness, and which is 
  2.8   delivered in an ambulatory setting by a physician or, physician 
  2.9   ancillary, or optometrist. 
  2.10     Enrollees are responsible for all co-payments in this 
  2.11  subdivision. 
  2.12     (b) The November 2006 MinnesotaCare forecast for the 
  2.13  biennium beginning July 1, 2007, shall assume an adjustment in 
  2.14  the aggregate cap on the services identified in paragraph (a), 
  2.15  clause (3), in $1,000 increments up to a maximum of $10,000, but 
  2.16  not less than $2,000, to the extent that the balance in the 
  2.17  health care access fund is sufficient in each year of the 
  2.18  biennium to pay for this benefit level.  The aggregate cap shall 
  2.19  be adjusted according to the forecast. 
  2.20     (c) Reimbursement to the providers shall be reduced by the 
  2.21  amount of the co-payment, except that reimbursement for 
  2.22  prescription drugs shall not be reduced once a recipient has 
  2.23  reached the $20 per month maximum for prescription drug 
  2.24  co-payments.  The provider collects the co-payment from the 
  2.25  recipient.  Providers may not deny services to recipients who 
  2.26  are unable to pay the co-payment, except as provided in 
  2.27  paragraph (d). 
  2.28     (d) If it is the routine business practice of a provider to 
  2.29  refuse service to an individual with uncollected debt, the 
  2.30  provider may include uncollected co-payments under this 
  2.31  section.  A provider must give advance notice to a recipient 
  2.32  with uncollected debt before services can be denied.