1.1 	A bill for an act
1.2 	relating to human services; changing medical
1.3 	assistance, general assistance, and MinnesotaCare
1.4 	provisions to align with practice; allowing military
1.5 	enrollees and military families to reenroll at certain
1.6 	times; modifying the Consumer-Directed Community
1.7 	Supports methodology; establishing a clinical trial
1.8 	work group; amending Minnesota Statutes 2004, sections
1.9 	256.045, subdivision 3a; 256B.02, subdivision 12;
1.10 	256B.056, subdivisions 5, 5a, 5b, 7, by adding
1.11 	subdivisions; 256B.057, subdivision 1; 256B.69,
1.12 	subdivision 4; 256D.045; 256L.01, subdivisions 4, 5;
1.13 	256L.03, subdivision 1b; 256L.04, subdivision 2, by
1.14 	adding subdivisions; 256L.05, subdivisions 3, 3a;
1.15 	256L.07, subdivisions 1, 3, by adding a subdivision;
1.16 	256L.15, subdivisions 2, 3; 549.02, by adding a
1.17 	subdivision; 549.04.
1.18 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.19 	Section 1. Minnesota Statutes 2004, section 256.045,
1.20 	subdivision 3a, is amended to read:
1.21 		Subd. 3a.Prepaid health plan appeals.  (a) All prepaid
1.22 	health plans under contract to the commissioner under chapter
1.23 	256B or 256D must provide for a complaint system according to
1.24 	section 62D.11.  When a prepaid health plan denies, reduces, or
1.25 	terminates a health service or denies a request to authorize a
1.26 	previously authorized health service, the prepaid health plan
1.27 	must notify the recipient of the right to file a complaint or an
1.28 	appeal.  The notice must include the name and telephone number
1.29 	of the ombudsman and notice of the recipient's right to request
1.30 	a hearing under paragraph (b). When a complaint is filed, the
1.31 	prepaid health plan must notify the ombudsman within three
2.1 	working days.Recipients may request the assistance of the
2.2 	ombudsman in the complaint system process.  The prepaid health
2.3 	plan must issue a written resolution of the complaint to the
2.4 	recipient within 30 days after the complaint is filed with the
2.5 	prepaid health plan.  A recipient is not required to exhaust the
2.6 	complaint system procedures in order to request a hearing under
2.7 	paragraph (b).
2.8 	(b) Recipients enrolled in a prepaid health plan under
2.9 	chapter 256B or 256D may contest a prepaid health plan's denial,
2.10 	reduction, or termination of health services, a prepaid health
2.11 	plan's denial of a request to authorize a previously authorized
2.12 	health service, or the prepaid health plan's written resolution
2.13 	of a complaint by submitting a written request for a hearing
2.14 	according to subdivision 3.  A state human services referee
2.15 	shall conduct a hearing on the matter and shall recommend an
2.16 	order to the commissioner of human services.  The commissioner
2.17 	need not grant a hearing if the sole issue raised by a recipient
2.18 	is the commissioner's authority to require mandatory enrollment
2.19 	in a prepaid health plan in a county where prepaid health plans
2.20 	are under contract with the commissioner.  The state human
2.21 	services referee may order a second medical opinion from the
2.22 	prepaid health plan or may order a second medical opinion from a
2.23 	nonprepaid health plan provider at the expense of the prepaid
2.24 	health plan.  Recipients may request the assistance of the
2.25 	ombudsman in the appeal process.
2.26 	(c) In the written request for a hearing to appeal from a
2.27 	prepaid health plan's denial, reduction, or termination of a
2.28 	health service, a prepaid health plan's denial of a request to
2.29 	authorize a previously authorized service, or the prepaid health
2.30 	plan's written resolution to a complaint, a recipient may
2.31 	request an expedited hearing.  If an expedited appeal is
2.32 	warranted, the state human services referee shall hear the
2.33 	appeal and render a decision within a time commensurate with the
2.34 	level of urgency involved, based on the individual circumstances
2.35 	of the case.

2.36 	Sec. 2. Minnesota Statutes 2004, section 256B.02,
3.1 	subdivision 12, is amended to read:
3.2 		Subd. 12.Third-party payer.  "Third-party payer" means a
3.3 	person, entity, or agency or government program that has a
3.4 	probable obligation to pay all or part of the costs of a medical
3.5 	assistance recipient's health services. Third-party payer
3.6 	includes an entity under contract with the recipient to cover
3.7 	all or part of the recipient's medical costs.

3.8 	Sec. 3. Minnesota Statutes 2004, section 256B.056, is
3.9 	amended by adding a subdivision to read:
3.10 		Subd. 3d.Reduction of excess assets. Assets in excess
3.11 	of the limits set forth in subdivisions 3 to 3c may be reduced
3.12 	to allowable limits as follows:
3.13 	(a) Assets may be reduced in any of the three calendar
3.14 	months before the month of application in which the applicant
3.15 	seeks coverage by:
3.16 	(1) designating burial funds up to $1500 for each
3.17 	applicant, spouse, and MA-eligible dependent child; and 
3.18 	(2) paying health service bills incurred in the retroactive
3.19 	period for which the applicant seeks eligibility, starting with
3.20 	the oldest bill.  After assets are reduced to allowable limits,
3.21 	eligibility begins with the next dollar of MA-covered health
3.22 	services incurred in the retroactive period.  Applicants
3.23 	reducing assets under this subdivision who also have excess
3.24 	income shall first spend excess assets to pay health service
3.25 	bills and may meet the income spenddown on remaining bills.
3.26 	(b) Assets may be reduced beginning the month of
3.27 	application by:
3.28 	(1) paying bills for health services that would otherwise
3.29 	be paid by medical assistance; and 
3.30 	(2) using any means other than a transfer of assets for
3.31 	less than fair market value as defined in section 256B.0595,
3.32 	subdivision 1, paragraph (b).

3.33 	Sec. 4. Minnesota Statutes 2004, section 256B.056,
3.34 	subdivision 5, is amended to read:
3.35 		Subd. 5.Excess income.  A person who has excess income
3.36 	is eligible for medical assistance if the person has expenses
4.1 	for medical care that are more than the amount of the person's
4.2 	excess income, computed by deducting incurred medical expenses
4.3 	from the excess income to reduce the excess to the income
4.4 	standard specified in subdivision 5c.  The person shall elect to
4.5 	have the medical expenses deducted at the beginning of a
4.6 	one-month budget period or at the beginning of a six-month
4.7 	budget period.  The commissioner shall allow persons eligible
4.8 	for assistance on a one-month spenddown basis under this
4.9 	subdivision to elect to pay the monthly spenddown amount in
4.10 	advance of the month of eligibility to the state agency in order
4.11 	to maintain eligibility on a continuous basis.  If the recipient
4.12 	does not pay the spenddown amount on or before the 20th last
4.13 	business day of the month, the recipient is ineligible for this
4.14 	option for the following month.  The local agency shall code the
4.15 	Medicaid Management Information System (MMIS) to indicate that
4.16 	the recipient has elected this option.  The state agency shall
4.17 	convey recipient eligibility information relative to the
4.18 	collection of the spenddown to providers through the Electronic
4.19 	Verification System (EVS).  A recipient electing advance payment
4.20 	must pay the state agency the monthly spenddown amount on or
4.21 	before noon on the 20th last business day of the month in order
4.22 	to be eligible for this option in the following month.
4.23 	
EFFECTIVE DATE. This section is effective March 1, 2006,
4.24 	or upon HealthMatch implementation, whichever is later.

4.25 	Sec. 5. Minnesota Statutes 2004, section 256B.056,
4.26 	subdivision 5a, is amended to read:
4.27 		Subd. 5a.Individuals on fixed or excluded income.
 4.28 	Recipients of medical assistance who receive only fixed unearned
4.29 	or excluded income, when that income is excluded from
4.30 	consideration as income or unvarying in amount and timing of
4.31 	receipt throughout the year, shall report and verify their
4.32 	income annually every 12 months.  The 12-month period begins
4.33 	with the month of application.
4.34 	
EFFECTIVE DATE. This section is effective March 1, 2006,
4.35 	or upon HealthMatch implementation, whichever is later.

4.36 	Sec. 6. Minnesota Statutes 2004, section 256B.056,
5.1 	subdivision 5b, is amended to read:
5.2 		Subd. 5b.Individuals with low income.  Recipients of
5.3 	medical assistance not residing in a long-term care facility who
5.4 	have slightly fluctuating income which is below the medical
5.5 	assistance income limit shall report and verify their income on
5.6 	a semiannual basis every six months.  The six-month period
5.7 	begins the month of application.
5.8 	
EFFECTIVE DATE. This section is effective March 1, 2006,
5.9 	or upon HealthMatch implementation, whichever is later.

5.10 	Sec. 7. Minnesota Statutes 2004, section 256B.056,
5.11 	subdivision 7, is amended to read:
5.12 		Subd. 7.Period of eligibility.  Eligibility is available
5.13 	for the month of application and for three months prior to
5.14 	application if the person was eligible in those prior
5.15 	months. Eligibility for months prior to application is
5.16 	determined independently from eligibility for the month of
5.17 	application and future months.A redetermination of eligibility
5.18 	must occur every 12 months. The 12-month period begins with the
5.19 	month of application.
5.20 	
EFFECTIVE DATE. This section is effective March 1, 2006,
5.21 	or upon HealthMatch implementation, whichever is later.

5.22 	Sec. 8. Minnesota Statutes 2004, section 256B.056, is
5.23 	amended by adding a subdivision to read:
5.24 		Subd. 9.Notice. The state agency must be given notice
5.25 	of monetary claims against a person, entity, or corporation that
5.26 	may be liable to pay all or part of the cost of medical care
5.27 	when the state agency has paid or becomes liable for the cost of
5.28 	that care.  Notice must be given according to paragraphs (a) to
5.29 	(d).
5.30 	(a) An applicant for medical assistance shall notify the
5.31 	state or local agency of any possible claims when the applicant
5.32 	submits the application.  A recipient of medical assistance
5.33 	shall notify the state or local agency of any possible claims
5.34 	when those claims arise.
5.35 	(b) A person providing medical care services to a recipient
5.36 	of medical assistance shall notify the state agency when the
6.1 	person has reason to believe that a third party may be liable
6.2 	for payment of the cost of medical care.
6.3 	(c) A party to a claim that may be assigned to the state
6.4 	agency under this section shall notify the state agency of its
6.5 	potential assignment claim in writing at each of the following
6.6 	stages of a claim:
6.7 	(1) when a claim is filed;
6.8 	(2) when an action is commenced; and 
6.9 	(3) when a claim is concluded by payment, award, judgment,
6.10 	settlement, or otherwise.
6.11 	(d) Every party involved in any stage of a claim under this
6.12 	subdivision is required to provide notice to the state agency at
6.13 	that stage of the claim.  However, when one of the parties to
6.14 	the claim provides notice at that stage, every other party to
6.15 	the claim is deemed to have provided the required notice for
6.16 	that stage of the claim.  If the required notice under this
6.17 	paragraph is not provided to the state agency, all parties to
6.18 	the claim are deemed to have failed to provide the required
6.19 	notice.  A party to the claim includes the injured person or the
6.20 	person's legal representative, the plaintiff, the defendants, or
6.21 	persons alleged to be responsible for compensating the injured
6.22 	person or plaintiff, and any other party to the cause of action
6.23 	or claim, regardless of whether the party knows the state agency
6.24 	has a potential or actual assignment claim.

6.25 	Sec. 9. Minnesota Statutes 2004, section 256B.057,
6.26 	subdivision 1, is amended to read:
6.27 		Subdivision 1.Infants and pregnant women.  (a) (1) An
6.28 	infant less than one year of age is eligible for medical
6.29 	assistance if countable family income is equal to or less than
6.30 	275 percent of the federal poverty guideline for the same family
6.31 	size.  A pregnant woman who has written verification of a
6.32 	positive pregnancy test from a physician or licensed registered
6.33 	nurse is eligible for medical assistance if countable family
6.34 	income is equal to or less than 200 275 percent of the federal
6.35 	poverty guideline for the same family size.  For purposes of
6.36 	this subdivision, "countable family income" means the amount of
7.1 	income considered available using the methodology of the AFDC
7.2 	program under the state's AFDC plan as of July 16, 1996, as
7.3 	required by the Personal Responsibility and Work Opportunity
7.4 	Reconciliation Act of 1996 (PRWORA), Public Law 104-193, except
7.5 	for the earned income disregard and employment deductions.
7.6 	(2) For applications processed within one calendar month
7.7 	prior to the effective date, eligibility shall be determined by
7.8 	applying the income standards and methodologies in effect prior
7.9 	to the effective date for any months in the six-month budget
7.10 	period before that date and the income standards and
7.11 	methodologies in effect on the effective date for any months in
7.12 	the six-month budget period on or after that date.  The income
7.13 	standards for each month shall be added together and compared to
7.14 	the applicant's total countable income for the six-month budget
7.15 	period to determine eligibility.
7.16 	(b)(1)  (Expired, 1Sp2003 c 14 art 12 s 19)
7.17 	(2) For applications processed within one calendar month
7.18 	prior to July 1, 2003, eligibility shall be determined by
7.19 	applying the income standards and methodologies in effect prior
7.20 	to July 1, 2003, for any months in the six-month budget period
7.21 	before July 1, 2003, and the income standards and methodologies
7.22 	in effect on the expiration date for any months in the six-month
7.23 	budget period on or after July 1, 2003.  The income standards
7.24 	for each month shall be added together and compared to the
7.25 	applicant's total countable income for the six-month budget
7.26 	period to determine eligibility.
7.27 	(c) Dependent care and child support paid under court order
7.28 	shall be deducted from the countable income of pregnant
7.29 	women.An amount equal to the amount of earned income exceeding
7.30 	275 percent of the federal poverty guideline plus the earned
7.31 	income disregards and deductions of the AFDC program under the
7.32 	state's AFDC plan as of July 16, 1996, as required by the
7.33 	Personal Responsibility and Work Opportunity Reconciliation Act
7.34 	of 1996 (PRWORA), Public Law 104-193, that exceeds 275 percent
7.35 	of the federal poverty guideline will be deducted for pregnant
7.36 	women and infants less than one year of age.
8.1 	(d) An infant born on or after January 1, 1991, to a woman
8.2 	who was eligible for and receiving medical assistance on the
8.3 	date of the child's birth shall continue to be eligible for
8.4 	medical assistance without redetermination until the child's
8.5 	first birthday, as long as the child remains in the woman's
8.6 	household.
8.7 	
EFFECTIVE DATE. The amendments to paragraphs (a) and (b)
8.8 	are effective retroactively from July 1, 2004, and the amendment
8.9 	to paragraph (c) is effective retroactively from October 1, 2003.

8.10 	Sec. 10. Minnesota Statutes 2004, section 256B.69,
8.11 	subdivision 4, is amended to read:
8.12 		Subd. 4.Limitation of choice.  (a) The commissioner
8.13 	shall develop criteria to determine when limitation of choice
8.14 	may be implemented in the experimental counties.  The criteria
8.15 	shall ensure that all eligible individuals in the county have
8.16 	continuing access to the full range of medical assistance
8.17 	services as specified in subdivision 6.
8.18 	(b) The commissioner shall exempt the following persons
8.19 	from participation in the project, in addition to those who do
8.20 	not meet the criteria for limitation of choice:
8.21 	(1) persons eligible for medical assistance according to
8.22 	section 256B.055, subdivision 1;
8.23 	(2) persons eligible for medical assistance due to
8.24 	blindness or disability as determined by the Social Security
8.25 	Administration or the state medical review team, unless:
8.26 	(i) they are 65 years of age or older; or
8.27 	(ii) they reside in Itasca County or they reside in a
8.28 	county in which the commissioner conducts a pilot project under
8.29 	a waiver granted pursuant to section 1115 of the Social Security
8.30 	Act;
8.31 	(3) recipients who currently have private coverage through
8.32 	a health maintenance organization;
8.33 	(4) recipients who are eligible for medical assistance by
8.34 	spending down excess income for medical expenses other than the
8.35 	nursing facility per diem expense;
8.36 	(5) recipients who receive benefits under the Refugee
9.1 	Assistance Program, established under United States Code, title
9.2 	8, section 1522(e);
9.3 	(6) children who are both determined to be severely
9.4 	emotionally disturbed and receiving case management services
9.5 	according to section 256B.0625, subdivision 20;
9.6 	(7) adults who are both determined to be seriously and
9.7 	persistently mentally ill and received case management services
9.8 	according to section 256B.0625, subdivision 20;
9.9 	(8) persons eligible for medical assistance according to
9.10 	section 256B.057, subdivision 10; and
9.11 	(9) persons with access to cost-effective
9.12 	employer-sponsored private health insurance or persons enrolled
9.13 	in an non-Medicare individual health plan determined to be
9.14 	cost-effective according to section 256B.0625, subdivision 15.
9.15 	Children under age 21 who are in foster placement may enroll in
9.16 	the project on an elective basis.  Individuals excluded under
9.17 	clauses (1), (6), and (7) may choose to enroll on an elective
9.18 	basis.  The commissioner may enroll recipients in the prepaid
9.19 	medical assistance program for seniors who are (1) age 65 and
9.20 	over, and (2) eligible for medical assistance by spending down
9.21 	excess income.
9.22 	(c) The commissioner may allow persons with a one-month
9.23 	spenddown who are otherwise eligible to enroll to voluntarily
9.24 	enroll or remain enrolled, if they elect to prepay their monthly
9.25 	spenddown to the state.
9.26 	(d) The commissioner may require those individuals to
9.27 	enroll in the prepaid medical assistance program who otherwise
9.28 	would have been excluded under paragraph (b), clauses (1), (3),
9.29 	and (8), and under Minnesota Rules, part 9500.1452, subpart 2,
9.30 	items H, K, and L.
9.31 	(e) Before limitation of choice is implemented, eligible
9.32 	individuals shall be notified and after notification, shall be
9.33 	allowed to choose only among demonstration providers.  The
9.34 	commissioner may assign an individual with private coverage
9.35 	through a health maintenance organization, to the same health
9.36 	maintenance organization for medical assistance coverage, if the
10.1 	health maintenance organization is under contract for medical
10.2 	assistance in the individual's county of residence.  After
10.3 	initially choosing a provider, the recipient is allowed to
10.4 	change that choice only at specified times as allowed by the
10.5 	commissioner.  If a demonstration provider ends participation in
10.6 	the project for any reason, a recipient enrolled with that
10.7 	provider must select a new provider but may change providers
10.8 	without cause once more within the first 60 days after
10.9 	enrollment with the second provider.
10.10 	(f) An infant born to a woman who is eligible for and
10.11 	receiving medical assistance and who is enrolled in the prepaid
10.12 	medical assistance program shall be retroactively enrolled to
10.13 	the month of birth in the same managed care plan as the mother
10.14 	once the child is enrolled in medical assistance unless the
10.15 	child is determined to be excluded from enrollment in a prepaid
10.16 	plan under this section.

10.17 	Sec. 11. Minnesota Statutes 2004, section 256D.045, is
10.18 	amended to read:
10.19 	256D.045 SOCIAL SECURITY NUMBER REQUIRED.
10.20 	To be eligible for general assistance under sections
10.21 	256D.01 to 256D.21, an individual must provide the individual's
10.22 	Social Security number to the county agency or submit proof that
10.23 	an application has been made. An individual who refuses to
10.24 	provide a Social Security number because of a well-established
10.25 	religious objection as described in Code of Federal Regulations,
10.26 	title 42, section 435.910, may be eligible for general
10.27 	assistance medical care under section 256D.03.The provisions
10.28 	of this section do not apply to the determination of eligibility
10.29 	for emergency general assistance under section 256D.06,
10.30 	subdivision 2.  This provision applies to eligible children
10.31 	under the age of 18 effective July 1, 1997.

10.32 	EFFECTIVE DATE. This section is effective March 1, 2006,
10.33 	or upon HealthMatch implementation, whichever is later.

10.34 	Sec. 12. Minnesota Statutes 2004, section 256L.01,
10.35 	subdivision 4, is amended to read:
10.36 		Subd. 4.Gross individual or gross family income.  (a)
11.1 	"Gross individual or gross family income" for nonfarm
11.2 	self-employed means income calculated for the six-month period
11.3 	of eligibility using as the baseline the adjusted gross income
11.4 	reported on the applicant's federal income tax form for the
11.5 	previous year and adding back in reported depreciation,
11.6 	carryover loss, and net operating loss amounts that apply to the
11.7 	business in which the family is currently engaged.
11.8 	(b) "Gross individual or gross family income" for farm
11.9 	self-employed means income calculated for the six-month period
11.10 	of eligibility using as the baseline the adjusted gross income
11.11 	reported on the applicant's federal income tax form for the
11.12 	previous year and adding back in reported depreciation amounts
11.13 	that apply to the business in which the family is currently
11.14 	engaged.
11.15 	(c) Applicants shall report the most recent financial
11.16 	situation of the family if it has changed from the period of
11.17 	time covered by the federal income tax form.  The report may be
11.18 	in the form of percentage increase or decrease "Gross individual
11.19 	or gross family income" means the total income for all family
11.20 	members, calculated for the six-month period of eligibility.
11.21 	
EFFECTIVE DATE. This section is effective March 1, 2006,
11.22 	or upon HealthMatch implementation, whichever is later.

11.23 	Sec. 13. Minnesota Statutes 2004, section 256L.01,
11.24 	subdivision 5, is amended to read:
11.25 		Subd. 5.Income. (a) "Income" has the meaning given for
11.26 	earned and unearned income for families and children in the
11.27 	medical assistance program, according to the state's aid to
11.28 	families with dependent children plan in effect as of July 16,
11.29 	1996.  The definition does not include medical assistance income
11.30 	methodologies and deeming requirements.  The earned income of
11.31 	full-time and part-time students under age 19 is not counted as
11.32 	income.  Public assistance payments and supplemental security
11.33 	income are not excluded income.
11.34 	(b) For purposes of this subdivision, and unless otherwise
11.35 	specified in this section, the commissioner shall use reasonable
11.36 	methods to calculate gross earned and unearned income including,
12.1 	but not limited to, projecting income based on income received
12.2 	within the past 30 days, the last 90 days, or the last 12 months.
12.3 	
EFFECTIVE DATE. This section is effective July 1, 2005.

12.4 	Sec. 14. Minnesota Statutes 2004, section 256L.03,
12.5 	subdivision 1b, is amended to read:
12.6 		Subd. 1b.Pregnant women; eligibility for full medical
12.7 	assistance services. Beginning January 1, 1999,A pregnant 
12.8 	woman who is enrolled in MinnesotaCare when her pregnancy is
12.9 	diagnosed is eligible for coverage of all services provided
12.10 	under the medical assistance program according to chapter 256B
12.11 	retroactive to the date the pregnancy is medically diagnosed of
12.12 	conception.  Co-payments totaling $30 or more, paid after the
12.13 	date the pregnancy is diagnosed of conception, shall be refunded.

12.14 	Sec. 15. Minnesota Statutes 2004, section 256L.04, is
12.15 	amended by adding a subdivision to read:
12.16 		Subd. 1a.Social security number required. (a)
12.17 	Individuals and families applying for MinnesotaCare coverage
12.18 	must provide a Social Security number.
12.19 	(b) The commissioner shall not deny eligibility to an
12.20 	otherwise eligible applicant who has applied for a Social
12.21 	Security number and is awaiting issuance of that Social Security
12.22 	number.
12.23 	(c) Newborns enrolled under section 256L.05, subdivision 3,
12.24 	are exempt from the requirements of this subdivision.
12.25 	(d) Individuals who refuse to provide a Social Security
12.26 	number because of well-established religious objections are
12.27 	exempt from the requirements of this subdivision.  The term
12.28 	"well-established religious objections" has the meaning given in
12.29 	Code of Federal Regulations, title 42, section 435.910.
12.30 	
EFFECTIVE DATE. This section is effective March 1, 2006,
12.31 	or upon HealthMatch implementation, whichever is later.

12.32 	Sec. 16. Minnesota Statutes 2004, section 256L.04,
12.33 	subdivision 2, is amended to read:
12.34 		Subd. 2.Cooperation in establishing third-party
12.35 	liability, paternity, and other medical support.  (a) To be
12.36 	eligible for MinnesotaCare, individuals and families must
13.1 	cooperate with the state agency to identify potentially liable
13.2 	third-party payers and assist the state in obtaining third-party
13.3 	payments.  "Cooperation" includes, but is not limited
13.4 	to, complying with the notice requirements in section 256B.056,
13.5 	subdivision 9,identifying any third party who may be liable for
13.6 	care and services provided under MinnesotaCare to the enrollee,
13.7 	providing relevant information to assist the state in pursuing a
13.8 	potentially liable third party, and completing forms necessary
13.9 	to recover third-party payments.
13.10 	(b) A parent, guardian, relative caretaker, or child
13.11 	enrolled in the MinnesotaCare program must cooperate with the
13.12 	Department of Human Services and the local agency in
13.13 	establishing the paternity of an enrolled child and in obtaining
13.14 	medical care support and payments for the child and any other
13.15 	person for whom the person can legally assign rights, in
13.16 	accordance with applicable laws and rules governing the medical
13.17 	assistance program.  A child shall not be ineligible for or
13.18 	disenrolled from the MinnesotaCare program solely because the
13.19 	child's parent, relative caretaker, or guardian fails to
13.20 	cooperate in establishing paternity or obtaining medical support.

13.21 	Sec. 17. Minnesota Statutes 2004, section 256L.04, is
13.22 	amended by adding a subdivision to read:
13.23 		Subd. 2a.Applications for other benefits. To be
13.24 	eligible for MinnesotaCare, individuals and families must take
13.25 	all necessary steps to obtain other benefits as described in
13.26 	Code of Federal Regulations, title 42, section 435.608.
13.27 	Applicants and enrollees must apply for other benefits within 30
13.28 	days.
13.29 	
EFFECTIVE DATE. This section is effective March 1, 2006,
13.30 	or upon HealthMatch implementation, whichever is later.

13.31 	Sec. 18. Minnesota Statutes 2004, section 256L.05,
13.32 	subdivision 3, is amended to read:
13.33 		Subd. 3.Effective date of coverage.  (a) The effective
13.34 	date of coverage is the first day of the month following the
13.35 	month in which eligibility is approved and the first premium
13.36 	payment has been received.  As provided in section 256B.057,
14.1 	coverage for newborns is automatic from the date of birth and
14.2 	must be coordinated with other health coverage.  The effective
14.3 	date of coverage for eligible newly adoptive children added to a
14.4 	family receiving covered health services is the date of entry
14.5 	into the family month of placement.  The effective date of
14.6 	coverage for other new recipients members added to the family
14.7 	receiving covered health services is the first day of the month
14.8 	following the month in which eligibility is approved or at
14.9 	renewal, whichever the family receiving covered health services
14.10 	prefers the change is reported.  All eligibility criteria must
14.11 	be met by the family at the time the new family member is
14.12 	added.  The income of the new family member is included with the
14.13 	family's gross income and the adjusted premium begins in the
14.14 	month the new family member is added.
14.15 	(b) The initial premium must be received by the last
14.16 	working day of the month for coverage to begin the first day of
14.17 	the following month.
14.18 	(c) Benefits are not available until the day following
14.19 	discharge if an enrollee is hospitalized on the first day of
14.20 	coverage.
14.21 	(d) Notwithstanding any other law to the contrary, benefits
14.22 	under sections 256L.01 to 256L.18 are secondary to a plan of
14.23 	insurance or benefit program under which an eligible person may
14.24 	have coverage and the commissioner shall use cost avoidance
14.25 	techniques to ensure coordination of any other health coverage
14.26 	for eligible persons.  The commissioner shall identify eligible
14.27 	persons who may have coverage or benefits under other plans of
14.28 	insurance or who become eligible for medical assistance.
14.29 	
EFFECTIVE DATE. This section is effective March 1, 2006,
14.30 	or upon HealthMatch implementation, whichever is later.

14.31 	Sec. 19. Minnesota Statutes 2004, section 256L.05,
14.32 	subdivision 3a, is amended to read:
14.33 		Subd. 3a.Renewal of eligibility.  (a) Beginning January
14.34 	1, 1999, an enrollee's eligibility must be renewed every 12
14.35 	months.  The 12-month period begins in the month after the month
14.36 	the application is approved.
15.1 	(b) Beginning October 1, 2004, an enrollee's eligibility
15.2 	must be renewed every six months.  The first six-month period of
15.3 	eligibility begins in the month after the month the application
15.4 	is approved received by the commissioner. The effective date of
15.5 	coverage within the first six-month period of eligibility is as
15.6 	provided in subdivision 3.Each new period of eligibility must
15.7 	take into account any changes in circumstances that impact
15.8 	eligibility and premium amount.  An enrollee must provide all
15.9 	the information needed to redetermine eligibility by the first
15.10 	day of the month that ends the eligibility period.  The premium
15.11 	for the new period of eligibility must be received as provided
15.12 	in section 256L.06 in order for eligibility to continue.
15.13 	
EFFECTIVE DATE. This section is effective March 1, 2006,
15.14 	or upon HealthMatch implementation, whichever is later.

15.15 	Sec. 20. Minnesota Statutes 2004, section 256L.07,
15.16 	subdivision 1, is amended to read:
15.17 		Subdivision 1.General requirements.  (a) Children
15.18 	enrolled in the original children's health plan as of September
15.19 	30, 1992, children who enrolled in the MinnesotaCare program
15.20 	after September 30, 1992, pursuant to Laws 1992, chapter 549,
15.21 	article 4, section 17, and children who have family gross
15.22 	incomes that are equal to or less than 150 percent of the
15.23 	federal poverty guidelines are eligible without meeting the
15.24 	requirements of subdivision 2 and the four-month requirement in
15.25 	subdivision 3, as long as they maintain continuous coverage in
15.26 	the MinnesotaCare program or medical assistance.  Children who
15.27 	apply for MinnesotaCare on or after the implementation date of
15.28 	the employer-subsidized health coverage program as described in
15.29 	Laws 1998, chapter 407, article 5, section 45, who have family
15.30 	gross incomes that are equal to or less than 150 percent of the
15.31 	federal poverty guidelines, must meet the requirements of
15.32 	subdivision 2 to be eligible for MinnesotaCare.
15.33 	(b) Families enrolled in MinnesotaCare under section
15.34 	256L.04, subdivision 1, whose income increases above 275 percent
15.35 	of the federal poverty guidelines, are no longer eligible for
15.36 	the program and shall be disenrolled by the commissioner.
16.1 	Individuals enrolled in MinnesotaCare under section 256L.04,
16.2 	subdivision 7, whose income increases above 175 percent of the
16.3 	federal poverty guidelines are no longer eligible for the
16.4 	program and shall be disenrolled by the commissioner.  For
16.5 	persons disenrolled under this subdivision, MinnesotaCare
16.6 	coverage terminates the last day of the calendar month following
16.7 	the month in which the commissioner determines that the income
16.8 	of a family or individual exceeds program income limits.
16.9 	(c)(1) Notwithstanding paragraph (b), families enrolled in
16.10 	MinnesotaCare under section 256L.04, subdivision 1, may remain
16.11 	enrolled in MinnesotaCare if ten percent of their annual income
16.12 	is less than the annual premium for a policy with a $500
16.13 	deductible available through the Minnesota Comprehensive Health
16.14 	Association.  Families who are no longer eligible for
16.15 	MinnesotaCare under this subdivision shall be given an 18-month
16.16 	notice period from the date that ineligibility is determined
16.17 	before disenrollment.  This clause expires February 1, 2004.
16.18 	(2) Effective February 1, 2004, notwithstanding paragraph
16.19 	(b), children may remain enrolled in MinnesotaCare if ten
16.20 	percent of their annual gross individual or gross family income
16.21 	as defined in section 256L.01, subdivision 4,is less than the
16.22 	annual premium for a six-month policy with a $500 deductible
16.23 	available through the Minnesota Comprehensive Health
16.24 	Association.  Children who are no longer eligible for
16.25 	MinnesotaCare under this clause shall be given a 12-month notice
16.26 	period from the date that ineligibility is determined before
16.27 	disenrollment.  The premium for children remaining eligible
16.28 	under this clause shall be the maximum premium determined under
16.29 	section 256L.15, subdivision 2, paragraph (b).
16.30 	(d) Effective July 1, 2003, notwithstanding paragraphs (b)
16.31 	and (c), parents are no longer eligible for MinnesotaCare if
16.32 	gross household income exceeds $50,000 $25,000 for the six-month
16.33 	period of eligibility.
16.34 	
EFFECTIVE DATE. This section is effective March 1, 2006,
16.35 	or upon HealthMatch implementation, whichever is later.

16.36 	Sec. 21. Minnesota Statutes 2004, section 256L.07,
17.1 	subdivision 3, is amended to read:
17.2 		Subd. 3.Other health coverage.  (a) Families and
17.3 	individuals enrolled in the MinnesotaCare program must have no
17.4 	health coverage while enrolled or for at least four months prior
17.5 	to application and renewal.  Children enrolled in the original
17.6 	children's health plan and children in families with income
17.7 	equal to or less than 150 percent of the federal poverty
17.8 	guidelines, who have other health insurance, are eligible if the
17.9 	coverage:
17.10 	(1) lacks two or more of the following:
17.11 	(i) basic hospital insurance;
17.12 	(ii) medical-surgical insurance;
17.13 	(iii) prescription drug coverage;
17.14 	(iv) dental coverage; or
17.15 	(v) vision coverage;
17.16 	(2) requires a deductible of $100 or more per person per
17.17 	year; or
17.18 	(3) lacks coverage because the child has exceeded the
17.19 	maximum coverage for a particular diagnosis or the policy
17.20 	excludes a particular diagnosis.
17.21 	The commissioner may change this eligibility criterion for
17.22 	sliding scale premiums in order to remain within the limits of
17.23 	available appropriations.  The requirement of no health coverage
17.24 	does not apply to newborns.
17.25 	(b) Medical assistance, general assistance medical care,
17.26 	and the Civilian Health and Medical Program of the Uniformed
17.27 	Service, CHAMPUS, or other coverage provided under United States
17.28 	Code, title 10, subtitle A, part II, chapter 55, are not
17.29 	considered insurance or health coverage for purposes of the
17.30 	four-month requirement described in this subdivision.
17.31 	(c) For purposes of this subdivision, Medicare Part A or B
17.32 	coverage under title XVIII of the Social Security Act, United
17.33 	States Code, title 42, sections 1395c to 1395w-4, is considered
17.34 	health coverage.  An applicant or enrollee may not refuse
17.35 	Medicare coverage to establish eligibility for MinnesotaCare.
17.36 	(d) Applicants who were recipients of medical assistance or
18.1 	general assistance medical care within one month of application
18.2 	must meet the provisions of this subdivision and subdivision 2.
18.3 	(e) Effective October 1, 2003, applicants who were
18.4 	recipients of medical assistance and had Cost-effective health
18.5 	insurance which that was paid for by medical assistance are
18.6 	exempt from is not considered health coverage for purposes of 
18.7 	the four-month requirement under this section, except if the
18.8 	insurance continued after medical assistance no longer
18.9 	considered it cost-effective or after medical assistance closed.

18.10 	Sec. 22. Minnesota Statutes 2004, section 256L.07, is
18.11 	amended by adding a subdivision to read:
18.12 		Subd. 5.Voluntary disenrollment for members of
18.13 	military. Notwithstanding section 256L.05, subdivision 3b,
18.14 	MinnesotaCare enrollees who are members of the military and
18.15 	their families, who choose to voluntarily disenroll from the
18.16 	program when one or more family members are called to active
18.17 	duty, may reenroll during or following that member's tour of
18.18 	active duty.  Those individuals and families shall be considered
18.19 	to have good cause for voluntary termination under section
18.20 	256L.06, subdivision 3, paragraph (d).  Income and asset
18.21 	increases reported at the time of reenrollment shall be
18.22 	disregarded.  All provisions of sections 256L.01 to 256L.18,
18.23 	shall apply to individuals and families enrolled under this
18.24 	subdivision upon six-month renewal.
18.25 	
EFFECTIVE DATE. This section is effective July 1, 2005.

18.26 	Sec. 23. Minnesota Statutes 2004, section 256L.15,
18.27 	subdivision 2, is amended to read:
18.28 		Subd. 2.Sliding fee scale to determine percentage of
18.29 	monthly gross individual or family income.  (a) The commissioner
18.30 	shall establish a sliding fee scale to determine the percentage
18.31 	of monthly gross individual or family income that households at
18.32 	different income levels must pay to obtain coverage through the
18.33 	MinnesotaCare program.  The sliding fee scale must be based on
18.34 	the enrollee's monthly gross individual or family income.  The
18.35 	sliding fee scale must contain separate tables based on
18.36 	enrollment of one, two, or three or more persons.  The sliding
19.1 	fee scale begins with a premium of 1.5 percent of monthly gross
19.2 	individual or family income for individuals or families with
19.3 	incomes below the limits for the medical assistance program for
19.4 	families and children in effect on January 1, 1999, and proceeds
19.5 	through the following evenly spaced steps:  1.8, 2.3, 3.1, 3.8,
19.6 	4.8, 5.9, 7.4, and 8.8 percent.  These percentages are matched
19.7 	to evenly spaced income steps ranging from the medical
19.8 	assistance income limit for families and children in effect on
19.9 	January 1, 1999, to 275 percent of the federal poverty
19.10 	guidelines for the applicable family size, up to a family size
19.11 	of five.  The sliding fee scale for a family of five must be
19.12 	used for families of more than five.  Effective October 1, 2003,
19.13 	the commissioner shall increase each percentage by 0.5
19.14 	percentage points for enrollees with income greater than 100
19.15 	percent but not exceeding 200 percent of the federal poverty
19.16 	guidelines and shall increase each percentage by 1.0 percentage
19.17 	points for families and children with incomes greater than 200
19.18 	percent of the federal poverty guidelines.  The sliding fee
19.19 	scale and percentages are not subject to the provisions of
19.20 	chapter 14.  If a family or individual reports increased income
19.21 	after enrollment, premiums shall not be adjusted until
19.22 	eligibility renewal.
19.23 	(b)(1) Enrolled families whose gross annual income
19.24 	increases above 275 percent of the federal poverty guideline
19.25 	shall pay the maximum premium.  This clause expires effective
19.26 	February 1, 2004.
19.27 	(2) Effective February 1, 2004, children in families whose
19.28 	gross income is above 275 percent of the federal poverty
19.29 	guidelines shall pay the maximum premium.
19.30 	(3) The maximum premium is defined as a base charge for
19.31 	one, two, or three or more enrollees so that if all
19.32 	MinnesotaCare cases paid the maximum premium, the total revenue
19.33 	would equal the total cost of MinnesotaCare medical coverage and
19.34 	administration.  In this calculation, administrative costs shall
19.35 	be assumed to equal ten percent of the total.  The costs of
19.36 	medical coverage for pregnant women and children under age two
20.1 	and the enrollees in these groups shall be excluded from the
20.2 	total.  The maximum premium for two enrollees shall be twice the
20.3 	maximum premium for one, and the maximum premium for three or
20.4 	more enrollees shall be three times the maximum premium for one.
20.5 	
EFFECTIVE DATE. This section is effective March 1, 2006,
20.6 	or upon implementation of HealthMatch, whichever is later.

20.7 	Sec. 24. Minnesota Statutes 2004, section 256L.15,
20.8 	subdivision 3, is amended to read:
20.9 		Subd. 3.Exceptions to sliding scale. An annual premium
20.10 	of $48 is required for all Children in families with income at
20.11 	or less than below 150 percent of the federal poverty guidelines
20.12 	pay a monthly premium of $4.
20.13 	
EFFECTIVE DATE. This section is effective March 1, 2006,
20.14 	or upon implementation of HealthMatch, whichever is later.

20.15 	Sec. 25. Minnesota Statutes 2004, section 549.02, is
20.16 	amended by adding a subdivision to read:
20.17 		Subd. 3.Limitation. Notwithstanding subdivisions 1 and
20.18 	2, where the state agency is named or intervenes as a party to
20.19 	enforce the agency's rights under section 256B.056, the agency
20.20 	shall not be liable for costs to any prevailing defendant.

20.21 	Sec. 26. Minnesota Statutes 2004, section 549.04, is
20.22 	amended to read:
20.23 	549.04 DISBURSEMENTS; TAXATION AND ALLOWANCE.
20.24 		Subdivision 1.Generally. In every action in a district
20.25 	court, the prevailing party, including any public employee who
20.26 	prevails in an action for wrongfully denied or withheld
20.27 	employment benefits or rights, shall be allowed reasonable
20.28 	disbursements paid or incurred, including fees and mileage paid
20.29 	for service of process by the sheriff or by a private person.
20.30 		Subd. 2.Limitation. Notwithstanding subdivision 1,
20.31 	where the state agency is named or intervenes as a party to
20.32 	enforce the agency's rights under section 256B.056, the agency
20.33 	shall not be liable for disbursements to any prevailing
20.34 	defendant.

20.35 	Sec. 27. PLANNING PROCESS FOR MANAGED CARE.
 20.36 	The commissioner of human services shall develop a planning
21.1 	process for the purposes of implementing at least one additional
21.2 	managed care arrangement to provide medical assistance services,
21.3 	excluding continuing care services, to recipients enrolled in
21.4 	the medical assistance fee-for-service program, effective
21.5 	January 1, 2007.  This planning process shall include an
21.6 	advisory committee composed of current fee-for-service
21.7 	consumers, consumer advocates, and providers, as well as
21.8 	representatives of health plans and other provider organizations
21.9 	qualified to provide basic health care services to persons with
21.10 	disabilities.  The department shall seek any additional federal
21.11 	authority necessary to provide basic health care services
21.12 	through contracted managed care arrangements.

21.13 	Sec. 28. CLINICAL TRIAL WORK GROUP; REPORT.
 21.14 	The commissioners of health and commerce shall, in
21.15 	consultation with the commissioner of employee relations,
21.16 	convene a work group regarding health plan coverage of routine
21.17 	care associated with clinical trials.  The work group must
21.18 	explore what high-quality clinical trials beyond cancer-only
21.19 	clinical trials should be covered by health plans.  All other
21.20 	types of clinical trials, disease-based or technology-based such
21.21 	as drug trials or device trials should be considered.  The work
21.22 	group shall use the current, cancer-only model voluntary
21.23 	agreement that includes definitions of high-quality clinical
21.24 	trials, protocol induced costs, and routine care costs as a
21.25 	starting point for discussions.  As determined appropriate, the
21.26 	work group shall establish model voluntary agreement guidelines
21.27 	for health plan coverage of routine patient care costs incurred
21.28 	by patients participating in high quality clinical trials.  The
21.29 	work group shall be made up of representatives of consumers,
21.30 	patient advocates, health plan companies, fully insured and
21.31 	self-insured purchasers, providers, and other health care
21.32 	professionals involved in the care and treatment of patients.
21.33 	The commissioners shall submit the findings and recommendations
21.34 	of the work group to the chairs of the senate and house
21.35 	committees having jurisdiction over health policy and finance by
21.36 	January 15, 2006.

22.1 	Sec. 29. CONSUMER-DIRECTED COMMUNITY SUPPORTS
22.2 	METHODOLOGY.
 22.3 	For persons using the home and community-based waiver for
22.4 	persons with developmental disabilities whose Consumer-Directed
22.5 	Community Supports budgets were reduced by the October 2004,
22.6 	state-set budget methodology, the commissioner of human services
22.7 	must allow exceptions to exceed the state-set budget formula up
22.8 	to the amount being spent by the person as of September 30,
22.9 	2004, when the individual's county of financial responsibility
22.10 	determines that:
22.11 	(1) necessary alternative services will cost the same or
22.12 	more than the person's current budget; and 
22.13 	(2) administrative expenses or provider rates will result
22.14 	in less hours of needed staffing for the person than under the
22.15 	Consumer-Directed Community Supports option.  Any exceptions the
22.16 	county grants must be within the county's allowable aggregate
22.17 	amount for the home and community-based waiver for persons with
22.18 	developmental disabilities.

22.19 	Sec. 30. COSTS ASSOCIATED WITH PHYSICAL ACTIVITIES.
 22.20 	The expenses allowed for adults under the Consumer-Directed
22.21 	Community Supports option shall include costs, including
22.22 	transportation, associated with physical exercise or other
22.23 	physical activities to maintain or improve the person's health
22.24 	and functioning.

22.25 	Sec. 31. WAIVER AMENDMENT.
 22.26 	The commissioner of human services shall submit an
22.27 	amendment to the Centers for Medicare and Medicaid Services
22.28 	consistent with sections 29 and 30 by August 1, 2005.

22.29 	Sec. 32. INDEPENDENT EVALUATION AND REVIEW OF UNALLOWABLE
22.30 	ITEMS.
 22.31 	The commissioner of human services shall include in the
22.32 	independent evaluation of the Consumer-Directed Community
22.33 	Supports option provided through the home and community-based
22.34 	services waivers for persons with disabilities under 65 years of
22.35 	age:
22.36 	(1) provision for ongoing, regular participation by
23.1 	stakeholder representatives through June 30, 2007;
23.2 	(2) recommendations on whether changes to the unallowable
23.3 	items should be made to meet the health, safety, or welfare
23.4 	needs of participants in the Consumer-Directed Community
23.5 	Supports option within the allowed budget amounts.  The
23.6 	recommendations on allowable items shall be provided to the
23.7 	senate and house of representatives committees with jurisdiction
23.8 	over human services policy and finance issues by January 15,
23.9 	2006; and 
23.10 	(3) a review of the statewide caseload changes for the
23.11 	disability waiver programs for persons under 65 years of age
23.12 	that occurred since the state-set budget methodology
23.13 	implementation on October 1, 2004, and recommendations on the
23.14 	fiscal impact of the budget methodology on use of the
23.15 	Consumer-Directed Community Supports option.

23.16 	Sec. 33. EFFECTIVE DATE.
 23.17 	Sections 29 and 30 are effective upon federal approval of
23.18 	the waiver amendment in section 31.  Sections 31 and 32 are
23.19 	effective the day following final enactment.