SF 56

Introduction - 84th Legislature (2005 - 2006)

Posted on 12/15/2009 12:00 a.m.

A bill for an act
relating to MinnesotaCare; increasing the limited
benefits cap; modifying the definition of gross
income; amending Minnesota Statutes 2004, sections
256L.01, subdivision 4; 256L.035.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2004, section 256L.01,
subdivision 4, is amended to read:

Subd. 4.

Gross individual or gross family income.

(a)
"Gross individual or gross family income" for nonfarm
self-employed means income calculated using as the baseline the
adjusted gross income reported on the applicant's federal income
tax form for the previous year and adding back in reported
depreciation, carryover loss, and net operating loss amounts
that apply to the business in which the family is currently
engaged.

(b) "Gross individual or gross family income" for farm
self-employed means income calculated using as the baseline the
adjusted gross income reported on the applicant's federal income
tax form for the previous year deleted text begin and adding back in reported
depreciation amounts that apply to the business in which the
family is currently engaged deleted text end .

(c) Applicants shall report the most recent financial
situation of the family if it has changed from the period of
time covered by the federal income tax form. The report may be
in the form of percentage increase or decrease.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005,
or upon receipt of federal approval, whichever is later.
new text end

Sec. 2.

Minnesota Statutes 2004, section 256L.035, is
amended to read:

256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE
ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.

(a) "Covered health services" for individuals under section
256L.04, subdivision 7, with income above 75 percent, but not
exceeding 175 percent, of the federal poverty guideline means:

(1) inpatient hospitalization benefits with a ten percent
co-payment up to $1,000 and subject to an annual limitation of
$10,000;

(2) physician services provided during an inpatient stay;
and

(3) physician services not provided during an inpatient
stay, outpatient hospital services, freestanding ambulatory
surgical center services, chiropractic services, lab and
diagnostic services, and prescription drugs, subject to an
aggregate cap of deleted text begin $2,000 deleted text end new text begin $10,000 new text end per calendar year and the
following co-payments:

(i) $50 co-pay per emergency room visit;

(ii) $3 co-pay per prescription drug; and

(iii) $5 co-pay per nonpreventive physician visit.

For purposes of this subdivision, "a visit" means an
episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is
delivered in an ambulatory setting by a physician or physician
ancillary.

Enrollees are responsible for all co-payments in this
subdivision.

(b) deleted text begin The November 2006 MinnesotaCare forecast for the
biennium beginning July 1, 2007, shall assume an adjustment in
the aggregate cap on the services identified in paragraph (a),
clause (3), in $1,000 increments up to a maximum of $10,000, but
not less than $2,000, to the extent that the balance in the
health care access fund is sufficient in each year of the
biennium to pay for this benefit level. The aggregate cap shall
be adjusted according to the forecast.
deleted text end

deleted text begin (c) deleted text end Reimbursement to the providers shall be reduced by the
amount of the co-payment, except that reimbursement for
prescription drugs shall not be reduced once a recipient has
reached the $20 per month maximum for prescription drug
co-payments. The provider collects the co-payment from the
recipient. Providers may not deny services to recipients who
are unable to pay the co-payment, except as provided in
paragraph deleted text begin (d) deleted text end new text begin (c) new text end .

deleted text begin (d) deleted text end new text begin (c) new text end If it is the routine business practice of a
provider to refuse service to an individual with uncollected
debt, the provider may include uncollected co-payments under
this section. A provider must give advance notice to a
recipient with uncollected debt before services can be denied.