1.1 	A bill for an act
1.2 	relating to human services; requiring mental health urgent care and psychiatric 
1.3 	consultation; reducing certain hospital payment rates; changing medical 
1.4 	assistance covered services; allowing intergovernmental transfers; creating 
1.5 	a new general assistance medical care program; requiring coordinated care 
1.6 	delivery systems; creating a temporary uncompensated care pool and prescription 
1.7 	drug pool; appropriating money;amending Minnesota Statutes 2008, sections 
1.8 	256.969, subdivision 27; 256B.0625, subdivision 13f, by adding a subdivision; 
1.9 	256B.0644; 256B.69, subdivision 20; 256L.05, subdivisions 3, 3a, 3c; 517.08, 
1.10 	subdivision 1c; Minnesota Statutes 2009 Supplement, sections 256.969, 
1.11 	subdivision 3a; 256B.0947, subdivision 1; 256B.196, subdivision 2; 256D.03, 
1.12 	subdivision 3; proposing coding for new law in Minnesota Statutes, chapters 
1.13 	245; 256B; 256D; repealing Minnesota Statutes 2008, sections 256.742; 256.979, 
1.14 	subdivision 8; 256B.195, subdivisions 4, 5; 256D.03, subdivision 9; 256L.07, 
1.15 	subdivision 6; 256L.15, subdivision 4; 256L.17, subdivision 7; Minnesota 
1.16 	Statutes 2009 Supplement, sections 256B.195, subdivisions 1, 2, 3; 256D.03, 
1.17 	subdivision 4.
1.18 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.19 	ARTICLE 1
1.20 	GENERAL ASSISTANCE MEDICAL CARE

1.21 	Section 1. [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC 
1.22 	CONSULTATION.
1.23 		Subdivision 1.Mental health urgent care and psychiatric consultation. The 
1.24 	commissioner shall include mental health urgent care and psychiatric consultation 
1.25 	services as part of, but not limited to, the redesign of six community-based behavioral 
1.26 	health hospitals and the Anoka-Metro Regional Treatment Center. These services must 
1.27 	not duplicate existing services in the region, and must be implemented as specified in 
1.28 	subdivisions 3 to 7.
1.29 		Subd. 2.Definitions. For purposes of this section:
2.1 	(1) mental health urgent care includes:
2.2 	(i) initial mental health screening;
2.3 	(ii) mobile crisis assessment and intervention;
2.4 	(iii) rapid access to psychiatry, including psychiatric evaluation, initial treatment, 
2.5 	and short-term psychiatry;
2.6 	(iv) nonhospital crisis stabilization residential beds; and
2.7 	(v) health care navigator services which include, but are not limited to, assisting 
2.8 	uninsured individuals in obtaining health care coverage; and
2.9 	(2) psychiatric consultation services includes psychiatric consultation to primary 
2.10 	care practitioners.
2.11 		Subd. 3.Rapid access to psychiatry. The commissioner shall develop rapid access 
2.12 	to psychiatric services based on the following criteria:
2.13 	(1) the individuals who receive the psychiatric services must be at risk of 
2.14 	hospitalization and otherwise unable to receive timely services;
2.15 	(2) where clinically appropriate, the service may be provided via interactive video 
2.16 	where the service is provided in conjunction with an emergency room, a local crisis 
2.17 	service, or a primary care or behavioral care practitioner; and
2.18 	(3) the commissioner may integrate rapid access to psychiatry with the psychiatric 
2.19 	consultation services in subdivision 4.
2.20 		Subd. 4.Collaborative psychiatric consultation. (a) The commissioner shall 
2.21 	establish a collaborative psychiatric consultation service based on the following criteria:
2.22 	(1) the service may be available via telephone, interactive video, e-mail, or other 
2.23 	means of communication to emergency rooms, local crisis services, mental health 
2.24 	professionals, and primary care practitioners, including pediatricians;
2.25 	(2) the service shall be provided by a multidisciplinary team including, at a 
2.26 	minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical 
2.27 	social worker;
2.28 	(3) the service shall include a triage-level assessment to determine the most 
2.29 	appropriate response to each request, including appropriate referrals to other mental health 
2.30 	professionals, as well as provision of rapid psychiatric access when other appropriate 
2.31 	services are not available;  
2.32 	(4) the first priority for this service is to provide the consultations required under 
2.33 	section 256B.0625, subdivision 13j; and
2.34 	(5) the service must encourage use of cognitive and behavioral therapies and other 
2.35 	evidence-based treatments in addition to or in place of medication, where appropriate.
3.1 	(b) The commissioner shall appoint an interdisciplinary work group to establish 
3.2 	appropriate medication and psychotherapy protocols to guide the consultative process, 
3.3 	including consultation with the Drug Utilization Review Board, as provided in section 
3.4 	256B.0625, subdivision 13j. 
3.5 		Subd. 5.Phased availability. (a) The commissioner may phase in the availability 
3.6 	of mental health urgent care services based on the limits of appropriations and the 
3.7 	commissioner's determination of level of need and cost-effectiveness.
3.8 	(b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin 
3.9 	and Ramsey Counties and children statewide who are affected by section 256B.0625, 
3.10 	subdivision 13j, and must include tracking of costs for the services provided and 
3.11 	associated impacts on utilization of inpatient, emergency room, and other services.
3.12 		Subd. 6.Limited appropriations. The commissioner shall maximize use 
3.13 	of available health care coverage for the services provided under this section. The 
3.14 	commissioner's responsibility to provide these services for individuals without health care 
3.15 	coverage must not exceed the appropriations for this section.
3.16 		Subd. 7.Flexible implementation. To implement this section, the commissioner 
3.17 	shall select the structure and funding method that is the most cost-effective for each county 
3.18 	or group of counties. This may include grants, contracts, direct provision by state-operated 
3.19 	services, and public-private partnerships. Where feasible, the commissioner shall make 
3.20 	any grants under this section a part of the integrated adult mental health initiative grants 
3.21 	under section 245.4661.

3.22 	Sec. 2. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is 
3.23 	amended to read:
3.24 		Subd. 3a.Payments. (a) Acute care hospital billings under the medical 
3.25 	assistance program must not be submitted until the recipient is discharged. However, 
3.26 	the commissioner shall establish monthly interim payments for inpatient hospitals that 
3.27 	have individual patient lengths of stay over 30 days regardless of diagnostic category. 
3.28 	Except as provided in section 256.9693, medical assistance reimbursement for treatment 
3.29 	of mental illness shall be reimbursed based on diagnostic classifications. Individual 
3.30 	hospital payments established under this section and sections 256.9685, 256.9686, and 
3.31 	256.9695, in addition to third party and recipient liability, for discharges occurring during 
3.32 	the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 
3.33 	inpatient services paid for the same period of time to the hospital. This payment limitation 
3.34 	shall be calculated separately for medical assistance and general assistance medical 
3.35 	care services. The limitation on general assistance medical care shall be effective for 
4.1 	admissions occurring on or after July 1, 1991. Services that have rates established under 
4.2 	subdivision 11 or 12, must be limited separately from other services. After consulting with 
4.3 	the affected hospitals, the commissioner may consider related hospitals one entity and 
4.4 	may merge the payment rates while maintaining separate provider numbers. The operating 
4.5 	and property base rates per admission or per day shall be derived from the best Medicare 
4.6 	and claims data available when rates are established. The commissioner shall determine 
4.7 	the best Medicare and claims data, taking into consideration variables of recency of the 
4.8 	data, audit disposition, settlement status, and the ability to set rates in a timely manner. 
4.9 	The commissioner shall notify hospitals of payment rates by December 1 of the year 
4.10 	preceding the rate year. The rate setting data must reflect the admissions data used to 
4.11 	establish relative values. Base year changes from 1981 to the base year established for the 
4.12 	rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 
4.13 	to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 
4.14 	1. The commissioner may adjust base year cost, relative value, and case mix index data 
4.15 	to exclude the costs of services that have been discontinued by the October 1 of the year 
4.16 	preceding the rate year or that are paid separately from inpatient services. Inpatient stays 
4.17 	that encompass portions of two or more rate years shall have payments established based 
4.18 	on payment rates in effect at the time of admission unless the date of admission preceded 
4.19 	the rate year in effect by six months or more. In this case, operating payment rates for 
4.20 	services rendered during the rate year in effect and established based on the date of 
4.21 	admission shall be adjusted to the rate year in effect by the hospital cost index.
4.22 	(b) For fee-for-service admissions occurring on or after July 1, 2002, the total 
4.23 	payment, before third-party liability and spenddown, made to hospitals for inpatient 
4.24 	services is reduced by .5 percent from the current statutory rates.
4.25 	(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 
4.26 	admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 
4.27 	before third-party liability and spenddown, is reduced five percent from the current 
4.28 	statutory rates. Mental health services within diagnosis related groups 424 to 432, and 
4.29 	facilities defined under subdivision 16 are excluded from this paragraph.
4.30 	(d) In addition to the reduction in paragraphs (b) and (c), the total payment for 
4.31 	fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 
4.32 	inpatient services before third-party liability and spenddown, is reduced 6.0 percent 
4.33 	from the current statutory rates. Mental health services within diagnosis related groups 
4.34 	424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 
4.35 	Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical 
4.36 	assistance does not include general assistance medical care. Payments made to managed 
5.1 	care plans shall be reduced for services provided on or after January 1, 2006, to reflect 
5.2 	this reduction.
5.3 	(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 
5.4 	fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 
5.5 	to hospitals for inpatient services before third-party liability and spenddown, is reduced 
5.6 	3.46 percent from the current statutory rates. Mental health services with diagnosis related 
5.7 	groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 
5.8 	paragraph. Payments made to managed care plans shall be reduced for services provided 
5.9 	on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
5.10 	(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 
5.11 	fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011, 
5.12 	made to hospitals for inpatient services before third-party liability and spenddown, is 
5.13 	reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis 
5.14 	related groups 424 to 432 and facilities defined under subdivision 16 are excluded from 
5.15 	this paragraph. Payments made to managed care plans shall be reduced for services 
5.16 	provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.
5.17 	(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 
5.18 	for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals 
5.19 	for inpatient services before third-party liability and spenddown, is reduced 1.79 percent 
5.20 	from the current statutory rates. Mental health services with diagnosis related groups 
5.21 	424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 
5.22 	Payments made to managed care plans shall be reduced for services provided on or after 
5.23 	July 1, 2010 2011, to reflect this reduction.
5.24 	(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 
5.25 	payment for fee-for-service admissions occurring on or after July 1, 2009, made to 
5.26 	hospitals for inpatient services before third-party liability and spenddown, is reduced 
5.27 	one percent from the current statutory rates. Facilities defined under subdivision 16 are 
5.28 	excluded from this paragraph. Payments made to managed care plans shall be reduced for 
5.29 	services provided on or after October 1, 2009, to reflect this reduction.

5.30 	EFFECTIVE DATE. This section is effective April 1, 2010.

5.31 	Sec. 3. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:
5.32 		Subd. 27.Quarterly payment adjustment. (a) In addition to any other payment 
5.33 	under this section, the commissioner shall make the following payments effective July 
5.34 	1, 2007:
6.1 	(1) for a hospital located in Minnesota and not eligible for payments under 
6.2 	subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8 
6.3 	percent of total patient days as of the base year in effect on July 1, 2005, a payment equal 
6.4 	to 13 percent of the total of the operating and property payment rates;
6.5 	(2) for a hospital located in Minnesota in a specified urban area outside of the 
6.6 	seven-county metropolitan area and not eligible for payments under subdivision 20, with 
6.7 	a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total 
6.8 	patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent 
6.9 	of the total of the operating and property payment rates. For purposes of this clause, the 
6.10 	following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria, 
6.11 	Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, 
6.12 	Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena; 
6.13 	(3) for a hospital located in Minnesota but not located in a specified urban area 
6.14 	under clause (2), with a medical assistance inpatient utilization rate less than or equal to 
6.15 	17.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment 
6.16 	equal to four percent of the total of the operating and property payment rates. A hospital 
6.17 	located in Woodbury and not in existence during the base year shall be reimbursed under 
6.18 	this clause; and
6.19 	(4) in addition to any payments under clauses (1) to (3), for a hospital located in 
6.20 	Minnesota and not eligible for payments under subdivision 20 with a medical assistance 
6.21 	inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect 
6.22 	on July 1, 2005, a payment equal to eight percent of the total of the operating and property 
6.23 	payment rates, and for a hospital located in Minnesota and not eligible for payments 
6.24 	under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent 
6.25 	of total patient days as of the base year in effect on July 1, 2005, a payment equal to 
6.26 	nine percent of the total of the operating and property payment rates. After making any 
6.27 	ratable adjustments required under paragraph (b), the commissioner shall proportionately 
6.28 	reduce payments under clauses (2) and (3) by an amount needed to make payments under 
6.29 	this clause.
6.30 	(b) The state share of payments under paragraph (a) shall be equal to federal 
6.31 	reimbursements to the commissioner to reimburse expenditures reported under section 
6.32 	256B.199, paragraphs (a) to (d). The commissioner shall ratably reduce or increase 
6.33 	payments under this subdivision in order to ensure that these payments equal the amount 
6.34 	of reimbursement received by the commissioner under section 256B.199, paragraphs (a) 
6.35 	to (d), except that payments shall be ratably reduced by an amount equivalent to the state 
6.36 	share of a four percent reduction in MinnesotaCare and medical assistance payments 
7.1 	for inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be 
7.2 	equivalent to the state share of a three percent reduction in these payments. Effective for 
7.3 	federal disproportionate share hospital funds earned on payments reported under section 
7.4 	256B.199, paragraphs (a) to (d), for services rendered on or after April 1, 2010, payments 
7.5 	shall not be made under this subdivision or subdivision 28.
7.6 	(c) The payments under paragraph (a) shall be paid quarterly based on each hospital's 
7.7 	operating and property payments from the second previous quarter, beginning on July 
7.8 	15, 2007, or upon federal approval of federal reimbursements under section 256B.199, 
7.9 	paragraphs (a) to (d), whichever occurs later.
7.10 	(d) The commissioner shall not adjust rates paid to a prepaid health plan under 
7.11 	contract with the commissioner to reflect payments provided in paragraph (a).
7.12 	(e) The commissioner shall maximize the use of available federal money for 
7.13 	disproportionate share hospital payments and shall maximize payments to qualifying 
7.14 	hospitals. In order to accomplish these purposes, the commissioner may, in consultation 
7.15 	with the nonstate entities identified in section 256B.199, paragraphs (a) to (d), adjust, 
7.16 	on a pro rata basis if feasible, the amounts reported by nonstate entities under section 
7.17 	256B.199, paragraphs (a) to (d), when application for reimbursement is made to the federal 
7.18 	government, and otherwise adjust the provisions of this subdivision. The commissioner 
7.19 	shall utilize a settlement process based on finalized data to maximize revenue under 
7.20 	section 256B.199, paragraphs (a) to (d), and payments under this section.
7.21 	(f) For purposes of this subdivision, medical assistance does not include general 
7.22 	assistance medical care.

7.23 	EFFECTIVE DATE. This section is effective for services rendered on or after 
7.24 	April 1, 2010.

7.25 	Sec. 4. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to 
7.26 	read:
7.27 		Subd. 13f.Prior authorization. (a) The Formulary Committee shall review and 
7.28 	recommend drugs which require prior authorization. The Formulary Committee shall 
7.29 	establish general criteria to be used for the prior authorization of brand-name drugs for 
7.30 	which generically equivalent drugs are available, but the committee is not required to 
7.31 	review each brand-name drug for which a generically equivalent drug is available.
7.32 	(b) Prior authorization may be required by the commissioner before certain 
7.33 	formulary drugs are eligible for payment. The Formulary Committee may recommend 
7.34 	drugs for prior authorization directly to the commissioner. The commissioner may also 
8.1 	request that the Formulary Committee review a drug for prior authorization. Before the 
8.2 	commissioner may require prior authorization for a drug:
8.3 	(1) the commissioner must provide information to the Formulary Committee on the 
8.4 	impact that placing the drug on prior authorization may have on the quality of patient care 
8.5 	and on program costs, information regarding whether the drug is subject to clinical abuse 
8.6 	or misuse, and relevant data from the state Medicaid program if such data is available;
8.7 	(2) the Formulary Committee must review the drug, taking into account medical and 
8.8 	clinical data and the information provided by the commissioner; and
8.9 	(3) the Formulary Committee must hold a public forum and receive public comment 
8.10 	for an additional 15 days.
8.11 	The commissioner must provide a 15-day notice period before implementing the prior 
8.12 	authorization.
8.13 	(c) Except as provided in subdivision 13j, prior authorization shall not be required or 
8.14 	utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:
8.15 	(1) there is no generically equivalent drug available; and
8.16 	(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
8.17 	(3) the drug is part of the recipient's current course of treatment.
8.18 	This paragraph applies to any multistate preferred drug list or supplemental drug rebate 
8.19 	program established or administered by the commissioner. Prior authorization shall 
8.20 	automatically be granted for 60 days for brand name drugs prescribed for treatment of 
8.21 	mental illness within 60 days of when a generically equivalent drug becomes available, 
8.22 	provided that the brand name drug was part of the recipient's course of treatment at the 
8.23 	time the generically equivalent drug became available.
8.24 	(d) Prior authorization shall not be required or utilized for any antihemophilic factor 
8.25 	drug prescribed for the treatment of hemophilia and blood disorders where there is no 
8.26 	generically equivalent drug available if the prior authorization is used in conjunction with 
8.27 	any supplemental drug rebate program or multistate preferred drug list established or 
8.28 	administered by the commissioner.
8.29 	(e) The commissioner may require prior authorization for brand name drugs 
8.30 	whenever a generically equivalent product is available, even if the prescriber specifically 
8.31 	indicates "dispense as written-brand necessary" on the prescription as required by section 
8.32 	151.21, subdivision 2.
8.33 	(f) Notwithstanding this subdivision, the commissioner may automatically require 
8.34 	prior authorization, for a period not to exceed 180 days, for any drug that is approved by 
8.35 	the United States Food and Drug Administration on or after July 1, 2005. The 180-day 
8.36 	period begins no later than the first day that a drug is available for shipment to pharmacies 
9.1 	within the state. The Formulary Committee shall recommend to the commissioner general 
9.2 	criteria to be used for the prior authorization of the drugs, but the committee is not 
9.3 	required to review each individual drug. In order to continue prior authorizations for a 
9.4 	drug after the 180-day period has expired, the commissioner must follow the provisions 
9.5 	of this subdivision.

9.6 	EFFECTIVE DATE. This section is effective April 1, 2010.

9.7 	Sec. 5. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
9.8 	subdivision to read:
9.9 		Subd. 13j.Antipsychotic and attention deficit disorder and attention deficit 
9.10 	hyperactivity disorder medications. (a) The commissioner, in consultation with the 
9.11 	Drug Utilization Review Board established in subdivision 13i and actively practicing 
9.12 	pediatric mental health professionals, must:
9.13 	(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs 
9.14 	and drugs used for attention deficit disorder or attention deficit hyperactivity disorder 
9.15 	based on available medical, clinical, and safety data and research. The commissioner 
9.16 	shall periodically review the list of medications and pediatric dose ranges and update 
9.17 	the medications and doses listed as needed after consultation with the Drug Utilization 
9.18 	Review Board;
9.19 	(2) identify situations where a collaborative psychiatric consultation and prior 
9.20 	authorization should be required before the initiation or continuation of drug therapy 
9.21 	in pediatric patients including, but not limited to, high-dose regimens, off-label use of 
9.22 	prescription medication, a patient's young age, and lack of coordination among multiple 
9.23 	prescribing providers; and
9.24 	(3) track prescriptive practices and the use of psychotropic medications in children 
9.25 	with the goal of reducing the use of medication, where appropriate.
9.26 	(b) Effective July 1, 2011, the commissioner shall require prior authorization and 
9.27 	a collaborative psychiatric consultation before an atypical antipsychotic and attention 
9.28 	deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria 
9.29 	identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric 
9.30 	consultation must be completed before the identified medications are eligible for payment 
9.31 	unless:
9.32 	(1) the patient has already been stabilized on the medication regimen; or
9.33 	(2) the prescriber indicates that the child is in crisis.
10.1 	If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed 
10.2 	within 90 days for payment to continue.
10.3 	(c) For purposes of this subdivision, a collaborative psychiatric consultation must 
10.4 	meet the criteria described in section 245.4862, subdivision 4.

10.5 	Sec. 6. Minnesota Statutes 2008, section 256B.0644, is amended to read:
10.6 	256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE 
10.7 	PROGRAMS.
10.8 	(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a 
10.9 	health maintenance organization, as defined in chapter 62D, must participate as a provider 
10.10 	or contractor in the medical assistance program, general assistance medical care program, 
10.11 	and MinnesotaCare as a condition of participating as a provider in health insurance plans 
10.12 	and programs or contractor for state employees established under section 43A.18, the 
10.13 	public employees insurance program under section 43A.316, for health insurance plans 
10.14 	offered to local statutory or home rule charter city, county, and school district employees, 
10.15 	the workers' compensation system under section 176.135, and insurance plans provided 
10.16 	through the Minnesota Comprehensive Health Association under sections 62E.01 to 
10.17 	62E.19. The limitations on insurance plans offered to local government employees shall 
10.18 	not be applicable in geographic areas where provider participation is limited by managed 
10.19 	care contracts with the Department of Human Services. 
10.20 	(b) For providers other than health maintenance organizations, participation in the 
10.21 	medical assistance program means that:
10.22 	 (1) the provider accepts new medical assistance, general assistance medical care, 
10.23 	and MinnesotaCare patients;
10.24 	(2) for providers other than dental service providers, at least 20 percent of the 
10.25 	provider's patients are covered by medical assistance, general assistance medical care, 
10.26 	and MinnesotaCare as their primary source of coverage; or
10.27 	(3) for dental service providers, at least ten percent of the provider's patients are 
10.28 	covered by medical assistance, general assistance medical care, and MinnesotaCare as 
10.29 	their primary source of coverage, or the provider accepts new medical assistance and 
10.30 	MinnesotaCare patients who are children with special health care needs. For purposes 
10.31 	of this section, "children with special health care needs" means children up to age 18 
10.32 	who: (i) require health and related services beyond that required by children generally; 
10.33 	and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional 
10.34 	condition, including: bleeding and coagulation disorders; immunodeficiency disorders; 
10.35 	cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other 
11.1 	neurological diseases; visual impairment or deafness; Down syndrome and other genetic 
11.2 	disorders; autism; fetal alcohol syndrome; and other conditions designated by the 
11.3 	commissioner after consultation with representatives of pediatric dental providers and 
11.4 	consumers. 
11.5 	(c) Patients seen on a volunteer basis by the provider at a location other than 
11.6 	the provider's usual place of practice may be considered in meeting the participation 
11.7 	requirement in this section. The commissioner shall establish participation requirements 
11.8 	for health maintenance organizations. The commissioner shall provide lists of participating 
11.9 	medical assistance providers on a quarterly basis to the commissioner of management and 
11.10 	budget, the commissioner of labor and industry, and the commissioner of commerce. Each 
11.11 	of the commissioners shall develop and implement procedures to exclude as participating 
11.12 	providers in the program or programs under their jurisdiction those providers who do 
11.13 	not participate in the medical assistance program. The commissioner of management 
11.14 	and budget shall implement this section through contracts with participating health and 
11.15 	dental carriers. 
11.16 	(d) Any hospital or other provider that is participating in a coordinated care 
11.17 	delivery system under section 256D.031, subdivision 6, or receives payments from the 
11.18 	uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to 
11.19 	provide services to any patient enrolled in general assistance medical care regardless of 
11.20 	the availability or the amount of payment.
11.21 	(e) For purposes of paragraphs (a) and (b), participation in the general assistance 
11.22 	medical care program applies only to pharmacy providers.

11.23 	Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0947, subdivision 1, 
11.24 	is amended to read:
11.25 		Subdivision 1.Scope. Effective November 1, 2010 2011, and subject to federal 
11.26 	approval, medical assistance covers medically necessary, intensive nonresidential 
11.27 	rehabilitative mental health services as defined in subdivision 2, for recipients as defined 
11.28 	in subdivision 3, when the services are provided by an entity meeting the standards 
11.29 	in this section.

11.30 	Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, is 
11.31 	amended to read:
11.32 		Subd. 2.Commissioner's duties. (a) For the purposes of this subdivision and 
11.33 	subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 
11.34 	services upper payment limit for nonstate government hospitals. The commissioner shall 
12.1 	then determine the amount of a supplemental payment to Hennepin County Medical 
12.2 	Center and Regions Hospital for these services that would increase medical assistance 
12.3 	spending in this category to the aggregate upper payment limit for all nonstate government 
12.4 	hospitals in Minnesota. In making this determination, the commissioner shall allot the 
12.5 	available increases between Hennepin County Medical Center and Regions Hospital 
12.6 	based on the ratio of medical assistance fee-for-service outpatient hospital payments to 
12.7 	the two facilities. The commissioner shall adjust this allotment as necessary based on 
12.8 	federal approvals, the amount of intergovernmental transfers received from Hennepin and 
12.9 	Ramsey Counties, and other factors, in order to maximize the additional total payments. 
12.10 	The commissioner shall inform Hennepin County and Ramsey County of the periodic 
12.11 	intergovernmental transfers necessary to match federal Medicaid payments available 
12.12 	under this subdivision in order to make supplementary medical assistance payments to 
12.13 	Hennepin County Medical Center and Regions Hospital equal to an amount that when 
12.14 	combined with existing medical assistance payments to nonstate governmental hospitals 
12.15 	would increase total payments to hospitals in this category for outpatient services to 
12.16 	the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 
12.17 	receipt of these periodic transfers, the commissioner shall make supplementary payments 
12.18 	to Hennepin County Medical Center and Regions Hospital.
12.19 	(b) For the purposes of this subdivision and subdivision 3, the commissioner shall 
12.20 	determine an upper payment limit for physicians affiliated with Hennepin County Medical 
12.21 	Center and with Regions Hospital. The upper payment limit shall be based on the average 
12.22 	commercial rate or be determined using another method acceptable to the Centers for 
12.23 	Medicare and Medicaid Services. The commissioner shall inform Hennepin County and 
12.24 	Ramsey County of the periodic intergovernmental transfers necessary to match the federal 
12.25 	Medicaid payments available under this subdivision in order to make supplementary 
12.26 	payments to physicians affiliated with Hennepin County Medical Center and Regions 
12.27 	Hospital equal to the difference between the established medical assistance payment for 
12.28 	physician services and the upper payment limit. Upon receipt of these periodic transfers, 
12.29 	the commissioner shall make supplementary payments to physicians of Hennepin Faculty 
12.30 	Associates and HealthPartners.
12.31 	(c) Beginning January 1, 2010, Hennepin County and Ramsey County shallmay 
12.32 	make monthly voluntary intergovernmental transfers to the commissioner in the following
12.33 	amounts: $133,333 bynot to exceed $12,000,000 per year from Hennepin County 
12.34 	and $100,000 by$6,000,000 per year from Ramsey County. The commissioner shall 
12.35 	increase the medical assistance capitation payments to Metropolitan Health Plan and 
12.36 	HealthPartners byany licensed health plan under contract with the medical assistance 
13.1 	program that agrees to make enhanced payments to Hennepin County Medical Center or 
13.2 	Regions Hospital. The increase shall be in an amount equal to the annual value of the 
13.3 	monthly transfers plus federal financial participation., with each health plan receiving its 
13.4 	pro rata share of the increase based on the pro rata share of medical assistance admissions 
13.5 	to Hennepin County Medical Center and Regions Hospital by those plans. Upon the 
13.6 	request of the commissioner, health plans shall submit individual-level cost data for 
13.7 	verification purposes. The commissioner may ratably reduce these payments on a pro rata 
13.8 	basis in order to satisfy federal requirements for actuarial soundness. If payments are 
13.9 	reduced, transfers shall be reduced accordingly. Any licensed health plan that receives 
13.10 	increased medical assistance capitation payments under the intergovernmental transfer 
13.11 	described in this paragraph shall increase its medical assistance payments to Hennepin 
13.12 	County Medical Center and Regions Hospital by the same amount as the increased 
13.13 	payments received in the capitation payment described in this paragraph.
13.14 	(d) The commissioner shall inform Hennepin County and Ramsey County on an 
13.15 	ongoing basis of the need for any changes needed in the intergovernmental transfers 
13.16 	in order to continue the payments under paragraphs (a) to (c), at their maximum level, 
13.17 	including increases in upper payment limits, changes in the federal Medicaid match, and 
13.18 	other factors.
13.19 	(e) The payments in paragraphs (a) to (c) shall be implemented independently of 
13.20 	each other, subject to federal approval and to the receipt of transfers under subdivision 3.

13.21 	EFFECTIVE DATE. This section is effective 60 days after federal approval.

13.22 	Sec. 9. [256B.197] INTERGOVERNMENTAL TRANSFERS; INPATIENT 
13.23 	HOSPITAL PAYMENTS.
13.24 		Subdivision 1.Federal approval required. This section is effective for federal 
13.25 	fiscal year 2010 and future years contingent on federal approval of the voluntary 
13.26 	intergovernmental transfers and payments authorized under this section and contingent on 
13.27 	payment of the intergovernmental transfers under this section.
13.28 		Subd. 2.Eligible nonstate government hospitals. (a) Hennepin County Medical 
13.29 	Center and Regions Hospital are eligible nonstate government hospitals.
13.30 	(b) If the commissioner obtains federal approval to include other hospitals, including 
13.31 	University of Minnesota Medical Center, Fairview, and SMDC Medical Center, the 
13.32 	commissioner may expand the definition of eligible nonstate government hospitals to 
13.33 	include other hospitals.
13.34 		Subd. 3.Commissioner's duties. (a) For the purposes of this subdivision, the 
13.35 	commissioner shall determine the fee-for-service inpatient hospital services upper 
14.1 	payment limit for nonstate government hospitals. The commissioner shall determine, 
14.2 	for each eligible nonstate government hospital, the amount of a supplemental payment 
14.3 	for inpatient hospital services that would increase medical assistance spending for each 
14.4 	eligible nonstate government hospital up to the amount that Medicare would pay for 
14.5 	the Medicaid fee-for-service inpatient hospital services provided by that hospital. If 
14.6 	the combined amount of such supplemental payment amounts and existing medical 
14.7 	assistance payments for inpatient hospital services to all nonstate government hospitals 
14.8 	is less than the upper payment limit, the commissioner shall increase the supplemental 
14.9 	payment amount for each eligible nonstate government hospital in proportion to the initial 
14.10 	supplemental payments in order to maximize the additional total payments.
14.11 	(b) The commissioner shall inform each eligible nonstate government hospital and 
14.12 	associated governmental entities of voluntary intergovernmental transfers necessary to 
14.13 	provide the nonfederal share for the supplemental payment amount attributable to each 
14.14 	eligible nonstate government hospital, as calculated under paragraph (a).
14.15 	(c) Upon receipt of a voluntary intergovernmental transfer from a governmental 
14.16 	entity associated with an eligible nonstate government hospital or from the eligible 
14.17 	nonstate government hospital, the commissioner shall make a supplemental payment, 
14.18 	using the amounts calculated under paragraph (a), to the associated eligible nonstate 
14.19 	government hospital.
14.20 	(d) The commissioner may implement the payments in this section through use of 
14.21 	periodic payments and voluntary intergovernmental transfers.
14.22 	(e) The commissioner shall inform eligible nonstate government hospitals and 
14.23 	associated governmental entities on an ongoing basis of the need for any changes needed 
14.24 	in the payment amounts or voluntary intergovernmental transfers in order to continue 
14.25 	the payments under paragraph (c) at their maximum level, including increases in upper 
14.26 	payment limits, changes in the federal Medicaid match, and other factors.

14.27 	Sec. 10. Minnesota Statutes 2008, section 256B.69, subdivision 20, is amended to read:
14.28 		Subd. 20.Ombudsperson. The commissioner shall designate an ombudsperson 
14.29 	to advocate for persons required to enroll in prepaid health plans under this section. The 
14.30 	ombudsperson shall advocate for recipients enrolled in prepaid health plans through 
14.31 	complaint and appeal procedures and ensure that necessary medical services are provided 
14.32 	either by the prepaid health plan directly or by referral to appropriate social services. At 
14.33 	the time of enrollment in a prepaid health plan, the local agency shall inform recipients 
14.34 	about the ombudsperson program and their right to a resolution of a complaint by the 
14.35 	prepaid health plan if they experience a problem with the plan or its providers.
15.1 	(b) The commissioner shall designate an ombudsperson to advocate for persons 
15.2 	enrolled in a coordinated care delivery system under section 256D.031, subdivision 6. The 
15.3 	ombudsperson shall advocate for recipients enrolled in a coordinated care delivery system 
15.4 	through the state appeal process, and assist enrollees in accessing necessary medical 
15.5 	services through the coordinated care delivery system directly or by referral to appropriate 
15.6 	services. At the time of enrollment in a coordinated care delivery system, the local agency 
15.7 	shall inform recipients about the ombudsperson program.

15.8 	Sec. 11. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is 
15.9 	amended to read:
15.10 		Subd. 3.General assistance medical care; eligibility. (a) General assistance 
15.11 	medical care may be paid for any person who is not eligible for medical assistance 
15.12 	under chapter 256B, including eligibility for medical assistance based on a spenddown 
15.13 	of excess income according to section 256B.056, subdivision 5, or MinnesotaCare for 
15.14 	applicants and recipients defined in paragraph (c), except as provided in paragraph (d), 
15.15 	and: Beginning April 1, 2010, the general assistance medical care program shall be 
15.16 	administered according to section 256D.031, unless otherwise stated, except for outpatient 
15.17 	prescription drug coverage which shall continue to be administered under this section and 
15.18 	funded under section 256D.031, subdivision 9, beginning June 1, 2010.
15.19 	(b) Outpatient prescription drug coverage under general assistance medical care is 
15.20 	limited to prescription drugs that:
15.21 	(1) are covered under the medical assistance program as described in section 
15.22 	256B.0625, subdivisions 13 and 13d; and
15.23 	(2) are provided by manufacturers that have fully executed general assistance 
15.24 	medical care rebate agreements with the commissioner and comply with the agreements. 
15.25 	Outpatient prescription drug coverage under general assistance medical care must conform 
15.26 	to coverage under the medical assistance program according to section 256B.0625, 
15.27 	subdivisions 13 to 13g.
15.28 	(c) Outpatient prescription drug coverage does not include drugs administered in a 
15.29 	clinic or other outpatient setting.
15.30 	(1) who is receiving assistance under section 256D.05, except for families with 
15.31 	children who are eligible under Minnesota family investment program (MFIP), or who is 
15.32 	having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
15.33 	(2) who is a resident of Minnesota; and
15.34 	(i) who has gross countable income not in excess of 75 percent of the federal poverty 
15.35 	guidelines for the family size, using a six-month budget period and whose equity in assets 
16.1 	is not in excess of $1,000 per assistance unit. General assistance medical care is not 
16.2 	available for applicants or enrollees who are otherwise eligible for medical assistance but 
16.3 	fail to verify their assets. Enrollees who become eligible for medical assistance shall be 
16.4 	terminated and transferred to medical assistance. Exempt assets, the reduction of excess 
16.5 	assets, and the waiver of excess assets must conform to the medical assistance program in 
16.6 	section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum 
16.7 	amount of undistributed funds in a trust that could be distributed to or on behalf of the 
16.8 	beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the 
16.9 	terms of the trust, must be applied toward the asset maximum; or
16.10 	(ii) who has gross countable income above 75 percent of the federal poverty 
16.11 	guidelines but not in excess of 175 percent of the federal poverty guidelines for the family 
16.12 	size, using a six-month budget period, whose equity in assets is not in excess of the limits 
16.13 	in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization.
16.14 	(b) The commissioner shall adjust the income standards under this section each July 
16.15 	1 by the annual update of the federal poverty guidelines following publication by the 
16.16 	United States Department of Health and Human Services.
16.17 	(c) Effective for applications and renewals processed on or after September 1, 2006, 
16.18 	general assistance medical care may not be paid for applicants or recipients who are adults 
16.19 	with dependent children under 21 whose gross family income is equal to or less than 275 
16.20 	percent of the federal poverty guidelines who are not described in paragraph (f).
16.21 	(d) Effective for applications and renewals processed on or after September 1, 2006, 
16.22 	general assistance medical care may be paid for applicants and recipients who meet all 
16.23 	eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period 
16.24 	beginning the date of application. Immediately following approval of general assistance 
16.25 	medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04, 
16.26 	subdivision 7, with covered services as provided in section 256L.03 for the rest of the 
16.27 	six-month general assistance medical care eligibility period, until their six-month renewal. 
16.28 	(e) To be eligible for general assistance medical care following enrollment in 
16.29 	MinnesotaCare as required by paragraph (d), an individual must complete a new 
16.30 	application.
16.31 	(f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are 
16.32 	exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
16.33 	(1) have applied for and are awaiting a determination of blindness or disability by 
16.34 	the state medical review team or a determination of eligibility for Supplemental Security 
16.35 	Income or Social Security Disability Insurance by the Social Security Administration;
16.36 	(2) fail to meet the requirements of section 256L.09, subdivision 2;
17.1 	(3) are homeless as defined by United States Code, title 42, section 11301, et seq.;
17.2 	(4) are classified as end-stage renal disease beneficiaries in the Medicare program;
17.3 	(5) are enrolled in private health care coverage as defined in section 256B.02, 
17.4 	subdivision 9;
17.5 	(6) are eligible under paragraph (k);
17.6 	(7) receive treatment funded pursuant to section 254B.02; or
17.7 	(8) reside in the Minnesota sex offender program defined in chapter 246B. 
17.8 	(g) For applications received on or after October 1, 2003, eligibility may begin no 
17.9 	earlier than the date of application. For individuals eligible under paragraph (a), clause 
17.10 	(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are 
17.11 	eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but 
17.12 	may reapply if there is a subsequent period of inpatient hospitalization.
17.13 	(h) Beginning September 1, 2006, Minnesota health care program applications and 
17.14 	renewals completed by recipients and applicants who are persons described in paragraph 
17.15 	(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility 
17.16 	by the county agency. If all other eligibility requirements of this subdivision are met, 
17.17 	eligibility for general assistance medical care shall be available in any month during which 
17.18 	MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare, 
17.19 	notice of termination for eligibility for general assistance medical care shall be sent to 
17.20 	an applicant or recipient. If all other eligibility requirements of this subdivision are 
17.21 	met, eligibility for general assistance medical care shall be available until enrollment in 
17.22 	MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).
17.23 	(i) The date of an initial Minnesota health care program application necessary to 
17.24 	begin a determination of eligibility shall be the date the applicant has provided a name, 
17.25 	address, and Social Security number, signed and dated, to the county agency or the 
17.26 	Department of Human Services. If the applicant is unable to provide a name, address, 
17.27 	Social Security number, and signature when health care is delivered due to a medical 
17.28 	condition or disability, a health care provider may act on an applicant's behalf to establish 
17.29 	the date of an initial Minnesota health care program application by providing the county 
17.30 	agency or Department of Human Services with provider identification and a temporary 
17.31 	unique identifier for the applicant. The applicant must complete the remainder of the 
17.32 	application and provide necessary verification before eligibility can be determined. The 
17.33 	applicant must complete the application within the time periods required under the 
17.34 	medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart 
17.35 	5, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining 
17.36 	verification if necessary.
18.1 	(j) County agencies are authorized to use all automated databases containing 
18.2 	information regarding recipients' or applicants' income in order to determine eligibility for 
18.3 	general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 
18.4 	in order to determine eligibility and premium payments by the county agency.
18.5 	(k) General assistance medical care is not available for a person in a correctional 
18.6 	facility unless the person is detained by law for less than one year in a county correctional 
18.7 	or detention facility as a person accused or convicted of a crime, or admitted as an 
18.8 	inpatient to a hospital on a criminal hold order, and the person is a recipient of general 
18.9 	assistance medical care at the time the person is detained by law or admitted on a criminal 
18.10 	hold order and as long as the person continues to meet other eligibility requirements 
18.11 	of this subdivision.
18.12 	(l) General assistance medical care is not available for applicants or recipients who 
18.13 	do not cooperate with the county agency to meet the requirements of medical assistance.
18.14 	(m) In determining the amount of assets of an individual eligible under paragraph 
18.15 	(a), clause (2), item (i), there shall be included any asset or interest in an asset, including 
18.16 	an asset excluded under paragraph (a), that was given away, sold, or disposed of for 
18.17 	less than fair market value within the 60 months preceding application for general 
18.18 	assistance medical care or during the period of eligibility. Any transfer described in this 
18.19 	paragraph shall be presumed to have been for the purpose of establishing eligibility for 
18.20 	general assistance medical care, unless the individual furnishes convincing evidence to 
18.21 	establish that the transaction was exclusively for another purpose. For purposes of this 
18.22 	paragraph, the value of the asset or interest shall be the fair market value at the time it 
18.23 	was given away, sold, or disposed of, less the amount of compensation received. For any 
18.24 	uncompensated transfer, the number of months of ineligibility, including partial months, 
18.25 	shall be calculated by dividing the uncompensated transfer amount by the average monthly 
18.26 	per person payment made by the medical assistance program to skilled nursing facilities 
18.27 	for the previous calendar year. The individual shall remain ineligible until this fixed period 
18.28 	has expired. The period of ineligibility may exceed 30 months, and a reapplication for 
18.29 	benefits after 30 months from the date of the transfer shall not result in eligibility unless 
18.30 	and until the period of ineligibility has expired. The period of ineligibility begins in the 
18.31 	month the transfer was reported to the county agency, or if the transfer was not reported, 
18.32 	the month in which the county agency discovered the transfer, whichever comes first. For 
18.33 	applicants, the period of ineligibility begins on the date of the first approved application.
18.34 	(n) When determining eligibility for any state benefits under this subdivision, 
18.35 	the income and resources of all noncitizens shall be deemed to include their sponsor's 
18.36 	income and resources as defined in the Personal Responsibility and Work Opportunity 
19.1 	Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 
19.2 	subsequently set out in federal rules.
19.3 	(o) Undocumented noncitizens and nonimmigrants are ineligible for general 
19.4 	assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 
19.5 	in one or more of the classes listed in United States Code, title 8, section 1101, subsection 
19.6 	(a), paragraph (15), and an undocumented noncitizen is an individual who resides in 
19.7 	the United States without the approval or acquiescence of the United States Citizenship 
19.8 	and Immigration Services.
19.9 	(p) Notwithstanding any other provision of law, a noncitizen who is ineligible for 
19.10 	medical assistance due to the deeming of a sponsor's income and resources, is ineligible 
19.11 	for general assistance medical care.
19.12 	(q) Effective July 1, 2003, general assistance medical care emergency services end.

19.13 	EFFECTIVE DATE. This section is effective April 1, 2010.

19.14 	Sec. 12. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.
19.15 		Subdivision 1.Eligibility. (a) Except as provided under subdivision 2, general 
19.16 	assistance medical care may be paid for any individual who is not eligible for medical 
19.17 	assistance under chapter 256B, including eligibility for medical assistance based on a 
19.18 	spenddown of excess income according to section 256B.056, subdivision 5, and who:
19.19 	(1) is receiving assistance under section 256D.05, except for families with children 
19.20 	who are eligible under the Minnesota family investment program (MFIP), or who is 
19.21 	having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
19.22 	(2) is a resident of Minnesota and has gross countable income not in excess of 75 
19.23 	percent of federal poverty guidelines for the family size, using a six-month budget period, 
19.24 	and whose equity in assets is not in excess of $1,000 per assistance unit.
19.25 	Exempt assets, the reduction of excess assets, and the waiver of excess assets must 
19.26 	conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d, 
19.27 	except that the maximum amount of undistributed funds in a trust that could be distributed 
19.28 	to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's 
19.29 	discretion under the terms of the trust, must be applied toward the asset maximum.
19.30 	(b) The commissioner shall adjust the income standards under this section each July 
19.31 	1 by the annual update of the federal poverty guidelines following publication by the 
19.32 	United States Department of Health and Human Services.
19.33 		Subd. 2.Ineligible groups. (a) General assistance medical care may not be paid for 
19.34 	an applicant or a recipient who:
20.1 	(1) is otherwise eligible for medical assistance but fails to verify their assets;
20.2 	(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;
20.3 	(3) is enrolled in private health coverage as defined in section 256B.02, subdivision 
20.4 	9;
20.5 	(4) is in a correctional facility, including an individual in a county correctional or 
20.6 	detention facility as an individual accused or convicted of a crime, or admitted as an 
20.7 	inpatient to a hospital on a criminal hold order;
20.8 	(5) resides in the Minnesota sex offender program defined in chapter 246B;
20.9 	(6) does not cooperate with the county agency to meet the requirements of medical 
20.10 	assistance; or
20.11 	(7) does not cooperate with a county or state agency or the state medical review team 
20.12 	in determining a disability or for determining eligibility for Supplemental Security Income 
20.13 	or Social Security Disability Insurance by the Social Security Administration.
20.14 	(b) Undocumented noncitizens and nonimmigrants are ineligible for general 
20.15 	assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 
20.16 	in one or more of the classes listed in United States Code, title 8, section 1101, subsection 
20.17 	(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the 
20.18 	United States without approval or acquiescence of the United States Citizenship and 
20.19 	Immigration Services.
20.20 	(c) Notwithstanding any other provision of law, a noncitizen who is ineligible for 
20.21 	medical assistance due to the deeming of a sponsor's income and resources is ineligible for 
20.22 	general assistance medical care.
20.23 	(d) General assistance medical care recipients who become eligible for medical 
20.24 	assistance shall be terminated from general assistance medical care and transferred to 
20.25 	medical assistance.
20.26 		Subd. 3.Eligibility and enrollment procedures. (a) Eligibility for general 
20.27 	assistance medical care shall begin no earlier than the date of application. The date of 
20.28 	application shall be the date the applicant has provided a name, address, and Social 
20.29 	Security number, signed and dated, to the county agency or the Department of Human 
20.30 	Services. If the applicant is unable to provide a name, address, Social Security number, 
20.31 	and signature when health care is delivered due to a medical condition or disability, a 
20.32 	health care provider may act on an applicant's behalf to establish the date of an application 
20.33 	by providing the county agency or Department of Human Services with provider 
20.34 	identification and a temporary unique identifier for the applicant. The applicant must 
20.35 	complete the remainder of the application and provide necessary verification before 
20.36 	eligibility can be determined. The applicant must complete the application within the time 
21.1 	periods required under the medical assistance program as specified in Minnesota Rules, 
21.2 	parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the 
21.3 	applicant in obtaining verification if necessary. 
21.4 	(b) County agencies are authorized to use all automated databases containing 
21.5 	information regarding recipients' or applicants' income in order to determine eligibility for 
21.6 	general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 
21.7 	in order to determine eligibility and premium payments by the county agency.
21.8 	(c) In determining the amount of assets of an individual eligible under subdivision 1, 
21.9 	paragraph (a), clause (2), there shall be included any asset or interest in an asset, including 
21.10 	an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or 
21.11 	disposed of for less than fair market value within the 60 months preceding application for 
21.12 	general assistance medical care or during the period of eligibility. Any transfer described 
21.13 	in this paragraph shall be presumed to have been for the purpose of establishing eligibility 
21.14 	for general assistance medical care, unless the individual furnishes convincing evidence to 
21.15 	establish that the transaction was exclusively for another purpose. For purposes of this 
21.16 	paragraph, the value of the asset or interest shall be the fair market value at the time it 
21.17 	was given away, sold, or disposed of, less the amount of compensation received. For any 
21.18 	uncompensated transfer, the number of months of ineligibility, including partial months, 
21.19 	shall be calculated by dividing the uncompensated transfer amount by the average monthly 
21.20 	per person payment made by the medical assistance program to skilled nursing facilities 
21.21 	for the previous calendar year. The individual shall remain ineligible until this fixed period 
21.22 	has expired. The period of ineligibility may exceed 30 months, and a reapplication for 
21.23 	benefits after 30 months from the date of the transfer shall not result in eligibility unless 
21.24 	and until the period of ineligibility has expired. The period of ineligibility begins in the 
21.25 	month the transfer was reported to the county agency, or if the transfer was not reported, 
21.26 	the month in which the county agency discovered the transfer, whichever comes first. For 
21.27 	applicants, the period of ineligibility begins on the date of the first approved application.
21.28 	(d) When determining eligibility for any state benefits under this subdivision, 
21.29 	the income and resources of all noncitizens shall be deemed to include their sponsor's 
21.30 	income and resources as defined in the Personal Responsibility and Work Opportunity 
21.31 	Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 
21.32 	subsequently set out in federal rules.
21.33 	(e) Applicants and recipients are eligible for general assistance medical care for a 
21.34 	six-month eligibility period, unless a change that affects eligibility is reported. Eligibility 
21.35 	may be renewed for additional six-month periods. During each six-month eligibility 
22.1 	period, recipients who continue to meet the eligibility requirements of this section are 
22.2 	not eligible for MinnesotaCare.
22.3 		Subd. 4.General assistance medical care; services. (a) Within the limitations 
22.4 	described in this section, general assistance medical care covers medically necessary 
22.5 	services that include:
22.6 	(1) inpatient hospital services;
22.7 	(2) outpatient hospital services;
22.8 	(3) services provided by Medicare-certified rehabilitation agencies;
22.9 	(4) prescription drugs;
22.10 	(5) equipment necessary to administer insulin and diagnostic supplies and equipment 
22.11 	for diabetics to monitor blood sugar level;
22.12 	(6) eyeglasses and eye examinations;
22.13 	(7) hearing aids;
22.14 	(8) prosthetic devices, if not covered by veteran's benefits;
22.15 	(9) laboratory and x-ray services;
22.16 	(10) physicians' services;
22.17 	(11) medical transportation except special transportation;
22.18 	(12) chiropractic services as covered under the medical assistance program;
22.19 	(13) podiatric services;
22.20 	(14) dental services;
22.21 	(15) mental health services covered under chapter 256B;
22.22 	(16) services performed by a certified pediatric nurse practitioner, a certified family 
22.23 	nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 
22.24 	nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 
22.25 	practitioner in independent practice, if (1) the service is otherwise covered under this 
22.26 	chapter as a physician service, (2) the service provided on an inpatient basis is not included 
22.27 	as part of the cost for inpatient services included in the operating payment rate, and (3) the 
22.28 	service is within the scope of practice of the nurse practitioner's license as a registered 
22.29 	nurse, as defined in section 148.171;
22.30 	(17) services of a certified public health nurse or a registered nurse practicing in 
22.31 	a public health nursing clinic that is a department of, or that operates under the direct 
22.32 	authority of, a unit of government, if the service is within the scope of practice of the 
22.33 	public health nurse's license as a registered nurse, as defined in section 148.171;
22.34 	(18) telemedicine consultations, to the extent they are covered under section 
22.35 	256B.0625, subdivision 3b;
23.1 	(19) care coordination and patient education services provided by a community 
23.2 	health worker according to section 256B.0625, subdivision 49; and
23.3 	(20) regardless of the number of employees that an enrolled health care provider 
23.4 	may have, sign language interpreter services when provided by an enrolled health care 
23.5 	provider during the course of providing a direct, person-to-person-covered health care 
23.6 	service to an enrolled recipient who has a hearing loss and uses interpreting services.
23.7 	(b) Sex reassignment surgery is not covered under this section.
23.8 	(c) Outpatient prescription drug coverage is covered in accordance with section 
23.9 	256D.03, subdivision 3. 
23.10 	(d) The following co-payments shall apply for services provided:
23.11 	(1) $25 for nonemergency visits to a hospital-based emergency room; and
23.12 	(2) $3 per brand-name drug prescription, and $1 per generic drug prescription, 
23.13 	subject to a $7 per month maximum for prescription drug co-payments. No co-payments 
23.14 	shall apply to antipsychotic drugs when used for the treatment of mental illness.
23.15 	(e) Co-payments shall be limited to one per day per provider for nonemergency 
23.16 	visits to a hospital-based emergency room. Recipients of general assistance medical care 
23.17 	are responsible for all co-payments in this subdivision. Reimbursement for prescription 
23.18 	drugs shall be reduced by the amount of the co-payment until the recipient has reached the 
23.19 	$7 per month maximum for prescription drug co-payments. The provider shall collect 
23.20 	the co-payment from the recipient. Providers may not deny services to recipients who 
23.21 	are unable to pay the co-payment.
23.22 	(f) Chemical dependency services that are reimbursed under chapter 254B shall not 
23.23 	be reimbursed under general assistance medical care.
23.24 	(g) Inpatient hospital services that are provided in community behavioral health 
23.25 	hospitals operated by state-operated services shall not be reimbursed under general 
23.26 	assistance medical care.
23.27 		Subd. 5.Payment rates and contract modification; April 1, 2010, to May 31, 
23.28 	2010. (a) For the period April 1, 2010, to May 31, 2010, general assistance medical 
23.29 	care shall be paid on a fee-for-service basis. Fee-for-service payment rates for services 
23.30 	other than outpatient prescription drugs shall be set at 37 percent of the payment rate in 
23.31 	effect on March 31, 2010.
23.32 	(b) Outpatient prescription drugs covered under section 256D.03, subdivision 3, 
23.33 	provided on or after April 1, 2010, to May 31, 2010, shall be paid on a fee-for-service 
23.34 	basis according to section 256B.0625, subdivisions 13 to 13g.
23.35 		Subd. 6.Coordinated care delivery systems. (a) Effective June 1, 2010, the 
23.36 	commissioner shall contract with hospitals or groups of hospitals that qualify under 
24.1 	paragraph (b) and agree to deliver services according to this subdivision. Contracting 
24.2 	hospitals shall develop and implement a coordinated care delivery system to provide 
24.3 	health care services to individuals who are eligible for general assistance medical care 
24.4 	under this section and who either choose to receive services through the coordinated 
24.5 	care delivery system or who are enrolled by the commissioner under paragraph (c). The 
24.6 	health care services provided by the system must include: (1) the services described in 
24.7 	subdivision 4 with the exception of outpatient prescription drug coverage but shall include 
24.8 	drugs administered in a clinic or other outpatient setting; or (2) a set of comprehensive 
24.9 	and medically necessary health services that the recipients might reasonably require to be 
24.10 	maintained in good health and that has been approved by the commissioner, including as a 
24.11 	minimum, but not limited to, emergency care, medical transportation services, inpatient 
24.12 	hospital and physician care, outpatient health services, preventive health services, mental 
24.13 	health services, and prescription drugs administered in a clinic or other outpatient setting. 
24.14 	Outpatient prescription drug coverage is covered on a fee-for-service basis in accordance 
24.15 	with section 256D.03, subdivision 3, and funded under subdivision 9. A hospital 
24.16 	establishing a coordinated care delivery system under this subdivision must ensure that the 
24.17 	requirements of this subdivision are met.
24.18 	(b) A hospital or group of hospitals may contract with the commissioner to develop 
24.19 	and implement a coordinated care delivery system as follows:
24.20 	(1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during 
24.21 	calendar year 2008, it received fee-for-service payments for services to general assistance 
24.22 	medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater 
24.23 	than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to 
24.24 	provide geographic access or to ensure that at least 80 percent of enrollees have access to 
24.25 	a coordinated care delivery system; and
24.26 	(2) effective December 1, 2010, a Minnesota hospital not qualified under clause 
24.27 	(1) may contract with the commissioner under this subdivision if it agrees to satisfy the 
24.28 	requirements of this subdivision.
24.29 	Participation by hospitals shall become effective quarterly on June 1, September 1, 
24.30 	December 1, or March 1. Hospital participation is effective for a period of 12 months and 
24.31 	may be renewed for successive 12-month periods.
24.32 	(c) Applicants and recipients may enroll in any available coordinated care delivery 
24.33 	system statewide. If more than one coordinated care delivery system is available, the 
24.34 	applicant or recipient shall be allowed to choose among the systems. The commissioner 
24.35 	may assign an applicant or recipient to a coordinated care delivery system if no choice 
24.36 	is made by the applicant or recipient. The commissioner shall consider a recipient's zip 
25.1 	code, city of residence, county of residence, or distance from a participating coordinated 
25.2 	care delivery system when determining default assignment. An applicant or recipient 
25.3 	may decline enrollment in a coordinated care delivery system. Upon enrollment into a 
25.4 	coordinated care delivery system, the recipient must agree to receive all nonemergency 
25.5 	services through the coordinated care delivery system. Enrollment in a coordinated care 
25.6 	delivery system is for six months and may be renewed for additional six-month periods, 
25.7 	except that initial enrollment is for six months or until the end of a recipient's period 
25.8 	of general assistance medical care eligibility, whichever occurs first. A recipient who 
25.9 	continues to meet the eligibility requirements of this section is not eligible to enroll in 
25.10 	MinnesotaCare during a period of enrollment in a coordinated care delivery system. From 
25.11 	June 1, 2010, to November 30, 2010, applicants and recipients not enrolled in a coordinated 
25.12 	care delivery system may seek services from a hospital eligible for reimbursement under 
25.13 	the temporary uncompensated care pool established under subdivision 8. After November 
25.14 	30, 2010, services are available only through a coordinated care delivery system.
25.15 	(d) The hospital may contract and coordinate with providers and clinics for the 
25.16 	delivery of services and shall contract with essential community providers as defined 
25.17 	under section 62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the extent 
25.18 	practicable. If a provider or clinic contracts with a hospital to provide services through the 
25.19 	coordinated care delivery system, the provider may not refuse to provide services to any 
25.20 	recipient enrolled in the system, and payment for services shall be negotiated with the 
25.21 	hospital and paid by the hospital from the system's allocation under subdivision 7.
25.22 	(e) A coordinated care delivery system must:
25.23 	(1) provide the covered services required under paragraph (a) to recipients enrolled 
25.24 	in the coordinated care delivery system, and comply with the requirements of subdivision 
25.25 	4, paragraphs (b) to (g);
25.26 	(2) establish a process to monitor enrollment and ensure the quality of care provided;
25.27 	(3) in cooperation with counties, coordinate the delivery of health care services with 
25.28 	existing homeless prevention, supportive housing, and rent subsidy programs and funding 
25.29 	administered by the Minnesota Housing Finance Agency under chapter 462A; and
25.30 	(4) adopt innovative and cost-effective methods of care delivery and coordination, 
25.31 	which may include the use of allied health professionals, telemedicine, patient educators, 
25.32 	care coordinators, and community health workers.
25.33 	(f) The hospital may require a recipient to designate a primary care provider or 
25.34 	a primary care clinic. The hospital may limit the delivery of services to a network of 
25.35 	providers who have contracted with the hospital to deliver services in accordance with 
25.36 	this subdivision, and require a recipient to seek services only within this network. The 
26.1 	hospital may also require a referral to a provider before the service is eligible for payment. 
26.2 	A coordinated care delivery system is not required to provide payment to a provider 
26.3 	who is not employed by or under contract with the system for services provided to a 
26.4 	recipient enrolled in the system, except in cases of an emergency. For purposes of this 
26.5 	section, emergency services are defined according to Code of Federal Regulations, title 
26.6 	42, section 438.114(a).
26.7 	(g) A recipient enrolled in a coordinated care delivery system has the right to appeal 
26.8 	to the commissioner according to section 256.045.
26.9 	(h) The state shall not be liable for the payment of any cost or obligation incurred 
26.10 	by the coordinated care delivery system.
26.11 	(i) The hospital must provide the commissioner with data necessary for assessing 
26.12 	enrollment, quality of care, cost, and utilization of services. Each hospital must provide, 
26.13 	on a quarterly basis on a form prescribed by the commissioner for each recipient served by 
26.14 	the coordinated care delivery system, the services provided, the cost of services provided, 
26.15 	the actual payment amount for the services provided, and any other information the 
26.16 	commissioner deems necessary to claim federal Medicaid match. The commissioner must 
26.17 	provide this data to the legislature on a quarterly basis.
26.18 	(j) Effective June 1, 2010, the provisions of section 256.9695, subdivision 2, 
26.19 	paragraph (b), do not apply to general assistance medical care provided under this section.
26.20 		Subd. 7.Payments; rate setting for the hospital coordinated care delivery 
26.21 	system. (a) Effective for general assistance medical care services, with the exception 
26.22 	of outpatient prescription drug coverage, provided on or after June 1, 2010, through a 
26.23 	coordinated care delivery system, the commissioner shall allocate the annual appropriation 
26.24 	for the coordinated care delivery system to hospitals participating under subdivision 
26.25 	6 in quarterly payments, beginning on the first scheduled warrant on or after June 1, 
26.26 	2010. The payment shall be allocated among all hospitals qualified to participate on the 
26.27 	allocation date. Each hospital or group of hospitals shall receive a pro rata share of the 
26.28 	allocation based on the hospital's or group of hospitals' calendar year 2008 payments for 
26.29 	general assistance medical care services, provided that, for the purposes of this allocation, 
26.30 	payments to Hennepin County Medical Center, Regions Hospital, and Fairview University 
26.31 	Medical Center shall be weighted at 110 percent of the actual amount. The commissioner 
26.32 	may prospectively reallocate payments to participating hospitals on a biannual basis to 
26.33 	ensure that final allocations reflect actual coordinated care delivery system enrollment. The 
26.34 	2008 base year shall be updated by one calendar year each June 1, beginning June 1, 2011.
26.35 	(b) In order to be reimbursed under this section, nonhospital providers of health 
26.36 	care services shall contract with one or more hospitals described in paragraph (a) to 
27.1 	provide services to general assistance medical care recipients through the coordinated care 
27.2 	delivery system established by the hospital. The hospital shall reimburse bills submitted 
27.3 	by nonhospital providers  participating under this paragraph at a rate negotiated between 
27.4 	the hospital and the nonhospital provider.
27.5 	(c) The commissioner shall apply for federal matching funds under section 
27.6 	256B.199, paragraphs (a) to (d), for expenditures under this subdivision.
27.7 	(d) Outpatient prescription drug coverage is provided according to section 256D.03, 
27.8 	subdivision 3, and paid on a fee-for-service basis under subdivision 9.
27.9 		Subd. 8.Temporary uncompensated care pool. (a) The commissioner shall 
27.10 	establish a temporary uncompensated care pool, effective June 1, 2010. Payments from 
27.11 	the pool must be distributed, within the limits of the available appropriation, to hospitals 
27.12 	that are not part of a coordinated care delivery system established under subdivision 6.
27.13 	(b) Hospitals seeking reimbursement from this pool must submit an invoice to 
27.14 	the commissioner in a form prescribed by the commissioner for payment for services 
27.15 	provided to an applicant or recipient not enrolled in a coordinated care delivery system. A 
27.16 	payment amount, as calculated under current law, must be determined, but not paid, for 
27.17 	each admission of or service provided to a general assistance medical care recipient on or 
27.18 	after June 1, 2010, to November 30, 2010.
27.19 	(c) The aggregated payment amounts for each hospital must be calculated as a 
27.20 	percentage of the total calculated amount for all hospitals.
27.21 	(d) Distributions from the uncompensated care pool for each hospital must be 
27.22 	determined by multiplying the factor in paragraph (c) by the amount of money in the 
27.23 	uncompensated care pool that is available for the six-month period.
27.24 	(e) The commissioner shall apply for federal matching funds under section 
27.25 	256B.199, paragraphs (a) to (d), for expenditures under this subdivision.
27.26 	(f) Outpatient prescription drugs are not eligible for payment under this subdivision.
27.27 		Subd. 9.Prescription drug pool. (a) The commissioner shall establish an 
27.28 	outpatient prescription drug pool, effective June 1, 2010. Money in the pool must 
27.29 	be used to reimburse pharmacies and other pharmacy service providers as defined in 
27.30 	Minnesota Rules, part 9505.0340, for the covered outpatient prescription drugs dispensed 
27.31 	to recipients. Payment for drugs shall be on a fee-for-service basis according to the rates 
27.32 	established in section 256B.0625, subdivision 13e. Outpatient prescription drug coverage 
27.33 	is subject to the availability of funds in the pool. If the commissioner forecasts that 
27.34 	expenditures under this subdivision will exceed the appropriation for this purpose, the 
27.35 	commissioner may bring recommendations to the Legislative Advisory Commission on 
27.36 	methods to resolve the shortfall.
28.1 	(b) Effective June 1, 2010, coordinated care delivery systems established under 
28.2 	subdivision 6 shall pay to the commissioner, on a quarterly basis, an assessment equal 
28.3 	to 20 percent of payments for the prescribed drugs for recipients of services through 
28.4 	that coordinated care delivery system, as calculated by the commissioner based on the 
28.5 	most recent available data.
28.6 		Subd. 10.Assistance for veterans. Hospitals participating in the coordinated care 
28.7 	delivery system under subdivision 6 shall consult with counties, county veterans service 
28.8 	officers, and the Veterans Administration to identify other programs for which general 
28.9 	assistance medical care recipients enrolled in their system are qualified.

28.10 	EFFECTIVE DATE. This section is effective for services rendered on or after 
28.11 	April 1, 2010.

28.12 	Sec. 13. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
28.13 		Subd. 3.Effective date of coverage. (a) The effective date of coverage is the 
28.14 	first day of the month following the month in which eligibility is approved and the first 
28.15 	premium payment has been received. As provided in section 256B.057, coverage for 
28.16 	newborns is automatic from the date of birth and must be coordinated with other health 
28.17 	coverage. The effective date of coverage for eligible newly adoptive children added to a 
28.18 	family receiving covered health services is the month of placement. The effective date 
28.19 	of coverage for other new members added to the family is the first day of the month 
28.20 	following the month in which the change is reported. All eligibility criteria must be met 
28.21 	by the family at the time the new family member is added. The income of the new family 
28.22 	member is included with the family's gross income and the adjusted premium begins in 
28.23 	the month the new family member is added.
28.24 	(b) The initial premium must be received by the last working day of the month for 
28.25 	coverage to begin the first day of the following month.
28.26 	(c) Benefits are not available until the day following discharge if an enrollee is 
28.27 	hospitalized on the first day of coverage.
28.28 	(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to 
28.29 	256L.18 are secondary to a plan of insurance or benefit program under which an eligible 
28.30 	person may have coverage and the commissioner shall use cost avoidance techniques to 
28.31 	ensure coordination of any other health coverage for eligible persons. The commissioner 
28.32 	shall identify eligible persons who may have coverage or benefits under other plans of 
28.33 	insurance or who become eligible for medical assistance.
28.34 	(e) The effective date of coverage for single adults and households with no children 
28.35 	formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 
29.1 	according to section 256D.03, subdivision 3, is the first day of the month following the 
29.2 	last day of general assistance medical care coverage.

29.3 	EFFECTIVE DATE. This section is effective January 1, 2011.

29.4 	Sec. 14. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
29.5 		Subd. 3a.Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 
29.6 	must be renewed every 12 months. The 12-month period begins in the month after the 
29.7 	month the application is approved.
29.8 	(b) Each new period of eligibility must take into account any changes in 
29.9 	circumstances that impact eligibility and premium amount. An enrollee must provide all 
29.10 	the information needed to redetermine eligibility by the first day of the month that ends 
29.11 	the eligibility period. If there is no change in circumstances, the enrollee may renew 
29.12 	eligibility at designated locations that include community clinics and health care providers' 
29.13 	offices. The designated sites shall forward the renewal forms to the commissioner. The 
29.14 	commissioner may establish criteria and timelines for sites to forward applications to the 
29.15 	commissioner or county agencies. The premium for the new period of eligibility must be 
29.16 	received as provided in section 256L.06 in order for eligibility to continue.
29.17 	(c) For single adults and households with no children formerly enrolled in general 
29.18 	assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 
29.19 	subdivision 3, the first period of eligibility begins the month the enrollee submitted the 
29.20 	application or renewal for general assistance medical care.
29.21 	(d) An enrollee who fails to submit renewal forms and related documentation 
29.22 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
29.23 	for one additional month beyond the end of the current eligibility period before being 
29.24 	disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 
29.25 	additional month.

29.26 	EFFECTIVE DATE. This section is effective January 1, 2011.

29.27 	Sec. 15. Minnesota Statutes 2008, section 256L.05, subdivision 3c, is amended to read:
29.28 		Subd. 3c.Retroactive coverage. Notwithstanding subdivision 3, the effective 
29.29 	date of coverage shall be the first day of the month following termination from medical 
29.30 	assistance or general assistance medical care for families and individuals who are eligible 
29.31 	for MinnesotaCare and who submitted a written request for retroactive MinnesotaCare 
29.32 	coverage with a completed application within 30 days of the mailing of notification of 
29.33 	termination from medical assistance or general assistance medical care. The applicant 
30.1 	must provide all required verifications within 30 days of the written request for 
30.2 	verification. For retroactive coverage, premiums must be paid in full for any retroactive 
30.3 	month, current month, and next month within 30 days of the premium billing. General 
30.4 	assistance medical care recipients may qualify for retroactive coverage under this 
30.5 	subdivision at a six-month renewal.

30.6 	Sec. 16. Minnesota Statutes 2008, section 517.08, subdivision 1c, is amended to read:
30.7 		Subd. 1c.Disposition of license fee. (a) Of the marriage license fee collected 
30.8 	pursuant to subdivision 1b, paragraph (a), $25 must be retained by the county. The local 
30.9 	registrar must pay $85 to the commissioner of management and budget to be deposited 
30.10 	as follows:
30.11 	(1) $50 $55 in the general fund;
30.12 	(2) $3 in the state government special revenue fund to be appropriated to the 
30.13 	commissioner of public safety for parenting time centers under section 119A.37;
30.14 	(3) $2 in the special revenue fund to be appropriated to the commissioner of health 
30.15 	for developing and implementing the MN ENABL program under section 145.9255; and
30.16 	(4) $25 in the special revenue fund is appropriated to the commissioner of 
30.17 	employment and economic development for the displaced homemaker program under 
30.18 	section 116L.96; and
30.19 	(5) $5 in the special revenue fund is appropriated to the commissioner of human 
30.20 	services for the Minnesota Healthy Marriage and Responsible Fatherhood Initiative under 
30.21 	section 256.742.
30.22 	(b) Of the $40 fee under subdivision 1b, paragraph (b), $25 must be retained by the 
30.23 	county. The local registrar must pay $15 to the commissioner of management and budget 
30.24 	to be deposited as follows:
30.25 	(1) $5 as provided in paragraph (a), clauses (2) and (3); and
30.26 	(2) $10 in the special revenue fund is appropriated to the commissioner of 
30.27 	employment and economic development for the displaced homemaker program under 
30.28 	section 116L.96.
30.29 	(c) The increase in the marriage license fee under paragraph (a) provided for in Laws 
30.30 	2004, chapter 273, and disbursement of the increase in that fee to the special fund for the 
30.31 	Minnesota Healthy Marriage and Responsible Fatherhood Initiative under paragraph (a), 
30.32 	clause (5), is contingent upon the receipt of federal funding under United States Code, title 
30.33 	42, section 1315, for purposes of the initiative.

30.34 	EFFECTIVE DATE. This section is effective July 1, 2010.

31.1 	Sec. 17. DRUG REBATE PROGRAM.
 31.2 	The commissioner of human services shall continue to administer a drug rebate 
31.3 	program for drugs purchased for persons eligible for the general assistance medical care 
31.4 	program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph 
31.5 	(cc), and 256D.03.

31.6 	EFFECTIVE DATE. This section is effective April 1, 2010.

31.7 	Sec. 18. TRANSITIONAL MINNESOTACARE PHASEOUT.
 31.8 	For any applicant or recipient who meets the requirements of Minnesota Statutes, 
31.9 	section 256D.03, subdivision 3, paragraph (d), before April 1, 2010, and who is not 
31.10 	exempt under Minnesota Statutes, section 256D.03, subdivision 3, paragraph (f), the 
31.11 	commissioner of human services shall continue the process of enrolling the recipient in 
31.12 	MinnesotaCare as required under Minnesota Statutes 2009 Supplement, section 256D.03, 
31.13 	subdivision 3, paragraph (d), and, upon the completion of enrollment, the recipient shall 
31.14 	receive services under MinnesotaCare in accordance with Minnesota Statutes, section 
31.15 	256L.03. County agencies shall continue to perform all duties necessary to administer the 
31.16 	MinnesotaCare program ongoing for individuals enrolled in MinnesotaCare according 
31.17 	to Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, paragraph (d), 
31.18 	including the redetermination of MinnesotaCare eligibility at renewal.

31.19 	EFFECTIVE DATE. This section is effective April 1, 2010.

31.20 	Sec. 19. REVISOR'S INSTRUCTION.
 31.21 	The revisor of statutes shall edit Minnesota Statutes, sections 256B.69 and 256B.692, 
31.22 	to remove references to the general assistance medical care program.

31.23 	EFFECTIVE DATE. This section is effective June 1, 2010.

31.24 	Sec. 20.  REPEALER.
 31.25 	(a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; and 256D.03, 
31.26 	subdivision 9, are repealed.
31.27 	(b) Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 4, is 
31.28 	repealed.
31.29 	(c) Minnesota Statutes 2008, section 256B.195, subdivisions 4 and 5, are repealed 
31.30 	effective retroactively to October 1, 2009.
31.31 	(d) Minnesota Statutes 2009 Supplement, section 256B.195, subdivisions 1, 2, and 
31.32 	3, are repealed effective retroactively to October 1, 2009.
32.1 	(e) Minnesota Statutes 2008, sections 256L.07, subdivision 6; 256L.15, subdivision 
32.2 	4; and 256L.17, subdivision 7, are repealed January 1, 2011.

32.3 	ARTICLE 2
32.4 	APPROPRIATIONS

32.5	Section 1. HUMAN SERVICES APPROPRIATION.
 	
32.6 	The sums shown in the columns marked "Appropriations" are added to or, if shown 
32.7 	in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, as amended 
32.8 	by Laws 2009, chapter 173, or other law, to the agencies and for the purposes specified in 
32.9 	this article. The appropriations are from the general fund, or another named fund, and are 
32.10 	available for the fiscal years indicated for each purpose. The figures "2010" and "2011" 
32.11 	used in this article mean that the addition to or subtraction from appropriations listed under 
32.12 	them are available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively. 
32.13 	"The first year" is fiscal year 2010. "The second year" is fiscal year 2011. "The biennium" 
32.14 	is fiscal years 2010 and 2011. Supplemental appropriations and reductions for the fiscal 
32.15 	year ending June 30, 2010, are effective the day following final enactment.

32.16				APPROPRIATIONS
	
32.17				Available for the Year
	
32.18				Ending June 30
	
32.19					2010
		2011

32.20	Sec. 2. HUMAN SERVICES

32.21	Subdivision 1.Total Appropriation
 	$
	(7,985,000)
	$
	(93,128,000)

32.22	Appropriations by Fund
	
32.23		2010
	2011
	
32.24	General
	34,807,000
	118,493,000
	
32.25	Health Care Access
	(42,792,000)
	(211,621,000)
	
32.26 	The amounts that may be spent for each 
32.27 	purpose are specified in the following 
32.28 	subdivisions.

32.29
32.30	Subd. 2.Children Support Enforcement 
Grants
 		-0-
		(300,000)
	
32.31 	Minnesota Healthy Marriage and 
32.32 	Responsible Fatherhood Initiative Fee. 
32.33 	Notwithstanding Minnesota Statutes, section 
32.34 	517.08, the balance and the fee revenue 
33.1 	available to the commissioner of human 
33.2 	services for the healthy marriage and 
33.3 	responsible fatherhood initiative in the state 
33.4 	government special revenue fund must be 
33.5 	transferred to and deposited into the general 
33.6 	fund by June 30, 2011.

33.7
33.8	Subd. 3.Children and Economic Assistance 
Operations
 		(1,408,000)
		(1,560,000)

33.9	Subd. 4.Basic Health Care Grants
 					
33.10 	The amounts that may be spent from this 
33.11 	appropriation for each purpose are as follows:

33.12	(a) MinnesotaCare Grants
		(42,792,000)
		(211,621,000)
	
33.13 	This appropriation reduction is from the 
33.14 	health care access fund.

33.15
33.16	(b) Medical Assistance Basic Health Care 
Grants - Families and Children
		-0-
		(49,000)

33.17
33.18	(c) Medical Assistance Basic Health Care 
Grants - Elderly and Disabled
		-0-
		(1,275,000)

33.19	(d) General Assistance Medical Care 
		39,413,000
		135,837,000
	
33.20 	For general assistance medical care payments 
33.21 	under Minnesota Statutes, section 256D.031.
33.22 	$5,500,000 in fiscal year 2010 and 
33.23 	$65,500,000 in fiscal year 2011 is for 
33.24 	payments to coordinated care delivery 
33.25 	systems under Minnesota Statutes, section 
33.26 	256D.031, subdivision 7.
33.27 	$4,375,000 in fiscal year 2010 and 
33.28 	$51,875,000 in fiscal year 2011 is for 
33.29 	payments for prescription drugs under 
33.30 	Minnesota Statutes, section 256D.031, 
33.31 	subdivision 9.
33.32 	$28,000,000 in fiscal year 2010 is for 
33.33 	provider and prescription drug payments 
34.1 	under Minnesota Statutes, section 256D.031, 
34.2 	subdivision 5.
34.3 	$1,538,000 in fiscal year 2010 and 
34.4 	$18,462,000 in fiscal year 2011 is for 
34.5 	payments from the temporary uncompensated 
34.6 	care pool under Minnesota Statutes, section 
34.7 	256D.031, subdivision 8. 
34.8 	Any amount under paragraph (d) that is not 
34.9 	spent in the first year does not cancel and is 
34.10 	available for payments in the second year.
34.11 	The commissioner may transfer any 
34.12 	unexpended amount under Minnesota 
34.13 	Statutes, section 256D.031, subdivision 9, 
34.14 	after the final allocation in fiscal year 2011 to 
34.15 	make payments under Minnesota Statutes, 
34.16 	section 256D.031, subdivision 7.
34.17 	Any unexpended amount not used for 
34.18 	general assistance medical care expenditures 
34.19 	incurred before April 1, 2010, under 
34.20 	Minnesota Statutes, section 256D.03, shall be 
34.21 	used to make payments under paragraph (d).

34.22	Subd. 5.Health Care Management
 					
34.23 	The amounts that may be spent from the 
34.24 	appropriation for each purpose are as follows:

34.25	Health Care Administration
		(2,998,000)
		(5,270,000)
	
34.26 	Base Adjustment. The general fund base 
34.27 	for health care administration is reduced by 
34.28 	$182,000 in fiscal year 2012 and $182,000 in 
34.29 	fiscal year 2013.

34.30	Subd. 6.Continuing Care Grants

34.31	(a) Mental Health Grants
		(200,000)
		(7,904,000)
	
34.32 	The general fund appropriation to the 
34.33 	commissioner of human services for adult 
35.1 	mental health grants in Laws 2009, chapter 
35.2 	79, article 13, section 3, subdivision 8, as 
35.3 	amended by Laws 2009, chapter 173, article 
35.4 	2, section 1, subdivision 8, is reduced by 
35.5 	$7,704,000 in fiscal year 2011. This is a 
35.6 	onetime reduction.
35.7 	$200,000 of the reduction in each year is 
35.8 	to eliminate specialty care grants for the 
35.9 	2007 mental health initiative infrastructure 
35.10 	investments.

35.11	(b) Other Continuing Care Grants
		-0-
		(2,037,000)
	
35.12 	HIV Grants. The general fund appropriation 
35.13 	for the HIV drug and insurance grant 
35.14 	program shall be reduced by $2,037,000 in 
35.15 	fiscal year 2011 and increased by $2,037,000 
35.16 	in fiscal year 2013. These adjustments are 
35.17 	onetime and must not be applied to the base. 
35.18 	Notwithstanding any contrary provision, this 
35.19 	provision expires June 30, 2013.

35.20	Subd. 7.Continuing Care Management
 		-0-
		1,051,000

35.21	Subd. 8.Transfers
 					
35.22 	The commissioner must transfer $29,538,000 
35.23 	in fiscal year 2010 and $18,462,000 in fiscal 
35.24 	year 2011 from the health care access fund to 
35.25 	the general fund. This is a onetime transfer.
35.26 	The commissioner must transfer $4,800,000 
35.27 	from the consolidated chemical dependency 
35.28 	treatment fund to the general fund by June 
35.29 	30, 2010.

35.30 	EFFECTIVE DATE. This article is effective April 1, 2010.